مجله دانشگاه علوم پزشکی مازندران
پیاپی 161 (خرداد 1397)

Background and Destruction of insulin-producing beta cells by T cells causes type-1 diabetes (T1D). Carbenoxolone has cytoprotective and anti-inflammatory effects, and has been shown to be capable of suppressing Th17 cells that are effectively involved in the pathogenesis of type 1 diabetes, therefore, we studied the effect of Carbenoxolone on T1D in C57BL/6 mice.
Forty male C57BL/6 inbred strain mice were randomly divided into four groups and in three groups diabetes was induced by streptozotocin. A positive control group was considered and two other groups received 50 mg/kg/day i.p. carbenoxolone (7 and 5 doses). Then, on days 7 and 14 after the disease induction, fasting blood sugar (FBS) level, anti-inflammatory cytokines IL-1β, IL-6 and TNF-α, and pathological changes of the pancreas were studied during the course of the disease.
Carbenoxolone increased the levels of IL-1β, IL-6, TNF-α, and FBS. Also, it significantly increased infiltration of inflammatory cells into the pancreatic islets (P It seems that carbenoxolone triggers a breakdown in Treg/Th17 balance by increasing the levels of pro-inflammatory cytokines and increases the number of Th17 cells, thereby causing toxic effects on the pancreatic beta cells and increasing the severity of the disease.

Background and Multidrug resistance (MDR) phenotype is a major complication in cancer chemotherapy. Gankyrin is a key point molecule in cell cycle regulation and may contribute to drug-resistance phenotype of tumor cells. The aim of this study was to compare the basal Gankyrin expression level in ovarian and gastric drug-resistant cells with their parental drug-sensitive cells.
In this experimental study, the Gankyrin expression at mRNA and protein levels in drug resistance cell lines was compared with their parental drug sensitive cell lines by real time RT-PCR and Western blotting.
Gankyrin mRNA expression in A2780/RCIS cells was statistically lower than A2780 cells (p= 0.00) but their difference was not statistically significant at protein level (p= 0.240). In addition, Gankyrin expression in EPG85-257/RDB was lower than its parental drug sensitive cell line at mRNA and protein level.
This study found an opposite relationship between Gankyrin expression and MDR phenotype related to the overexpression of MDR transportes. This suggestes for the first time that the incidence of MDR phenotype could inhibit tumorgenisity.

Background and A long non-coding transcript Lnc-Ang362 plays critical role on the expression of miR-221 and miR-222. Knockdown of Lnc-Ang362 reduces the expression of these miRNAs as well as vessel smooth muscle cell proliferation in response to vascular injury. This study, for the first time, considered the possible association between Lnc-Ang362 rs7887062A/G polymorphism with the risk of atherosclerotic coronary artery disease (CAD) in low risk patients.
In this case-control study, 299 subjects, including 150 patients with atherosclerotic CAD and 149 healthy individuals (control group) enrolled. Genotyping of the rs7887062 was done using PCR-RFLP method. Data were analyzed using SPSS v.19.
The frequency of heterozygote AG and G-allele carriage (GG) genotypes were greater in controls compared to the patients, supporting the protective role against CAD. The G allele reduced the risk of disease (OR: 0.32, 95%CI: 0.15- 0.7, P=0.004). In cross tabulation of the study population based on gender, reduced risk of CAD in the presence of AG and G-carriage genotypes was seen in both males and females.
Lnc-Ang362 variant could be considered as a molecular screening marker for low risk susceptible subjects to atherosclerotic CAD.

Background and Chronic Rhinosinusitis (CRS) as a common disease has different clinical signs and symptoms. In the recent decades only a few local signs and symptoms of CRS are included in its diagnostic criteria while many important ones seem to have been missed out. Considering the very close compatibility of CRS with “Nazlah” and “Zokam” in the manuscripts of Persian Medicine, we reviewed some signs, symptoms and consequences of CRS in the main literatures of both modern medicine and Persian Medicine in order to suggest a more comprehensive diagnostic perspective.
This study reviewed medical databases and main manuscripts of Persian Medicine using English, Arabic, and Farsi keywords including chronic rhinosinusitis, Nazlah, and Zokam with no time limitation. Data were then compared, interpreted, and analyzed.
Studying the data available showed that a wide range of signs, symptoms, and consequences are ob observable served in CRS. The complexity of clinical features of CRS versus the current linear understanding of it, has led up to some difficulties to design a final framework for defining and semiologic description of CRS.
Reducing the CRS diagnostic criteria just to some of its local nasosinusal features may cause diagnostic ignorance of a wide spectrum of patients whose nasosinusal appearances are not so obvious while having other problems outside the organ. So we suggest a more comprehensive approach to recognize CRS through considering both local and general signs and symptoms for a better and more qualitative treatment.

Background and The purpose of this study was to evaluate the oral health status in people with history of drug abuse.
This cross- sectional study was done in five addiction treatment centres located in Sari, Iran 2016-2017, using random cluster sampling. The Decayed, Missing and Filled teeth (DMFT) index was calculated for 120 samples. ANOVA, T-test, and multiple linear regression model were applied for statistical analysis.
A total of 104 men and 16 women participated in this study. The mean DMFT of subjects was 19.53±8.30 teeth. Individuals with a lower age of the onset of drug abuse, addiction period of ≥ 10 years, and those who brushed less than once a day and took sweet snacks more than three times daily had significantly higher DMFT. Statistical analysis also indicated that age, education, brushing pattern, sweet consumption, duration of drug use and the time of last dental visit showed to have a significant relationship with changes in DT, MT, and FT indexes.
Individuals with a history of drug dependence studied here, had a poor oral health status. Therefore, appropriate educational, preventive and therapeutic actions are required to improve oral health and the quality of life in people with history of drug abuse.

Background and Healthy lifestyle is an important factor in prevention of chronic diseases. The health of medical students is highly influential due to their fundamental role in every health system. In this study, the health-promoting lifestyle and its determinants were evaluated in medical, dental, and pharmacy students.
This cross-sectional study was conducted in 650 students using stratified sampling in Kerman, Iran 2016. The health-promoting lifestyle profile (HPLP-II) was used and data was analyzed applying univariate and multivariate linear regression analysis in SPSS.
The mean score for health-promoting lifestyle was 104.93±22.9 which had no significant relationship with gender, marital status, living condition, and the education levels. There was a significant association between the field of study and the mean score for health-promoting lifestyle, nutrition, spiritual growth, interpersonal relationship, and stress management (P The health-promoting lifestyle is believed to be inappropriate in medical, dental and pharmacy students in Kerman University of Medical Sciences. However, medical students had a better lifestyle compared to dental and pharmacy students. Authorities should provide university students with training programs on healthy lifestyle.

Background and Lung cancer is the third cause of death and amongst the five common cancers in Iran. The aim of this study was to analyze the survival rate of patients with lung cancer and identifying the variables influencing their survival.
In a retrospective cohort study, the data was extracted from the medical records of 259 patients with lung cancer who had attended Tehran Shariati Hospital during 2005-2015. The survival rate was estimated using the Kaplan-Meier method and log-rank test was applied for comparison of survival function. The event was specified as death due to lung cancer. The Cox’s proportional hazard model was used to investigate the effect of various variables on patient survival time using the R software.
The mean age of the patients was 62.86±12.46 and the estimated median survival time was 2.4 years (2.93±3.33). Hundred and forty patients (54%) died. According to the Kaplan-Meier method, 1, 2, and 3 years survival rates were estimated to be 63%, 53%, and 46%, respectively. Based on Cox proportional hazards analysis, the patient’s survival time was significantly associated with PCO2 (HR= 1.021), age at diagnosis (HR= 0.805), type of tumor (NSCLC vs. SCLC) (HR= 0.567), and brain metastasis (HR= 1.792).
The survival time for patients with lung cancer was found to be quite short. This time decreases by increase in patients’ age. Also, the risk of death in a patient either with SCLC or metastasis was higher than other patients.

Background and Leveling of health services and resources is implemented in Iran to promote the health situation and preventing unnecessary visits and waste of human and financial resources. The relationship between these levels is built through referral system. The aim of this study was to analyze the patient referral system at all levels of the health system using Strengths, Weaknesses, Opportunities and Threats (SWOT) approach.
This qualitative study was done by semi-structured and in-depth interviews in 2016. The sample size consisted of 20 people including administrative officers, family physicians, executive managers, and individuals working in insurance sector and 10 people receiving insurance services who were selected purposefully. Data was analyzed using content and structural analysis.
The strengths included: reducing the costs, providing equitable access to health services, promoting the health level, and providing services in an evolutionary level. The weaknesses included not informing the people, physician issues, poor monitoring and evaluation, management issues, payment mechanisms, electronic health records, insurance organizations, and inadequate facilities and equipment of health centers. Opportunities included: the importance of health and health care for the leadership and the parliament, job creation, active participation of the private sector, the high level of literacy of the target group (people), and the cooperation of insurance organizations. The threats included lack of coordination and alignment between policy makers and planners, the therapeutic focus of health system, lack of attention of people to health care, and the influences of private sector.
The appropriate implementation of referral system promotes the health of society and increases the healthcare burden. But today, it does not follow its own rules which is caused by different factors. Therefore, health authorities should address these by appropriate planning and timely actions.

Background and Identification of risk in hospital waste management have a major role in reducing the cost of surplus and preventing the spread of diseases. In this quantitative analysis, we aimed at determining waste components, evaluating hospital waste management, and prioritizing the risks in Sari Fatemeh Zahra Hospital.
We performed a descriptive-cross-sectional study in 2015. Tchobanoglous method was used for quantitative-physical analysis of the waste. The individualized rapid assessment tool was applied to evaluate waste management. Preliminary Hazard Analysis and failure mode and effect analysis models were used to identify and prioritize the risks.
Total waste production, general waste, infectious wastes, and sharp objects were 1011.54, 600.45, 384.94, and 26.15 kg/day, respectively. Plastics, organic materials, and textiles constituted the highest amount of waste products. According to the individualized rapid assessment tool, the score obtained by the hospital was 82.15% indicating an excellent waste management. In preliminary hazard analysis, failure mode, and effect analysis models, 23 errors were observed, of which 9 had a priority number greater than 100.
The models studied showed that mixing the sharp waste material with other garbage, disposal of non-infectious and semi-household waste in infectious bins and vice versa are of high risk and need corrective measures.

Background and Cervical cancer is the third leading cause of cancer-related death in women. There are not enough information about the trends of this cancer in Iran, so, this study aimed to investigate the incidence and trends of changes in incidence of cervical cancer in Iran.
This study was a reanalysis of existing data (2003-2009) obtained from the National Cancer Registry in Iran. The incidence rates were standardized based on population as suggested by World Health Organization. Then, the incidence trend of cervical cancer was determined by STATA.
An increasing trend of cervical cancer was seen between 2003 and 2008 while a descending trend of the disease was observed in 2008- 2009. A total of 4273 cases of cervical cancer were registered in Iran. The number of people who developed the disease raised from 394 in 2003 to 907 in 2009, showing a three-fold increase.
According to current study, the incidence of cervical cancer is increasing in Iran, especially in central regions. Therefore, early detection through screening programs and trainings, particularly in patients at higher risk of cervical cancer is recommended.

Background and Mifepristone is an oral synthetic steroid with antiglucocorticoid and antiprogesterone activities. Therefore, it could be dangerous during pregnancy since it causes cytogenetic damage and, consequently, abortion. Flavonoid compounds such as naringin have antioxidant properties and eliminate various free radicals. Naringin is abundantly found in Iran, so, we investigated its cellular effects against cytogenetic damage caused by mifepristone on blood lymphocyte using micronucleus method.
In this experimental study, 5ml Venous blood were collected from 5 healthy and non-smokers using heparin syringe. Different naringin concentrations followed by 43µg/ml damage dose of mifepristone were injected to the cells. To evaluate the production of micronucleus in restrained binucleated lymphocytes in cytokine, the slides were prepared and evaluated by optical microscopy. The mean values were compared applying ANOVA test (posttest: Tukey) in SPSS and p The highest frequency of micronucleus was observed in the positive control group (17.67±1.528) and the lowest was seen in the naringin group at 232µg/ml (1.33.5774) (P Naringin is a potent antigenotoxin against the damage caused by mifepristonethan, therefore, it could be used as a protective agent against the toxic effects of mifepristone.

Background and Fast diagnosis of pneumococcal infections is of great importance in achieving successful outcomes. The aim of this study was to use PCR process based on capsular encoding genes of Streptococcus pneumonia.
In this experimental study, specific primers were designed based on the reference sequences of the Streptococcus pneumoniae cpsB, cpsD, aroE, and psaA genes. All bacteria were subjected to DNA extraction separately. Then, the PCR protocol was performed. Sequencing of the PCR products was done and data was analyzed descriptively.
The primer pairs against the cpsB, cpsD, aroE, and psaA genes amplified 159, 202, 254, and 286 bp fragments, respectively. The alignments and comparison of amplified sequences showed a high homology (100%) with the reference genes.
According to this study, it is possible to diagnose Streptococcus pneumoniae based on virulence genes, and differentiate the pathogenic Streptococcus pneumoniae from nonpathogenic strains and also viridans groups. Therefore, this method is suggested in diagnosis of pathogenic Streptococcus pneumoniae strains.

Background and Restless Legs Syndrome (RLS) is a neurological disorder which can reduce the duration and quality of sleep and consequently affect quality of life. Understanding the prevalence of this syndrome in patients with multiple sclerosis (MS) and its associated factors could be of great benefit in enhancing their quality of life.
This cross-sectional study was conducted in 300 MS patients attending an MS clinic. They were selected using random sampling. After clinical examination, demographic information and disease characteristics were recorded and RLS rating scale was used for each patient.
The prevalence of RLS was 43.3% in MS patients. Some factors were found to be responsible including older age, longer MS duration, pattern of disease and the level of disability caused by MS.
RLS evaluations should be done regularly in MS patients especially in those with sleep disorders. This could cause timely diagnosis and treatment, thereby leading to a better quality of life in these patients.

Background and Cyclophosphamide and ifosfamide are two most widely used and hazardous drugs in chemotherapy centers. This study aimed at determining surface contamination with cyclophosphamide and iphosphamide in chemotherapy centers.
This descriptive cross-sectional study was carried out in three chemotherapy centers affiliated with Hamedan University of Medical Sciences, Iran 2016. Twenty eight samples were collected from contaminated surfaces. The samples were then prepared by solid phase extraction and analyzed by HPLC/UV apparatus.
The mean values for surface contamination of cyclophosphamide and ifosfamide were 57.28 ± 63.8 and 44.15 ± 5.5 ng/cm2, respectively. The highest levels of contamination with both drugs were observed at exhaust hood surfaces and the lowest level of contamination was seen in nursing station and staff resting place. The clothes and gloves of nurses were also found to be contaminated.
Daily number of medications, the location of drug preparation room and injection room, nursing station, staff resting place, daily cleaning programs, and repairing and maintenance of ventilation systems were amongst the major factors affecting surface contamination in chemotherapy centers.

Local block and awake intubation are the choice for airway management in patients with anticipated difficult airways. This paper reports a case of a 67 year old man with snoring and hoarseness and laryngeal mass in stroboscopy (12X12X10), candidate for elective surgery. He was intubated awake and the mass was resected. Therefore, patients with horseness and snoring should not be anesthetized immediately since the mass might be large and intubation would be difficult.

Background and Carpal Tunnel Syndrome is the most common entrapment neuropathy caused by increased pressure of median nerve in the wrist area. The results of electronic searches in several studies have shown different prevalence rates of this syndrome in Iran in different populations. So, the purpose of this study was to estimate the prevalence of carpal tunnel syndrome in Iran using meta- analysis.
Relevant keywords were searched in national and international databases. The articles were then selected based on inclusion/ exclusion criteria and quality assessment. Data including author names, year of publication, sample size, sample descriptions, assessment criteria, and the prevalence rate of carpal tunnel syndrome were entered in Excel. The standard error of the prevalence of carpal tunnel syndrome in each study was calculated based on the formula for binomial distribution. According to the I-squared heterogeneity and Q indices, the random or fixed effect model were used to estimate the overall prevalence. Also, sensitivity analysis, meta-regression, and survey of publication bias were carried out.
A systematic search was completed and 10 articles met the inclusion criteria with 11 evidence of the prevalence of carpal tunnel syndrome in Iran. A total of 14525 people had been studied in whom the prevalence of carpal tunnel syndrome varied from 1.82% to 64.6%. The overall prevalence of carpal tunnel syndrome with physical examination based on the random effect model was estimated to be 17.53% (95% CI, 13.74- 21.31%).
This meta- analysis showed a relatively high prevalence of carpal tunnel syndrome in Iran. But, the frequency of this syndrome in different target groups requires further investigations.

Leishmaniasis is a major public health problem, but so far there are no effective commercially available vaccines for this disease. Its control strategy is only reliant on therapy, but currently the drugs available for the treatment of leishmaniasis are also limited and a great concern is the rapid rate of resistance to common drugs. The first step in discovery and development of new drugs is to identify an appropriate drug target. Accordingly, it is important to recognize the metabolic pathways in which the leishmania parasites live and selecting a target in the parasite biological pathway, absent in the host or different from the host homolog. Discovery of new drugs requires high costs and takes a lot of time (up to 15 years). Therefore, choosing the approved drugs in the market for various diseases, including leishmaniasis is very cost-effective considering the mechanism of drug action and other aspects. Miltefosin is an effective anti-cancer agent that is also used for different types of leishmaniasis. In recent years, researchers have focused on the anti-leishmanial effects of pharmaceutical compounds or anticancer drugs to find more effective compounds with lower side effects. The present article mainly reviews the anticancer drugs that have been tested for their anti-leishmanial effects in both in vitro and in vivo conditions.

Completion of the human genome project revealed that the molecular mechanisms of cellular responses to different situations cannot be predicted from the sequence of their genes. Hence, most biological researches are focused on the roles of proteins which are much more challenging tasks. Omics technologies, instead of analyzing individual components of an organism by conventional biochemical methods such as the function of a gene, protein or biochemical reaction, study all the components and their interactions within a global site. In the past two decades, omics technologies have been used as efficient and powerful tools in almost all aspects of clinical and pharmaceutical researches, including biomarker discovery, drug target discovery, evaluation of the efficacy of drugs, safety assessment, and personalized medicine. In this article, omics technologies such as genomics, transcriptomics, proteomics and metabolomics, and their advances are reviewed and their applications in clinical and pharmaceutical researches, particularly in the areas of drug targets, biomarkers, and personalized medicine are discussed.