مجله دانشگاه علوم پزشکی مازندران
پیاپی 173 (خرداد 1398)

Muscular atrophy is a condition derived from different diseases and aging. Molecular study of the disease condition can help in developing diagnostic methods and treatment approaches. In this study, protein interaction network was analyzed to understand molecular events at protein levels. In this experimental study, the network was constructed and analyzed using Cytoscape and its plug-in STRING. In addition, Network Analyzer and MCODE were applied to analyze the centrality and clustering, respectively. Bingo explored the gene ontology of the determined protein complexes. The findings showed five key genes in the network of atrophy including AKT1, ALB, DMD, SMN1, and SMN2. Furthermore, six clusters of proteins were obtained from which two significant ones were considered for gene ontology analysis. All the central proteins, AKT1, ALB, DMD, SMN1, and SMN2 are present in the clusters of our interests. It can be concluded that the panel of biomarkers introduced could be of great help in understanding the pathology of muscular atrophy.

Diabetes mellitus is highly prevalent in the world and poor wound healing in diabetic patients is a serious public health issue nowadays. In this study, we evaluated the healing effects of olive leaf extract ointment on cutaneous wound in diabetic rats. Thirty six male rats were di vided into three groups: a control group and two experimental groups to receive either olive leaf ointment or derma heal ointment. Diabetes was induced by a single streptozotocin injection (65mg/kg). Three days later, fasting blood glucose was measured by a glucometer. Rats with blood glucose levels above 250 mg/dl were considered as diabetic. Under anesthesia, a circular full-thickness incision (10 mm diameter) was made in shaved dorsal region. Animals in control group received only distilled water, while treatment groups were treated with ointments (once/daily) until the end of the experiment. To investigate the effects of olive leaf ointment on diabetic wounds, macroscopic and microscopic studies were performed at days 4, 7, 10, 14, and 21. Macroscopic and microscopic evaluations showed significantly higher rate of wound healing in experimental groups compared to the control group in all days after wound creation (P<0.05). But, wound contraction was significantly higher in the group receiving derma heal ointment compared with that in the group treated with olive leaf ointment (P<0.05). There were no significant differences between the two experimental groups in microscopic indices (P>0.05). In this study, wound healing was significantly promoted when diabetic wounds were treated with olive leaf ointment.

In recent decades, various efforts have been made to replace synthetic materials with natural disinfectants that have less disadvantages and lead to similar or even better results. The present study was conducted to compare the effect of Artemisia aucheri and Zataria multiflora as natural disinfectants with those of Deconex and sodium hypochlorite as two industrial disinfectants on Candida albicans. This experimental study was conducted in 128 resin acrylic dentures. After the inoculation of C. albicans on each denture, they were divided into four groups, each containing 32 dentures. Deconex, Sodium hypochlorite, Artemisia aucheri, and Zataria multiflora were administered in each group in four densities (0.1, 0.01, 0.001, and 0.0001). The data were analyzed in SPSS V19 applying t-test.  The four disinfectants were applied for 10 and 60 min. Deconex showed the highest disinfection effect on samples (P<0.05). There were no significant differences between the effect of Artemisia aucheri and Zataria multiflora after 60 min and 10 min. However, it was found that the potency of Artemisia aucheri and Zataria multiflora increased after 60 min. Current findings showed chemical disinfectants with higher potency in short-time intervals, compared to the natural ones. But, after a longer period of time, Artemisia aucheri and Zataria multiflora exerted similar effects as those of the synthetic disinfectants.

Etiology of rheumatoid arthritis is not fully recognized. The purpose of this study was to use universal and specific primers to trace bacteria in the blood and synovial fluid in patients with rheumatoid arthritis. In this experimental study, a PCR method was developed to identify a wide range of bacteria in general and Staphylococcus aureus in specific. Ninety five synovial fluid and 100 blood samples being stored at -80°C were assayed. Genome extraction was performed. Universal primer pairs were used for amplification of 16SrRNA and a specific primer was used for nuc gene of Staphylococcus aureus. Then, the PCR product of the specific primer was sequenced and data were analyzed. The samples of synovial fluid and blood samples of rheumatoid arthritis patients which were negative in bacteriological culture showed 33 (34%) and 36 (36%) cases to be positive for 16Sr RNA, respectively. Also, 21 cases of synovial fluid and only 1 blood sample were positive for Staphylococcus aureus.  The results showed the presence of 16SrRNA gene of different bacteria, including Staphylococcus aureus in blood and synovial fluid of patients. Based on current findings, it is likely to explain a part of the etiology of rheumatoid arthritis, thereby modifying some treatment protocols.

Anti-retroviral therapy has raised life expectancy of HIV+ patients, but, it is associated with some adverse effects. Physical exercise as a non-pharmacological approach could be helpful in reducing some adverse effects. The aim of this study was to investigate the effectiveness of resistance training (RT) and lifestyle modification program (LMP) on TCD+ cell count and body composition of HIV+ patients. In a clinical trial, HIV+ patients (n=31) were randomly assigned into the following groups: RT (n=12), LMP (n=13), and control (n=6). In RT group, trainings were carried out using elastic bands (3 times a week/ 8 weeks). Participants in LMP did recreational sport activities and attended life style modification classes (twice a week/ 8 weeks). The control group was observed without any intervention. TCD4+cell count and body composition characteristics were assessed before and after the study. Compared with LMP, RT significantly improved anthropometric characteristics
(P< 0.05). TCD4+cell counts increased significantly in both intervention groups, compared to those of the control group (P< 0.05). Interventions in current study, as non-pharmacological therapy, could be used alongside anti-retroviral therapy to improve immune competence and counteracting with unwanted changes in body composition of people with HIV.
(Clinical Trials Registry Number: IRCT201604034076N18)

Current research was carried out to compare the effectiveness of integrative approaches; Emotionally Focused Couple Therapy (EFT) and Integrative Behavioral Couple Therapy (IBCT) in improving the symptoms of emotional regulation in couples with marital conflict. Statistical population included all couples attending Ahvaz Mehrvaran Psychological Clinic. Six couples were selected using purposive sampling. Single case study was used in this experiment. EFT and IBCT were conducted in two to four stages at base line phase within 16 sessions, and the subjects were followed up for three months. They completed Emotional Regulation dysregulation Scale (DERS). Data were analyzed applying visual inspection, improvement percentage, and reliable change index. The participants aged 25 to 40 years of age and either completed high school or had higher educations. Improvement rates in subjects at post-treatment and follow-up attending EFT and IBCT were 31.07% and 31.27% and 24.39% and 24.18%, respectively. In two couples attending EFT the RCI values significantly changed at post-treatment and follow-up stage (P<0.05). In this study, Emotionally Focused Couple Therapy was found to be more effective than Integrative Behavioral Couple Therapy on the magnitude and stability of changes.

Depression is a common psychiatric disorder in patients with breast cancer. This study was performed to follow-up breast cancer patients with depression receiving citalopram and group psychotherapy for six months. This clinical trial was conducted in 40 breast cancer patients with depressive disorder. Among the patients, 20 received citalopram (20-40 mg/day) and the rest, besides the same dose of citalopram, attended 8 sessions of group psychotherapy. The patients were assessed at baseline and six months later. Hospital Anxiety and Depression Scale (HADS) and WHO-QOL BREF questionnaires were administered. Then treatment outcomes and quality of life were compared between the two groups applying t-test. The mean scores for depression and anxiety were 12.05±2.19 and 13.25±2.90 at baseline which declined to 2.05±2.06 and 4.55±2.42, respectively, after six months (P<0.05). Quality of life score in patients attending group psychotherapy sessions improved significantly after six months (80.86) compared to that at baseline (40.82), while slight changes were observed in the group receiving only citalopram (P<0.001). Citalopram and group psychotherapy were found to be significantly effective after six months on depression, anxiety, and quality of life in breast cancer patients with depressive disorder receiving citalopram.
(Clinical Trials Registry Number: IRCT2015063022991N1)

Non::union:: of bone fracture is a clinical and treatment challenge. Satisfactory repair of orthopedic fractures is of great importance and systemic treatment is used to achieve this goal. This study aimed to investigate the effect of Teriparatide (CinnoPar®) on non::union:: fractures. A quasi-experimental study was conducted in 17 patients with non::union:: bone fractures. Radiographic evaluation was performed before the intervention and non::union:: was confirmed by a radiologist. Then, all patients received Teriparatide for three months. Afterwards, a control x-ray image was taken to assess the outcome. Sixteen patients (mean age: 45.18±20.51) with non::union:: fracture were evaluated, including nine males and seven females. The mean time after the accident was 50 ±24.48 weeks. Femoral bone was the most reported impaired site (n=8). After treatment with Teriparatide (CinnoPar®) improvements were seen in 10 patients (P= 0.002).  Treatment with CinnoPar® was found to be effective to some extent. However, due to the small sample size in this study, the efficacy of CinnoPar® needs further assessments.

Occlusion is a decreasing factor on longevity of peripheral intravenous catheters (PIVCs). Continuous flushing (injection of specific volume of solution such as Normal Saline (N/S) before and after each drug infusion into PIVCs at determined interval time) is one of the effective methods in in vitro studies to maintain the PIVCs patency. The aim of this study was to investigate the effect of continuous flushing on the duration of PIVCs patency. In a randomized controlled trail, 72 patients hospitalized in medical/surgical department in Esfarayen Imam Khomeini Hospital, north east of Iran, were randomly assigned into either an intervention group or a control group. In intervention group, 5 ml of N/S solution was injected within 5 seconds before and after injection of any drug into the PIVCs. If another drug was administered at the same time, it was injected and flushing technique was performed again. The PIVCs patency was monitored every 12 hours using a checklist. Data were analyzed applying Chi-square, Fisher exact, and Mann-Whitney tests. Mean age of the participants in intervention and control groups were 41.85 ± 13.14 and 45.52 ± 14.03, respectively, which were homogeneous based on Mann-Whitney test (P= 0.219). In current study, 33.33% and 11.09% of the catheters remained patent after 96 hours in intervention and control groups, respectively. According to Chi-square test, the two groups were significantly different in terms of type of catheter patency (P=0.04). Findings suggest continuous flushing as an appropriate method that could increase the longevity of the PIVCs.
(Clinical Trials Registry Number: IRCT20141222020394N4)

Malocclusion is the most prevalent dental anomaly that influences the function of affected people. As a common orthodontic index, the Index of Orthodontic Treatment Needs (IOTN) classifies the malocclusions according to occlusal indexes of an individual. This research aimed at evaluating the need for orthodontic treatment in students aged 12-14 years old in Sari using IOTN Index in academic year 2016-2017. In this descriptive cross-sectional study, the IOTN was used for 576 students in six different schools. The IOTN index includes two components which are closely related; in current study, only the dental health component (DHC) was assessed. Data analysis was done in SPSS V21 applying Chi-square. A total of 576 students was studied of whom most (29.2%) were in grade 2, which showed little need for treatment (30% males and 28% females). Only 2.8% were graded as 5 on the IOTN scale meaning serious need for orthodontic treatment. Male and female students were homogeneous in grading distribution and there was no significant difference between the two groups (P< 0.75). The frequency of need for orthodontic treatment was 25.35%. In this study, most of the individuals showed little need of orthodontic treatment and there was no significant difference between the two groups in grading distribution.

Q fever is a worldwide zoonosis which is an endemic in many regions. Its diagnosis is usually missed especially in human. This research aimed at investigating acute Q fever among suspected patients in northern Iran. This cross-sectional study was conducted in 56 suspected cases of Q fever selected from 476 febrile patients admitted in Qaemshahr Razi Hospital, Iran 2016, with systemic or respiratory symptoms.  Blood samples and sera were tested for detection of IgG phase II antibodies against C. burnetii by quantitative ELISA. Seroconversion and/or four-fold rise in IgG phase II titers were the diagnostic criteria of acute Q fever infection. The prevalence of acute Q fever was 5.37% (95% CI: 1.84, 14.61%). Risk factors for Q fever infection included living close to livestock farms and consumption of unpasteurized milk or dairy products. However, these risk factors were not significantly different between patients with Q fever and seronegative cases of Q fever (P<0.612).  In current study, 23.21% of the participants were found with a history of Q fever infection. Acute Q fever was diagnosed in many cases in north of Iran indicating a high prevalence of the disease. Therefore, Q fever serology must be checked in seronegative suspected brucellosis.

The midwife's self-efficacy in supporting mothers during labor affects the onset of midwifery support in labor and childbirth. To date, there is no appropriate national instrument for measuring midwives self-efficacy of labor support in Iran. The present study aimed to investigate the factorial structure, validity and reliability of the Persian version of the self-efficacy for labor support scale. A methodological study was carried out in which 213 midwives from selected hospitals affiliated to Tehran University of Medical Sciences enrolled between January 2017 and September 2017. The participants completed a demographic questionnaire and the self-efficacy for labor support scale. In order to assess the validity of the instrument, qualitative face and content validity was performed. Construct validity was also evaluated using confirmatory factor analysis. Finally, the reliability of the scale was studied by Spearman's correlation coefficient and internal consistency. The qualitative face and content validity of the Persian version of labor support self-efficacy scale was confirmed, and a confirmatory factor analysis showed that it was well structured. The reliability of the scale using Cronbach's alpha coefficient was 0.93 and the Spearman's coefficient correlation was 0.72 indicating a good reliability of the Persian version of the scale. The findings showed that the Persian version of the self-efficacy for labor support scale has good validity and reliability and could be used as an appropriate instrument for assessing self-efficacy for labor support by midwives in Iran.

Recognizing the educational needs of students determine their learning goals and leads to better design of course books and educational materials. In this regard, high quality textbooks are a real need. This study aimed to analyze the content of "English for Dentistry Students'' course book based on the viewpoint of dental students. A descriptive cross-sectional study was performed in all dentistry students at Sari School of Dentistry, Iran 2018.  The participants all had passed the English for Specific Purposes (ESP) modules (I and II). The research was carried out using a questionnaire based on Sheldon model of evaluation modified by Karimi consisting of six dimensions. Data analysis was done in SPSS V24. A total of 123 dentistry students was studied. There were no significant differences between males and females average score for each dimension (P=0.01). The average score for the dimensions of practical subjects, content related to the objectives of the course, linguistic subjects, and order of the contents was 8.83±1.93 and the average score for subjects and subject layout was 12.93±1.86. Overall, dentistry student showed a moderate level of satisfaction towards ''English for Dentistry Students'' course book. In order to enhance learning, course books should include a variety of pictures and other educational tools such as movies and animations could be beneficial too.

There are various clinical forms of cutaneous leishmaniasis (CL) and there is lack of access to diagnostic local laboratories especially in endemic regions. The present study aimed to conduct molecular examination of the typical and atypical clinical forms of CL in endemic area of Bam, Iran. This cross-sectional study was carried out between 2013 and 2014. The diagnosis was performed by direct smears from skin lesions, Giemsa staining, and microscopic examination. Total DNA was extracted from positive and negative direct smears. PCR method was used to determine the genus and species of Leishmania.  In this study, 353 suspected cases of CL in Bam Health Center were investigated of whom 278 (78.7%) were positive by microscopic examination. Forty skin smears from typical lesions were positive by both PCR and microscopic examinations, but out of 40 skin smears from atypical lesions which were negative by microscopic observation, Leishmania DNA was detected in 6 (15%) samples. Leishmania tropica was identified in all positive samples. In current study, microscopy method was not found reliable enough for diagnosis of CL. Therefore, for early diagnosis of the disease PCR is recommended in negative smears of patients suspected of CL.

5-Flourouracil (5-FU) is one of the most common chemical drugs used in chemotherapy of patients with cancers. Dihydropyrimidine dehydrogenase (DPD) is a critical enzyme in the catabolism of 5-FU. More than 80% of the administered 5-FU is catabolized by DPD. c.1905+1G>A mutation on DPD gene is the most important mutation associated with DPD enzymatic deficiency which leads to toxicity. The aim of this study was to investigate the frequency of c.1905+1G>A mutation on DPD gene among patients with colorectal cancer in Mazandaran province, north of Iran, 2016. In this descriptive study, 60 patients with colorectal cancer were selected and the genomic DNA was extracted from 200 µl of peripheral blood using commercial DNA extraction kit (Yekta Tajhiz Iran). For identification of c.1905+1G>A mutation on DPYD gene PCR-RFLP method was used applying Mae II restriction enzyme. The patients were 26 females and 34 males. The c.1905+1G>A mutation was detected only in one male subject (1.6%) in the heterozygous state. The present study showed low frequency of c.1905+1G>A mutation in Mazandaran province. However, genetic test is recommended for identification of this mutation in oredr to predict the toxicity of the 5-FU in patients with colorectal cancer.

Nitrous oxide (N2O) is an anesthetic widely used in operating rooms. Chronic exposure to N2O causes decrease in mental performance, peripheral neuropathy, and polyneuropathy. The aim of this study was to compare neurological complications caused by N2O exposure between operating room staff and other hospital staff. In this multicenter cohort study, operating room staff (n=110) and non-operating room staff (n= 224) in Arak Valiasr Hospital and Isfahan Al-zahra Hospital were randomly selected and individually matched. Both groups were examined for neuropathic symptoms and their medical history was recorded. Clinical neurological exams such as Romberg test were used in both groups. Patients with neuropathic sign and symptoms were referred to a neurology clinic to confirm any diagnosis. The two groups were significantly different in ataxia, numbness, weakness and paresthesia of upper and lower limb, Romberg test score, and levels of Vitamin B12 (P<0.05). No significant differences were observed between the two groups in mean Hemoglobin level, temperature sense, touch and two-point discrimination, stereo gnosis, tandem walking, and plantar and dorsal flexion (P≥ 0.05). Chronic exposure to nitrous oxide was found to decrease serum vitamin B12 levels and caused neurological symptoms and complications. Therefore, clinical and laboratory evaluations and monitoring of exposure to nitrous oxide is necessary.

Delirium is a recurrent cognitive disorder which is one of the most common neurologic diagnosis in patients who have had pelvic surgeries. This complication occurs in a short time and early diagnosis results in early management. Current study was done to investigate the frequency of delirium and identifying the factors affecting its incidence in patients with pelvic surgeries. This analytical study was performed in patients >60 years of age admitted in orthopedic wards in Rasht hospitals, Iran, due to pelvic surgery. The samples (n=252) were selected using convenience sampling. Data were collected using a demographic questionnaire and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria. All patients were examined before the surgery, at 6, 24, 48, and 72 hours after the surgery and also before discharge in which their cognitive status and average cognitive scores were recorded. We investigated 252 patients (mean age: 72.90±7.33) including 67 (26.6%) males and 185 (73.4%) females of whom 69% were married. Overall incidence of delirium was 18.3%. Significant association was found between the incidence of delirium and history of smoking, psychiatric medications (P< 0.001), and the type of anesthesia (P< 0.05). This study showed high prevalence of delirium in patients who have had pelvic surgery. Therefore, more focus on the factors affecting the incidence of delirium before the surgery and evaluation of patients early after the surgery could be beneficial in reducing the rate of delirium.

Patient safety culture is essential in preventing patient injuries in hospitals. Safety attitude is one of the valid tools used in assessment of safety culture among nurses. The purpose of this study was to investigate the nurses safety attitude and also understanding the effect of demographic characteristics, work shifts, and job demands on that. This cross-sectional study was conducted in 325 nurses in Babol, north of Iran, 2016.  Demographic and organizational information were recorded. The Safety Attitude Questionnaire (SAQ) and Job Content Questionnaire (JCQ) were used. Data analysis was done using regression analysis in SPSS V24. The average values for psychological and physical demands of nurses were 32.7±9.4 and 8.8±2.8, respectively. According to the SAQ, the dimensions of stress recognition (73.6 ±17.9) and perception of management (48.8±16.2) were found with the highest and lowest mean scores, respectively. Also, regression model showed the wards, psychological demands, and physical work demands as the predictors of nurses attitude toward safety (P <0.05). According to this study, reducing the psychological and physical demands associated with work could improve safety attitude in nurses. Also, nursing managers should provide nurses with some training courses on controlling unsafe behavior and safety attitudes.

Attitude of nurses and nursing students toward spirituality and spiritual care is a major factor in meeting patients spiritual needs. This study aimed at investigating the attitude of nurses and nursing students toward spirituality and spiritual care in Iran using a meta-analysis. National and international databases were searched using relevant keywords. Information about the articles, their methodology, and results were recorded. To examine the heterogeneity between studies Cochran test (Q) and I-squared were used. The mean score for the attitude of nursing students and nurses, and a randomized design with 95% confidence interval was calculated in forest plots. In initial search, 1618 articles were found and eventually 12 were selected according to the study inclusion criteria. By combining the results across preliminary studies, the mean scores for nursing students attitudes were 56.51 (95% CI, 55.08-57.93) and 42.24 (95% CI, 33.07-51. 40) based on Spirituality and Spiritual Care Rating Scale and Spiritual Care Perspectives Scale, respectively. Also, the mean scores for the nurses attitudes based on Spiritual Care Perspectives Scale and Spirituality and Spiritual Care Rating Scale were 51.43 (95% CI, 39.47-63.48) and 57.61 (95% CI, 54.31-60.92). Current meta-analysis showed moderate attitude toward spirituality and spiritual care among nurses and nursing students. Therefore, spiritual care modules should be delivered to nursing students and knowledge-intensive workshops should be carried out among nurses.

Transdermal patches are now widely used in topical and transdermal drug delivery systems (TDDS). Up to now, TDDS has been used in several conditions, such as smoking cessation, analgesic effect, nausea, contraception, and hormone therapy. Basically, there are two types of transdermal patches: the reservoir-type patches and the matrix-type patches. First generation TDDS were designed for delivery of drugs in low-dose. In second-generation delivery systems, drug penetration was increased using chemical enhancers and iontophoresis. Several methods such as microneedles, electroporation, and cavitational ultrasound are used as the third generation of TDDS for targeting their effects to skin’s barrier layer of stratum corneum. Microneedles are currently studied through clinical trials as suitable delivery system for macromolecules and vaccines, such as insulin and influenza vaccine. This review article describes the structure of different types of transdermal patches and some marketed products. It also introduces a framework for present and future developments of percutaneous drug delivery by transdermal patches.

Correction to: Intestinal Parasitic Infections in Patients Attending Gastrointestinal Clinics
Niloofar Amin1,Hafez Fakheri2,
Vahid Hossini2,
Hajare Ziaei3,
Azadeh Dadashi1,
Bahman Rahimi4,
Shirzad Gholami5
1 Medical Student, Student Research Committee, Faulty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
2 Professor, Department of Gastroenterology, Gut and  Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Assistant Professor, Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
4 PhD Student in Parasitology and Mycology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
5 Associate Professor, Department of Parasitology and Mycology, Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
In the article published in volume 26, issue 146, 2017, the name of Hafez Fakheri was published incorrectly, which is now corrected.

Correction to: Frequency of Psychiatric and Psychological Disorders in Patients with Type II Diabetes
Mollod Eskandari Khanghahi1,
Seyyed Hamzeh Hosseini2,
Ozra Akha3,
Mahdie Nasiri4
1 General Practitioner, Islamic Azad University, Tonekabon Branch, Tonekabon, Iran
2 Professor, Department of Psychiatry, Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
3 Associate Professor, Department of Endocrinology, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
4 MA in Clinical Psychology, Faculty of Educational Sciences and Psychology, Alzahra University, Tehran, Iran 
* Corresponding Author: Ozra Akha - Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
(E-mail: [email protected])


In the article published in volume 27, issue 155, 2017, the email address for corresponding author was published incorrectly, which is now corrected.