مجله دانشگاه علوم پزشکی مازندران
پیاپی 242 (اسفند 1403)

 Post-traumatic stress disorder (PTSD) is a psychiatric disorder caused by traumatic events. Various treatments, including pharmacotherapy and psychotherapy, have been investigated, but the role of exercise as a promising intervention remains underexplored. From a neurobiological perspective, PTSD is associated with dysregulation in several brain regions involved in emotion regulation, memory processing, and fear responses. This study investigates the effects of voluntary and forced exercise on behavioral responses and serum levels of IGF-1 and corticosterone in ovariectomized rats with PTSD.

Fifty-six adult female Wistar rats were randomly selected and kept under normal laboratory conditions. First, the rats were divided into control and ovariectomized groups. Ovariectomy was performed under deep anesthesia. After a recovery period, the single prolonged stress (SPS) method was used to induce PTSD. Rats were subjected to voluntary exercise using a running wheel or forced exercise on a treadmill. Anxiety was measured using the elevated plus maze, and cognitive performance was assessed using the Object Recognition Memory Test. Afterward, the animals were euthanized under deep anesthesia, and serum samples were collected. Corticosterone and IGF-1 levels were measured by ELISA.

In the control and ovariectomized groups, both types of exercise resulted in decreased anxiety, with a more pronounced anti-anxiety effect observed in the voluntary exercise group. Voluntary exercise significantly improved memory in both the control and ovariectomized groups. Forced exercise also enhanced memory in the ovariectomized group, albeit to a slightly lesser extent than voluntary exercise. Both types of exercise in the control and ovariectomized groups led to a significant reduction in serum corticosterone levels. Notably, this reduction was more pronounced with voluntary exercise compared to forced exercise.

Voluntary exercise effectively reduces anxiety, enhances cognitive function, and modulates physiological stress markers in ovariectomized rats with PTSD.

 The presence of COVID-19 drugs in waters globally indicates that conventional wastewater treatment technologies have not been successful in removing them. This study aimed at investigating the efficiency of superchlorination and Fenton processes in removing favipiravir and hydroxychloroquine from hospital wastewater.

In this study, the degradation of hydroxychloroquine and favipiravir from synthetic wastewater was carried out using superchlorination and the Fenton process at an experimental scale. The concentration of the remaining drugs in the treated samples was analyzed using HPLC-UV equipment. The effect of changes in the initial concentration of drugs, chlorine, [Fe²⁺], [H₂O₂] concentration, pH, and contact time was also investigated, and the optimal values for each of the desired parameters were determined. Mineralization was measured using a TOC Analyzer.

Based on the results of this research, the optimal conditions in the superchlorination test include the following: the initial concentration of both drugs is 50 ppm, the optimal pH is 7, the chlorine concentration for favipiravir removal is 150 ppm, and for hydroxychloroquine, it is 200 ppm. The contact time is 60 minutes. Also, the optimal conditions of the Fenton process for favipiravir removal include: pH 7, initial concentration of 50 mg/L, [Fe²⁺] of 1 mmol/L, [H₂O₂] of 3 mmol/L, and contact time of 30 minutes. For hydroxychloroquine, the optimal conditions are as follows: pH 7, initial concentration of 50 mg/L, [Fe²⁺] of 0.5 mmol/L, [H₂O₂] of 0.5 mmol/L, and contact time of 10 minutes.

The conducted experiments demonstrate the effectiveness of superchlorination and the Fenton process in removing wastewater containing favipiravir and hydroxychloroquine. The efficiency of these methods in removing antibiotics with a similar structure or enhancing their biodegradability can also be investigated.

 Due to the relatively high cost of cosmetic restorations with indirect composite resins, the time required for their complete replacement, and, in some cases, the need for significant tooth structure removal, repairing these restorations may sometimes be a more appropriate approach. This study aimed to investigate and compare the effects of different surface preparation methods on the shear bond strength between indirect and direct composite resins.

In this study, 102 indirect composite resin blocks of Ivoclar SR Nexco Paste were fabricated and assigned to three groups (n = 34) based on the preparation method. Group 1: roughening and etching with 37% phosphoric acid; Group 2: roughening and etching with 9.5% hydrofluoric acid; Group 3: air abrasion with 50-μm aluminum oxide particles. A total of 500 thermal cycles were performed before the repair process, and surface preparations were carried out. After applying the adhesive in all groups, the samples were repaired using the direct Ivoclar Heliomolar composite resin. The samples were then subjected to fracture by an Instron machine at a speed of 0.5 mm/min, and the shear bond strength was recorded. The data were then converted to MPa and evaluated using one-way ANOVA and the Tukey test.

The highest shear bond strength was recorded in Group 2 (mean± SD = 24.64± 2.28), and the lowest bond strength was recorded in Group 1 (mean± SD= 10.31± 1.67).

In this study, preparation with hydrofluoric acid resulted in higher shear bond strength compared to phosphoric acid and air abrasion.

COVID-19 is one of the most dangerous diseases of the present century, and the most effective way to protect against it is through vaccination. This study aimed to examine the impact of vaccination on preventing severe and fatal outcomes from COVID-19 in Hormozgan Province.

This was a retrospective cohort study. A total of 18,788 patients aged over 18 years with COVID-19 were included. Sampling was conducted through a census, and data analysis was performed using Chi-square test, Fisher's exact test, and ordinal logistic regression models. Data were analyzed using SPSS version 22.

The odds of experiencing severe and fatal outcomes in unvaccinated patients were 2.1 times higher compared to vaccinated individuals (P< 0.001). Male sex (OR= 1.6, P< 0.001), age over 35 years (OR= 2.1, P< 0.001), a history of cardiovascular disease (OR = 2.4, P< 0.001), diabetes (OR = 1.4, P< 0.001), cancer (OR= 3.3, P< 0.001), chronic kidney disease (OR= 2.3, P< 0.001), and chronic lung disease (OR = 1.9, P<0.001) were all statistically significant risk factors for severe and fatal outcomes.

Vaccination against COVID-19 significantly reduces the risk of severe and fatal outcomes. Additionally, chronic and debilitating diseases are associated with an increased likelihood of death and severe outcomes in COVID-19 patients. Efforts to increase vaccination coverage, particularly among vulnerable groups, are strongly recommended.

Cardiovascular diseases are among the chronic diseases with a high mortality rate. Considering the importance of person-centered medicine and Iranian medicine, the concept of temperament has a great impact on the occurrence of diseases. The aim of this study is to investigate the temperament of patients with an acute heart attack.

A descriptive cross-sectional study was conducted on 280 new patients, aged 20 to 60 years, diagnosed with their first acute heart attack, confirmed by a cardiologist based on clinical and laboratory findings, at the Mazandaran Heart Center from April to September 2024. The study population was selected using convenience sampling.

The mean age of the patients was 51.81±5.98 years, and 70% were male. The frequency of hot temperament, both singly and in combination, differed significantly between the sexes (P= 0.011), as did wet temperament compared to other temperaments (P<0.001).

The results of this study indicate that most patients with acute heart attacks have a hot and humid temperament. Therefore, according to the principles of Iranian medicine, maintaining health and effectively treating these patients requires avoiding factors that increase hot and humid temperament, such as overeating, obesity, physical inactivity, and inadequate sleep. In other words, individuals with a hot and humid temperament are more susceptible to this disease and should adopt preventive measures that help reduce this temperament, including proper nutrition, regular exercise, and adequate sleep.

 Oral squamous cell carcinoma is the most common malignancy of the oral cavity. In solid tumors, cancer cells and stromal cells (fibroblasts, inflammatory cells, endothelial cells) play a role in tumor progression, angiogenesis, local invasion, and metastasis. Mast cells contribute to carcinogenesis by releasing chemical mediators in their granules through various pathways, including suppressing the immune system, enhancing angiogenesis, destroying the extracellular matrix, and increasing the mitosis of tumoral cells. Several studies have investigated the role of mast cells in oral squamous cell carcinoma. While some suggest that mast cells play an angiogenic and tumorigenic role, others do not confirm this, highlighting the contradictory findings in this area. In this study, we discuss the role of mast cells in oral squamous cell carcinoma.

The mean number of mast cells was significantly lower in higher microscopic grades compared to poor grades (P<0.05). However, there was no significant difference in the average number of mast cells based on age, gender, or location of occurrence (P>0.05).

the mean number of mast cells was significantly lower in microscopic grade and higher than poor (P-value˂0/05). But there was no significant difference in the average number of mast cells based on age, gender and place of occurrence (P˃0/05).

The significant increase in the average number of mast cells in microscopic grades II and III compared to grade I indicates the role of mast cells as an indicator of disease progression. This finding may support the use of novel treatment approaches, such as mast cell degranulation inhibitors and anti-angiogenic therapies.

 Declining fertility rates and decreasing population growth are major challenges for the country. Numerous studies have been conducted to identify factors influencing this issue. One such factor is the childbirth experience. This research examines the relationship between previous childbirth experiences and fertility decisions in women with one child.

This cross-sectional study was conducted in 2023-2024 on 400 women with one child covered by health centers in Shahrud. Health centers were selected from various city areas (northern, southern, eastern, western, and central) to represent the city's socio-economic diversity. Data were collected using standardized demographic, childbirth experience, and fertility decision-making questionnaires. The validity and reliability of the questionnaires were confirmed in previous studies. The scoring of the questionnaires was based on the Likert scale, with fertility decision scores categorized into three levels: weak (29-69), moderate (70-100), and strong (101-150). Data were analyzed using Chi-square tests, one-way ANOVA, and linear regression in SPSS version 25.

The mean age of the women was 30.02 ± 5.48 years, their spouses' mean age was 34.31 ±4.90 years, the mean age at marriage was 7.37± 2.58 (???) years, and the mean age of the first child was 3.96±1.21 years. Of the participants, 42% had moderate childbearing intentions, 33% had strong intentions, and 25% had weak intentions. Regression analysis revealed that childbirth experience significantly impacted childbearing decisions (OR=1.34,P<0.001). Additionally, higher childbirth experience scores were associated with increased intentions to have more children (P<0.001). Other demographic variables showed no significant effect.

Childbirth experiences in women with one child play a significant role in the decision to have a second child. Positive experiences increase fertility desire, while negative experiences cause hesitation. Emotional support, education, and improved maternity care can strengthen fertility intentions and contribute to population policies.

 Individuals undergoing chronic hemodialysis face various daily challenges due to their unique lifestyle, which significantly reduces their quality of life. Self-care plays a crucial role in improving health behaviors and delaying the progression to the final stages of the disease. Since self-care is comprehensive, learnable, and improvable, this study aimed to investigate the relationship between loneliness and self- care in elderly patients undergoing hemodialysis.

This cross-sectional study involved 138 elderly patients undergoing hemodialysis at the Citizen Dialysis Center in Sari, selected through a census method. Data collection tools included a socio-demographic questionnaire, the Standardized Elderly Self-Care Scale, and the Russell Loneliness Scale. Data were analyzed using SPSS version 22, employing both descriptive and inferential statistics. The significance level was set at P≤ 0.05.

The average age of the participants was 68.67±6.28 years, and the majority (51.4%) were female. Pearson correlation analysis revealed no significant association between total self-care scores and loneliness (r=0.14,P=0.108), physical self-care scores and loneliness (r=-0.03,p=0.694), or illness-related self-care scores and loneliness (r=0.11,P=0.218). However, a significant negative correlation was observed between spiritual self-care scores and loneliness (r=-0.33,P=0.001) and between social self-care scores and loneliness (r=-0.20,P=0.018). As loneliness scores increased, spiritual and social self-care scores declined.

The findings underscore the importance of addressing the emotional and social needs of elderly hemodialysis patients along with their physical health needs to enhance their overall quality of life. Healthcare providers and policymakers should implement self-care interventions, particularly those emphasizing spiritual and social aspects, into care plans for elderly hemodialysis patients to reduce the negative impact of loneliness and promote their well-being.

 The communication and mutual understanding between healthcare service providers and patients are serious concerns in the health system. The purpose of this study is to evaluate and compare the impact of reading stories on increasing the level of general empathy and patient empathy in nursing students at Mazandaran University of Medical Sciences.

The statistical population of this quasi-experimental study consisted of 82 nursing students, who were divided into two groups of 41 subjects each, an experimental group and a control group, using the simple random method. Story reading was carried out in six sessions, each lasting two hours, conducted online over six weeks in a semester. The students completed the Davis General Empathy Questionnaire and the Jefferson Scale of Empathy before and after the sessions.

In this study, general empathy and patient sympathy were evaluated in three time periods: before the intervention, immediately afterthe intervention, and seven days after the end of the intervention. Jefferson sympathy scores increased from 44.71 before the intervention to 61.37 immediately after the intervention and then decreased to 57.98 seven days later, indicating a positive effect of the intervention. Davis empathy scores also increased from 51.93 before the intervention to 76.53 immediately after the intervention and then decreased to 60.13 seven days later. To compare empathy levels, the analysis of variance test with repeated measures was used. However, before performing the sphericity hypothesis test, Mauchly's test was conducted. Since it was not significant (P < 0.001), the Greenhouse-Geisser test was used, and a significant difference was reported in the three measurement periods (P < 0.001).

Story reading is effective in improving nursing students' sense of general empathy and sympathy toward patients. It is recommended that this method be implemented in universities to enhance empathy training.

 The use of smartphones has significantly increased among students. Although this technology offers various benefits, its misuse can lead to negative consequences, such as nomophobia. Given the adverse effects of nomophobia, this study aims to investigate the relationship between nomophobia, perceived stress, and perceived social support among medical students at Mazandaran University of Medical Sciences.

This cross-sectional study was conducted in 2023 on a sample of 273 medical students at Mazandaran University of Medical Sciences, selected through convenience sampling. Data were collected using demographic checklist, the Perceived Stress Scale (PSS), and the Nomophobia Questionnaire (NMP-Q). Statistical analysis was performed using SPSS and AMOS software (version 24) through descriptive and analytical statistics, as well as path analysis. A significance level of P < 0.05 was considered.

The participants had a mean age of 23.31±2.99 years, and 57.5% were female. All students reported experiencing some degree of nomophobia, with 56% at a moderate level, 12.8% at a mild level, and 31.1% at a severe level. Path analysis revealed a significant direct relationship between perceived stress and the severity of nomophobia (r=0.24, P<0.05). However, no significant association was observed between nomophobia and perceived social support (r=0.19, P>0.05). The model fit indicated that perceived stress and perceived social support collectively accounted for 6.0% of the variance in nomophobia severity. Goodness-of-fit indices confirmed an acceptable model fit (CMIN/df = 1.85, IFI = 0.95, TLI = 0.85, GFI = 0.99, CFI = 0.95, RMSEA = 0.056).

Nomophobia is prevalent among medical students, with most experiencing moderate levels. Perceived stress was significantly associated with the severity of nomophobia, while perceived social support had no significant effect. The findings emphasize the need for interventions to reduce stress and increase awareness of smartphone addiction among medical students.

 Ethical decision-making is a fundamental aspect of management and a vital competency for healthcare professionals, enabling them to handle complex responsibilities effectively. Surgical technology students, as one of the key groups involved in bedside care, train and work in a complex environment. Due to their close interaction with patients and their presence in the high-risk environment of the operating room, this group experiences higher levels of stress and must make proper ethical decisions in response to ethical dilemmas encountered at the bedside. This study aims to explore the experiences of ethical decision-making among surgical technology trainees.

This qualitative study was conducted in 2023 at Golestan University of Medical Sciences. Using a purposive sampling method, 15 eighth-semester surgical technology students voluntarily participated in the study. Data were collected through semi-structured, interactive, face-to-face interviews with open-ended questions focusing on students' experiences of ethical decision-making during clinical training. For data analysis, MAXQDA software (version 24) and the conventional content analysis approach proposed by Graneheim and Lundman were employed.

Data analysis yielded a total of 283 meaning units, categorized into three main themes: "Violation of Patient Rights," with four subcategories; "Violation of Student Rights," with five subcategories; and "Educational Shortcomings in Students", with two subcategories.

This study highlights the crucial need for ethical decision-making skills among surgical technology students and underscores the importance of addressing educational shortcomings to better prepare them for the challenges of the operating room environment

 Halitosis, or bad breath, is a condition in which the smell of a person's breath becomes unpleasant. This condition is not only the third most common reason for dental visits, but it also carries significant social and psychological consequences. Despite considerable advancements in dentistry and medicine, halitosis remains both a diagnostic and therapeutic challenge. Therefore, exploring complementary approaches is necessary. The aim of this study is to investigate the etiology and treatment measures for bad breath in Persian medical texts.

This study employs qualitative content analysis to examine bad breath in traditional Persian medicine texts. Eight books from the 3rd to 5th centuries A.H., such as the Canon of Medicine Alhavi, etc were sourced from the Noor Digital Library and other electronic resources.

According to the opinions of Persian medical sages, 17 different causes of bad breath were identified, primarily caused by conditions in the mouth, stomach, and lungs. These causes include ulcers, decay, and infection in the mouth, stomach disorders with the accumulation of infectious substances, and lung infections. For treatment, depending on the underlying cause in each case, health measures and lifestyle modifications, as well as single and compound drugs, have been suggested. These treatments include the consumption of celery, cloves, cardamom, and myrtle fresh foliage with seedless raisins, among others.

Persian sages identified oral and dental diseases, as well as gastrointestinal problems, as the main causes of halitosis and treated it based on the underlying cause of bad breath. Some of the causes and treatments from traditional Persian medicine for this condition have been supported and validated by modern scientific research after centuries. Further investigations and clinical trials could pave the way for utilizing this valuable ancestral heritage.

 COVID-19, caused by the SARS-CoV-2 virus, primarily targets the respiratory system but can also impair other organs, including the pancreas, potentially increasing the risk of new-onset diabetes. Emerging evidence highlights that some patients recovering from COVID-19 face an elevated risk of developing diabetes, underscoring the need for further investigation. This study aims to determine the prevalence and identify potential risk factors for new-onset diabetes in patients recovering from COVID-19.

This cohort study involved 933 patients with confirmed COVID-19, all of whom were admitted to Qaemshahr Razi Hospital and had no prior diabetes diagnosis. Patients were stratified based on the severity of their COVID-19 infection and followed for three months post-discharge. Fasting plasma glucose (FPG) and HbA1c tests were performed to diagnose diabetes. Detailed demographic data, clinical indicators, and inflammatory markers, including CRP, LDH, and D-dimer, were recorded for analysis. Data analysis was conducted using SPSS software, and appropriate statistical tests were applied to compare variables across patient groups.

The findings revealed that patients with new-onset diabetes were significantly older, had higher body mass indices, and had a positive family history of diabetes. Elevated levels of inflammatory markers, such as CRP and LDH, were observed in these patients. Moreover, the severity of COVID-19 symptoms, including shortness of breath and fever, was significantly associated with the development of diabetes.

This study demonstrates a clear association between COVID-19 and an increased risk of diabetes, particularly in patients with severe disease manifestations. Post-recovery blood glucose monitoring is strongly recommended, and timely management should be prioritized for patients diagnosed with diabetes.

 The sudden outbreak of the 2019 coronavirus (COVID-19) in Wuhan, China, has led to a public health crisis. To prevent COVID-19 transmission, dentists and dental students should use personal protective equipment (PPE) and implement cross-contamination prevention methods while performing dental work. Therefore, the purpose of this study is to examine the use of personal protective equipment among dental students at Mazandaran University of Medical Sciences.

In this cross-sectional study, 143 dental students at Mazandaran University of Medical Sciences were included in 2020 using the census method. Information, including the year of admission to the university, age, and gender, along with items related to the use of protective gowns, masks, gloves, shoe protectors, and eye protection, was collected from the participants. Data were collected using a researcher-made demographic questionnaire consisting of 33 questions related to the use of PPE against COVID-19. Data analysis was performed using the Pearson and Spearman correlation coefficients in SPSS version 24. The significance level was set at P< 0.05.

During this study, 143 dental students, including 67 men (46.9%) and 76 women (53.1%), were studied. The findings showed that there was a statistically significant relationship between age, year of admission, and marital status with the use of PPE (P<0.05). However, no significant relationship was found between the use of PPE and students' gender or place of residence.

According to the findings, the level of compliance with personal protective principles was moderate in more than half of the students. However, it is necessary to provide additional training to students who are in direct contact with these patients to prevent viral diseases, including COVID-19.

Ilioinguinal fistula is an abnormal connection between the ileum and vagina, representing a rare complication following gynecological surgeries. This article presents a rare case of a 63-year-old woman who developed an Ilioinguinal fistula five years after undergoing hysterectomy, oophorectomy, and radiotherapy for uterine cancer. The sudden onset of foul-smelling vaginal discharge prompted her to visit a gynecology clinic, leading to a referral to the surgical department and subsequent diagnostic imaging via MRI, which ultimately revealed the Ilioinguinal fistula. This case highlights an uncommon complication in gynecologic surgeries, particularly those related to uterine cancer, and underscores the significant role of radiotherapy in fistula formation. The challenges of early diagnosis and the importance of appropriate treatment strategies for effective management are emphasized. This case report contributes to increasing awareness among specialists about potential postoperative complications, especially in patients who have undergone radiotherapy, thereby facilitating timely diagnosis and targeted interventions.

Invasive aspergillosis is known as one of the most dangerous fungal diseases, especially in immunocompromised individuals or patients with long-term hospitalization in intensive care units. This disease imposes a significant burden on the Iranian health system with its high mortality rate and high costs due to hospitalization and treatment. On the other hand, the increasing resistance of Aspergillus species, especially Aspergillus fumigatus, to azole drugs is a serious challenge. The country's lack of an effective strategy and program to monitor and treat this disease is a major obstacle to its control. Researchers from the Invasive Fungal Research Center affiliated with Mazandaran University of Medical Sciences, by presenting this policy brief report, emphasize the need for immediate action and attention to a multifaceted approach of clinical vigilance, ongoing research, and management of environmental factors, and propose operational solutions including the establishment of continuous clinical and environmental monitoring systems, the development of rapid diagnostic tests, research and development of new drugs, specialized training of medical staff, the development of aspergillosis infection control protocols, and monitoring the use of azole fungicides in agriculture. The development of a comprehensive national program, cooperation between policymakers and health managers, researchers and medical mycologists, and other health and medical specialists, along with interdisciplinary measures, will play an important role in managing this crisis.