Mazandaran University of Medical Sciences

OBJECTIVE With the evolution of neuroendovascular treatments, there is a great trend to treat acutely ruptured wide-necked aneurysms with stent-assisted coiling (SAC) and flow diverters (FDs), which inevitably requires dual antiplatelet therapy (DAPT). This therapy can increase the rate of hemorrhagic complications following other neurosurgical maneuvers, such as external ventricular drain (EVD) placement or removal. In this study, the authors aimed to evaluate the safety of DAPT in patients with aneurysmal subarachnoid hemorrhage (SAH) treated with SAC or FDs and the therapy’s potential benefit in reducing cerebral ischemia and cerebral vasospasm. METHODS In this retrospective study, the authors reviewed the records of patients who had been admitted to their hospital with acute aneurysmal SAH and treated with SAC, FDs, and/or coiling between 2012 and 2022. Patients were classified into two groups: a DAPT group, including patients who had received DAPT for SAC or FDs, and a non-DAPT group, including patients who had not received any antiplatelet regimen and had been treated with coiling. Perioperative hemorrhagic and ischemic complications and clinical outcomes were compared between the two groups. RESULTS From among 938 cases of acute ruptured aneurysms treated during 10 years of study, 192 patients were included in this analysis, with 96 patients in each treatment group, after propensity score matching. All basic clinical and imaging characteristics were equivalent between the two groups except for the neck size of aneurysms (p < 0.001). EVD-related hemorrhage was significantly higher in the DAPT group than in the non-DAPT group (p = 0.035). In most patients, however, the EVD-related hemorrhage was insignificant. Parent artery or stent-induced thrombosis was higher in the DAPT group than in the non-DAPT group (p = 0.003). The rate of cerebral ischemia was slightly lower in the DAPT group than in the non-DAPT group (11.5% vs 15.6%, p = 0.399). In the multivariate analysis, cerebral ischemia, rebleeding before securing the aneurysm, extracranial hemorrhage, and cerebral vasospasm were the predictive factors of a poor clinical outcome (p < 0.001, p < 0.001, p = 0.038, and p = 0.038, respectively). CONCLUSIONS The DAPT regimen may be safe in the setting of acute aneurysmal SAH. Although EVD-related hemorrhage is more common in the DAPT group than the non-DAPT group, it is usually insignificant without any neurological deficit.

Objectives This study evaluated the relationship between acquired cataract’s different types and the ABO and Rh blood classes. Methods Overall, 520 patients, by randomized sampling method, participated in this retrospective cross-sectional study. After reviewing the patient’s medical records and laboratory results, the patient’s demographics, ABO group, Rh, and cataract type were documented. Results A total of 520 patients were included in the research, with a mean age of 67.57 ± 11.85. Most of them were female (n = 286, 55%). Mix (n = 230, 44%) and nuclear sclerotic (NS) (n = 167, 32%) cataracts were the most common types. The posterior subcapsular cataract (PSC) prevalence in females was significantly higher than in males (16.1% vs.7.3% p = 0.002). Also, men had more NS cataracts than females (89, 38% vs. 78, 27.3%) (p = 0.009). Patients with PSC were significantly younger than others (all p-values < 0.001). Our results showed that cataract types are independent of blood group types and Rh (P > 0.05). Conclusion Although our findings showed that cataract types are independent of blood group types and Rh, they can be compared with future studies on the association of other Blood-Group Systems in developing acquired cataracts.

Key Clinical Message Systemic lupus erythematosus (SLE) can have various manifestations. Although cardiac involvement is very common in SLE patients, a severe acute pericarditis as the first manifestation of SLE in a male patient is relatively rare. A 36‐year‐old male was admitted to our hospital with acute pericarditis, large circumferential fibrinous pericarditis, and major criteria of a high‐risk case of acute pericarditis. After a complete investigation, the underlying disease was revealed to be SLE. All of his symptoms were completely resolved after 6 weeks of treatment with non‐steroidal anti‐inflammatory drugs and corticosteroids with no need for a pericardiocentesis. Patients with acute fibrinous pericarditis should be considered and precisely investigated for multiorgan autoimmune process such as SLE, to avoid unnecessary intervention, and minimize the risk of recurrence and chronicity of the condition.

Background Tooth decay and other oral health (periodontal) diseases are highly prevalent worldwide and present a significant economic burden. Oral health is particularly important for adolescents, as the World Health Organization has identified tooth decay as one of the most pressing global health issues. This study aims to identify predictors of oral health behaviors among students aged 13–15 years in the city of Shushtar, Iran. Methods The present research is a cross-sectional study that was conducted during the summer of 2022 on 415 adolescents from the first secondary school in Shushtar. Two standard questionnaires were used to collect data, consisting of demographic information and questions related to measuring awareness, attitude, performance, and self-efficacy regarding oral health behaviors among adolescents. The collected data was analyzed using SPSS 22 statistical software through descriptive statistics, Pearson correlation, and regression analysis. Results The average scores for awareness, attitude, self-efficacy in brushing teeth, self-efficacy in flossing, self-efficacy in going to the dentist, and adolescents’ performance on oral health behaviors are 5.72 ± 2.06, 36.40 ± 6.36, 25.40 ± 7.49, 14.15 ± 6.06, 15.80 ± 5.59, and 14.01 ± 4.02, respectively. Conclusion Based on the results of this study, it can be concluded that adolescents have low levels of awareness, performance, self-efficacy, and a positive attitude towards oral health. Considering the significance of adolescence as a stage for shaping oral health behaviors and their impact on adulthood, it is recommended to increase awareness among adolescents and improve their health behaviors by conducting educational classes in schools.

Introduction The provision of ethical care is a critical component of the medical profession, and adherence to the patient's bill of rights is essential to ethical care. This study aimed to investigate medical students’ attitudes toward the provisions of the patient's ethical charter. Methods A cross-sectional descriptive-analytical study was conducted between March 2022 to July 2022 among several medical students in the 1st to 10th semesters at Mazandaran University of Medical Sciences. Data were collected using valid and reliable questionnaires containing 22 questions about the patient's bill of rights provisions. The questionnaire scoring scale was based on the five-point Likert scale. Students' views were classified into three levels: favorable, relatively favorable, and unfavorable. Results 230 medical students participated in the study, with a mean age of 21.96 ± 2.89, and 37% were women. The average student had a relatively favorable attitude toward the patient's Bill of Rights provisions. There were no significant differences between men and women or between students who had related programs about the patient's bill of rights and those who did not. The correlation between age and semester by attitude score towards the patient's right charter showed a significant relationship. With increasing age, the attitude toward patient rights standards worsened. Higher-semester students were more unfavorable toward the patients' bill of rights provision. Conclusion The study findings suggest that implementing medical courses and programs related to the patient's bill of rights could be more effective. Medical students' attitudes towards the patient's ethical charter worsen with increasing age and academic term. Further studies are required to identify the reasons behind this trend and improve the implementation of medical courses and programs related to the patient's bill of rights.

Background The unprecedented COVID-19 pandemic placed immense stress on healthcare professionals worldwide. This strain often resulted in imbalances in their physical and mental well-being, necessitating effective coping mechanisms. In light of this context, this study investigates the correlations between the fear of COVID-19, self-coping strategies, and positive emotions, with particular reference to the Iranian health care industry. Methods Data were collected from 1050 healthcare professionals in Iran and the data were analysed sing structural equation modelling. Results The study revealed that pandemic fear negatively impacts self-coping strategies and positive emotions during crisis scenarios. Conversely, self-coping strategies have a positive correlation with positive emotions. The research also underscored the role of resilience in reinforcing the favorable link between self-coping strategies and positive emotions. Conclusions This study is one of the first to explore the significance of resilience and self-coping strategies among Iranian healthcare professionals during the pandemic. Its findings offer valuable insights for researchers and practitioners, paving the way for further contributions in this field. Future research endeavors may consider investigating the effects of various psychological interventions, including breathing techniques, self-talk, physical exercises, yoga, optimizing sleep, and dietary measures on the resilience and self-coping practices of healthcare professionals.

Introduction Angiodysplasia is a vascular lesion responsible for 6% of lower gastrointestinal bleeding cases. It is generally located in the cecum and ascending colon in elderly patients. Angiodysplasia of the gallbladder is a rare condition. The main objective of this literature review was to summarize the demographics, clinical signs and symptoms, gross findings, histopathology, immunohistochemistry, treatment, and follow-up of patients with gallbladder angiodysplasia. Methods and materials The authors searched PubMed, ScienceDirect, and Google Scholar using relevant keywords. The search was performed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using appropriate keywords. The case reports included were those dealing exclusively with human subjects, were published in the English language, and had free, full-text, public access. Data was extracted and case reports were evaluated. Results Of the 1097 studies initially identified, 3 (0.27%) were analyzed. There were two females (66.6%) and one male (33.3%). The mean age of presentation was 47.6 years. The most common presenting complaint was colicky right upper abdominal pain in two cases (66.6%). Elective cholecystectomy was performed in only two cases (66.6%). In one case (33.3%), petechiae were diffusely present in the gastric mucosa and patchy in the gallbladder, duodenum, jejunum, ileum, cecum, and ascending colon on autopsy. Histopathological findings were consistent with gallbladder angiodysplasia in all three cases (100%). On immunohistochemistry CD-34, CD-31, and D2-40 were positive in only one case. Conclusions Despite conflicting data, histological and immunohistochemical analyses play major roles in the diagnosis of gallbladder angiodysplasia. Nonetheless, further clinical studies are required to provide universal guidelines for the treatment and diagnosis of angiodysplasia of the gallbladder.

Background Gene regulation by microRNA (miRNA) is central in T lymphocytes differentiation processes. Here, we investigate miRNA-29b (miR-29b) roles in the reprogramming of T cell differentiation, which can be a promising therapeutic avenue for various types of inflammatory disorders such as rheumatoid arthritis and multiple sclerosis. Methods and results Adipose Mesenchymal Stem Cell-derived exosomes (AMSC-Exo) enriched with miR-29b were delivered into naive CD4⁺ T (nCD4⁺) cells. The expression level of important transcription factors including RAR-related orphan receptor gamma (RORγt), GATA3 binding protein (GATA3), T-box transcription factor 21, and Forkhead box P3 was determined by quantitative Real-Time PCR. Moreover, flow cytometry and Enzyme-linked Immunosorbent Assay were respectively used to measure the frequency of T regulatory cells and the levels of cytokines production (Interleukin 17, Interleukin 4, Interferon-gamma, and transforming growth factor beta. This study indicates that the transfection of miR-29b mimics into T lymphocytes through AMSC-Exo can alter the CD4⁺ T cells’ differentiation into other types of T cells. Conclusions In conclusion, AMSC-Exo-based delivery of miR-29b can be considered as a new fascinating avenue for T cell differentiation inhibition and the future treatment of several inflammatory disorders.

Background Healthcare workers (HCWs) are essential resources, and their health and wellbeing are key not only for offering constant and useful care facilities to clients, but also for maintaining the safety of the workforce and patients. The risk of severe mental health problems among HCWs may have increased during large outbreaks of COVID-19. To evaluate the psychosocial status and risk perception of HCWs who participated in treating COVID-19 patients in Northern Iran, we performed a web-based cross-sectional study. Methods The web-based cross-sectional design was applied between June 27 and September 2, 2021. Using convenience sampling, 637 HCWs were recruited from hospitals in Northern Iran (Mazandaran). The HCWs completed self-report questionnaires that included a sociodemographic information form, the 12-item General Health Questionnaire, Impact of the Event Scale-Revised, Risk Perception Questionnaire, and Anxiety Stress Scale‐21. The data were analyzed via descriptive and inferential statistics and univariate/multivariate logistic regression to assess the risk factors linked to each psychosocial consequence. Results The results reveal that the COVID-19 pandemic had an adverse psychosocial influence on HCWs, which was already apparent 1.5 years after the crisis began. Based on the results, 71.6%, 55.6%, and 32.3% of HCWs reported having anxiety, depression, and stress symptoms, respectively, since the outbreak of this disease. The logistic regression models displayed that marital status, having children, and working hours with patients were all risk factors of psychosocial impairment. Conclusions The outbreak of COVID-19 can be considered an important experience of a bio-disaster resulting in a significant rate of psychiatric problems in HCWs. There is a need for designing and promoting supportive programs to help HCWs cope and to improve their psychosocial state, and the present study has detected for whom psychosocial support may be effective and practical 1.5 years after the primary outbreak. Moreover, detecting and managing concerns and reducing infection-related embarrassment/stigma are essential for improving HCWs’ mental health.

The increase in economic activities and the industrialization of countries have caused the growth of pollution created by waste and sewage. In particular, the textile industry produces large amounts of liquid contaminants due to the large amounts of water employed during the production of fabrics. In addition, dyes are another category of organic compound used in many industries, such as pharmaceuticals and rubber making. The presence of limitations in physico-chemical methods for the degradation of various dyes has stimulated the interest of researchers worldwide. One of the most economical ways is the use of photocatalytic decomposition under UV light radiation by green nanoparticles (NPs). In recent years, various metal NPs have been made using the green method that is cost-effective, eco-friendly, safe, and simple. Selenium (Se) is a crucial semiconductor metal that is widely utilized for its outstanding photovoltaic and optoelectronic attributes. Due to the excellent physical characteristics of Se, such as thermo-conductivity, anisotropy, and high photoconductivity, it has been used for removing various organic dyes. Hence, green SeNPs have attracted much attention in the catalytic decomposition process. The current review focuses on providing comprehensive studies concerning the degradation or reduction of various organic dyes through green SeNPs as an effective and efficient method and their mechanisms. It highlights the importance of utilizing green chemistry and catalytic properties. The aim is to benefit researchers from both academic and industrial backgrounds.

Trichobezoars are hairballs in the gastrointestinal tract that usually develop due to the consumption of hair after pulling it. However, some rare case reports suggest that trichobezoar can also occur in the respiratory system. In this context, we present an unusual case of a 25‐year‐old woman who experienced dyspnea, productive cough, and leukocytosis. The patient was found to have a trichobezoar in her respiratory tract, accompanied by the presence of hair in her digestive tract.

Background: Bed bugs (Cimex lectularius) are blood-sucking insects that bite humans usually at night and cause nui­sance, psychological and social problems. These insects are considered a health hazard in densely populated places such as prisons. The aim of this study was to evaluate the knowledge, attitude and practice of inmates, soldiers, and prison staff regarding bed bugs in Mazandaran prisons. Methods: This is a descriptive-analytical study in which 450 inmates and 210 staff (105 personnel and 105 soldiers) from prisons of Mazandaran Province were included in the study. Data on knowledge, attitude, and practice of the par­ticipants regarding bed bugs were collected using a structured questionnaire. To determine the relative content validity coefficient, the questionnaire was assessed by 10 specialists in terms of difficulty, inappropriateness, and ambiguity of the phrases. The reliability of the questionnaire was measured using Cronbach's Alpha and then the data were analyzed using SPSS software version 20. Results: The maximum mean scores of knowledges, attitude, and practice between the three target groups were 16.42%, 44.07% and 71.21% respectively. Prison staff had the highest knowledge and practice, and inmates showed the highest attitude regarding bed bugs. There was no significant difference between the knowledge and attitude of inmates, prison staff and soldiers (P> 0.05) but there was a significant difference in their practice (P< 0.05). Conclusion: Results of this study confirmed that all three groups of people in the prisons need appropriate education regarding all aspects of bed bug including its control.

Ocrelizumab is a humanized antiCD20, thought to be a highly effective disease-modifying therapy (DMT). Its most frequent adverse effects are infusion-related reactions (IRRs). To reduce these reactions, the first dose of ocrelizumab is administered as two 300 mg infusions separated by two weeks. However, in the phase II trial of ocrelizumab, severe IRRs were not significantly different between two doses of 600 mg dose (two separate 300 mg doses) and 2000 mg dose (two separate 1000 mg doses). We compared the IRRs in undivided full (one 600 mg) and divided (two 300 mg) doses of ocrelizumab which is the standard protocol. MS patients (relapsing or primary progressive MS) who are selected to receive ocrelizumab by neurologist or MS fellowship were enrolled in an open-label randomized controlled trial. Iranian biosimilar of the drug (Xacrel® by Cinnagen, approved by the Iranian Food and Drug Administration in 2021) was used. The participants received the first dose of ocrelizumab as either one 600 mg dose in one session or two 300 mg doses in two weeks apart. IRRs during or in the first 24 h after infusion were recorded. Of 332 participants, 150 received two 300 mg doses, and 182 received one 600 mg dose (by random selection). Life-threatening adverse effects were not observed in both groups. Overnight admission or permanent drug discontinuation was not needed. Temporary drug discontinuation was significantly higher in the one 600 mg dose group (p-value < 0.001). During the infusions, malaise (p-value: 0.003), skin reactions (p-value: 0.04), throat swelling (p-value: 0.03), and dyspnea (p-value: 0.01) were significantly increased in the intervention group. However, in the first 24 h, there was no significant difference between two different treatment protocols (one 600 mg dose or two 300 mg doses) in the onset of IRRS (p-value: 0.12). These findings suggest one 600 mg dose of ocrelizumab administration for the first dose is relatively safe. With some protocol modifications, it could lead to fewer patient referrals, saving time and cost and improvement the access for patients.

Cholesterol plays a significant role in stabilizing lipid or membrane rafts, which are specific cellular membrane structures. Cholesterol is involved in numerous cellular processes, including regulating virus entry into the host cell. Multiple viruses have been shown to rely on cholesterol for virus entry and/or morphogenesis. Research indicates that reprogramming of the host’s lipid metabolism is associated with hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in the progression to severe liver disease for viruses that cause chronic hepatitis. Moreover, knowing the precise mode of viral interaction with target cells sheds light on viral pathogenesis and aids in the development of vaccines and therapeutic targets. As a result, the area of cholesterol-lowering therapy is quickly evolving and has many novel antiviral targets and medications. It has been shown that microRNAs (miRNAs) either directly or indirectly target the viral genome, preventing viral replication. Moreover, miRNAs have recently been shown to be strong post-transcriptional regulators of the genes involved in lipid metabolism, particularly those involved in cholesterol homeostasis. As important regulators of lipid homeostasis in several viral infections, miRNAs have recently come to light. In addition, multiple studies demonstrated that during viral infection, miRNAs modulate several enzymes in the mevalonate/cholesterol pathway. As cholesterol metabolism is essential to the life cycle of viral hepatitis and other viruses, a sophisticated understanding of miRNA regulation may contribute to the development of a novel anti-HCV treatment. The mechanisms underlying the effectiveness of miRNAs as cholesterol regulators against viral hepatitis are explored in this review. Graphical Abstract

BACKGROUND: Work-related musculoskeletal disorders (WRMSDs) and ergonomic risk factors are very common in bakery workers. OBJECTIVE: The purpose of this study is to (1) assess the prevalence of musculoskeletal disorders among bakers because they use automated machines or traditional baking, and (2) to determine the strategies to prevent musculoskeletal disorders in bakers. METHODS: A systematic review of PubMed, Scopus, and Web of Science was conducted from the beginning to February 4, 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mesh keywords and phrases were used to execute the search strategy. Information on MSDs and ergonomic risk factors in bakery workers was collected. Two reviewers worked independently on study selection, data extraction, and paper quality ranking. RESULTS: This study identified 14 papers from seven countries. Although the prevalence of MSDs in bakery workers has been studied, only a handful of them have been studied ergonomic risk factors, and the findings have been very limited. The association between different risk factors and MSDs seemed significant compared to many other occupational diseases. The traditional bread-baking system and lack of mechanization may increase the risk of MSDs in bakery workers. CONCLUSION: WRMSDs for bakery workers have been less studied than other occupational diseases. Our systematic review found several significant relations between the factors influencing the prevalence of MSDs. This study also showed the comparison of traditional and modern cooking systems with diseases of the upper limbs, shoulders, and back pain as possible fields for future research.

Background Patients who experience angina and acute myocardial infarction often receive diagnostic coronary angiography and percutaneous coronary intervention. Case presentation A 54-year-old Persian man with acute coronary syndrome was admitted to the hospital and underwent elective percutaneous coronary intervention. Two hours after the procedure, the patient experienced ophthalmoplegia and diplopia. The diagnosis was abducens nerve palsy resulting in transient lateral rectus palsy. The cause is presumed to have been an ischemic event affecting the unilateral abducens nerve. This could have occurred owing to the microembolism during the percutaneous coronary intervention, which resulted in left lateral rectus palsy. Within 1 month, the diplopia was relieved completely, and the physical examination was normal. Conclusion The occurrence of neuro-ophthalmic complications that may arise from percutaneous coronary intervention is extremely rare. To our knowledge, this is the second reported case of unilateral rectus palsy associated with percutaneous coronary intervention.

Background Enzybiotics are promising alternatives to conventional antibiotics for drug-resistant infections. Exolysins, as a class of enzybiotics, show antibacterial effects against methicillin-resistant Staphylococcus aureus (MRSA). This study evaluated a novel exolysin containing an SH3b domain for its antibacterial activity against MRSA. Methods This study designed a chimeric exolysin by fusing the Cell-binding domain (SH3b) from Lysostaphin with the lytic domain (LYZ2) from the gp61 enzyme. Subsequently, LYZ2-SH3b was cloned and expressed in Escherichia coli (E. coli). Finally, the antibacterial effects of LYZ2-SH3b compared with LYZ2 and vancomycin against reference and clinical isolates of MRSA were measured using the disc diffusion method, the minimal inhibitory concentration (MIC), and the minimal bactericidal concentration (MBC) assays. Results Analysis of bioinformatics showed that LYZ2-SH3b was stable, soluble, and non-allergenic. Protein purification was performed with a 0.8 mg/ml yield for LYZ2-SH3b. The plate lysis assay results indicated that, at the same concentrations, LYZ2-SH3b has a more inhibitory effect than LYZ2. The MICs of LYZ2 were 4 µg/mL (ATCC 43,300) and 8 µg/mL (clinical isolate ST239), whereas, for LYZ2-SH3b, they were 2 µg/mL (ATCC 43,300) and 4 µg/mL (clinical isolate ST239). This suggests a higher efficiency of LYZ2-SH3b compared to LYZ2. Furthermore, the MBCs of LYZ2 were 4 µg/mL (ATCC 43,300) and 8 µg/mL (clinical isolate ST239), whereas, for LYZ2-SH3b, they were 2 µg/mL (ATCC 43,300) and 4 µg/mL (clinical isolate ST239), thus confirming the superior lytic activity of LYZ2-SH3b over LYZ2. Conclusions The study suggests that phage endolysins, such as LYZ2-SH3b, may represent a promising new approach to treating MRSA infections, particularly in cases where antibiotic resistance is a concern. But further studies are needed.