---

Background and purpose: Matrix metalloproteinases (MMPs) are a group of enzymes degredating the extracellular matrix. MMPs have an important role in inflammation, tumor growth, metastasis and angiogenesis. Among the MMPs, MMP1 and MMP2 have special implication in angiogenesis. Isosorbide, as a nitric oxide donor, has been widely used in treatment of many cardiovascular diseases. Besides the inhibitory effect of isosorbide on angiogenesis, tumor growth and metastasis has been revealed in vivo. Regarding the important role of MMPs in tumor growth, metastasis and angiogenesis and also the suppressive effect of isosorbide on angiogenesis, tumor growth and metastasis, In this study, the isosorbide effect on MMP-2 and MMP-9 activity of leukemic and fibrosarcoma cells has been evaluated. Materials and methods: The leukemic THP-1 and fibrosarcoma Wehi-164 cells were cultured in complete RPMI medium. Then the cells in the presence of phorbol myristate acetate (PMA) (25 ng/ml), incubated with different concentrations of isosorbide (0.0004, 0.004, 0.04, and 0.4 mM) for 24 hours. Thereafter, the isosorbide effect on MMP-2 and MMP-9 activity of the cells was evaluated by gelatin zymography assay. Statistical comparisons between the groups were done by analysis of variance (ANOVA). Results: The MMPs activity of PMA-stimulated leukemic THP-1 and fibrosarcoma Wehi-164 cells treated with different concentrations of isosorbide did not show any statistical significant difference with untreated control cells. Conclusion: The results of this study demonstrated that isosorbide had no statistical significant effect on MMPs activity of leukemic THP-1 and fibrosarcoma Wehi-164 cells. These findings proposed that anti- angiogenic effect of isosorbide, which was declared by other investigations, may possibly be owing to non-MMP activity mediated mechanisms.

---

Pantoprazole is a proton-pump inhibitor that is commonly prescribed for the treatment of gastroesophageal reflux-related disorders. Acute interstitial nephritis is an uncommon though important side-effect of these classes of drugs. We reported a case with acute interstitial nephritis due to pantoprazole. A 25-year-old woman from Ardabil was admitted to our hospital with the complaint of fever, abdominal pain, icterus, oliguria, nausea and vomiting. In laboratory investigations, she had leukocytosis, microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The patient was diagnosed with sepsis, acute pancreatitis and hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura, and she was treated with broad-spectrum antibiotics, hemodialysis and plasmapheresis. One week after treatment, symptoms were improved, and serum creatinine was decreased. Due to the dyspepsia, pantoprazole was prescribed. Following the administration of pantoprazole, serum creatinine was increased again. Urinalysis revealed pyuria and white blood cell (WBC) cast, and a subsequent renal biopsy confirmed a diagnosis of acute interstitial nephritis. Physicians should be aware that drug-induced acute interstitial nephritis can be associated with proton-pump inhibitors. Early detection of this rare adverse reaction may prevent acute renal failure.

---

Background and purpose: One of the most common complications of catheter in hemodialysis patients is infections and many methods have been proposed to prevent it. This study compared the effects of heparin lock-antibiotics and heparin to prevent infections in patients undergoing hemodialysis. Materials and methods: This single blind clinical trial included 122 patients who were randomly assigned to receive heparin lock (group A) or heparin-antibiotic lock (group B). The subjects in each group were matched for the presence or absence of risk factors. Occurrence of any of the four symptoms of fever, chills (if no other obvious source of infection was found), redness, purulent discharge was considered catheter-site infection. The medication regimens were cefazolin (5 mg/dl) and heparin 2500 IU/ml. Results: The mean age of patients in Group A and B were 57.12 ± 17.34 and 57.61 ± 19.64 years, respectively (P= 0.088). The patients who developed infections included 22 (36%) patients in group A and 11 (18%) patients in group B (P= 0.02). Conclusion: Heparin-cefazolin lock in group B considerably decreased the incidence of catheter infection. Therefore, it could be used as an effective method to prophylaxis of hemodialysis catheter infection.

---

Background and purpose: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of increased liver enzymes. The world population are suffering from NAFLD (30% in IRAN, 20% - 40% in western countries, and 5% - 30% in Asia-Pacific). The prevalence of NAFLD is higher in hyperlipidemic, diabetic and obese people. This study assessed the preventive effect of sylmarin on the progression of NAFLD/NASH. Materials and methods: This clinical trial was performed in 41 patients with NAFLD referring to gastrointestinal clinics in Sari. The patients were randomly divided into case and control groups. The case group was treated with a tablet containing 140 mg silymarin twice a day for six months and the control group was given placebo for the same period. The data was analyzed using independent t-test, paired t-test and Chi-Square in SPSS. Results: At the end of the treatment period the improvement of steatosis in sonography was more significant in case group (P= 0.03). Liver enzymes reduced significantly in silymarin group compared to other group (P= 0.002 for ALT and P= 0.01 for AST). Conclusion: In this study sylmarin reduced the liver enzymes in the intervention group. Therefore, it could be of great benefit in the treatment of NAFLD.

---

Background and purpose: Hemodialysis is the most common treatment that is used in end-stage renal disease. Since there is not a clear picture of how the adequacy of hemodialysis treatment at this center, this study aimed to determine the adequacy of dialysis in hemodialysis patients at Qaemshar Razi Hospital in 2012. Material and methods: This was a cross-sectional study. The samples were selected from 60 hemodialysis patients of Razi Hospital, Ghaemshahr, three months after their last dialysis. The data were collected through a questionnaire by the researchers. The adequacy of dialysis as measured by Kt/v and URR overall nutrition was calculated by standard PCR. Data analysis was conducted using descriptive and analytical statistical tests in SPSS (Version 18) software. Results: Dialysis adequacy indices mean Kt/v, 1.15 ± 0.31, the mean URR 60.81±10.73, and the average amount of PCR-21.63 ± 9.57 was. According to the criteria Kt/v, 41.7 the percentage of patients were good dialysis adequacy. The Kt/v greater than 1.2, 43.3 the percentage Close to the optimal rate. The fraction ratio of urea 20 percent of patients with URR of 65% (with optimal dialysis adequacy), close to the optimal level of URR of 15% of patients had between 64-55 gain. Conclusion: The standard Kt/v and URR high percentage Patients of the center had inadequate dialysis. It is therefore necessary to investigate and eliminate its causes.

---

Background and purpose: Celiac disease (CD) is a genetic disorder that causes inflammation in the lining of the small intestine. Recent literature has shown a relation between inflammatory bowel disease and celiac disease. This study aimed at determining the prevalence of celiac disease in patients with ulcerative colitis (UC). Material and Methods: In this cross-sectional study 84 patients (aged 17-79 years of old) with UC underwent screening test for CD. Anti TTG Ab and Total IgA Ab were checked for all patients Results: The mean age of the patients was 39.26±13.29 years. In all cases Anti TTG and Total IgA Ab were negative. Conclusion: In this study we found no association between CD and UC. However, more studies with larger sample size are recommended to find the exact relation between these diseases.

---

Background and purpose: Female nurses are exposed to many problems due to their working situation. This will make them vulnerable to stress, burnout, and emotional exhaustion. In this study we structurally analyzed burnout among nurses while considering acceptance, commitment, and emotion regulation. Material and Methods: This descriptive-correlational study was conducted in May 2013 and included 180 nurses working in a hospital located in city of Isfahan. A total of 119 cases was randomly selected using Morgan table. Maslach Burnout Inventory (MBI), Acceptance and Commitment Therapy (ACT), and Cognitive Emotion Regulation Questionnaire (CERQ) were used to collect the data. Data was then analyzed using SPSS and Lisrel program. Results: The results indicated a significant correlation between burnout, emotion regulation, and acceptance and commitment. Structural equation modeling showed direct relationships between burnout and ACT and emotion regulation and ACT. We also found ACT with a mediation effect in the relationship between burnout and emotion regulation. Conclusion: This study showed emotion regulation and ACT as the main indicators for burnout.

---

Background and purpose: Diagnosis of death due to old age or accidents, in which the heart and brain stop working, is not often so difficult. Sometimes, despite signs of death, diagnosis of death is not that easy. Brain death is an example of this type of dubious death which has been the subject of interest among jurists and physicians since the second half of the nineteenth century. This issue is of great importance in many cases such as allowing or not allowing euthanasia of the patient, organ transplant, burial, etc. The aim of this paper was to investigate brain death in Islamic law and comparing the Islamic scholars'(faqihs) opinion with that of the physicians. Material and methods: This review article included many Islamic sources such as holy Qur'an and hadith and some (electronic) references published until 2013. Results: Physicians believe that brain death is the complete and irreversible loss of brain function, and consider that as the end of life. But Faqihs, looking to the patient's future, say that - according to Quran-"Tavffi" is the complete separation of soul from the body. Conclusion: Faqihs and physicians' opinions are not the same on this issue and faqihs believe that brain-dead should not be considered completely dead, so ending their life should not be permitted.

---

Background and purpose: Many researches have pointed a key role for vitamin D in the body’s immune system. Low level of vitamin D is associated with progression to AIDS. In this study, the serum level of vitamin D in HIV infected patients was studied and compared with a control group. Material and methods: In this cross-sectional study the levels of vitamin D were evaluated in 35 HIV infected patients whose disease was diagnosed by ELISA test and confirmed with western blot test. The control group consisted of 35 healthy individuals who were matched for age, sex, nutrition and their exposure to sun light (according their jobs). In both group the serum vitamin D level was measured using ELISA test. The level of vitamin D was evaluated in the HIV infected group according to their age, sex, BMI, and CD4 level. Results: The serum level of vitamin D was significantly lower in HIV infected patients than that of the control group. We observed no association between the serum level of vitamin D and the patients’ sex, age, BMI, CD4 and consumption of antiretroviral drugs. Conclusion: According to the low levels of vitamin D in HIV infected patients, administration of vitamin D supplement sounds reasonable. However, further studies are recommended to evaluate the effect of vitamin D treatment among such patients.

---

Background and purpose: Both hypothermia and Decompressive craniectomy (DC) have been shown to reduce ischemic injury in experimental middle cerebral artery occlusion (MCAO). This study was designed to evaluate the effect of delayed combination of DC and Local Hypothermia (LH) on infarct size, neurological outcome and blood brain barrier (BBB) disruption in a rat model of stroke. Material and Methods: MCAO was induced in 36 Wistar rats assigned to three groups of control, Decompressive Craniectomy (DC) and combination of Hypothermia and Craniectomy (HC). Infarct size and BBB disruption were measured 48 hour after ischemia insult. Neurological deficits were assessed at 24 and 48 hours after stroke using sticky tape test, hanging-wire test and Bederson’s scoring system. BBB disruption was measured by Evans blue dye leakage. Results: Compared to the control group, infarct size reduced significantly in DC and HC groups (P<0.001), however, combination therapy was more neuroprotective compared to craniectomy alone (P<0.01). Compared to the control group, BBB disruption was significantly reduced in DC (P<0.05) and HC (P<0.01).While compared to the control group sticky tape test (P<0.05 at 24 h P<0.001 at 48 h) and hanging-wire test (P<0.05) showed better behavioral performance only in HC, and Bederson test showed improved behavioral functions of HC animals (P<0.01). At the same time neurological deficits also decreased in HC group (P<0.05 at 24 h P<0.01 at 48 h) compared to the DC group. Conclusion: According to this study although both delayed local hypothermia and craniectomy are protective after stoke, combination therapy of them is more neuroprotective than given alone.

---

Background and purpose: Hydrocarbons such as Polycyclic Aromatic Hydrocarbons (PAHs) are considered as priority organic compounds pollutants of the Caspian Sea due to their high toxicity nature. Increasing the concentration of hydrocarbons in the environment has adverse effect on aquatic life and human health. This study was conducted to determine the 16 Polycyclic Aromatic Hydrocarbons (16PAHs) concentrations in the edible tissue of Cyprinus Carpio in the Caspian Sea.. Material and Methods: A total of 28 samples of fish were collected during winter and spring. All samples were prepared by Soxhlet and extracting processes and then determined using High Performance Liquid Chromatography (HPLC) instrument. Results: Results showed that pattern of 16PAH compounds were obtained in 82% of samples (23 samples out of 28) for 3, 4 and 5 rings. The mean concentration and standard error (±SE) of edible tissue of Cyprinus Carpio mussels were observed 2.21 (±0.42) μg/g.dw. Conclusion: We observed Pyrene (75%), Fluorathene (61%), Benzo (a) pyrene (43%) and Chrycene (36%) in edible tissue of Cyprinus Carpio. Hence, consumption of this fish could endanger human health.

---

Background and purpose: Nitrate is probably the most widespread groundwater contaminant in the world, due to its high water solubility. It imposes a serious threat to human health and contributes to eutrophication. The objectives of this study were set to explore how the factors of ultraviolet light and ionic strength could influence the nano zero valent iron (NZVI) system for nitrate removal. Material and methods: In this study, response surface methodology was employed for the design and analysis of experiments .Experiments were carried out as per Box–Behnken) BBD) surface statistical design with four input parameters namely NZVI dose (0.5–2g/L), initial concentration (50–150mg/L), contact time (15–60min), and ionic strength (1000-5000μmho/cm). All experiments were performed in the presence and absence of UV irradiation. Results: The Maximum reduction efficiency for experiments in the presence and absence of UV irradiation was 85.3% and 91.6% in nano zero valent iron dose 2g/L, initial concentration 100mg/L, Contact time 60, and ionic strength 3000μmho/cm. The proposed model was essentially in accordance with the experimental case with correlation coefficient R2 = 0.9992, 0.9946 and Adj-R2 = 0.9982, 0.9884, respectively. Conclusion: Removal efficiency of nitrate increased with increase in time and NZVI dosage. In contrast, it decreased when ionic strength and initial concentration increased. Also, UV irradiation accelerated the removal of nitrate.

---

Background and purpose: Ischemic Heart Disease (IHD) is one of the most important complications of diabetes mellitus (DM). This study was designed to investigate the prevalence of IHD and related factors in patients with type II DM in north of Iran. Materials and methods: A cross sectional study was conducted in 1021 patients with diabetes type II attending endocrine clinics affiliated with Mazandaran University of Medical Sciences, Iran, 2010 to 2012. Age, gender, history of myocardial infarction, hypertension, hyperlipidemia, smoking and other recognized complications of DM were recorded. All patients were referred to cardiologist and the exercise test was used and if needed the thallium perfusion scan and coronary angiography were done for patients without history of myocardial infarction,coronary artery bypass surgery or stent placement. Results: There were 1021 patients and 907 were female (88.8%). Mean age and duration of diabetes were 54.4 (95% CI: 53.8- 55.1) and 8.8 (95% CI: 8.4 - 9.2) years, respectively. Almost 87% (95% CI: 85-89) and 53% (95% CI: 50-56) had dyslipidemia and hypertension, respectively. Among the patients, 274 patients (37% males and 25% females, 26.8% 95% CI: 24.1-29.5) were suffering from IHD (P =0.006). According to regression logistic analysis duration of diabetes, older age, hypertension, and low left ventricular ejection fraction were independent predictor factors for IHD. Conclusion: Approximately one-third of diabetic patients are suffering from IHD. This disorder can be asymptomatic in individuals with diabetes, therefore, it may not be diagnosed in almost half of patients. Most important associated factors are older age, duration of diabetes, hypertension and low left ventricular ejection fraction.

---

Background and purpose: Gestational diabetes mellitus is one of the main complications in pregnancy.  Periodontitis associated with increase in inflammatory factors is a risk factor in pregnancy. In this study we investigated the relation between periodontitis and related inflammatory mediators and gestational diabetes mellitus.

Materials and methods: A total of 100 singleton pregnant women with gestational diabetes and 100 singleton pregnant women with normal glucose level (gestational age >20 weeks) were included. The patients underwent dental examinations and those with periodontitis and gingivitis were identified. Blood samples were taken and ESR and hsCRP were measured in all patients. Data was analyzed in SPSS applying independent t-test and qui square.

Results: The prevalence of periodontitis in patients and controls were 36% and 28%, respectively (P= 0.22). All periodontitis were moderate and no severe periodontitis was observed. Gingivitis was seen in both pregnant women with diabetes (74%) and control patients (83%) (P= 0.12). Among the subjects 18% of patients and 22% of the control group had severe gingivitis while others had moderate to mild gingivitis (P= 0.45). Dental plaques were seen in 73% of pregnant women with diabetes and 91% of the control group (P= 0.01). No significant relationship was seen in inflammatory mediators between the individuals with/without periodontitis and gingivitis.

Conclusion: In this study, no relationship was found between gestational diabetes, gingivitis, severity of gingivitis, periodontitis, and inflammatory markers. According to the lower levels of dental plaque in pregnant women with gestational diabetes other reasons rather than poor oral hygiene are believed to be involved. Due to higher false positive estimation of probing depth caused by gingival hypertrophy in pregnancy, more precise criteria are needed to investigate periodontitis in pregnant women.

---

Background and purpose: Gastric cancer is the fourth most common cancer and the second leading cause of cancer death worldwide. North of Iran is a high risk area for gastric cancer. Bcl2 family is the most important regulator of apoptosis and -938C>A single nucleotide polymorphism of bcl2 gene promoter has been demonstrated to influence gastric cancer susceptibility. In this research we studied the effect of -938C>A genotype on gastric cancer.

Materials and methods: This analysis was performed in 87 patients with gastric cancer who underwent surgery in Mazandaran and Golestan province along with 104 healthy individuals as controls. DNA extracted from peripheral blood samples was applied in PCR-SSCP (Polymerase chain reaction-single strand conformation polymorphism) analysis to determine -938C>A genotype. The association of the -938C>A genotype and gastric cancer risk as well as demographic and clinicopathological characteristics were analyzed by logistic regression method.

Results: Frequency of AA, CC and AC genotypes in cases were 13.79, 16.09 and 70.12% and 15.38, 23.08, and 61.54% in control group, respectively. Statistical analysis indicated that the AC genotype was significantly (P=0.0009) associated with a decreased risk for gastric cancer by 0.2 fold (OR=0.276) compared with the combined genotype of AA+CC. No significant association was found between -938C>A genotype with demographic and clinicopathological characteristics. 

Conclusion: The study showed that the presence of AC genotype may decrease the risk of gastric cancer. So, investigating the -938 C>A single nucleotide polymorphism of bcl2 gene promoter could be an appropriate molecular marker that could be used to determine individual sensitivity to gastric cancer and also for designing cancer prevention programs.

---

Background and purpose: Diabetes mellitus is one of the most common metabolic diseases and neuropathy is one of the main complications of diabetes. Modification of eating habit is the most effective and most economical way in prevention of diabetic complications. This research aimed at studying the relationship between food habits and diabetic neuropathy.

Materials and methods: This cross-sectional study was performed in 176 patients with diabetic neuropathy attending Sari Imam Khomeini Hospital, 2016. They were selected via convenience sampling. Data was collected using food habits questionnaire, neuropathy complication checklist, and demographic questionnaire. Data was then analyzed using Chi-square, K-S, Mann–Whitney, Spearman correlation and Linear Regression in SPSS V18.

Results: The results showed that 78 (44.3%) and 98 (55.7%) patients had undesirable and somewhat favorable food habits, respectively. About sensory neuropathy complications, the highest and lowest prevalence was associated with limbs tingling (93.3%) and soft tissue atrophy in foots (7.4%). While digestive disorders (57.4%) and syncope (8%) were the most and least common autonomic complications, respectively. A negative significant correlation was found between food habits and prevalence of diabetic neuropathy complications (P=0.03, r= -0.21).

Conclusion: According to the results, modification of food habits is necessary. The prevalence of some complications (autonomic and sensory) was found to be high in current study. So, any intervention to prevent diabetic complications and their progress should focus on modification of food habits and lifestyle, and lowering blood glucose level.

---

Background and purpose: Diabetes is a chronic disease which requires lifelong use of drugs. These drugs have high costs, therefore, there is a need to find economic, efficient, simple, and local solutions. This study aimed to investigate the effect of oral supplementation of cinnamon on glucose and glycosylated hemoglobin (HbA1c) levels in patients with type II diabetes.
Materials and methods: This clinical trial was conducted in 136 patients with type II diabetes in Birjand, Iran 2015. They were randomly assigned into intervention or placebo groups (n=68 per group). Subjects in the intervention group received 500 mg of cinnamon three times a day after breakfast, lunch, and dinner for 90 days (1500 mg daily). While the other group were advised to take the placebo in the same manner. Fasting blood sugar and HbA1c levels were measured before and after the study.
Results: In this study, the levels of HbA1c reduced significantly in intervention group after the treatment (P≤0.05). Daily intake of 1500 mg of cinnamon for 90 days was found to be effective in reducing glycosylated hemoglobin levels, but it did not have a significant effect on reducing fasting blood sugar in 90 days (P≥0.05).
Conclusion: Daily dose of 1500 mg of cinnamon for 90 days significantly reduced the HbA1C levels in type II diabetic patients and also had a moderate effect on fasting blood sugar concentrations. Therefore, it is recommended alongside conventional medication used in treatment of type II diabetes mellitus.
(Clinical Trials Registry Number: IRCT2016100230098N1)
 
 

---

---

Lead may cause toxicity in case of frequent occupational exposure or non-occupational exposure as a result of water, soil, and air pollution. Opium abuse is an important cause of lead poisoning among the people in Middle East, including Iran. Symptoms are not specific and include fatigue, impaired concentration and memory, and non-specific abdominal pain. The abdominal pain which is known as lead colic is in differential diagnosis with other common and emergent causes of abdominal pain. The key to making an accurate diagnosis in these cases, is to focus on a precise history to investigate any probable exposure. Measurement of the serum lead level will help in making definite diagnosis in suspected cases.
The present article introduces a young man attending an emergency department with abdominal pain. He ignored any occupational lead exposure or opium abuse. When all clinical and para-clinical investigations failed to detect the cause of pain, serum lead level was tested which revealed lead poisoning. After taking more precise history, he finally disclosed using oral opium. He underwent treatment with Dimercaprol 10 mg 3 times per day for 5 days, then twice a day and all symptoms resolved within two weeks.
 

---

 Background and purpose: Despite wide fight against malaria in endemic regions, it is still one of the most serious infectious diseases in some parts of the world. Primakin is effective in treatment and prevention of malaria. However, individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency are at risk for hemolysis and its complications when taking primakin. This study was performed to determine the prevalence of G6PD deficiency in patients suspected of favism in Qaleh Ganj, Kerman, Iran.
Materials and methods: This study was conducted in 2020 and blood samples were taken from all patients suspicious of favism attending Shohada Hospital in Qaleh Ganj, southern Iran. The G6PD enzyme activity was evaluated by fluorescent spot test using a commercial kit. Data were analyzed using SPSS V23.
Results: In this study, 235 patients (88 males and 147 females) were examined. Fifty eight people (24.7%) had abnormal levels (deficiency) of G6PD enzyme, 38 (65.6%) of whom had severe deficiency and 20 (34.4%) had partial deficiency. No significant relationship was found between sex and G6PD level (P= 0.96).
Conclusion: The study showed a high prevalence of G6PD deficiency in this region. So, attention should be paid to this issue when prescribing oxidative drugs, especially antimalarial drugs.