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Background and purpose: In Iranian folk medicine, the leaves and rhizomes of the plant Sambucus ebulus have been used topically for curing painful joint diseases. This study was undertaken to evaluate the anti-inflammatory and antinociceptive efficacy of different parts of Sambucus ebulus in mice and rats.
Materials and Methods: Different parts of Sambucus ebulus were collected from Sari. Fruits, leaves and roots were fractionated by successive solvent extraction with hexane, ethyl acetate and finally methanol. Anti-nociceptive and anti-inflammatory activities of extracts were determined using hot plate, writhing and carrageenan-induced inflammation tests in mice and rats respectively.
Results: Nearly all extracts showed a dose dependent and marked analgesic and anti-inflammatory activities when compared to the control. Only hexane extract of leaves did not show any anti-inflammatory activity up to 600 mg/kg i.p. Hexane extract possessed significantly higher activity than methanol extract. Ethyl acetate extract were withdrawn because of severe nociceptive response in mice. No extracts exhibited any toxicity up to 2 g/ kg body weight intraperitoneally in mice for one week.
Conclusion: The results of the present study support the folkloric utilization of this herb. Hexane extract of fruits showed highest analgesic and anti-inflammatory activities. Phytochemical analysis, the elucidation of exact mechanism of action and active components responsible for the hypernociceptive effect of ethyl acetate extract requires further investigations.

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Background and purpose: Candidal denture stomatitis is a common complication. The side effects and resistance to Candida against to nystatin have led researchers to look for other antifungal compounds. According to their recommendation, using grape vinegar and rose water can be a traditional mouthwash. The aim of the present study was to investigate the effect of this mouthwash on Candida in clinic and laboratory. Material and Methods: The clinical and laboratory investigation of 30 patients with grade 2 and 3 candidal denture stomatitis were randomly divided into two groups and treated with nystatin or traditional mouthwash. Clinically, the Candida colony counts in saliva samples before and after treatment were analyzed. Minimum inhibitory concentration and fungicidal concentration were obtained on Candida isolates. Results: Clinical symptoms improved in all patients with traditional mouthwash, while this rate was 69.23% for nystatin. All patients were satisfied in traditional mouthwash treatment, while3 9% of nystatin group were satisfied. Experimental results showed that both groups, the number of colonies of Candidaalbicans reduced in saliva. Most species of isolates was Candida albicans (81.81%). The MIC and MFC traditional mouthwash were 3.125 and 12.5 respectively Conclusion: Due to the efficacy and not having side effects in traditional mouthwash, and the patients’ complaints of the side effects of nystatin, traditional mouthwash grape vinegar and rose water can be administered as a pharmaceutical composition for the treatment of denture stomatitis candidiasis (Clinical Trials Registry Number: IRCT2013042713136N1)

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Background and purpose: Acetaminophen is one of the most popular analgesic and antipyretic drugs and its overdose can cause severe damage to liver and kidneys in human and animals. Renal dysfunction and acute renal injury can occur without damage in the liver. Unlike kidney damage, mechanisms of liver damage are poorly understood. The aim of present study was to investigate the protective effect of curcumin, derived from Curcuma longa, on acetaminophen-induced kidney damage. Materials and methods: This study was performed in rats that were divided into five groups. Group I as control, group II was i.p. injected with curcumin (200 mg/kg b.w). Group III received DMSO as vehicle control. Group IV was treated with a single dose of acetaminophen (1000 mg/kg b.w, i.p.), and group V that received acetaminophen+Curcumin. After 24 hours, all rats were sacrificed with mild anesthesia. Urea and creatinine levels were measured in the plasma, and the levels of lipid peroxidation (TBARS) and superoxide dismutase (SOD) and catalase (CAT) activity in the kidney and total antioxidant capacity of plasma (TAC) were determined. Data analysis was done using SPSS and the differences between the groups were analyzed applying t-test and Mann Whitney tests at the significance level of 0.05. Results: Administration of acetaminophen caused elevated level of urea and creatinine in plasma and TBARS in kidney. While the activities of SOD and CAT decreased in kidney tissue. Curcumin with acetaminophen decreased the urea, creatinine and TBARS levels significantly but it significantly increased the activity of SOD, CAT, TAC. Conclusion: Our results showed curcumin as the potent protective agent against acetaminophen induced biochemical alterations and oxidative damage in rats. However, further studies are necessary to identify the curcumin’s mechanism of biochemical reaction before clinical application.

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Background and purpose: Vitiligo is a common acquired pigmentation disorder. There are various therapeutic options for the treatment of vitiligo which bare some limitations due to their side effects. Recently topical immunomodulators (TIMS) such as topical Pimecrolimus have been used for the treatment of vitiligo in children as safe and efficient therapeutic options. This study compared the efficacy of the combination therapy of Pimecrolimus 1% cream and Mometasone cream with either agent alone in the treatment of childhood vitiligo. Materials and methods: In a nonrandomized double blind interventional study, 50 patients were enrolled. In each patient three lesions was selected. Topical Pimecrolimus cream 1% was applied to the first lesion twice daily, topical Mometasone furoat 0.1% ointment was applied for the second lesion every night, and Pimecrolimus cream 1% and topical Mometasone ointment 0.1% were applied to the third lesion twice/daily for the first five days. Topical Mometasone furoat 0.1% ointment was used at nights for the rest of the days of the week. All three treatments were administered simultaneously over three months. The data was analyzed using SPSS V.20. Results: Forty patients completed the study period whose mean age was 10.6 years and 46% were male. Significant decreasing trend was seen in the lesions size over time (P< 0.0001). However, this decreasing trend was not statistically significant among the three treatment groups at the end of the study (P= 0.5). Conclusion: In this study combination therapy had no any advantage to either Pimecrolimus or Mometasone. However, due to the limited number of patients in this study, further studies with large sample sizes are needed to evaluate the efficacy of this type of combination therapy and other combination therapies. (Clinical Trials Registry Number: ACTRN12611001165976)

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Background and purpose: Diazinon is a widely used organophosphorus pesticide around the world especially in rice paddy fields. Some studies showed that such toxic chemicals can influence the health conditions of fish at various levels including fish immune system and increase the fish susceptibility to infectious diseases. Materials and methods: In this study, histopathological effects of different sublethal concentrations of diazinon at 1, 2 and 4 mg/L were investigated on gills, liver, spleen, kidney and nostril of grass carp (Ctenopharyngodon idella). One hundred and twenty grass carps weighing 850±155 g were studied at 1, 7, 15, 30 and 45 days post-exposure to the toxicant for 12 hours at 18- 22ºC. Results: Light microscopic examinations of tissues showed that toxicant concentrations caused severe damages to the cells and tissues structure such as congestion of blood vessels, haemorrhage, cellular infiltration, pyknosis of cells nuclei, vacuolar degeneration and general necrosis in the tissues of kidney, spleen and liver. Conclusion: There were degenerative changes of interstitial tissue and detachment of tubular basement membrane in kidney. We also observed hyperplasia and fusion of secondary lamellae, separation and sloughing of epithelium from the underlying basement membrane in gill sections and denudation of epithelial surface in nostril.

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Background and purpose: Glutathione is one of the main antioxidants in animals which can protect against hazardous oxidative substances. Diospyros lotus consisted of antioxidants such as flavonoids and naphthoguinones which can influence the glutathione levels. On the other hand, Senecio vulgaris is expected to change the glutathione level, because of possessing toxic and oxidative compounds called pyrrolizidine alkaloid. The purpose of this study was to determine the effect of Senecio vulgaris extract on the glutathione level and the protective effect of Diospyros lotus plant. Materials and methods: At the beginning, the plants Senecio vulgaris and Diospyros lotus were extracted. Then, the selected six groups of mice (n=5) were administered by the extracts and the liver glutathione levels were measured separately and coincidently through spectrophotometry method. Results: This study showed that the extract of Diospyros lotus plant significantly increased the level of glutathione (P<0.001) compared with that of the control group but senecio vulgaris decreased the amount of glutathione (P<0.001). But, Senecio vulgaris decreased the glutathione level (p<0.001). According to the increased level of glutathione (P<0.05) compared to the groups exposed to Senecio vulgaris, the plant Diospyros lotus extracts showed more protective effects. Conclusion: The results revealed the protective effect of Diospyros lotus plant extracts. It is believed that the protective mechanism against toxic compounds is contributed to the existence of antioxidative substances including flavonoids and naphthoguinones in Diospyros lotus, that protect the liver against toxic pyrrolizidine alkaloid compound found in Senecio vulgaris.

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Backgound and purpose: Recent rise in elderly population points to the need for social support, and focusing on these people’s relationships and quality of life. Social support acts as a mechanism to tackle isolation and loneliness, and high level of quality of life results in more joy, satisfaction, healthy life, economic prosperity, educational opportunities and creativity. This study aimed at assessing the quality of life of the elderly attending rehabilitation centers considering demographic variables such as the elderly’s marital status, sex, educational background and the type of rehabilitation center being admitted to. Material & methods: This descriptive study was performed in 281 individuals referring to rehabilitation centers in Mazandaran province. A researcher made questionnaire was used to assess the status of social support and to investigate the elderly’s quality of life the standardized questionnaire (36-SF) was used. Results: The results indicate a significant difference between the mean scores of social support and its components and the mean score of the test. The overall qualities of life for elderly were higher than average. We also observed a significant correlation between social support and the elderly’s marital status, educational background, and the type of rehabilitation center. Conclusion: According to the services offered by studied rehabilitation centers the quality of life of elderly was in satisfactory condition. There was no significant difference between quality of life, marital status, and educational background. However, we found a significant relationship between the type of rehabilitation center and quality of life of elderly.

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The relationship between nanotechnology and immunology can be evaluated from different aspects. The application of nanotechnology and immunology is widespread and has important features in medical biotechnology. Delivery of active immunological compounds to the target sites using nano-carriers is one of the issues related to nanotechnology and immunology. Moreover, successful application of nanotechnology in the field of immunology resulted in development of new generations of vaccines, adjuvants and immunomodulatory drugs that aim to improve response to infectious and non-infectious diseases. Nanotechnology plays a key role in the formation of new vaccines and immunosuppressive agents. On the other hand, the manipulation and control of objects at the nano scale level can promote our conception of immune responses. In current review we discuss the effect of size, charge, shape, hydrophobic and porosity properties of a compound on the immune response and investigate the role of nanotech‌nology in engineering of each of these features. It is expected that in future the collaboration between nanotech‌nology and immunology could lead to new strategies in prevention and treatment of human diseases.

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Background and purpose: Infant mortality rate (IMR) is one of the most important indices and a human development index (HDI). This study was designed to estimate the IMR, under-five mortality rate (U5MR), life expectancy (LE) at birth in Iran and 31 provinces and to compare the results in five-year intervals using 2006 and 2011 census data. Materials and methods: In a cross-sectional study we used Cole-Demeny West (CD West) model using indirect method to estimate the childhood mortality rates, life expectancy at birth, number of children ever born (CEB) and children surviving (CS) rat. The analyses were performed in QFive program of MORTPAK 4.3 software. Results: IMR, U5MR, mortality rate in children aged 1- 4 and LE at birth for 2006 census were estimated to be 47.3, 14.5, 61.2 per 1000 live births and 64.4 years, respectively. Whereas, for 2011 census, they were calculated 21.9, 4.1, 25.9 per 1000 live births and 72.1 years, respectively. The maximum IMR and U5MR for 2011 were calculated in Sistan and Baloochestan (31.8, 38.8), Southern Khorasan (30.9, 37.7) and Semnan (29.9, 36.3) per 1000 live births. The minimum IMR and U5MR for 2011 were observed in Qom (13.5, 15.6), Mazandaran (13.8, 16) and Tehran (15.8, 18.4) per 1000 live births. Conclusion: The results indicate childhood mortality rates have declined dramatically during the five-year interval. In addition, ranking the provinces in terms of childhood mortality rates and LE can be used in detecting provinces poor in reproductive and child health and finally pave the way for adapting long- term health strategies.

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HLA-G is a nonclassical HLA class Ib, which is located on chromosome 6 (6p.21.3). In contrast to HLA class I molecules, HLA-G has restricted polymorphism. Expression of this molecule in the physiological conditions limits to certain tissues such as thymus, cornea, nail matrix, trophoblast and pancreas. Up to now, 50 alleles of HLA-G molecules have been discovered with 16 distinct functional proteins. Alternative splicing of RNA primary transcript results in seven isoforms including four membrane bound (G1-G4) and three soluble (G5-G7) isoforms. Today, many roles have been described for HLA-G molecule in various physiological and pathological conditions such as pregnancy, transplantation, autoimmune and infectious diseases. Induction of HLA-G expression is one of the immune system evasion mechanisms in some infectious and tumoral conditions. The importance of HLA-G expression during pregnancy and establishment of fetal-maternal tolerance has been proved. In this review paper we discussed the genetics, biology and the role of HLA-G molecule in some physiological and pathological conditions.

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Multiple Sclerosis (MS) is a complex autoimmune demyelinating disease of the central nervous system. Although the main cause of MS is still unknown, several risk factors may contribute in MS development. In the search for the etiology of MS, infectious agents, genetic factors, and/or their combination were believed to participate in MS occurrence. The association between MS and infectious diseases was proposed by Pierre Marie in 1884. It was later accepted following epidemiological studies, analysis on twins, immigrants and animal model. This study aimed at investigating the possible relationship between infectious agents and MS. Our findings showed that viral agents such as EBV, borna virus, measles, mumps, and fungi are possible agents in MS development, while parasites may induce immunomodulatory effects. Identifying the relationship between MS and infectious agents and determining a special pathogenic agent for MS could lead to novel treatment strategies. Furthermore, it may result in developing preventive programs. Therefore, further studies are needed to understand and identify the infectious agents that might affect the pathogenesis of MS and their mechanism of actions.

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Background and purpose: Crohn disease (CD) is an autoimmune disorder in which a failure of tolerance to the intestinal antigens plays a pivotal role in the pathogenesis of this disease. Treg cells control immune responses to self and foreign antigens and have an important role in maintaining self-tolerance. In this study we evaluated the frequency of Tregs in the peripheral blood of patients with Crohn disease compared with healthy control group.

Materials and methods: In a case-control study, 18 patients with Crohn disease and 20 healthy volunteers were enrolled. Blood sampling was done in both patients and controls and peripheral blood mononuclear cells were isolated. Then, the frrequency of CD4⁺CD25⁺FoxP3⁺CD127^low/– Tregs and CD4⁺CD25⁺FoxP3^– activated effector T cells were evaluated by flow cytometry. Data analysis was performed in GraphPad Prism and SPSS.

Results: The results showed that the frequency of Treg cells in the peripheral blood of CD patients was significantly lower compared to that of the healthy controls. In addition, a significant decrease in Treg/activated effector T cells ratio was observed in CD patients compared to controls.

Conclusion: The results showed that Crohn disease is associated with a decrease in the peripheral blood Tregs pool. Moreover, it seems that the balance between Tregs and effector T cells is disturbed in CD patients.

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Background and purpose: Multiple sclerosis (MS) is one the most prevalent diseases associated with neurological and non-traumatic disability in adults. This autoimmune disease affects the central nervous system (CNS) and manifests different signs and symptoms. The prevalence of disease and age of onset varies considerably across the world. This study aimed at investigating demographic, clinical characteristics, and different risk factors in patients with MS.

Materials and methods: The study was performed on 152 MS patients from May 2013-July 2014. McDonald diagnostic criteria were used for disease diagnosis. Data was recorded and analyzed in SPSS V.17.

Results: The mean age of patients was 31.6 ± 7.3 and females were three times more likely to be afflicted with MS. Most of the female patients were married. The majority of patients had benign disease (86.4%), and positive family history of MS was found in 21.2%. Plaque lesions in MRI were seen in 94% of the patients. Sensory loss, visual impairment and depression were observed in 45.7%, 43.8%, and 9.2%, respectively. Visual impairment was the first sign of the disease that was observed in most of the patients (41.3%). Fatigue and sexual dysfunction were significantly different between relapse-remitting, primary progressive, and secondary progressive form of MS (P= 0.05 and P= 0.02, respectively). Fatigue was associated with disease progression but other symptoms were not significantly different between three forms of the disease.

Conclusion: Demographic and clinical characteristics of MS in Mazandaran province were similar to those reported from other countries. MS registry is recommended to record all MS cases in order to increase knowledge on demographic and clinical characteristics, treatment options, and patient’s response to medications. Furthermore, high familial prevalence of multiple sclerosis in Mazandaran province compared with other regions in Iran calls for further genetic analyses.

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Background and purpose: Seroma formation is the most common complication after breast cancer surgery that cause prolonged therapy duration, increases the costs and infection rates. This study aimed at investigating the efficacy of local phenytoin application on reduction of serous fluid and drainage duration and seroma formation following modified radical mastectomy (MRM).

Materials and methods: A randomized clinical trial was performed in 31 patients who had MRM and axillary lymph node dissection (ALND). They were divided into two groups. A placebo group received normal saline (15ml) under the skin flap whereas 1% phenytoin was locally used in treatment group one day after the surgery. In further examinations, the patients were evaluated for seroma formation, surgery site infection and other complications such as hematoma or necrosis. 

Results: The mean duration of drain use in experimental group and placebo group were 3.94 and 5.92 days, respectively (P=0.01). The mean levels of serous fluid drainage were 128.3 and 210.7 ml in the group receiving phenytoin and placebo group, respectively (P=0.01). In a two-week follow-up, seroma formation were observed in both groups (treatment group: n=3 (16.7%) and placebos n=9 (69.2%)) (P=0.004). 

Conclusion: Application of local phenytoin 1% following MRM could be effective in preventing seroma formation, reducing the amount of serous drainage and shortening the drainage duration.

(Clinical Trials Registry Number: IRCT20161111786N6)

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Background and purpose: Carpal tunnel syndrome is one of the most common causes of orthopedic referrals. Today, many surgeons tend to perform minimally incision surgery (MIS). This study was conducted to compare the results of open surgery and MIS by Smillie knife.

Materials and methods: In this prospective study, 72 patients (98 surgeries) with carpal tunnel syndrome were randomly divided into two groups of open surgery (n= 46) and MIS by Smillie knife
(n= 52). Clinical improvements were investigated in both groups according to the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). Electrodiagnostic improvement, duration of surgery, length of incision, and complications were compared between the two groups using paired-sample t-test, independent t-test, and Chi-square test.

Results: Paresthesia resolved immediately after surgery, except in two cases in open surgery group and one case in MIS group. After the surgeries, no difference was seen in electrodiagnostic parameters between the two groups. The number of individuals with pain was significantly lower in MIS group in week two and six after the surgery (P=0.035 and P=0.011 respectively). The Boston score showed no significant difference between the two groups after three months but after six months the score was significantly different in MIS group (P=0.515 and P=0.029 respectively). One patient in open surgery group suffered wound dehiscence after removal of sutures.

Conclusion: MIS is associated with quicker clinical improvements and because patients receive no anesthesia, it is superior to classic surgery.

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Background and purpose: Tumors are one of the most important threats to human life and improving the drugs used in their treatment is always necessary.  Isatin is found in many plants and also synthesized through different methods.  Many studies have been done on Isatin ring, including the construction of Dibromoisatin derivatives that exhibit anti-cancer effects. The aim of this study was to determine the cytotoxic effects of Dibromoisatin derivatives on cervical and liver cancer cells.
Materials and methods: In this study, 10 Dibromoisatin derivative made at concentrations of 1, 50, 100, 200, and 400 µg/mL were tested against cervical (HeLa) and liver cancer cell lines (HepG2). The cell viability was assessed by MTT assay and the IC50 value was calculated in PRISM software.
Results: Comparing the cytotoxic effects of Dibromoisatin derivatives showed that the highest cytotoxic effects in both cell lines was detected in composition No. 9 with IC50 value of HepG2= 1.194 and IC50 value of HeLa= 0.025.
Conclusion: These derivatives were more effective against liver cancer cells and some Dibromoisatin derivatives were found to have high toxicity against cancer cells, therefore, they could be of great benefit in improving the drugs used in chemotherapy.
 
 

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Background and purpose: Urban family physician was implemented as a pilot project in Fars and Mazandaran provinces in Iran since 2012. This study aimed at SWOT analysis of urban family physician from the perspective of beneficiaries.
Materials and methods: This qualitative research was conducted through in-depth and semi-structured interviews in 2016. Nine people including faculty members, family physicians, senior managers and health professionals who were fully informed about the family physician project. They were selected via purposive sampling. Verbatim transcription of interview data was done and analyzed using framework method.
Results: The main strengths included health services provision, easy accessibility to health services, classification of services, and decrease in unnecessary costs. The weak points according to SWOT analysis included management and planning, human resources, physical resources, referral system, electronic health records, payment mechanism, health services purchasing organizations, intersectoral coordination, and assessment and control systems. Authorities’ support, legal backing, educated human resources, and capacity of private section along public section were identified as the opportunities of the project. Furthermore, failure in public-private sector cooperation, health market and, society needs were considered as the threats.
Conclusion: This study showed the strengths and weaknesses of family physician plan, and the opportunities and threats it is faced with. Hence, it is necessary to find solutions and perform necessary interventions in order to eliminate the weaknesses and threats and maintain and improve the strengths and opportunities before its implementation throughout the country.
 
 

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 Background and purpose: Pyrrolizidine alkaloids (PAs) are a group of chemical compounds that are seen as secondary metabolites in different plant families. These compounds can cause liver, kidney, and lung damages and their presence in various herbal products increases the risk of injury. This study aimed at performing qualitative and quantitative evaluation of pyrrolizidine alkaloids in medicinal plants in herb shops in Sari, north of Iran.
Materials and methods: Hundred twenty-six herbal samples were collected from herb shops in Sari, Iran 2018. Ehrlich reagent was used for qualitative evaluation. Then, gas chromatography was used to identify and quantify the alkaloids.
Results: Experiments revealed that Echium amoenum contained supinine (6.61%), europine (12.83%), and no heliotrine. Malva sylvestris had 31.68% and 3.54% heliotrine and europine, respectively and no supinine. Helicteres isora, Melissa officinalis, Triticum sp. and Rosmarinus officinalis contained 11.81, 22.16, 10.17, and 5.33% supinine and 41.51, 19.31, 55.48, and 35.44% heliotrine, respectively. None of these plants showed europine. Urtica dioica was the only plant that contained all three compounds (14.87% supinine, 30.17% heliotrine, and 5.37% europine).
Conclusion: A small number of samples contained pyrrolizidine alkaloids. Therefore, there is no threat in using them. Further studies are required to investigate more herbal products.

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Kartagener's syndrome is a rare autosomal recessive genetic disorder characterized by a clinical triad: chronic sinusitis, bronchiectasis, and situs inversus. This triad includes persistent inflammation of the sinuses, abnormal dilation of the bronchi, and a mirror-image arrangement of internal organs. The syndrome is commonly associated with mutations in genes critical for ciliary function, particularly DNAH5, which encodes a protein essential for normal ciliary motility. This case report describes a novel pathogenic variant in the DNAH5 gene identified in a 2-year-old Iranian female diagnosed with Kartagener's syndrome. She presented with recurrent episodes of pneumonia beginning in the neonatal period, with symptoms first appearing at 12 days of age. Notably, she was born to consanguineous parents, although no family history of recurrent pneumonia or infertility was reported. The diagnosis was supported by the presence of dextrocardia, consistent with her situs inversus. Among the approximately 49 genes implicated in primary ciliary dyskinesia (PCD) and Kartagener's syndrome, mutations in DNAH5 are a known cause of chronic respiratory infections and organ laterality defects. In accordance with the American College of Medical Genetics and Genomics (ACMG) guidelines, the variant DNAH5 (NM_001369.3): c.1190_1193del (p.Phe397Ter) was classified as likely pathogenic based on criteria PS1 and PM2. Its very low allele frequency in genomic databases, including Iranome, along with its consistency with ACMG criteria and the patient’s clinical manifestations, supports the classification of this variant as pathogenic.