Journal of Arak University of Medical Sciences

Evaluation of the Efficacy of Memantine in Combination with Ritalin on the Severity of Hyperactivity and Attention Deficit Symptoms in Children

Fahimeh Omidi

Background and Aim: Attention Deficit Hyperactivity Disorder is a common psychiatric disorder in children and paying attention to drugs that were used in this disorders are important. This study compares the efficacy of Ritalin with Memantin that is added to Ritalin on the severity of ADHD and attention deficit disorder in children.
Materials and Methods: This study is a clinical trial. All of 76 patients with diagnostic criteria for ADHD had been selected from the group of children that they were 7-12 years old, through diagnostic interviews in control & experimental groups based on DSM-V. At first, both groups filled out the Connors parent questionnaire for assessing the severity of the symptoms. Then, Ritalin was prescribed for the patients in the control group and Memantin was added to Ritalin for the patients in the experimental group for one month. The two groups again completed the questionnaire and the effectiveness of drugs was compared.
Ethical Considerations: This study with research ethics code 139510 has been approved by research ethics committee at Arak university of medical sceinces and also has been registered with code IRCT2016080829268N1 at Iranian Registry of Clinical Trials (IRCT).
Findings: According to the P-value of this test, there was no significant difference between the two groups after taking the drugs, which is equal to 0.324 and more than 0.05. But in that groups, there was a significant difference in severity of the symptoms between groups before and after taking the drugs.
Conclusion: Although the symptoms severity of hyperactivity decreased, there was no significant difference between these two groups. The Memantin added to Ritalin did not have a special effect on reducing the severity of symptoms compared to Ritalin. We can conclude the Ritalin might have had a significant effect on the symptoms reduction.

The Evaluation of Five Plant Extracts Inhibitory Potential against Bacterial Quorum Sensing of Staphylococcus Aureus

Elham Pishgar

Background and Aim: A variety of bacteria like Staphylococcus aureus utilize quorum sensing to perform their important activities such as biofilm formation and production of virulence factors. Interfering with the bacterial QS will disable the bacteria to perform above-mentioned vital activities. The principal aim of the study was to evaluate the effects of five plant extracts against bacterial Quorum sensing of Staphylococcus aureus.
Materials and Methods: Thirteen strains of Staphylococcus aureus were isolated from patients with dental implant infection and identified. The plant species were collected from vicinity gardens of Fars Province and extracted using 96% ethanol. The anti-QS and antimicrobial susceptibility methods were then carried out to evaluate their bactericidal and QS properties with the use of Agrobacterium tumefaciens NTL/PZLR4. Furthermore, the biofilm production of the isolates was evaluated by microtiter plate (MTP) assay.
Ethical Considerations: This study with research ethics codes 01-16-1-1959 and 73/118248 has been approved by research ethics committee at Islamic Azad University, Jahrom and research sciences branch, respectively.
Findings: The results of the study disclosed that the extract of raspberry blossom possesses significantly (p<0.05) anti-QS property (>21 mm). The anti-QS activity was proved by creating clear halo sides of the wells formed by Agrobacterium tumefaciens NTL/PZLR4. Moreover, the extracts of tarragon, wheat flower, flixweed and basil showed antimicrobial properties.
Conclusion: According to the anti-biofilm and anti-QS properties of raspberry blossom extract against the isolates of Staphylococcus aureus, it could be considered as a mouthwash against dental bacterial infection with the identification of active compounds in the raspberry.

Effectiveness of Mindfulness Based Stress Reduction on Health Status and Symptoms of Patients with CAD after CABG

Mehdi Zemestani

Background and Aim: Considering the effect of coronary heart disease (CAD) on the health status, the present study aimed to investigate the effectiveness of Mindfulness-Based Stress Reduction on health status and disease symptoms of patients with CAD after CABG.
Materials and Methods: The research method was single subject. The statistical population of study included all patients with coronary artery disease in Tabriz city who referred to Shahid Madani Hospital in Tabriz during the second six months of the year 2016 for rehabilitation after surgery. The study sample consisted of four available CAD patients. Seattle's Angina Questionnaire (SAQ) and a researcher-designed scale for CAD symptoms were used as tools. Data were analyzed through recovery percentage, PND, SMD and visual analysis of chart method.
Ethical Considerations: This study with research ethics code 2384411 has been approved by research ethics committee at Tabriz university of medical sciences, Iran.
Findings: Results indicated that MBSR has a moderate efficiency in improving the disease symptoms. The effectiveness of MBSR is relatively low in improving the health status of patients with CAD.
Conclusion: It can be concluded that MBSR is a relatively effective treatment on reducing disease symptoms of CAD patients and is a relatively poor intervention to improve the health status of these patients.

The Role of the Estrogen Receptors of Paragigantocellularis Lateralis Nucleus in the Antinociceptive Effect of 17β-Estradiol during Proestrus Phase of Estrous Cycle of Female Rats

Roghaieh Khakpay

Background and Aim: Intra-paragigantocellularis lateralis (LPGi) injection of 17β-estradiol produces robust antinociceptive effect on the inflammatory pain in the both male and ovariectomized female rats which is possibly mediated through estrogen receptors of this nucleus. This study aimed to examine the role of estrogen receptors in the pain modulatory effect of 17β-estradiol during proestrus phase of female rats.
Materials and Methods: In this study, the female Wistar rats in the range of 200-270 gr were used. For studying the influence of intra-LPGi injection of 17β-estradiol on the acute inflammatory pain modulation, cannulation into the LPGi nucleus was performed after entrance into the proestrus cycle. After entrance in the proestrus phase once again, drugs were injected and 15 minutes later, formalin was injected into the rat's hind paw. Then, formalin-induced paw jerking behavior was recorded for 60 min.
Ethical Considerations: This study with research ethics code IR.TBZMED.VCR.REC.1397.385 has been approved by research ethics committee at Tabriz University of Medical Sciences.
Findngs: The results of this study showed that intra-LPGi injection of 17β-estradiol during proestrus phase significantly attenuated paw jerking frequency both in the first (p<0.01) and in the second (p<0.001) phases of formalin test. Pretreatment of the LPGi nucleus with estrogen receptor antagonist (ICI182,780) neutralized the 17β-estradiol-induced analgesia.
Conclusion: Our results indicated that intra-LPGi injection of 17β-estradiol induces robust analgesia on the inflammatory pain during the proestrus phase. Thus, it can be concluded that the antinociceptive effect of 17β-estradiol is probably mediated via estrogen receptors.

Frequency of Oral Motor Dysfunction during Feeding and Some of Its Effective Factors in Children with Cerebral Palsy

Mojtaba Bayani

Background and Aim: Feeding problems can limit the participation of children with cerebral palsy (CP) in the daily activities of life, especially feeding and eating. The aim of this study was to determine frequency of primary oral reflexes and oral motor dysfunction in children with CP.
Materials and Methods: This study was a descriptive-analytic and cross-sectional study that has been done on children with CP aged 2-15 years old. The participants were chosen by a convenience sampling from the rehabilitation clinics in the city of Arak in 2017. The presence of primary abnormal oral reflexes including Bite, Rooting, and Tongue Thrust was evaluated; and Oral motor assessment scale was used to evaluate oral motor function.Data were analyzed using statistical tests including chi-squared test.
Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.1395.82 has been approved by research ethics committee at Arak university of medical sciences, Iran.
Findings: Based on the present results, the most subjects with primitive oral reflexes (bite, rooting, tongue thrust) were found at levels of IV and V Gross Motor Function Classification System Expanded &Revised(GMFCS E&R) and at level of III Manual Abilities Classification System and type of quadriplegia spastic. The highest frequency of passive in oral motor was observed in level of V and functional in oral motor in levels of I and II GMFCS E&R. Furthermore, there was significant difference between gross motor function and oral motor function.
Conclusion: The study results demonstrated a significant difference between GMFCS E&R levels and oral motor function. Therefore, it was suggested that particular attention should be paid to oral motor function in terms of evaluations of gross motor function.

Depression and Social Anxiety in Primary School Children in the Context of Cognitive Flexibility of Mothers

Tooraj Sepahvand

Background and Aim: Depression and social anxiety are prevalent disorders in children, that are related to cognitive pathology of parents. This research has been conducted with the aim of comparing depression and social anxiety in primary school children of normal mothers with high and low levels of cognitive flexibility.
Materials and Methods: This research was a causal-comparative design study. The population of the research was all the fourth to sixth grade of primary school children of Arak city (and their mothers) in 2016-2017 years. For selecting the research sample, the method of convenience sampling was used. Thus, based on scores of mothers in Cognitive Flexibility Scale, two groups of mothers with high and low levels of cognitive flexibility were selected, and the scores of their children that responsed to Children’s Depression Inventory and Social Anxiety Scale for Children and Adolescents, were compared by Multivariate Analysis of Variance (MANOVA).
Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.1397.298 has been approved by research ethics committee at Arak University of Medical Sciences.
Findings:The results indicated significant difference in the liner composition of dependent variables of two groups. (wilks, lambda= 0.892, F_97,2= 14.474, p< 0.000). Univariate analysis of variance indicated that the children of mothers with low level of cognitive flexibility have more depression and social anxiety compared to children of mothers with high level of cognitive flexibility.
Conclusion: In general, cognitive flexibility of mothers is related to depression and social anxiety of children, probably by ability to perceive difficult situations as controllable, perceive alternative explanations of human behaviors and generate alternative solutions to difficult situations of responding to children. Therefore, mothers need to be more educated and refined in their cognitive flexibility so that they can cause more improvement in depression and social anxiety of children.

The Effect of Atorvastatin on Inslin Resistance in Patients with Type Two Diabetes

Afsaneh Talaei

Background and Aim: Regarding the controversy about the effects of atorvastatin on blood glucose control and diabetes, we evaluated the effects of atorvastatin on blood glucose and insulin resistance in the present study.
Materials and Methods: 88 type two diabetic patients (T2DP), were treated with anti-diabetes oral agents were enrolled in a double blind randomized clinical trial, placebo control. Then they were randomly classified into two 44 cases groups. The intervention group took atorvastatin 40 mg daily and control group took placebo for three months and fasting blood glucose (FBS), insulin resistance, HbA1c and lipid profile were measured and compared at the beginning and the end of the study. Data were analyzed using student t-test and paired t-test.
Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.90.108.10 has been approved by research ethics committee at Arak University of Medical Sciences.
Findings: After three months, insulin, insulin resistance and HbA1c decreased significantly in the intervention group than control group, while FBS non-significantly decreased. Total cholesterol and LDL cholesterol (Low density Lipoprotein) were also decreased.
Conclusion: It seems atorvastatin is effective to decrease FBS and insulin resistance in diabetic patients.

High Prevalence of Extended Spectrum Beta-Lactamase Resistance of Shigella Species in Diarrhea Samples in Khomein, Iran

Ehsanollah Ghaznavi-Rad

Background and Aim: Shigella species are one of the main causes of dysentery. This study aimed to determine the frequency and antibiotic resistance patterns of Shigella species isolated from infectious diarrhea samples in khomein, Iran.
Materials and Methods: A total of 54 infectious diarrhea samples obtained from patients were included in this descriptive cross-sectional study from June 2017 through November 2018. The infectious diarrhea samples were cultured to XLD, MacConkey agar and GN Broth. The phenotypic antibiotic resistance profiles were determined.
Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.1396.307 has been approved by research ethics committee at Arak University of Medical Sciences.
Findings: Out of 54 infectious diarrhea samples, 11 (20.3%) with Shigella spp were identified using culture media. S. sonnei 9(81.8%) and S. flexneri 2(18.1%) were the single species found. The highest antibiotic resistance rates were found for cotrimoxazole 11(100%), ampicillin 10(90.9%), cefixime, cefotaxime and ceftriaxone 9(81.8%). In this study, 8 (72.7%) of the isolates were ESBL and 1 (9%) were AmpC positive.
Conclusion: This study showed that Shigell spp are the main bacterial agent causing dysentery in infectious diarrhea samples in khomein, Iran. This should be taken into consideration by infectious specialists especially during empirical treatment.

The Effect of Cisplatin and Eucalyptus Extract on KRAS Gene Expression in A549 Cell Line of Lung Cancer

Mahsa Kavousi

Background and Aim: Lung cancer is one of the most contagious cancers in all of the world. Recently, several potential oncogenes and carcinogens have been identified, including EGFR, BRAF, KRAS and ALK genes. With due attention to the high prevalence of lung cancer, its death rate, the complications of chemotherapy and the efforts to find effective and less effective drugs, this study was done to investigate the effect of a plant extract so that results are available to manufacturing centers.
Materials and Methods: In this study, the effect of Eucalyptus extract and cisplatin on the expression of KRAS gene in A549 lung cancer cell line was investigated. To determine the cell survival, MTT was used and IC50 was determined. After determining IC50, the cells were exposed to less than IC50 concentrations of the extract and drug for 48 hours. Then, the amount of β-ACTIN and KRAS genes expressions in control and extract treated and drug treated groups were determined. For this purpose, a specific primers were designed for β- ACTIN and KRAS, and Real-Time PCR was be done.
Ethical Considerations: This study with research ethics code IR.IAU.East Tehran.REC.1396.3 has been approved by research ethics committee at Islamic Azad University, Tehran- East Branch, Iran.
Findings: The results showed that the amount of IC50 of the extract and drug was 8.75 and 1.77 mg/ml, respectively. In addition, the expression of genes in control and treated cells with extract and drug was compared. The expression of the KRAS gene relative to the reference gene in the cancer cell line treated with extract and drug, for 48 hours, was significantly decreased 2.89 and 9.25, respectively (p = 0).
Conclusion: Regarding the reduction of the relative gene expression in the A549 treated group, future studies on targeted lung cancer treatment can be promising and the potential for the use of plant compounds is more evident.

The Effect of Curcumin Supplementation on Expression of Regulatory Signaling Genes of Cardiac Muscle Growth Messenger in Obese Male Rats

Sirous Farsi

Background and Aim: Curcumin is one of the most important nutritional polyphenols that is included in daily supplements diet highly and plays a role in moderating some of the intracellular messenger pathways associated with the regulation of pathologic hypertrophy. The purpose of the present study is to survey the effect of curcumin supplementation on the expression of some genes regulators of the pathological processes of the heart muscle in rats.
Materials and Methods: In this eight-week experimental study, 12 male Sprague Dawley rats were divided into two groups: obesity control (n=6) and curcumin supplement (n=6). Curcumin supplementation was conducted for eight weeks. 24 hours after the completion of the curcumin supplement protocol, the rats were dissected and their heart muscle was removed. The expression of the genes (AMPK, mTOR, S6K, 4EBP, COL1, COL3, and Ang) was performed using Real-Time PCR technique. The expression of the genes was calculated by the 2^-∆∆CT method. One way ANOVA was applied to determine the significance of the variables among the study groups.
Ethical Considerations: This study with research ethics code IR.SUMS.REC.1396.S446 has been approved by research ethics committee at Shiraz University of Medical Sciences.
Findings:The results has showed that supplement group of curcumin reduced the expression of mTOR (p < 0.001), S6K (p < 0.011), 4EBP (p > 0.005) collagen 1 (p > 0.002), Collagen 3 (p < 0.001) and Ang (p < 0.003) compared to the placebo group. There was also an increase in the expression of AMPK gene (p < 0.001) which was statistically significant.
Conclusion: it seems that the supplementation of 10 mg curcumin moderate the pathological pathway of cardiac muscle hypertrophy by reducing or keeping up the expression of mTOR gene in obese rats and increasing the expression of AMPK gene. Moreover, this supplement can affect on reducing the pathological hypertrophy during the consumption of curcumin supplementation

Assessment of One-, Three- and Five-Year Survival Rates in Patients with Colon Cancer in Hamedan Province from 2003 to 2017

Ghodratoalleh Roshanaei

Background and Aim: Colon cancer is one of the most common cancers in the gastrointestinal tract. Colon cancer is the third death cause among cancers. The aim of this study was to estimate the survival rate and determine the effective factors in colon cancer patients.
Materials and Methods: In this study, 193 colon cancer patients referring to Hamadan Imam Khomeini Clinic during the years 2003-2017 in a retrospective cohort study were used. Follow up of all patients was done by referral and phone call up to 2017. The Kaplan -Meyer model was used to estimate the survival of patients. Also, the effect of prognostic factors on the survival of patients was obtained by Cox regression model. The software used to analyze the data was STATA 11 and the significance level was 0.05.
Ethical Considerations: This study with research ethics code IR.UMSHA.REC.1396.144 was approved in Research Ethics Committee of Hamadan University of medical sciences, Iran.
Findings: The mean age of the patients at diagnosis was 57.09 ± 12.9 years. The probability of survival of one-, three- and five-year was 0.82, 0.61 and 0.48 percent, respectively. Also, the cancer stage has a significant effect on survival time of the patients.
Conclusion: Based on the Cox model, only the stage of cancer was effective on the survival time of patients with colon cancer. Therefore, timely diagnosis also helps prevent disease progression, as well as increase the survival time of the patient, especially at an advanced age.

Pulmonary Mucormycosis: A Case Report

Abdollatif Moini

Background and Aim: Mucormycosis represents a group of life threatening infections caused by fungi of the order mucorales. Mucormycosis results in higher rates of morbidity and mortality than many other infections. A high index of suspicion and considering risky factors are critical for diagnosis and early initiation of therapy is necessary to optimize outcomes. In this paper, we report a woman with pulmonary mucormycosis.
Case Report: A 47-year old woman with a history of uncontrolled diabetes presented with cough, hemoptysis, dyspnea and dysphagia from 3 weeks ago. On physical examination, course crackles, generalized wheezing and stridor were found along with fever. Laboratory testing demonstrated a high-titer ESR, CRP3+ and leukocytosis. The ENT examination revealed a mild erythema of the vocal cords. An initial chest-x-ray was compatible with a pulmonary infiltration in the right middle lobe. Ct-scan of the sinuses was unremarkable. Bronchoscopy findings and lung biopsy was consistent fibrinoleukocytic exudates with extensive necrosis and broad hyphae and was reported fungal infection in favor of mucormycosis. She was eventually treated with amphotericin B.
Ethical Considerations: This study with research ethics code IR.ARAKMU.REC.1398.48 has been approved by research ethics committee at Arak University of Medical Sciences.
Conclusion: Mucormycosis has high mortality in diabetic patients and has even higher rates in uncontrolled diabetics. Therefore, due to underestimation and undertreatment of the condition, mucormycosis must be considered in diabetics underestimate pneumonia.