Journal of Mazandaran University of Medical Sciences
Year:2023 | Volume:33 | Issue:ویژه نامه 1 (آبان)|Papers Count:41

Background and purpose: Type 1 diabetes (T1D) is an insulin-dependent disease, that results from the destruction of pancreatic islets beta cells. The main objective of this study was to determine the effects of decellularized gastric matrix (DSM) on the function of Min6 cells (a beta cell line). Materials and methods: In this experimental study, the stomachs of Wistar rats were decellularized with sodium dodecyl sulfate (SDS) and Triton X-100. The DSM was characterized by scanning electron microscopy, determination of residual DNA and histological examinations. After seeding the Min6 cells on the DSM scaffold, the glucose challenge test and mRNA expression of insulin-related genes were examined to evaluate the function of the cells. Results: The main components of the DSM, such as collagens and glycosaminoglycans, remained intact after decellularization. In addition, the very low DNA residues and the suitable mechanical behavior of the DSM provided an ideal extracellular microenvironment for the Min6 cells. The glucose challenge test showed that the seeded cells secreted more insulin and C-peptide in the DSM than in the 2D culture. The expression of specific insulin-related genes such as Pdx-1, INS, MAF-A, and Glut-2 was significantly higher in the recellularized scaffold than in the traditional 2D cells. Conclusion: These results show that DSM is a suitable scaffold for the stabilization of artificial pancreatic islets.

Background and purpose: One of the most complications of diabetes are chronic skin wounds. Recently Human Amniotic Membrane Scaffold (HAMS) used as a wound dressing. In this study, the impact of HAMS on the rate of wound closure and the number of mast cells in the granulation tissue of diabetic rats was evaluated. Materials and methods: 45 diabetic rats were divided into 3 groups: healthy wound, diabetic wound, and diabetic wound transplanted with HAMS. 30 days after diabetes induction via injecting 55mg/kg of Streptozotocin, a circular wound with a diameter of 15mm was created. HAMS was transplanted to the wound and the percentage of wound closure and the density of type 1, 2 and 3 mast cells in the granulation tissue were evaluated on days 7, 14 and 21. Results: HAMS transplantation significantly enhanced the wound closure compared to diabetic group (P<0.05). Comparing to healthy group, the number of all types of mast cells and their total number in diabetic group was significantly decreased on day 7 (P<0.001) and significantly increased on days 14 and 21 (P<0.001). However, these changes modulated in HAMS transplanted group, in which in all cases except for type 3 mast cell on day 7 there were significant differences compared to diabetic group (P<0.01). Moreover, in HAMS transplant group, the number of type 1 and 3 mast cells on day 14 reached the level of healthy group. Conclusion: These results suggested that HAMS improves the diabetic wound healing via modulating inflammatory reactions by affecting the mast cells density in the granulation tissue.

Background and purpose: Disorder in the brain oxidant-antioxidant system is the main cause of neurodegenerative diseases. Although the favorable effects of exercise and garlic supplementation on nervous system disorders are known, but their interactive effect is not well known. Therefore, the aim of the present study was to determine the effects of aerobic training and garlic supplementation on superoxide dismutase, glutathione peroxidase and malondialdehyde of brain tissue in aged rats with Parkinson’s disease. Materials and methods: 40 Sprague-Dawley male rats (weight 250±20 gr) were randomly divided into five groups (1) healthy control, (2) Parkinson's control, (2) Parkinson's- aerobic exercise, (3) Parkinson's- garlic supplement and (5) Parkinson's-aerobic exercise-garlic supplement. In this study, rats were infected with Parkinson's disease by injecting 2 mg/kg of reserpine. Aerobic training was performed five sessions a week and each session lasted 15-48 minutes at speed of 10-24 meters per minute, for eight weeks. Supplement groups received daily 500 mg/kg garlic by gavage. Data were analyzed by one-way analysis of variance and Tukey post hoc test at the P<0.05. Results: The activity of GPx and MDA in the Parkinson's-supplemented garlic, Parkinson's-aerobic exercise and Parkinson's-aerobic exercise-supplemented garlic groups was higher than the Parkinson's control group (P≥0.05). The activity of SOD in the Parkinson's - aerobic exercise - garlic supplementation group were higher than the Parkinson's control group (P≥0.05). SOD was significantly higher in the aerobic exercise and Parkinson's-aerobic exercise-garlic supplementation than the Parkinson's-garlic supplementation group, and it was significantly higher the in the Parkinson's group-aerobic exercise-garlic supplement than the Parkinson's group-aerobic exercise (P≥0.05). Conclusion: It seems that aerobic exercise with garlic supplement can help improve antioxidants and reduce oxidative stress in the brain tissue of rats with Parkinson's disease.

Background and purpose: Exercise training-induced sinus bradycardia is a common cardiac adaptation and change in athlete’s related to a reduction in intrinsic heart rate. This study aimed to investigate the effect of four weeks of high fat diet, four weeks of exercise training volume reduction and four weeks of detraining following six weeks of high-volume exercise training on the level of Hyperpolarization-activated, cyclic nucleotide-gated (HCN4). Materials and methods: Thirty Sprague Dawley rats were divided into six groups randomly. Group 1 was the control group with standard diet. Group 2 was trained for ten weeks with high-volume exercise training and standard diet. Group 3 was trained for six weeks; after that, rats were trained with a volume reduction training protocol with standard diet. Group 4 was trained for six weeks; after that, rats were trained with a volume reduction training protocol with high fat diet. Group 5 was trained for six weeks and detrained for four weeks with high fat diet. Group 6 was trained for six weeks and detrained for four weeks with standard diet. After ten weeks, the level of HCN4 protein was assessed by Western Blotting for all groups. Results: Our results have revealed that all experimental groups showed a reduction in HCN4 levels compared to the control group—the lowest HCN4 level for groups 2, 6, 3, 4, 5 and 1, respectively (P≤0.05). Besides, the result of electrocardiograph has demonstrated that the heart rate and RR interval in all experimental groups showed a reduction and elevation compared to the control group, respectively (P≤0.05). Conclusion: Volume reduction training protocol in could restore sinus bradycardia effects rather than detraining after high-volume exercise training, but the effect of high fat diet should be investigated more.

Background and purpose: Fluoride varnish application is a successful approach in preventative dentistry. Considering the antimicrobial capabilities of Grape Seed Extract (GSE) and its impact on tooth re-mineralization, the current study was conducted to comparre the effect of this extract, with and without fluoride varnish, as well as their synergistic effects on the caries-causing bacteria Streptococcus mutans and Lactobacillus acidophilus. Materials and methods: In the current laboratory-analytical study, the disk agar diffusion (growth inhibition halo) and microbroth dilution tests were used to investigate the antibacterial properties and minimum inhibitory concentration (MIC) of the compounds. Ampicillin and Erythromycin discs were utilized for positive control, and sterile physiological serum was used for negative control. The collected data was analyzed using SPSS software (version 16) and analysis of variance (ANOVA), Kruskal-Wallis, U-Man-Whitney, and independent t-tests. Results: The largest diameter of the growth inhibition halos in S. mutans and L. acidophilus were found in 2.5 mg/ml varnish (12.0±0.7 mm) and 5 mg/ml GSE (13.6±1.1 mm), respectively. Moreover, the smallest halo diameter was recorded in 2.5 mg/ml GSE (7.0±0.9 mm) and the combination of the two extracts at 2.5 mg/ml concentration (5.6±0.9 mm), respectively. Varnish had the lowest MIC in both bacterial species tested (1.8±0.7 mg/ml), and there was no evidence of a synergistic interaction between the two compounds; however, GSE performed comparatively similar to varnish at a dosage of 5 mg/ml. Conclusion: Based on the findings of the present study, GSE can be considered an acceptable alternative to fluoride varnish in the early phases of dental caries treatment and prevention.

Background and purpose: The selection of co-ligand has a profound effect on the labeling efficiency, biodistribution, and tumor-targeting ability of 99mTc-labeled HYNIC-conjugated peptides. This study compared the in-vitro and in-vivo properties from the 99mTc-labeling of 6-Hydrazinonicotinamide-conjugated neurotensin (HYNIC-[βAla7-Tle12] NT (5-13)) by Tricine/EDDA and Tricine as two co-ligand systems. Materials and methods: After radiolabeling, cellular specific binding, affinity and internalization were evaluated toward the HT-29 cell line, as neurotensin overexpressing cells for both of them. Finally, the biodistribution studies were performed on HT-29 xenografted tumor-bearing nude mice, and the imaging was performed using a gamma camera. Results: The radiochemical purity of 99mTc labeled peptide with tricine and tricine/EDDA as co-ligands was found over 95%, and they showed desirable saline and serum stability up to 24 h. The dissociation constant (Kd) value for radiolabeled peptide with tricine and tricine/EDDA toward NT receptors were determined as 50.41 ± 9.76 and 32.66 ± 4.00, respectively. Internalization of radiolabeled peptide with tricine/EDDA was reported almost 2-fold more than radiolabeled peptide with tricine as co-ligand for HT-29 cell line after 4 h incubation. In biodistribution and imaging, the tumor/muscle activity ratio was 2.30 and 4.20, 1.74 and 2.28 at 2 h post-injection with tricine and tricine/EDDA, respectively. Conclusion: Despite relatively similar radiochemical properties of both peptide radio-complexes with 99mTc, the complex labeled with a mixture of tricine/EDDA as co-ligands showed more suitable in vivo properties than tricine.

Background and purpose: Pseudoviruses, due to their immunity and adaptability, are valuable tools for developing vaccines and therapeutic drugs, particularly for emerging viruses. SARS-CoV-2, due to its high mortality rate and ease of transmission, should be handled under Biosafety Level 3 conditions, making the development of vaccines and therapeutic drugs challenging in many research centers. The present study aimed to produce a lentivirus pseudotype that can be used in neutralization assays based on pseudovirus under Biosafety Level 2 conditions. Materials and methods: The SARS-CoV-2 Spike protein gene was inserted into the HIV-1 genome. Confirmation of entry was obtained through flow cytometry, electron microscopy, and immunofluorescence. Finally, the neutralization capacity of convalescent COVID-19 patients' sera was measured using the pseudovirus-based neutralization assay. Results: The results of flow cytometry, electron microscopy, and immunofluorescence confirmed the entry of the Spike gene. Furthermore, the sera of convalescent patients showed significantly higher neutralizing capacity compared to the control group that had not been exposed to SARS-CoV-2. Conclusion: The results of this study demonstrated that the use of the produced lentivirus pseudotype can measure the neutralizing capacity of patients' sera, and the pseudovirus-based neutralization assay serves as a suitable alternative for assessing the neutralization of live SARS-CoV-2. Moreover, this test can effectively evaluate vaccines or therapeutic drugs for combating this deadly virus.

Background and purpose: Novel coronavirus (COVID-19) can cause acute kidney injury (AKI), and underlying kidney diseases worsen the prognosis of COVID-19 patients. Materials and methods: This observational study examined the clinical and laboratory outcomes of patients with COVID-19 and assessed the major risk factors for death and intensive care unit (ICU) hospitalization in COVID-19 patients. The sample consisted of 296 COVID-19 patients with or without underlying kidney diseases. In total, 37 patients died (mean age: 66.6 ± 17.6). Results: Most patients who passed away initially suffered from shortness of breath (37.8%), cough (21.6%), old age, insulin use, central nervous system (CNS) disease, septic shock, hypoalbuminemia (P<0.0001), and high international normalized ratio (P<0.0001). Median time to death was higher in patients hospitalized in the ICU than in those without chronic kidney disease (OR=3.08; P=0.006). The use of azithromycin and ceftriaxone was lower than the use of Recigen and meropenem in deceased people (P<0.0001). Conclusion: The risk of mortality and ICU hospitalization was higher in patients with CKD than in those without CKD. The results revealed the therapeutic effects of azithromycin and ceftriaxone and the side effects of Recigen and meropenem in deceased COVID-19 patients. In addition, low albumin level, high INR, neutrophil count, white blood cell (WBC) significantly increased the risk of death in these patients.

Background and purpose: Major depressive disorder (MDD) is among the most common psychiatric diseases. Brain-derived neurotrophic factor (BDNF) is a suitable biomarker for treatment response. In the present research، serum changes of this biomarker were assessed between the two groups of MDD patients undergoing Fluoxetine therapy and cognitive-behavioral therapy (CBT). Materials and methods: In this randomized controlled trial study, 40 female MDD patients (DSM-V criteria) were assigned to two Fluoxetine therapy (20 mg/d for 3 months) (N=20) and CBT (90-minute sessions، once a week، for 12 weeks) (N=20) groups. The Beck Depression Inventory-II (BDI-II) score and serum BDNF concentration were measured before and after the treatment. The data were analyzed at a significance level of P≤0.05 using Graphpad prism 9 statistical software. Results: The BDI-II score significantly decreased in both Fluoxetine therapy (from 23.2±1.5 to 11.1±1.01) and CBT (from 26.8±0.6 to 9.5±0.8) groups. No significant change was observed in the serum BDNF level in the Fluoxetine therapy group، while it was increased in the CBT group (from 1.13±0.71 to 3 ± 0.72 ). The intergroup comparison after treatment indicated that the BDI-II score decrease and the serum BDNF increase were higher in the CBT group than in the Fluoxetine therapy group. Conclusion: The BDI-II score decrease and the serum BDNF increase were higher in the CBT group than in the Fluoxetine therapy group. Thus، it seems appropriate for MDD treatment. Serum BDNF is not an appropriate biomarker for treatment response. It is suggested that a study be conducted with a larger sample size and a longer investigation period.

Background and purpose: The health Locus of control (HLC) as a psychological variable has an effective role in predicting self-care behaviors in type 2 diabetic patients, health education programs focusing on strengthening HLC improve the effectiveness of interventions. The aim of the study was to determine the effectiveness of educational intervention based on HLC on self-efficacy, self-care and metabolic indicators of T2D patients. Materials and methods: In an experimental study, 84 T2D patients reffered to health care centers of Qazvin city were assigned to experimental and control groups using multi-stage random sampling. The theory based education regarding HLC included 2 individual counseling sessions and three 45-minute group training sessions. Data collection tools included demographic items, summery of Diabetes self-care activity questionnaire (Toobert et al., 2000), and self-efficacy scale (Rohani et al., 2018), multidemnsion health locus of control scale (Moshki et al., 2006), and FBS and HbA1c measurements. Data were analyzed with SPSS 25.0 software and chi-square tests, independent t test, analysis of covariance. Results: The mean of self-efficacy, dimensions of health locus of control, the total score of self-care along with its dimensions have improved significantly in the experimental group after controlling the effect of the pre-test (P<0.05). Moreover, the mean of HbA1c (from 7.46±1.82 to 6.14±1.23) and FBS (from 154.8±56.63 to 115.5±40.19) was significantly reduced in the experimental group after controlling the effect of the pre-test (P<0.001). Conclusion: Designing educational interventions focusing on strengthening the HLC can lead to improvement of self-efficacy, self-care behaviors and blood glocuse reduction in T2D patients.

Background and purpose: Given the inevitable use of metformin in treatment, the management and possible elevation of cobalamin levels by metformin use should be addressed. However, the reduction in vitamin B12 levels caused by metformin has been mentioned in many studies and books, but there is no suggestion for the concomitant use of vitamin B12 with metformin. This study was conducted with the aim of assessing the association between metformin use and vitamin B12 depletion in type 2 patients Materials and methods: In this descriptive cross-sectional study, 96 people were randomly selected. Two clinic patients referred to Tankab Hospitals and Imam Sajjad (AS) Ramsar Hospital internal clinic with normal CBC from the beginningwere included in this study. Information was recorded in patient records through paraclinics and interviews. 5 ml of venous blood samples was drawn these patients who had been taking metformin for at least 6 months to determine hemoglobin levels, red blood cell indices including MCV, and vitamin B12 levels. CBC and B12 plasma level were taken.t-tests and analysis of variance, Mann-Whitney and Kruskal-Wallis tests, chi-square tests and logistic regression were used. The software used in this study is IBM-SPSS V.20, and the significance level of the tests is considered to be less than 5%. Results: In this study, 96 patients were examined. The differences in vitamin B12 levels in diabetic patients taking metformin were borderline significant depending on age (P=0.063). The vitamin B12 level was significantly higher in men than in female patients (P=0.023). There were no statistically significant differences in vitamin B12 levels depending on BMI, Hb level, underlying disease and use of other hypoglycaemic medication (P>0.05). The frequency of vitamin B12 level was significantly lower in diabetic patients taking metformin with normal MCV than in patients with MCV (P=0.012). The frequency of vitamin B12 level was highestin diabetic patients taking 2000 mg metformin per day (13.3%) and lowest in patients taking 500 mg per day, and this difference was statistically significant (P=0.013). Conclusion: The results show that metformin causes a decrease in vitamin B12 levels in diabetics who take it. Due to the high prevalence of vitamin B12 deficiency caused by metformin and its relationship with dose and duration of use, patients ' serum levels of vitamin B12 should be monitored regularly and, in case of deficiency or symptoms of deficiency, patients should take vitamin B12 supplements to improve the quality of treatment and prevent complications caused by diabetes and metformin.

Background and purpose: Young and college students are susceptible to risk factors associated with metabolic syndrome due to living conditions. In micronutrient studies, low levels of magnesium and zinc in women have been shown to be associated with metabolic syndrome. The present study aimed to investigate the relationship between the consumption of different food groups and the components of metabolic syndrome, as well as to investigate the relationship between zinc and serum magnesium levels and the average intake of food groups among female students living in the dormitories of Mazandaran University of Medical Sciences. Materials and methods: In this descriptive study, 80 female students in the age range (18-25 years) participated. Metabolic syndrome indices, including anthropometric indices, lipid profile, fasting blood sugar, zinc, and serum magnesium were examined. Food intake information was obtained through food frequency questionnaire and 24-hour food recall. Results: In this research, magnesium and zinc levels were in the normal range, and no significant relationship was observed between these two elements and metabolic syndrome indices. The prevalence of metabolic syndrome with at least three simultaneous indices was seen in three patients (3.7%). Vitamin D and vitamin E intakes were at the lowest ratio compared to DRI. Only one indicator of metabolic syndrome, HDL cholesterol, in 100% of people was less than 50 mg/dl. Conclusion: Due to the nutritional boundaries that exist in dormitories for college students, appropriate planning is needed to supplement support in this group of society to prevent the long-term consequences of nutrient shortages and its future potential health hazards.

Background and purpose: Metabolic syndrome (MetS) refers to a combination of metabolic disorders which is considered a set of risk factors for chronic diseases such as cardiovascular disease and type 2 diabetes. Oral contraceptive pills (OCPs) are one of the most popular and effective methods of preventing pregnancy. The aim of this study is to investigate the relationship between the use of OCPs and MetS in the Tabari cohort population. Materials and methods: The current cross-sectional study utilized data collected in the enrolment phase of the Tabari cohort study (TCS). In total data of 5979 women aged 35 to 70 years were analyzed. The obtained data were analyzed using Chi-square tests and logistic regression analysis to assess the relationship between the use of OCPs and its duration with the risk of MetS and its components. Results: The prevalence of MetS among women participated in TCS was 49% (2930 individuals). The frequency of OCPs consumption was 42.9% (2563 individuals). The average duration of OCP use in women with and without MetS was 69.15±67.06 71.46±68.38 months respectively (P=0.388). After adjusting of confounding variables, no statistically significant association was observed between the use of OCPs and MetS and its parameters (except blood pressure). Similarly, the duration of taking these pills was also not significantly associated with MetS and these parameters. Conclusion: The use of oral contraceptives is not associated with MetS and other parameters, but its use, especially in the long term, can be accompanied by high blood pressure.

Background and purpose: Intraventricular hemorrhage (IVH) is known as a major complication of Prematurity. In this study, we aimed to examine complete blood count (CBC) variables in preterm infants with IVH. Materials and methods: In this cross-sectional descriptive study, we studied preterm infants less than or equal to 34 weeks and less than 1500 g admitted to the NICU and neonatal ward of Bu Ali Sina and Imam Khomeini hospitals in Sari from 1395 to 1398.  The presence of IVH in brain ultrasonography was recorded in these neonates. Results: Out of 367 neonates, 49.05% were boys and 50.95% were girls. The mean gestational age was 30.96±2.30 weeks and the mean weight of the patients was 1461±504.99 g. 41 patients (11.17%) had intraventricular hemorrhage. Infants with a history of maternal diabetes were more common in the group with intraventricular hemorrhage (P= 0.042). Mean hemoglobin, MCV and MCH were significantly higher in the group with ventricular hemorrhage and mean CRP and blood glucose were higher in this group (P<0.05). The results of logistic regression model showed that Higher blood sugar in the newborn, history of diabetes in the mother, history of receiving surfactant in the newborn, and lower MCH and MCV in the newborn baby's CBC were significantly effective in he chance of intraventricular hemorrhage (P<0.05). Also, hemoglobin and MCH were significantly lower in grades 2, 3 and 4 than grade 1of IVH. Conclusion: Results of the present study showed that Microcytic hypochromic anemia can be used to predict the occurrence of IVH.

Background and purpose: Patients admitted at the intensive care unit (ICU) need blood draws for chemistry analytes and arterial blood gas (ABG) analysis. Repeated blood drawing is one of the most common causes of anemia in these group of patients. Measurement of analytes only by ABG analyzer can be beneficial for preventing anemia. The aim of this study was to compare the biochemical analytes in venous and ABG samples in ICU patients. Materials and methods: This cross-sectional study was performed in 223 patients hospitalized in the ICU. These patients undergoing ABG analysis and simultaneous venous sampling. The value of Ca, Na, K, Hct, and glucose were measured in venous samples with a laboratory auto-analyzer and in arterial samples with an ABG analyzer. Results: The mean age of patients was 61.14±16.96 years. The mean difference between ABG and serum samples was 1.12 mEq/L for sodium, -0.29 mEq/L for potassium, -0.98 mg/dl for calcium, 0.33 mg/dl for glucose, and 4.39%% for hematocrit. In addition, 95% limit of agreement was -12.3 to 9 for sodium, -0.7 to 1.29 for potassium, -1.31 to 3.8 for calcium, -39.13 to 40.32 for glucose, and -13.5 to 8.5 for hematocrit. Conclusion: Because of acceptable agreement for sodium, potassium, and hematocrit, ABG analyzer can be used in ICU patients and emergency situations. There is a remarkable bias between the ABG-measured and laboratory-measured calcium and glucose, so the calcium and glucose measurement by the ABG analyzer are not reliable.

Background and purpose: Zygomycosis (mucormycosis) is a rare fungal infection with high morbidity and mortality. This study evaluated mucormycosis's clinical and paraclinical features in patients admitted to Buali Hospital in Sari & Razi Hospital in Ghaemshahr, Mazandaran Province, Iran. Materials and methods: This retrospective and cross-sectional study reviewed the patients' files with proven or probable mucormycosis admitted to Buali & Razi hospitals from 20 April 2011 to 20 April 2018. The Student's T-test and Fisher's exact test were performed for data analysis using SPSS version 27 software. P ≤ 0.05 was considered as a significant value. Results: Out of 33 patients studied, 18 (54.55%) were female and 15 (45.45%) were male. The average age of the patients was 48.84 years. Among the signs and symptoms of the disease, most cases were related to headache. Diabetes was the most common underlying disease in these patients 28 (93.3%). The mortality rate in these patients was 48.48%, of which 25% related to mucormycosis. The genus Mucor and Rhizopus were the most common agents isolated in 9 cases of positive cultures. Conclusion: Results indicate that people with diabetes are more susceptible to mucormycosis than others, and that control and reduction of diabetes in the community can significantly reduce the incidence of mucormycosis. surgery combined with timely medical treatment also has the highest survival rate.

Background and purpose: Hypertension is one of the risk factors for cardiovascular diseases that is common in the elderly. Self-esteem is also one of the psychological factors that affects the physical and mental health of the elderly. Lifestyle can also affect both factors of hypertension and self-esteem. However، the relationship between lifestyle and self-esteem in elderly people with hypertension has been less studied. The aim of this study was to investigate the relationship between lifestyle and self-esteem in elderly people with hypertension. Materials and methods: In this descriptive- analytical study، 300 elders over the age of 60 who had no cognitive problems were selected from the health center in Sari city. The data collection tools included: demographic characteristics questionnaire، Iranian elderly lifestyle questionnaire، Rosenberg self-esteem questionnaire. Results: The results showed that the Mean±SD age of the participants was 67.22 ± 2.92 years and most of the elderly (71.3 percent) had a moderate lifestyle. Also, the average self-esteem score in the elderly under study was (35.42 ± 4.43). The results showed that there was a significant direct relationship between lifestyle and self-esteem of elderly people with hypertension (P>0.001, r= -0.62). Conclusion: Improving lifestyle is an important step in increasing self-esteem. It seems necessary to carry out educational-counseling interventions to improve the lifestyle of the elderly.

Traffic accidents are one of the most important causes of death and disability in the world, which cause much damage to countries and millions of people every year. Many researchers have focused on the time series caused by different aspects of these accidents. Box-Jenkins is one of the most common and widely used time series forecasting models, which is used under the condition of model stationarity. With the advancement of technology and the development of neural networks in time series, the discussion of comparing the predictive power of these models with traditional time series models has been raised. In this study, we investigated the traffic accidents leading to death or injury in iran during 2011 to 2021. Materials and methods: Statistical analyses related to the SARIMA time series model have been performed by using Minitab and EViews and the LSTM neural network model by Python and Visual Studio Code. Results: During period of the study, The trend of the number of deaths has always been decreasing, but the number of injured has been increasing before the coronavirus epidemic and decreasing after that. The highest number of dead and injured has always been in Shahrivar (August and September) every year and the months with 9 days off had significantly less deaths and more injuries. 21.38% and 27.56% of dead and injured were women. The ages of 20 to 29 had the highest number of deaths and injuries, but children and the elderly were more vulnerable and their share in the deaths was more than the injuries. According to the results, as the weather worsens, the share of accidents leading to death increases. In comparison of SARIMA and LSTM the results indicated that LSTM has been better in estimating data trends. The forecast shows the increasing trend of fatality and injuries in the comind years. Conclusion: Compared to the SARIMA model, the LSTM model showed better performance in predicting trend and time series components.

Background and purpose: Attending in a dental office is usually not easy for children who need dental services. Moreover, the level of children cooperation has a significant impact on choosing the appropriate treatment method. The goal of this study was to examine the association between the parenting style as well as the level of fear and cooperation among children aged 4-12 who were referred to Sari Dental School. Materials and methods: This cross-sectional study involved 150 children referred to Sari Dental School in 2023. The Baumrind questionnaire, children’s fear table, and Frankel index were used to measure the parenting style, children’s fear, and level of cooperation, respectively. Pearson’s correlation coefficient test and independent t-test were used in the analytical statistics of this study to investigate the relationship between dependent and independent variables. Results: Among the 150 participants, 70 (46.7%) were girls and 80 (53.3%) were boys. There was a significant relationship between authoritarian and permissive parenting styles and the level of fear and cooperation in the children. This association was positive for fear and negative for cooperation. Authoritative parenting style had a significant positive correlation with cooperation, unlike fear. A significant relation was observed between gender and fear, but no association was observed between gender and cooperation. Conclusion: According to the findings of this study, parenting style is related to children's level of fear and cooperation in dental visits, and parents have a remarkable influence on their child's behavior.

Background and purpose: This study aimed to localize impacted maxillary canines and root resorption of neighboring incisors using cone beam computed tomography (CBCT) in 12-20-year-old patients referred to two private oral and maxillofacial radiology centers in Sari. Materials and methods: In this descriptive-analytical study, 89 CBCT images were included. Of which, 31 images related to unilateral buccal impaction of the maxillary canine and 58 images related to unilateral palatal impaction of the maxillary canine were analyzed in order to measure the parameters of central and lateral resorption and the amount of resorption of these teeth. Data were analyzed in SPSS software (version 21) at a significance level of 0.05. Results: Findings revealed no statistically significant relationship between gender and the side of indentation (buccal and palatal). Moreover, the highest position was related to the palatal site in both genders. Based on the chi-square test, there was no significant relationship between gender and latent canine position. Nonetheless, there was a significant relationship between age and latent position, as well as the occurrence of decayed lateral and the position of the impacted canine, which is the opposite of the lateral tooth in the central tooth. Conclusion: This investigation revealed that the incidence of lateral tooth resorption was associated with the latent canine position, while the incidence of central tooth resorption did not demonstrate a significant correlation

Background and purpose: The preference of sleep-wake schedule, or chronotype, has an effect on a person's health, which depends on various factors. Some factors, such as personality traits, are different in people with different chronotypes, and this difference affects a person's view of quality of life. The purpose of this study is to investigate the relationship between chronotype with quality of life, gender and personality factors in students. Materials and methods: A cross-sectional and descriptive-analytical study was conducted among the students of Mazandaran University of Medical Sciences in 2018-2019 using available sampling method. Information was collected using demographic questionnaire and MEQ morning and evening questionnaires, SF_12 quality of life and NEO-FFI personality traits. Data were analyzed by 24 SPSS software. Results: 403 students with an average age of 22. 83 years (standard deviation 2. 81) participated in this study. The number of 124 people (30. 77%) had a completely and relatively evening personality, 227 people (56. 3%) had an average or lower quality of life, and 351 people (87. 1%) had a conscientious personality. The characteristic of conscientiousness was significantly higher with relatively morning MEQ (P-value <0. 0001). The quality of life of people with evening time personality was significantly (P-value <0. 05) lower than other groups. Temporal personality was a significant predictor of conscientious personality type, and moderate temporal personality was a significant predictor of quality of life. Conclusion: People with morning chronotype had a more responsible personality trait. People with evening chronotype had a lower average quality of life. Considering the relationship between personality traits and people's chronotype, the higher prevalence of evening chronotype, and the effect that chronotype has on the quality of life, the need to screen the sleep schedule pattern in students seems necessary.

Background and purpose: Heavy metals are among the pollutants that can cause destructive and fatal effects on marine organisms, including fish, in aquatic environments. This study aimed to determine and compare the concentration of heavy metals in the edible tissue of highly consumed farmed fishes (trout and carp) and marine fishes (carp, mullet, and whitefish) in Mazandaran province, Iran. Materials and methods: In this study, 10 farmed fishes of Rainbow trout and Carp and 20 marine fishes of Carp, Leaping mullet, and Rutilus kutum were purchased from several cities of Mazandaran province, including Sari, Farahabad, Babolsar, Fereydoun Kanar, and Mahmoud Abad from the fishmongers market in two seasons (spring and summer). In this study, the edible tissues were completely separated and homogenized by a meat grinder; then, the freeze-dried tissues were analyzed by an ICP-MS to identify heavy metal contents. Results: The average length and weight of the sampled marine fish species were 33.05±6.24 cm and 354.65±230.54 gr, respectively. Also, the length and weight of the farmed fish species were 33.45±10.30 cm and 586.45±501.32 gr, respectively. The results showed that the average concentration of most heavy metals in both farmed and marine species was within the permissible ranges, and only the average amount of zinc and manganese in both groups was reported higher than the maximum allowed permissible ranges. Spearman's statistical analysis showed no significant relationship between the metal concentration and the fish's length and weight (P<0.05, n=30 and rs=-0.219). Conclusion: This study revealed that although the concentrations of studied elements in sampled farmed and marine fishes were within the permissible range compared to Food and Drug Administration (FDA), World Health Organization (WHO), and Food and Agriculture Organization (FAO) standards, the average concentrations of Mn and Zn were higher than the mentioned standards.

Background and purpose: Textile industries play a vital role in the economy of any country, and the management of their effluent is crucial for environmental sustainability. The use of various dyes during the production process results in highly colored wastewater that requires treatment before discharging into the environment. Thus, the objective of this study was to assess the effectiveness of the adsorption process as one of the best and simplest methods for the removal of Acid Red 18 (AR-18) dye from aqueous environments. Materials and methods: In this experimental study, we focused on the synthesis and characterization of magnesium oxide (MgO) nanoparticles. Then, the efficiency of this adsorbent was investigated for the adsorption of AR-18 dye from aqueous solutions, and then its removal efficiency was compared with powdered activated carbon (PAC). The research involved evaluating the impacts of various variables such as solution pH, adsorbent dosage, contact time, and initial dye concentration on the adsorption process. Non-linear analysis using OriginPro 18 software was used to model adsorption kinetics and isotherms data. Results: The results of the study indicated that the solution pH had a negligible impact on the removal of AR-18 dye within the investigated concentration range. However, for PAC adsorbent, increasing the contact time and adsorbent dosage resulted in higher removal efficiency of the dye, and equilibrium was reached after 120 minutes. The general order kinetic model and Liu isotherm model well described the experimental data. Conclusion: Based on the results of the study, it was found that magnesium oxide (MgO) nanoparticles were not effective as an adsorbent for the removal of AR-18 dye and exhibited low adsorption efficiency. On the other hand, powdered activated carbon (PAC) demonstrated a significantly higher adsorption efficiency and can be considered as an effective adsorbent for the removal of AR-18 dye from aqueous solutions.

Background and purpose: Considering that chlorine disinfectants are one of the most common disinfectants for disinfecting water and wastewater, hospital environments, etc., and there are questions about the stability of chlorine in solutions and on surfaces. So, the purpose of this study is to investigate the effect of environmental factors on the stability of sodium hypochlorite solutions stored in different conditions. Materials and methods: In this study, sodium hypochlorite solution was used for solution preparation. According to the number of parameters and based on the design of the experiment (DoE) and the response surface modeling (RSM) using the Box-Benken design (BBD), 29 experiments were performed. The solutions were stored in opaque plastic bottles covered with aluminum foil. The stability of solution in concentration of 0.05, 0.5 and 1% with the pHs of 5, 7.5 and 10 stored at 4, 25 and at 45°C, and the storage time of 15, 30, and 60 days was examined. The residual chlorine concentration was determined by the iodometric method according to the standard method. Results: The results of this study showed that the chlorine stability decreases with increasing concentration of chlorine solution, increasing temperature and storage time. Solutions with neutral pH (7.5) showed less stability than acidic and alkaline solutions. Based on the experimental design and RSM using BBD, the linear effect of the temperature, pH, initial concentration and time was significant (P<0.05). There was a negative correlation between the amount of available chlorine and time. Conclusion: This study showed that different storage conditions of sodium hypochlorite solution strongly affect the stability of its chlorine, so it is recommended to pay attention to these factors when using this solution for disinfection.

Background and purpose: Trimethyltin chloride (TMT) is an organotin thermal stabilizer used in plastics manufacture, and has strong neurotoxicity, especially on the hippocampus. The aim of this study was to investigate the effects of resveratrol, an antioxidant, in reducing the side effects of TMT on the hippocampus. Materials and methods: In this experimental study, 48 male Wistar rats were randomly divided into four groups: control, TMT (8 mg/kg, single dose), ethanol, and resveratrol (30 mg/kg). Animals received six days of treatment with resveratrol. At the end of the treatment period, the spatial, working, and reference memories were investigated using a radial arm maze. Histological evaluation and the expression of Bax and Bcl2 were analyzed in the hippocampus. Results: According to our findings, TMT damaged spatial, working, and reference memories. The number of pyknotic cells and the expression of Bax significantly increased (P˂0.05) while the expression of Bcl2 decreased (P˂0.05). In addition, resveratrol could improve these negative effects of TMT on the hippocampus (P˂0.05). Conclusion: Resveratrol may prevent damages caused by TMT in the hippocampus of rat. Resveratrol might be a candidate for use as an adjunct therapy against the neurotoxicity of TMT.

Background and purpose: Gallstones are caused by the accumulation and density of fat-soluble substances inside the gallbladder. In traditional medicine Echium amoenum increases gallbladder secretions. so the aim of this study was to investigate the effect of Echium amoenum extract and Viola odorata on gallstone dissolution. Materials and methods: At first, gallstones were collected and the stone compounds were identified by UV and DSC. Gallstones are divided into equal parts in terms of size and weight (200 mg). Three acidic, alkaline and distilled water media were prepared as a control group along with the experimental groups which contained Echium amoenum and viola odorata extracts with concentrations of 1 mg/ml, 10 mg/ml, 100 mg/ml and 500 mg/ml, respectively. A gallstone sample was placed in it and sampled after 24 and 48 hours and the dissolution rate of the stone compounds was measured by an auto-analyzer. Results: The UV spectrum showed the presence of bilirubin in the gallstones and the DSC thermogram showed the presence of cholesterol in the stones. Examination of isolated gallstone compounds showed Echium extract with a concentration of 500 mg was able to dissolve 70% of the calcium and the Viola extract with a concentration of 500 mg has been able to dissolve 50% of the cholesterol and 80% of the stone’s calcium. Conclusion: Echium amoenum and Viola odorata have a significant effect on the dissolution of gallstones (P<0. 0001).

Background and purpose: This study examines the ultrasound in diagnosing abnormal urological conditions in AmirKola Children's Hospital. Materials and methods: Children with febrile acute pyelonephritis meeting specific inclusion criteria were enrolled in the study, encompassing those aged 1 month to 18 years during the period 2011-2021. Ultrasound was conducted to diagnose structural abnormalities of the urinary system. Results: Indicate that enlarged kidneys above the normal size (29%) and hydronephrosis (27%) were the most common abnormalities. Among the findings, boys exhibited a higher prevalence of abnormalities compared to girls. Ultrasound was effective in diagnosing anomalies in children below two years (41%) and above two years (47%). E.coli (83%) was the most common microorganism across all age groups and genders. Conclusion: The study suggests that ultrasound, as a non-invasive, accessible, and cost-effective method, is recommended for diagnosing urological abnormalities in children with febrile acute pyelonephritis.

Background and purpose: Nosocomial infections, especially in the intensive care unit (ICU), are critical medical problems worldwide, increasing the length of hospital stay, treatment costs, and mortality. The present study aimed to assess the prevalence of mortality caused by hospital infections in patients admitted to the ICU of Imam Khomeini Hospital, Sari. Materials and methods: The cross-sectional descriptive study was conducted on 289 patients admitted to the ICU of Imam Khomeini Hospital, Sari, from 2019-2020. Culture reports (positive/negative), detected microorganisms, antibiotic sensitivity, and cases of mortality were recorded and evaluated in the checklist. Results: Among 289 patients, 112 cases were female, and 177 subjects were male. The mean age of the deceased was 63.10±14.11 years. According to the data, 86% of patients recovered and 14% died. The most common cause of nosocomial infection was Enterobacter (17.3%), and the most common nosocomial infection was pneumonia (45.3%). The majority of patients who died had taken ceftriaxone. Conclusion: Identification of factors related to increased mortality in patients with nosocomial infections can have a significant function in the management and control of hospital infections. In the present study, multiple drug resistance in pathogens was high. The highest mortality rate was related to Stenotrophomonas maltophilia infection.

Background and purpose: Human papillomavirus (HPV) infection is known as an important cause of invasive cervical neoplasms and carcinomas. The purpose of this study was to identify types of HPV in patients referred to Imam Khomeini Hospital in Sari with precancerous lesions and cervical cancer during 2013-2017 Materials and methods: This research is a descriptive-analytical retrospective cross-sectional study based on existing documents and files. In this study, for 5 years (2013-2017), 219 patients who underwent HPV DNA test and colposcopy and had premalignant and cancerous lesions were included in the study using the appropriate checklist. Data analysis was done using statistical tests, Chi-Square Test, One-Way ANOVA. Results: In this study, the highest frequency was related to type 16 with the frequency of 73 (33.33%) people. Most of the patients had dysplasia in stages 1) CIN2, Cervical Intraepithelial Neoplasia 1 (CIN and CIN3) and were infected with one type of HPV. Also, 94 (44.76%) of the patients had normal pap smears and the highest frequency of abnormal pap smears with atopic squamous cells of undetermined significance (ASCUS) with a frequency of 43 (20%) and inflammation with a frequency of 36 (16.43%) were reported. In addition, 65 (30%) of the patients had a normal colposcopy and the highest frequency of colposcopies Abnormality was related to koilocytosis with a frequency of 76 (35%) and CIN 1 with a frequency of 67 (30.59%). Conclusion: Since the HPV virus has no signs and symptoms, and considering the high prevalence of its high-risk type in this study in Iran and its relationship with cancerous and precancerous lesions, timely diagnosis and quick treatment are suggested to prevent the transformation of precancerous lesions to advanced cancer.

Background and purpose: Despite cardioprotective strategies against ischemia/reperfusion injury following coronary artery bypass graft (CABG), its complications still exist. Therefore, the present study aimed to determine the cardioprotective effects of propofol against ischemic/reperfusion injury following CABG. Materials and methods: In this double-blind clinical trial study, 70 patients undergoing CABG were admitted to Fatemeh Zahra Hospital, Sari, Iran, 2017 were evaluated. The participants were divided into two groups of the anesthetic induction group with the combination of propofol, midazolam, fentanyl, and ether and the anesthetic induction group with nesdonal, midazolam, fentanyl, and ether. The data were registered in the checklist made by the researcher. The data were analyzed by SPSS software using descriptive and analytical statistical tests. Results: An increase in the level of creatinine and C-reactive protein was observed in both study groups from the time of opening the aortic clamp until 15 min after, and a decrease in the ventricular ejection fraction from before surgery to 48 h post-surgery(P<0.05). An increase in troponin level was reported only in the anesthetic induction group with propofol, midazolam, fentanyl, and ether (P=0.04). Conclusion: Considering the increased levels of creatinine, troponin, serum C-reactive protein, and the decrease in ventricular ejection fraction in the propofol combination group, this drug is not superior in reducing ischemia/reperfusion injury compared to the nasedonal combination.

Background and purpose: Tuberculosis is one of the leading causes of death from infectious diseases worldwide. Rifampin, a drug used to treat tuberculosis, has recently come under the spotlight. It is particularly important for the treatment of tuberculosis, and a reduction in its bioavailability has a significant impact on patient treatment and drug resistance. Therefore, this study aims to investigate the serum levels of rifampin in patients with tuberculosis. Materials and methods: The current study is descriptive-cross-sectional. In the years 2019-2020, plasma samples were collected from 30 patients treated for tuberculosis in educational-therapeutic centers in Mazandaran province. Only patients between 18 and 65 years of age who had been definitively diagnosed with tuberculosis, who were not pregnant or breastfeedingand who were being treated with a drug regimen were included in the study. Rifampin levels in the collected samples were measured using HPLTC. Results: According to the data, 30% of patients had a rifampin level of less than 8, while 16.7% had a rifampin level of more than 24. The study found that there was a significant association between rifampin serum levels and full or empty stomach status. However, there was no significant association between rifampin serum level and the age, sex, liver toxicity, and mortality rate of the patients. Conclusion: It has been observed that many tuberculosis patients do not reach the required rifampin serum level, which may lead to treatment failure. To minimize this failure, it is recommended to take the drug on an empty stomach.

Background and purpose: The deleterious effects of chronic stress on dimensions health have already been stablished. Hair cortisol concentration is a promising new tool for the assessment of long-term stress. This study was conducted for determining the relationship between perceived stress and hair cortisol in women health care workers. Materials and methods: This cross sectional study was conducted in 2018, among 188 women health care workers in Babol/Iran. Data collection was done using a demographic and perceives stress questionnaire. Hair cortisol was extracted according to exiting protocol. Data analysis was done with SPSS21 software at a significance level of P<0.05. Results: 69.3% of participants had high level of stress. The mean amount of extracted HCC was 1.74 (1.63) pg/mg. There was significant difference between means the HCC of groups with low stress level 1.457(1.163) and high stress levels 1/928(1.829). (P= 0.04). Conclusion: There was significant relationship between of the HCC and perceived stress. HCC was increased in participants with high perceived stress level.

Background and purpose: Edentulism is a dental system defect that has a serious impact on quality of life. This study aimed to compare oral health-related quality of life (OHRQoL) between mandibular edentulous patients with conventional dentures (CCD) and implant-supported overdentures (IOD). Materials and methods: In this retrospective cohort study, 88 mandibular edentulous patients were selected in two groups of CCD and IOD. After registering the demographic information, the OHRQoL questionnaire (OHIP-14) was completed by each patient. Quantitative data were described with mean (standard deviation) and qualitative with number (percentage). Data analysis was done with SPSS21 statistical software. A significance level of 0.05 was considered. Results: Out of 88 patients participating in this study, 39 were men and 49 were women. The findings showed that the mean OHRQoL score had no significant relationship with age and gender of the patients (P>0.05). The total score of OHRQoL in the CCD group was significantly higher than the IOD group (12.36 ± 8.14 vs. 8.82 ± 6.08; P=0.02). Conclusion: According to the results of the study, gender and age did not have much effect on the OHRQoL. The OHRQoL of people who used IOD was better than those who used CCD.

Schmidt syndrome is a polyendocrinopathy characterized by multiple organ failures. Patients with two or more of the following characteristics are diagnosed with this syndrome: Graves' disease, adrenal insufficiency, autoimmune thyroiditis, and type I diabetes. The present case report concerns a Schmidt syndrome patient (polyglandular autoimmune syndrome type II). The patient is a 42-year-old woman with type I diabetes and complaints of imbalance, weakness and lethargy, weight loss, darkened skin, blood pressure drop, hypoglycemia, and hyperkalemia who visited the Hospital frequently and was discharged every time after intravenous potassium chloride and dextrose injections and orders to reduce insulin consumption at home. Her blood cortisol level was measured in her last visit with suspicion of adrenal insufficiency, which was revealed to be low (less than 0.5 μg/dL). A high ACTH, low aldosterone, and normal renin were also reported, indicating secondary adrenal insufficiency. Furthermore, T4 and TSH tests were performed, reporting a TSH lower than 0.2 in the initial TSH test, which was revealed to be normal after the test was repeated. Subclinical hyperthyroidism was indicated, given the high TRAb figure. The patient underwent treatment with fludrocortisone and prednisolone, which improved her condition. This report accentuates that diabetic patients with reduced insulin requirements must be checked for adrenal insufficiency immediately to prevent potential complications.

The treatment of impacted maxillary permanent incisors is challenging due to its importance for facial aesthetics. This anomaly has several detrimental effects that can lead to aesthetic and dental occlusal problems. Dental impactions can be associated with various factors. The most common factors associated with impacted teeth include extra teeth, odontomas, cysts, root anomalies, deviation from the eruption pathway, retention of supernumerary deciduous teeth, genetics, bone disease, and trauma to primary teeth. In addition, the highest probability of the transposition phenomenon was observed in the upper permanent canines. Transposition of the upper permanent canines occurs in 80% of cases with the first premolar and in 20% of cases with the lateral incisor. Both general and local factors can be responsible for tooth displacement. Local factors include genetic factors as well as dental anomalies (congenital absence of lateral incisors, conically shaped lateral incisors, rotation, hypodontia), migration of the tooth buds from their natural growth path, root dilaceration, dental trauma and enamel formation disorders. Cone beam computed tomography (CBCT) is the most accurate imaging procedure for diagnosing tooth misalignment. Intraoral surgery with sequential movements of impacted and displaced teeth helps to achieve an optimal treatment result. This study reports a case of the patient in whom an impacted central incisor was radiographically detected in the late mixed dentition together with transposition of the maxillary permanent canine.

while vaccination against SARS‐CoV‐2 could stop the pandemic of COVID19, there are still concerns about the vaccine‐related side effects.One of the neurological adverse effects following administration of COVID vaccines  is motor neuron disease. In this case we report a unique case of motor neuron disease post the second dose of Sinopharm vaccine is presented.A 43 years old man with no evidence of prior SARS COV2 infection presented with progressive muscular weakness after receiving the second dose of Sinopharm covid-19 vaccine. Upon physical examination, laboratory data, Electromyogram and Nerve Conduction Study (EMG-NCS) and also muscle biopsy suggested the diagnosis of Covid-19 associated motor neuron disease. The patient was treated with Riluzole and Edaravone to delay the progression rate. This case described a possible link between Covid-19 Sinopharm vaccine and motor neuron disease. However further data are required to confirm such an association.

Intraventricular hemorrhage (IVH) in children is uncommon and it comprises about 3% of spontaneous cerebral hemorrhages. Intraventricular hemorrhage occurs mostly simultaneously with cerebral hemorrhage or subarachnoid hemorrhage. Primary IVH occurs mostly in adults; however, it has been reported since the age of nine. Acute hemorrhage may cause sudden or thunderclap headaches, decreased level of consciousness, and neck stiffness along with focal neurological deficits and convulsions and can be rapidly fatal. An eight-year-old girl with no history of underlying disease was referred to the Emergency Department of Hazrat Masoumeh Hospital, Qom, Iran, with sudden headache, vomiting, and visual disturbances. There, she had generalized seizures, and after entering the Pediatric Intensive Care Unit, she suffered from irregular breathing and bilateral mydriasis of the pupils without reaction to light. In the brain computed tomography scan, bilateral IVH and hydrocephalus were seen. Finally, the patient was declared brain-dead and died four weeks later. Sudden spontaneous IVH in children is rare and creates potentially dangerous and emergency conditions for them. To manage the treatment of these patients, attention should be paid to the three principles of stopping bleeding, controlling hydrocephalus, and treatment of intracerebral pressure. Early treatment prevents severe brain complications and death. For patients with headaches, vomiting, and restlessness, we must consider careful neurological examinations.The purpose of presenting this article was to diagnose and manage emergency treatment in children with cerebral hemorrhage and intracerebral pressure control to prevent neurological complications and death.

Takayasu's arteritis is a chronic, idiopathic, inflammatory disease that mainly affects large blood vessels such as the aorta and its branches, and is mostly prevalent among women younger than 40 years old. Although involvement of the central nervous system and stroke may occur during the course of the disease, it is uncommon as the initial manifestation of the patient. Here, a 58-year-old patient is presented with stroke symptoms and occlusion of the left and right carotid and left vertebral arteries since 7 years ago. The patient was subjected to laboratory examination, imaging, and additional investigations, and with Takayasu's diagnosis, she underwent treatment with corticosteroids, cyclophosphamide (and then methotrexate), and antiplatelet therapy. In addition to the occurrence of stroke as the first manifestation of the disease, the development of symptoms at the age of 51 indicated that the inflammatory process had probably started more than a decade before the symptoms.

Background and purpose: Dengue fever has become a major public health problem in many regions of the world due to increased trade and travel and problems in controlling Aedes vectors. The purpose of this policy brief is to review, analyze and present evidence-based policies for dengue prevention and control. Materials and methods: The present research is a systematic review in order to compile a policy brief in Iran, which was carried out in 3 stages according to its methodology. In the first stage, the justification and description of the problem was done in a systematic manner and by examining scientific documents through searching in national and international scientific databases, websites, guidelines and books. In the second stage, a draft of the priority elements related to the policy framework was prepared by the first author and discussed with the other authors. In the third stage, the draft questions were categorized and summarized, and then the policies were compiled in close discussion with all authors. Results: According to the recommendations of the best available evidence in the literature, five policy options were presented for the prevention and control of dengue fever, including 1- development of basic, applied and innovative research 2- Strengthening the capacity and capability of the human, infrastructural and health system in all relevant sectors for the surveillance, control, monitoring and evaluation 3- strengthening inter- and intra-sectoral coordination and collaboration 4- community engagement and mobilization 5- scaling up of functions and integrating tools. Conclusion: In order to increase the long-term impact of policies, it is recommended to use an integrated approach with the continuous support of all stakeholders (local, national, regional).

Due to the increase in the average age and metabolic diseases in the Iranian population, an increase in the prevalence of atherosclerotic aortic valve stenosis is expected. In severe and symptomatic cases of this disease, if the valve is not replaced, the death rate increases by 50% with every two years of age. Non-invasive intervention of aortic valve implantation through catheter (TAVI) is suitable for patients in whom open heart surgery is impossible or associated with high risk. Despite the widespread use of the TAVI method around the world and in some medical centers of the country, until now this method has not been started and performed in the Mazandaran Heart Center, a specialized and sub-specialized referral center for cardiovascular patients in Mazandaran province and other parts of the north of the country; Also, provision of a 3D esophageal echocardiography device is necessary as a basic prerequisite. In this policy brief, evidence-based solutions in this field and the challenges ahead have been proposed and presented to policymakers and managers in the field of cardiovascular health by the researchers of the Cardiovascular Research Center of Mazandaran University of Medical Sciences. Therefore, the officials pay sufficient attention to the necessity of equipping the Mazandaran heart center with a 3D transesophageal echocardiography device and funding it, providing physical facilities including a dedicated operating room and training facilities to form a specialized team skilled in TAVI procedure and insurance coverage for this Service is emphasized.

Background and purpose: The preference of sleep-wake schedule, or chronotype, has an effect on a person's health, which depends on various factors. Some factors, such as personality traits, are different in people with different chronotypes, and this difference affects a person's view of quality of life. The purpose of this study is to investigate the relationship between chronotype with quality of life, gender and personality factors in students. Materials and methods: A cross-sectional and descriptive-analytical study was conducted among the students of Mazandaran University of Medical Sciences in 2018-2019 using available sampling method. Information was collected using demographic questionnaire and MEQ morning and evening questionnaires, SF_12 quality of life and NEO-FFI personality traits. Data were analyzed by 24 SPSS software. Results: 403 students with an average age of 22.83 years (standard deviation 2.81) participated in this study. The number of 124 people (30.77%) had a completely and relatively evening personality, 227 people (56.3%) had an average or lower quality of life, and 351 people (87.1%) had a conscientious personality. The characteristic of conscientiousness was significantly higher with relatively morning MEQ (P-value <0.0001). The quality of life of people with evening time personality was significantly (P-value <0.05) lower than other groups. Temporal personality was a significant predictor of conscientious personality type, and moderate temporal personality was a significant predictor of quality of life. Conclusion: People with morning chronotype had a more responsible personality trait. People with evening chronotype had a lower average quality of life. Considering the relationship between personality traits and people's chronotype, the higher prevalence of evening chronotype, and the effect that chronotype has on the quality of life, the need to screen the sleep schedule pattern in students seems necessary.