Razi Journal of Medical Sciences

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ABSTRACT Adhesion bands and adhesion formation is one of the most importants post surgical complication in pelvic and abdominal operations. Post operation adhesions are the most common cause of intestinal obstruction in the western world. Approximatly one-third of all intestinal obstruction are likely to be due to adhesions. In over 10% of infertile women, adhesion formation is the main cause of infertility. Major studies in prevention of adhesion formation have based on anti-inflamatory agent. In this study we decided to compare corticostroid agents in intraperitoneal injection for reduction of postsurgical intraperitoneal adhesions. Forty rats devided to 4 groups (N=10) and after anesthesia with 50mg ketamine intraperitoneally and laparatomy, an abrasion between uterine horns was created and then, 10mg talc powdered in each rat. Also in the group A 10ml normal saline, group B 1mg/kg betamethazone phosphate, group C 1mg/kg dexamethazone and group D 1mg/kg betamethazone-LA added into peritoneum. Then abdominal wall was repaired. After 4 weeks relaparatomy was done and adhesions with modified Swolin method was registered. In comparison among groups there were statistically significant difference in the rate of adhesions (P=0.04). It showed betamethazone-LA decreases grade of adhesion (P=0.07). Difference between betamethazone-LA and control group in amount and thickness and strength of adhesion was statistically significant. In the previous studies multiple intramuscular injection of betamethazone phosphate decreased fibrin formation in rats and multiple dose of dexamethazone intraperitoneally and orally were effective in reducing of adhesions. But at the present study single dose of betamethazone-LA intraperitoneally reduced rate of adhesion and betamethazone phosphate and dexametazone were ineffective.

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  Background : Chronic obstructive pulmonary disease (COPD) causes significant mortality and morbidity. The role of infectious agents has been determined in pathogenesis of the disease. Pneumocystis jirovecii is a fungus that causes pneumonia in immune deficient patients. The organism has been detected in the respiratory tracts of asymptomatic patients in low levels, which is called colonization. Several studies have determined the association of this organism with COPD. Our study aim to evaluate the prevalence of pneumpcystis jirovecii colonization in patients with COPD.

  Methods : 60 patients with COPD, went under bronchoscopy and BAL was performed. The disease severity was determined with BODE index. Colonization with pneumocystis jirovecii was evaluated with PCR in the BAL fluid.

  Results: The prevalence of pneumocystis jirovecii colonization in COPD patients in our study was 5%.

  Conclusion: The prevalence of pneumocystis colonization is lower than the published studies in developed world, which could be due to ecologic differences.

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Background: Air pollution is one of the disadvantages of unsustainable development cause to short and long term sanitary effects without consideration of environment in addition to destruction of environment. Therefore, the present research was conducted with the purpose of quantifying and estimating of health endpoints related to SO2 pollutants in six cities (Tehran, Mashhad, Isfahan, Shiraz and Tabriz) by using AirQ model during 1390.

Methods: At first, the raw data related to SO2 pollutant was received from environmental organizations of the under review cities. Then, according to WHO criterion and programming in Excel software, required parameter in AirQ tool was calculated and finally results are presented in tables for death.

Results: the results showed that, annual average concentration of SO2 in Tehran, Mashhad, Shiraz, Isfahan, Tabriz and Urmia are 49, 31, 11, 12, 21 and 76 mg/m3 respectively. The maximum and minimum of accumulative cases of cardiovascular mortality attributed to SO2 is related to Urmia and Tabriz cities that were 89 cases with 5.64 attributable proportion and 32 cases with 0.91 attributable proportions respectively.

Conclusion: The rate of air pollution in large cities of Iran is increased and become more intense day to day. Thus, this issue needs to pay more attention of officials and specialists for air pollution control.

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Background & Aims: Type 1 diabetes is an autoimmune disease that destroys pancreatic β cells and accounts for 5-10% of all cases of diabetes. In type 1 diabetes, blood glucose levels are not sufficiently regulated and rise to abnormal levels for a long time. This chronic hyperglycemia is characteristic of diabetes and a major cause of many disease-related complications (1). Although many physiopathological aspects of diabetes are still unclear, it is well established that oxidative stress plays a major role in the development and spread of the disease (2). Catalase (CAT) is an antioxidant enzyme and is present in almost all living tissues that consume oxygen. This enzyme uses iron or manganese as a cofactor and catalyzes the degradation or reduction of hydrogen peroxide (H2O2) into water and molecular oxygen (4). The enzyme glutathione peroxidase plays an important role in inhibiting the process of lipid peroxidation and thus protects cells against oxidative stress (6). Recently, many attempts have been made to use stem cell transplantation in the treatment of type 1 diabetes (8-10).
Recent studies have shown that stem cells reduce glucose levels further by acting on the paracrine glands rather than directly affecting insulin-producing cells (10, 12). On the other hand, the positive effects of regular exercise on various diseases such as type 1 diabetes have been identified (13). In the study of Pereira et al. (2016), the swimming exercise protocol for 8 weeks plays a role in controlling blood sugar and improves oxidative stress in the blood of diabetic rats by increasing the level of catalase (15). Also, a study showed that after 6 weeks of endurance training, glutathione peroxidase activity in the hippocampal tissue of rats with diabetes significantly increased (16). However, Farhangi et al. (2016) in a study investigated the effect of eight weeks of endurance training on the activity of some antioxidant enzymes and lipid peroxidation of cardiac tissue of streptozotocin-induced diabetic rats. Cardiac tissue catalase activity was not affected by endurance training (17).
Recent studies have provided support for the use of resistance training to improve glucose control in type 1 diabetic patients (20). However, the effect of this type of exercise on skeletal muscle antioxidant factors has not been studied in type 1 diabetic subjects. On the other hand, in the field of changes in skeletal muscle antioxidant factors in response to endothelial stem cell injection, it can be said that no research has been done so far. Therefore, the aim of this study was to investigate the effect of resistance training and endothelial stem cell injection on skeletal muscle antioxidant enzymes in type 1 diabetic rats.

Methods: In this experimental study, 36 male Wistar rats were divided into six groups of control (healthy), basal diabetic control, diabetic control, diabetes + stem cell injection, diabetes + resistance training and diabetes + stem cell injection + resistance training. In this study, rats became diabetic intraperitoneally using streptozotocin as a single dose of 40 mg/kg. Resistance exercises including climbing a one-meter ladder with weights hanging from the tail were performed for 17 sessions. 500,000 bone-derived stem cells were injected by a cell counter. Data were analyzed using independent t-test, 2-factor analysis of variance and Bonferroni hoc test at P<0.05.
Results: The results showed that after the intervention, the levels of catalase, glutathione and glutathione peroxidase in the group of resistance training, stem cell injection and resistance training with stem cell injection were significantly higher than the control group (P<0.001). Also, the levels of catalase, glutathione and glutathione peroxidase in the rats of the resistance training group with simultaneous injection of stem cells were significantly higher than the resistance training and stem cell injection groups (P<0.001).
Conclusion: The results of the present study showed that resistance training and endothelial stem cell injection resulted in an increase in skeletal muscle antioxidant enzymes in type 1 diabetic rats. The findings of this study were consistent with the results of Previous research (24, 25). A possible explanation for the increase in skeletal muscle antioxidant enzymes in post-exercise diabetic rats may be that the compensatory response to the combination of risk factors (diabetes-induced hyperglycemia) by overproduction of hydrogen peroxide by increasing the concentration of this Enzymes take place. This post-workout antioxidant enhancement is probably an attempt to balance the increase in reactive oxygen species under high blood sugar conditions. Therefore, exercise protects against oxidative stress by increasing the levels of catalase, superoxide dismutase and glutathione peroxidase in the skeletal muscle tissue of diabetic rats. The mechanism of changes caused by exercise has been investigated. The mechanism of change of antioxidant enzymes in training groups is to increase intracellular responses and reactions of different body tissues to oxidative stress produced during exercise and catabolism of synthetic components of proteins and cell defense structure (27).
The results of our study show that stem cells with dose of 500,000 cells in rats muscle can significantly increase the protein level of catalase, glutathione and glutathione peroxidase in diabetic rats. The results can be elucidated by considering how STZ works, which increases reactive oxygen species, so that STZ causes cell DNA damage (29). stem cells have been shown to be resistant to oxidative stress production conditions such as ionizing radiation (34). In addition, stem cells are not susceptible to cell death due to oxidative stress. stem cells exposed to oxidative stress show low intracellular concentrations of reactive species with high expression of enzymes needed to control oxidative stress such as catalase and glutathione peroxidase (35). Because the definition of oxidative stress is the lack of an appropriate amount of ROS repellent tool (36) and previous research has shown that mesenchymal stem cells have the ability to reduce the severity of oxidative stress and increase the amount or activity of ROS neutralizing enzymes (35). It is thought that stem cell therapy may help increase antioxidant capacity in type 1 diabetes. There were some limitations in the present study, such as the lack of measurement of lipid peroxidation indices and antioxidant capacity of diabetic rats. Also, since the interactive effect of exercise and endothelial stem cells on the levels of antioxidant enzymes in type 1 diabetics, few studies have been performed, so more studies are needed to investigate the mechanisms affecting changes in these indices. Therefore, it is suggested that the interactive effect of other training methods and endothelial stem cells on the levels of antioxidant enzymes in type 1 diabetic subjects be investigated in future studies. It seems that the intervention of resistance training with simultaneous injection of stem cells can help improve the antioxidant enzymes of skeletal muscle in type 1 diabetes.

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Background & Aims: Horner's syndrome is a rare disease with three clinical signs of ptosis, miosis and unilateral anhydrosis of the face and neck. In this syndrome, Hodgkin's lymphoma should be considered as one of the first life-threatening symptoms. Horner's syndrome, or oculosympathetic paralysis, is a rare disease first reported by Mr. Horner (1883-1886) with three clinical signs including unilateral ptosis, miosis, and Unilateral and unilateral anhidrosis of the face and neck were described, all due to involvement of the oculosympathetic pathway (1). Horner syndrome results from an interruption of the oculosympathetic pathway. This condition does not usually cause vision problems or other significant symptoms, but is important as a warning sign that the oculosympathetic pathway has been interrupted, potentially with serious and even life-threatening processes. The oculosympathetic pathway has a long and circuitous course, beginning in the brain and traveling down the spinal cord to exit in the chest, then up the neck and into the orbit. The sympathetic nervous supply is responsible for the dilation of the pupil (mydriasis). When disrupted, parasympathetic supply is uninhibited, and constriction of the pupil (miosis) ensues. The reaction of the pupils to light and accommodation is normal as those systems do not depend on sympathetic nerve supply. Therefore, this syndrome with unimpressive clinical findings and insignificant symptoms may be a sign of serious pathology in the head, chest, or neck. Patients with Horner syndrome present with a slightly droopy upper lid and a smaller pupil on the affected side; less commonly, there is a deficiency of sweating over the brow or face on the affected side (2). Horner syndrome is almost always diagnosed clinically, though pharmacological testing can be used to confirm the diagnosis. Imaging modalities such as PET, CT and MRI are important components of work‐up for patients presenting with acquired Horner syndrome (3). Factors that cause this disease include trauma, brain tumors, migraines, cluster headaches, hyperthyroidism, and lung cancer(4). Because Horner syndrome sometimes occurs as the first sign of a life-threatening condition, a thorough post-diagnosis systemic examination is necessary to follow up on patients for signs and symptoms (5). This is a clonal malignancy (dependent on asexual reproduction) of the lymphatic system with different clinical manifestations that can be treated in the early and advanced stages (6). Horner's syndrome is an unusual initial manifestation of Hodgkin's disease, and, in this case, it was due to oculosympathetic damage from mediastinal compression (7, 8). The aim of this study was to report and introduce a patient referred to Imam Khomeini Hospital in Kermanshah with a diagnosis of Horner's syndrome and Hodgkin's lymphoma.
Case Presentation: The patient is a 30-year-old man with left ptosis about 50 days before seeing an ophthalmologist. The patient also complains of sweating on the right side of the body and lack of sweating on the left side of the upper torso and face. No previous history of specific illness or family history of the symptoms were reported. In ocular examinations, the corrected vision of both eyes is equal to 10/10, normal eye movements, mild ptosis in the range of 2 mm in the left eye, meiosis of the left eye and the development of Anisocoria (an ocular complication in which the pupil of one eye from Size differs from other pupils.) Was reported more clearly in low light. According to the mentioned symptoms, Horner syndrome was presented to the patient. A complete and appropriate examination is sufficient for the initial diagnosis of this syndrome, but in order to confirm the diagnosis and determine the location of the injury, naphazoline drops were used. In this way, this drop was poured in both eyes of the patient and after a few minutes, the ptosis disappeared and the amount of anisocoria decreased. At present, after starting treatment, in addition to improving anisocoria, the amount of ptosis has decreased and the patient is satisfied with continuing treatment. On systemic examination, several large lymph nodes on the left side of the neck were touched in the area of the sternocleidomastoid muscle (SCM). Ultrasound of this area also showed a lymphadenopathy measuring 15 x 25 mm deep in the SCM muscle in the subclavian space (Subclavian triangle) and a lymph node measuring 10 x 15 mm in the upper region of the supraclavicular space with involvement of the upper mediastinum. MRI (Magnetic resonance imaging) of the brain and spinal cord was also reported to be normal. An X-ray of the chest showed umbilical cord lymphadenopathy. Finally, after biopsy of Hodgkin's lymph node, the diagnosis of cervical lymph node was made.
Conclusion: In the present report, after examining the patient, Horner syndrome was clinically confirmed and after Hodgkin's lymph node biopsy, the diagnosis of Hodgkin's lymphoma was made. Involvement was also seen in the SCM muscle area and the upper mediastinum. In line with the results of the present study in a study by Simon et al. Conducted in 1985 on a 22-year-old woman with Horner syndrome, a mass in the mediastinum was observed on a patient's chest X-ray and evaluated. Further leads to the diagnosis of Hodgkin. This study suggests that Horner's syndrome is an unusual early manifestation of Hodgkin's disease caused by damage to the oculosympathetic pathway due to pressure on the mediastinum(9). A 1980 study by Maloney et al. On 450 patients with Horner's syndrome reported less than 3 percent of Hodgkin's lymphoma(7). Another study by Giles et al. In 1958 on 216 patients with Horner syndrome identified three cases of Hodgkin's lymphoma(6). Also, a 1940 study by Goldman et al., Conducted on 212 patients with Hodgkin's disease, reported no cases of Horner's syndrome(10). Kaplan also stated in his 1980 study that no cases of the syndrome were observed in patients with Hodgkin's disease(11). However, in the present report, MRI of the patient's brain and spinal cord was normal and no complication was observed. However, Williams et al., In their 1959 study of the complications of leukemia and lymphoma, found that neurological complications occur in 15% of patients with Hodgkin's lymphoma(12). Jackson et al., Who studied Hodgkin's disease in 1945, also noted complications such as brain and spinal cord injuries, polyneuropathy, mononorrhea, and myopathy(13).According to the results of this study, with the confirmation of Hodgkin's lymphoma in the patient, it is necessary that in addition to the entire oculosympathetic pathway, the patient be examined for neoplasms, including Hodgkin's lymphoma, due to its high potential. Also, due to the involvement of the upper mediastinum, it can be stated that Horner's syndrome is an unusual initial manifestation of Hodgkin's disease, which is caused by damage to the oculosympathetic pathway due to pressure on the mediastinum. In general, according to the results of the present study and similar studies among the early life-threatening symptoms, although Hodgkin's disease has been reported as uncommon, but due to the high potential for its treatment, it should be Patients with this syndrome should be considered. Also, with the publication of the present study, we can point to the sensitivity among ophthalmologists in identifying certain cases of malignancies associated with Horner's syndrome, which can lead to their early detection and better prognosis. Unfortunately, the lack of similar Iranian and foreign studies and the unavailability of the full text of some other articles for comparison prevented a comprehensive decision on the results.

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Background & Aims: Health tourism, also known as medical tourism or medical travel, refers to travel to another country or region to receive medical treatment, procedures or services. The concept of health tourism has gained popularity in recent years due to rising healthcare costs in developed countries, the availability of high-quality medical facilities in developing countries, and the ease of international travel. Health tourism can provide patients access to high quality medical treatments, reduce healthcare costs and improve their quality of life. However, it is important to carefully consider the risks and benefits of health tourism before deciding to travel for medical treatment. Patients should research the treatment facility and provider and ensure appropriate health insurance coverage prior to travel. In the meantime, one of the aspects investigated in the fields of health tourism has been the behavior of consumers of these services, as well as the effects of social networks on this behavior. One of the studied cases is in the field of consumer behavior in relation to social networks, which has been studied in various researches in recent years. In fact, social networks are one of the most used areas in recent years of social networks, which have greatly occupied various markets. In recent years, the amount of use of social networks in Iran has increased so much that the scope of using these networks has led to political debates and influencing the results of elections. In this research, considering the increasing role of social networks, its impact on health tourism has been investigated from the point of view of consumers of medical services in the form of medical tourists.
Methods: In terms of research methodology, the current research is applied, survey and correlation research. The statistical population of this research includes all social network users in medical centers providing health tourism services in Tehran. The size of the statistical population was 850 people during the study period, and using the Cochran formula, the sample size was determined to be 256 people. In order to measure the research variables, a questionnaire was used. The validity of this tool has been examined through construct validity, and reliability has been examined and confirmed using Cronbach's alpha coefficient. In the analysis method section, first the measurement model was formed and the fit of the model was examined based on the indicators. Finally, based on the structural modeling method, the relationships between the research variables were examined and the results were presented.  Amos software is used in this section.
Results: The results showed that the amount and type of use of social networks had a significant effect on the behavior before, during and after the use of health tourism services.
Conclusion: One of the ways social media can influence health tourism is by giving patients access to information about medical facilities and doctors in other countries. Patients can read reviews, watch videos and connect with others who have undergone similar treatments. This can help them make informed decisions about where to go for treatment and what to expect when they get there.
Another way social media can influence health tourism is by providing a platform for medical professionals to share their expertise and build their reputation. Doctors, nurses, and other healthcare providers can use social media to showcase their skills, share educational content, and interact with patients and other professionals in their field. This can help them attract patients from other countries who are looking for quality care. On the other hand, social media can also have negative effects on health tourism. For example, false or misleading information can spread quickly on social media, which can lead to patients making poor decisions about where to seek treatment. In addition, some medical facilities and doctors may use social media to promote themselves in unethical ways, such as exaggerating the benefits of their treatments or making false claims about their qualifications. As a result, social media and health tourism are two distinct concepts that can interact in different ways. While social media can give patients access to valuable information and help medical professionals build their reputation, it can also pose risks for patients seeking accurate and reliable information about treatments and medical facilities in other countries. The relationship between the type and amount of use of social networks and the behavior of health tourists before, during and after the use of medical services was investigated. The results have shown that social networks can have a positive and direct effect on the behavior of consumers of health tourism services.