Razi Journal of Medical Sciences

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Introduction: the current study aimed to investigate the therapeutic and improving effects of oral consumption of grape seed extract (Viis vinifera) with and without aerobic exercise on the some of the most important cardiovascular and metabolic parameters levels in obese middle-aged women with type 2 diabetes.
Methods: 36 women with diabetes as the available sample were purposefully selected and randomly divided into four groups (9 people in each group): 1) exercise+ grape seed extract supplement, 2) exercise + placebo, 3) supplement of grape seed extract and 4) placebo. Participants performed four weeks’ aerobic training (5 days a week) with an intensity of 65-75% of the reserve heart rate. The supplementations group received one grape seed extract capsule and the placebo group consumed starch powder in capsules (the same color and shape as the grape seed capsules).
Results: The results of dependent t-test showed that levels of glucose, insulin, LDL-C, VCAM-1, ICAM1, CRP and homocysteine were significantly decreased and HDL-C were significantly increased in the post-test compared to the pre-test (P <0.05). A significant decrease in glucose, insulin, LDL-C, VCAM-1, ICAM1, CRP and homocysteine levels and a significant increase in HDL-C levels was observed in the exercise supplement, exercise placebo and supplement groups compared to the placebo group (P <0.05).
Conclusion: It seems that consumption of grape extract as a method of improving cardiovascular and metabolic parameters solely can have a positive effect on the control of diabetes. Although when combined with aerobic training the effect gets better.
 

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 Background:
An emerging disease surfaced in China in December 2019, manifesting as acute respiratory syndrome, rapidly evolving into a global pandemic (1-3). The cause was identified as the severe acute respiratory syndrome coronavirus (SARS-CoV-2), designated COVID-19 by the World Health Organization on January 30, 2020 (4). In response to its high fatality rate and contagiousness, countries worldwide implemented widespread closures, including Iran, where all administrative, commercial, and educational activities ceased. Consequently, virtual education gained prominence to mitigate academic setbacks and ensure continuity (5). This shift necessitated educators, many inexperienced in virtual teaching, to adapt quickly (6). Medical education also adapted to these conditions, with significant impacts on student learning in hospital settings. Face-to-face teaching in hospitals and clinics was curtailed due to the disease burden in Iran, leading to substantial changes in medical education (7, 8). Studies in Iran have yielded conflicting findings on the pandemic's effects on medical education, highlighting both the efficacy of online and virtual medical courses and varying outcomes (8-12). Recognizing the significance of the semiology course for medical students, crucial for learning clinical examinations and patient interaction skills before entering hospital departments, emphasizes the need for structured training in semiology. This foundational unit underpins medical and clinical education, playing a vital role in future patient care and healthcare management (13). The current research was designed with the aim of investigating the level of students' satisfaction and students' views on different aspects of practical semiology unit courses in two groups of students who completed the course in person and virtual.

Methods:
 This study was a meticulous examination conducted among medical students enrolled at Iran University of Medical Sciences (IUMS) in Tehran throughout the year 2022. To ensure ethical standards, the study commenced following approval from the IUMS Ethics and Research Committee (approval number: IR.IUMS.REC.1401.490).  Participants in this study were enrolled using convenience sampling into two groups: a virtual learning group and a face-to-face learning group, both meticulously matched in demographic characteristics such as age, gender, and academic semester. The sampling strategy employed convenience sampling, categorizing participants into two distinct groups: face-to-face and virtual learning environments. This stratification aimed to maintain demographic equilibrium concerning variables such as age, gender, and academic semester, thereby mitigating potential confounding factors. Adequate sample sizes were computed to uphold statistical power, mandating a minimum of 193 participants encompassing both groups: 65 in the virtual cohort and 128 in the face-to-face cohort. The practical semiology curriculum was tailored based on specific needs identified among students at Iran University of Medical Sciences (IUMS). For the virtual course, educational content included 57 carefully crafted instructional videos sourced from expert lectures and practical demonstrations. These resources were made available on the IUMS online platform prior to the course commencement, ensuring accessibility and preparation for virtual learners. Conversely, the face-to-face course was conducted in a spacious, well-ventilated facility equipped with 15 dedicated learning stations. Each station accommodated 5-9 students, an instructor, and occasionally a simulated patient actor when required. These stations were fully stocked with essential tools and educational aids, facilitating hands-on learning experiences under direct educator supervision. The curriculum spanned three intensive modules over 12 days, covering critical topics such as clinical history-taking, physical examinations, and technical competencies including surgical techniques and invasive procedures. Outcome measures centered on evaluating student perceptions of the learning environment and overall satisfaction levels. This assessment was conducted using the Dundee Ready Education Environment Measure (DREEM) (14) questionnaire, a validated tool designed to assess educational climate effectiveness across domains like learning, teaching quality, academic self-perception, educational atmosphere, and social conditions. The DREEM questionnaire assesses students' perceptions across several dimensions: learning, teachers, academic ability, educational atmosphere, and social conditions of education. Each component uses a 5-point Likert scale, with scores categorized into poor, moderate, and high levels based on predefined score ranges. Additionally, student satisfaction with the semiology course is evaluated through a separate 10-question online questionnaire, also using a 5-point Likert scale, with scores classified into poor, moderate, and high satisfaction levels. Statistical analysis of collected data utilized SPSS software, employing standard metrics such as mean ± standard deviation for continuous variables and percentages for categorical data. Comparative analysis included Mann-Whitney U tests, independent sample t-tests, and chi-square tests as appropriate, with significance set at P ≤ 0.05. These rigorous analytical approaches aimed to discern significant differences and draw robust conclusions regarding the efficacy of each educational modality in fostering student learning and satisfaction in semiology training at IUMS.

 Results:
A total of 325 medical students were included in this study. 22.8% of the students (n=74) had participated in virtual training and 77.2% of the students (n=251) had participated in the face-to-face semiology course. The average age of students was 22.65 ± 2.75 years and ranged from 20 to 38 years (P=0.8). 54.2% (n=176) were male students and 45.8% (n=149) were female students (P=0.01) (Table 1).
Table 1. Demographic Characteristics of the Participants by Type of Learning Groups.

Characteristics	face-to-face learning group (n=251)	Virtual learning group (n=74)	P value[1]
Gender, n (%) Male Female	127 (50.6%) 124 (49.4%)	49 (66.2%) 25 (33.8%)	0.01
Age, years (SD)[2]	22.49 (2.4)	22.97 (2.9)	0.8

The relationship between the type of students' training course (face-to-face or virtual) and their level of satisfaction was investigated. Statistical analysis did not show a significant relationship between these two variables (P=0.1) (Table 2).
Table 2. Satisfaction of the Participants by Type of Learning Groups.

Characteristics	face-to-face learning group (n=251)	Virtual learning group (n=74)	P value[3]
Satisfaction, n (%) Poor Moderate High	0 (0) 16 (6.4) 235 (93.6)	1 (1.3) 7 (9.5) 66 (89.2)	0.1

 The dimensions of the DREEM questionnaire were examined, Overall, poor perception had a very low prevalence (0-1.4%). In contrast, high perception in students showed a prevalence of more than 90% in all dimensions in face-to-face education and between 77 and 91.9% in virtual education. Except for SPSCE, in other dimensions, the level of high perception was significantly higher in students with face-to-face education (P<0.05) (Table 3).
Table 3. Examining and Comparing the Dimensions of Students' Perception by Type of Learning Groups.

Characteristics	face-to-face learning group (n=251)	Virtual learning group (n=74)	P value3
Students' perception of learning, n (%) Poor Moderate High	1 (0.4) 23 (9.2) 227 (90.4)	0 (0) 17 (23) 57 (77)	0.006
Students' perception of teachers, n (%) Poor Moderate High	0 (0.4) 12 (4.8) 239 (95.2)	0 (0) 14 (18.9) 60 (81.1)	0.001>
Students' perception of their academic ability, n (%) Poor Moderate High	0 (0) 13 (5.2) 238 (94.8)	1 (1.4) 11 (14.9) 62 (83.8)	0.003
Students' perception of educational atmosphere, n (%) Poor Moderate High	0 (0) 8 (3.2) 243 (96.8)	1 (1.4) 8 (10.8) 65 (87.8)	0.005
Students' perception of the social conditions of education, n (%) Poor Moderate High	0 (0) 14 (5.6) 237 (94.4)	0 (0) 6 (8.1) 68 (91.9)	0.4

Conclusion:
In general, according to the DREEM index, the level of satisfaction with education in general and in all its dimensions was reported to be high and suitable for both learning groups. The overall score of satisfaction and perception with education based on DREEM, for a group of students who participated in face-to-face learning, in all dimensions including: SPL, SPT, SPAA, SPEA and SPSCE was more than the virtual group. This study showed that although virtual training has high satisfaction among students, the face-to-face training method caused higher academic satisfaction and perception. Therefore, considering the nature of the semiology course and its clinical importance, it is suggested that this course and, in general, courses that have a high clinical aspect, be taught face-to-face. It is recommended to compare the final test results of students in two face-to-face and virtual groups of semiology course in other studies.
 

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 The side effects of toxic trace elements such as lead in the exposed subjects have been investigated in past years. Lead disturbs microvascular system, and changes the plasma level of lipids and lipoproteins. In this research the role of lead in plasma lipids and endothelial permeability of aorta were studied.

  Two groups of white male rabbits were under investigation for forty days. Group I were used lead water drinking contained 54.7 ppm lead during the experiment. The other group had drinking water with no lead. The plasma lipids, lipoproteins, lead, iron, total iron bounding capacity, and calcium were measured before and after the experiments. Both groups also were subjected to determination of endothelial permeability of aorta, direct blood pressure, and other pathological findings.

  The results indicated no weight gain in group I animals, while other group animals weight were increased significantly during the experiment (P<0.05). No hypertension was resulted in lead receiving animals, but a decrease of endothelial permeability of aorta was seen in group I.

  Partial decreasing of endothelial permeability in aorta in lead drinking group may confirm the different effect of lead in peripheral vascular system from blood brain barrier.

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Osteoarthritis (OA) is the most common joint disease in the world and it’s an important cause of longterm health problems and the most frequency reported reason for disability in the papulation. To determine the relationship between disability and depression cross sectioanl study in kerman was design in OA patients. OA was diagnosed by criteria of American college of Rheumatology, disability measured with Clin-HAQ and depression measured with Beck inventory questionnaire. Of 200 OA patients 83.5% were female, meanage of this population was 54.1±11.3 years, 6 pearson had treuma, 21 diabetes mellitus and 52 had hypertension, mean of MBI was 26.6±5.5 kg/m² and depression were 16.6±9.3 and disability was 0.97±0.4 wald foeward stepwise logestic regression models had been shown that depression and female sex were significants predictors for disability and disability was significants predictors for depression. OA Occurred in elderly people Age > 50 and is more frequent in women than men. Depression and disability have relationship together and which of them has a risk factor for other in patients with OA.

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Introduction:

ultrasound or CT scans (incidentaloma). Among adrenal cysts the most common types are epithelial cysts

and pseudocysts. Intracystic hemorrhage is one of the possible complications of adrenal pseudocysts.

Adrenal cysts are rare and usually asymptomatic they are occasionally identified during

Case Report:

vomiting and acute anemia. CT scan showed a huge mass between the liver and the right kidney.

Thereafter, the cyst was resected. It contained 5000

Histopathological examination revealed adrenal pseudocyst with a dense fibrous tissue wall and foci of

chronic inflammation. The patient was fully recovered after the surgery.

The patient of the present study was a young woman with right superior abdominal pain,ml of bloody dark and brown thrombotic liquid.

Conclusion:

like kidney, liver and gallbladder. Intracystic hemorrhage, whether spontaneous or post-traumatic, may

lead to acute anemia which, as soon as the diagnosis is confirmed, indicates surgery. The operation is

usually laparotomic adrenalectomy, since the laparoscopic approach is not sufficient to control large masses

with active bleeding inside.

Adrenal cysts may cause differential diagnostic problems with masses of contiguous organs

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  Introduction: The use of abdominal zippers for temporary abdominal closure was devised to facilitate repeated explorations, allowing multiple cleansing of the peritoneal cavity and the detection and management of septic complications. In our study, an open abdomen using a sterile zip in a patient with gangrenous bowels and reanastomosis derived infection is reported.

 Case report: In this study a patient with a history of appendectomy one year before referral (had referred to the physician with a one month complaint of abdominal pain) is presented. The patient underwent laparatomy twice. Most of his small intestine was resected due to the gangrene and primary anastomosis was performed. Finally after three days, the patient underwent multiple cleansing of the abdominal cavity following purulent discharge from the incision, acute respiratory distress syndrome and sepsis with diagnosis of discharge from the site of anastomosis. Zipper locked method was used for temporary closure of abdomen wall in order to facilitate multiple access of abdominal cavity. Finally, abdominal wall was closed constantly.

 Conclusion: Temporary closure of the abdomen by means of devices such as zip gives the opportunity of rapid, easy and safe assessment, management and treatment of these patients to the surgeons.

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  Background: Equality in distribution of health facilities is the main indicator for increasing the availability of the facilities to the society. The aim of this study was to classify Bushehr province towns in health structural indicators using Numerical Taxonomy.

  Methods : This was a descriptive cross sectional study that used 21 health structural indicators in the towns of Bushehr province. Data was collected from statistical yearbook. Data analysis was done using Numerical Taxonomy, Excel 2010 and SPSS/18.

  Results: There is large gap between townships of Bushehr province in terms of enjoyment of structural indicators of health services. Ganaveh township with 0 . 477 score and Deyr township with 0 . 973 score had the highest and lowest scores, respectively in regard to enjoyment of health structural indicators.

  Conclusions: In order to improve less developed indicators and decrease differences in enjoyment of health services indicators among townships, especially in Deyr town, it is proposed that development-oriented planning must be carried out appropriately in these townships.

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Introduction: The pickle and salted pickle, traditional fermented products, are popular in Iran. There has been done a lot of researches about these group of foods all over the world. According to few researches in this subject in Iran, the aim of this study was to isolate and identify the diversity of dominant lactic acid bacteria in pickles and salted pickles. Materials and Methods: This research was performed by analyzing 70 samples of different pickle and salted pickles. The isolates were identified as LAB by Gram staining and Catalase by using MRS agar. then those strains were identified at the species level by physiological tests such as NH3 production from arginine, CO2 production from glucose in MRS broth containing inverted Durham tubes, growth at temperatures of 15°C, 30°C, 45°C in MRS broth and Carbohydrate fermentation. Results: In total, 114 presumptive LAB with Gram-positive and Catalase-negative properties were obtained from these samples. The results revealed that all isolates were identified as L.plantarum, L.brevis, L.pentosus, L.casei, L.paracasei and Leu.mesenteroides. The most predominant LAB in these pickles was L. plantarum. Conclusion: The importance of LAB as an important group of probiotics and one of the most useful hurdles is clear. In other hand since vegetables are source of prebiotics, all kinds of pickles can be one of the best choices for producing different kinds of non dairy probiotic functional food products. The results indicate dominant LAB in traditional pickles and salted pickles produced in Tehran, Iran which provides raw data for further studies to improve traditional or industrial production.

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Background and Aim: Allergy to some food products is a usual affair which appears to be caused by immunologic and non immunologic reactions. One of the most important factors generating these reactions is mediating the IgE which can cause anaphylaxis. Additionally one of the most renowned allergens is wheat. However the best method for curing these patients is avoiding from allergen, modern approaches such as oral immunotherapy can be used for lowering or prevention of IgE increasing in these patients. The aim of this study is evaluation of total and specific IgE in patients before and after desensitization.
Methods: Patients suffering from wheat Allergy were recruited and 12 individuals of them approved by physical examination and Double-blind Placebo-controlled Food Challenge. Then they were put into desensitization protocol containing 2phases: first phase was gradually increased prescription of semolina and second was gradually increased doses of spaghetti. Eventually total and specific IgE to wheat was determined by ELISA before and after desensitization.
Results: Before and after desensitization specific IgE to wheat was measured in patients. Although it was shown little increase in specific IgE but there was no significant difference between after and before specific IgE. Total IgE was also measured before and after desensitization and despite of little increase in total IgE, there was no significant difference between after and before total IgE in patients.
Conclusion: In this study it was shown the effect of oral immunotherapy on specific and total IgE in patients suffering from wheat allergy but more study is needed in order to find the best initiation time of desensitization, how to increase gradual doses and the other factors influencing the process of immunotherapy.

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Background: Aerobic training is well supported as a useful component of an exercise. One of the most common adaptations that occur in this type of training is creating new vessels and increased angiogenesis factors. Aerobic training can be effective on angiogenesis.The aim of this study was to investigate the effect of aerobic training on cardiac expression of mir-126 in
normal and diabetic rats.
Methods: 35 Rats divided to two categories, diabetic and non-diabetics rats. Then each category of diabetic and non diabetic animals divided to two groups: under training and nontraining.Cardiac muscle was removed and immediately placed into liquid nitrogen. Cardiac expression of mir-126 investigated in rat cardiac muscle using Real-time PCR. For data analysis, One-way ANOVA and post-hoc Tukey’s test were used.
Results: The study results showed diabetes significantly decreases cardiac expression of
mir126 and 8 weeks of aerobic training significantly increases cardiac expression of mir126
in healthy and diabetic rats.
Conclusion: It seems aerobic training can prevent negative effects of diabetes via angiogenic path. Thus, kindle regulatory rocesses by mir126 that via aerobic training are impressed, could be worthy strategy on development of new theraphy methods in diabetes treatment.

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Background: Enterococci are gram-positive cocci that have frequently been isolated from animal and vegetable foods. The aim of this study was to identify the prevalence and antibiotic susceptibility of enterococci isolated from seven types of vegetables randomly selected from grocery stores in Tehran.
Methods: In this cross-sectional study, 140 samples were collected from April to October 2015. Enterococci were detected in samples using the Gram stain and biochemical tests such as catalase reaction, and hydrolyze bile esculin and identified at the species level by the common biochemical tests. Antibiotic susceptibility test of isolates with six antibiotics was also done using the disc diffusion method.
Results: Eighty-four out of 140 (60%) samples showed enterococci. Of these, 72.6% belonged to the species Enterococcus faecium. The results showed that 10, 6, 5, 1 and 1 isolates were E.durans, E. gallinarum, E. faecium, E. avium and E.casseliflavus respectively. Low percentages of microorganisms were resistant to tetracycline (15%), ampicillin (4%), and chloramphenicol (4%). A high percentage of microorganisms were resistant to gentamicin (93%), vancomycin (48%), and erythromycin (32%).
Conclusion: The results revealed contamination of dried vegetables in Tehran. According to the findings, we conclude that training of dealers and food suppliers are necessary and healthy principals should be followed. Also, supervision on food packing and storage should be considered to prevent food microbial contamination.
 

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Background: The purpose of this study was comparison of the effect of a therapeutic exercise program and oral administration of saffron on the levels of IL-6, TNF-a and glycemic control in type 2 diabetic women
Methods: 48 type 2 diabetic obese women were randomly divided into four equal groups (saffron + training, training + placebo, saffron, placebo). The saffron group + training and training + placebo groups performed aerobic training with intensity of 60-75% of maximal heart rate for 8 weeks (three sessions per week). Daily dose of 400 mg of Saffron sprout powder (once a day) was used for two months. The placebo contained 400 mg of wheat flour. The following IL-6, TNF-a, Blood glucose and HbA1c variables; lipid profiles and HOMA-IR were tested. The Shapiro-Wilk test, variance analysis with repeated measures, Bonferron's post hoc test, and one way analysis of variance with LSD post-test.
Results: In the post-test phase, the pre-test the variables IL-6 and TNF-α, blood glucose and HbA1c in intervention groups decreased significantly, and also in the post-test between group, saffron + training with training + placebo, saffron + training  with saffron, saffron + training  with placebo and saffron with placebo there was a significant difference (p<0.05). Also, in variables of weight and BMI, there were statistically significant differences between saffron + training with placebo groups, training + placebo with placebo groups, and saffron with the placebo groups (p<0.05).
Conclusion: It can be possible aerobic exercise and saffron consumption have a protective effect against the increased levels of blood glucose and HbA1c. It is possible that the reduction of blood glucose, IL-6 and TNF-a in saffron recipients is due to the presence of saffron metabolites, especially flavonoids (crostein and crocin) and increased antioxidant defense system through saffron.

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Background: Salmonellosis is a gastroenteritis caused by the infection with different serotypes of Salmonella. Salmonella enterica is an enterica subtype, enteritidis, typhimurium, and infantis are the most important factors of gastroenteritis in humans. In recent years, increasingly commonly used antibiotics and treatments are resistant. The main purpose of this study was to compare the antibacterial effects of lytic bacteriophage Cocktail and ciprofloxacin on Salmonella enterica strains in laboratory conditions.
Methods: Standard strains of salmonella (enteritidis, typhimurium, and infantis) were collected from the Faculty of Veterinary Medicine, University of Tehran, and their specific bacteriophages were isolated by soft agar method. Specificity of bacteriophages was investigated for strains of Salmonella and Staphylococcus aureus, Shigella dysenteriae and Enteropathogenic E. coli (EPEC) bacteria using spot test. Antibiotic sensitivity was determined using E-Test method. In order to obtain an appropriate headline for evaluating the therapeutic results, different concentrations of bacteriophage with bacteria were evaluated. Finally, the preventive and therapeutic effect was evaluated in comparison with ciprofloxacin.
Results: Different concentrations of bacteriophages have the ability to reduce and eliminate strains of salmonella (enteritidis, typhimurium, and infantis). Bacteriophage specific plaque against other strains of Salmonella and other intestinal pathogenic bacteria did not have any lytic function.
Conclusion: The results showed that bacteriophages function as specified. Due to the increasing prevalence of antibiotic resistance and treatment concerns, bacteriophages can be a good alternative to the use of antibiotics in the treatment of bacterial infections.
 
 

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Background: There is clear evidence to support the importance of regular physical activity and the use of antioxidants in the prevention or control of cardiovascular diseases, especially those that cause cardiac apoptosis. Our aim in this study was to determine the simultaneous effect of six weeks forced swimming and Crocin supplementation on the expression of 3 cardiomyocyte gene caspase in male rats infected with hydrogen peroxide.
Methods: 36 male Wistar rats were randomly divided into six groups of sham injections (saline), hydrogen peroxide, hydrogen peroxide and Crocin, hydrogen peroxide and forced swimming, hydrogen peroxide and forced swimming and Crocin, control group. The forced swimming protocol was held in two stages in training and exercises. For induction, H₂O₂ was given as sub peritoneal injection for 3 weeks once every other day and 30 minutes before the exercise. Crocin was injected in the peritoneum. Real Time PCR was used to express the Caspase 3 gene. To confirm the incidence of apoptosis, tissue samples were assessed by Tannel method. Statistical analysis was performed using Kolmogorov-Smirnov test for natural distribution. Then, the variance (Levin test) and Perth data were analyzed. Finally, one-way ANOVA was used to test the statistical hypotheses and the Scheffe post hoc test was used.
Results: Hydrogen peroxide induction was associated with a significant increase in expression of Caspase 3 gene expression and six weeks of forced swimming resulted in a significant decrease in Caspase 3 gene expression in rats' myocardial tissue, as well as interaction of six weeks of forced swimming and induction of Crocin, Caspase 3, which is completely visible in the results of the Tannal.
Conclusion: Regular forced swimming as well as Crocin consumption separately led to a significant reduction in gene expression. Caspase 3 was found in the rat's myocardium tissue. On the other hand, the combination of training and Crocin had a synergistic effect on inhibiting Caspase 3 gene expression in hydrogen peroxide poisoned rats.
 

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Background: In recent decades, palliative care is considered as a multidisciplinary approach which has been specified based on the nature and type of its target patients and their psychological needs. Assessment of these needs and attention to them are among psychologist's tasks that involve many challenges including the ambiguity of roles and educational and research needs. This review article aimed to investigate their specialized skills in assessment, intervention, and research, and explore the theoretical and practical aspects of this field in the palliative care setting.
Methods: In the present review article, database searching method was applied using the keywords of palliative, psychologist, advanced cancer, end of life, hospice, terminally ill, chronic illness, bereavement, and grief. PubMed, Elsevier, Scopus, Science Direct, and ProQuest databases were searched and eligible articles published between 1997 and 2017 were retained.
Results: Psychologists at palliative care team are involved in various stages of the disease. Communication and assessment are presented as the first steps of their services and then specific counseling and psychotherapy are provided for any psychological disorder and problem of patients. These psychologists will continue their services to the family of patients at the time of hospitalization until the stages of loss and mourning. The support and care of members of the palliative care team and participation in research projects are among other tasks of them.
Conclusion: Due to the multiple functions of psychologists in the palliative care team and the widespread provision of services from patients to their families and members of the palliative care team, it is essential to acquire specialized skills and continuing training for themlearning of nursing students as well as accepting responsibility professionals in medical sciences.

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Background: Foodborne diseases and resistance to antimicrobial agents are two of the world's most widespread global issues. Also, the excessive use of antibiotics has led to the resistance of bacteria belonging to the Enterobacteriaceae family to antibiotics, especially in carbapenems. Citrobacter is an opportunistic bacterium that is resistant to antibiotics in the emerging bacteria and has been challenging the treatment.
Methods: From 704 rectal swabs sent to the microbiological laboratory, 84 isolates of Citrobacter were isolated and identified using microbiological methods, differential tests and the API-20E kit. Antibiotic susceptibility was performed by disc diffusion method.
Results: Of the 84 isolates of Citrobacter isolated from patients with diarrhea, the dominant species was Citrobacter Ferrandi. (42.9%), 36 isolates from men and (57.1%) were isolated from 48 isolates. The highest and lowest antibiotic susceptibility belonged to meropenem (100%) and ampicilin (57%) respectively.
Conclusion: Recently, antibiotic-resistant citrobacters have emerged in hospital infections. The results of this study indicate that monitoring of antimicrobial resistance in Citrobacter is necessary. The policy of using antibiotics should be developed in hospitals, so that effective antibiotics can be prescribed and administered uncontrolledly.
 

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Background: Change in vascular function is considered to be an indicator for vascular disease. Effective factors on vascular function are enzyme eNOS and apoptotic regulator factors including BCL-2 and BAX. The purpose of this study was to investigate the effect of aerobic exercise during pregnancy on vascular gene expression of BCL-2, BAX, and eNOS in Sprague dawley rats offspring
Methods: Ten 8-week-old females Sprague Dawley rats were randomly divided into two groups of exercise during pregnancy (T) (221±9.9) and sedentary (C) (223.8±8). The aerobic exercise training was performed immediately after observation of the vaginal plaque for 21 days and 5 sessions per week with moderate intensity (35-45% vo2 max). About 2 days before delivery, their training program was terminated. Femoral artery samples were collected at 8 weeks of male offspring age. Data was analyzed with independent t-test for between group comparisons. The level of significance was set at p<0.05. Statistical analyses were carried out using the SPSS software (version 16).
Results: The results of the study showed that 21 days of aerobic exercise training with moderate intensity during pregnancy increased significantly mRNA of the BCL-2 gene(P=0.004), decreased significantly mRNA of the BAX gene in male offspring (p=0.000), but there was no significant change in mRNA of the eNOS gene (p=0.494).
Conclusion: It seems that moderate aerobic exercise during pregnancy can reduce apoptosis as a result of vascular dysfunction in adult offspring.
 

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Today, vascular diseases such as atherosclerosis are one of the leading causes of death in the world and the prevalence of it in older societies is rising. The current treatments for repair of cardiovascular function include organ transplantation, surgical reconstruction, mechanical or artificial devices, or the use of metabolic products. Although these methods are commonly used, they did not grow significantly due to the shortage of donors and transmission of infection complications, rejection tissue by the patient's body. Currently, many researches are underway in the field of tissue and medical engineering for the development of new artificial vessels for small diameter vessels. In general, it can be classified as a source of biomaterials for natural and synthetic (biodegradable and non-degradable) broad spectrum of chemical and mechanical properties. The main purpose of tissue engineering is the design of alternative materials in vitro condition using live cells in order to restore the physiological function of the patient's tissue, which is similar to the natural tissue lost. In fact, tissue engineering as an interdisciplinary approach involves incorporating the principles of engineering, cellular and molecular biology, and clinical medicine. The tissue engineering structures consist of three major components: cells, materials, and growth factors. In this article, a review of the biomaterials, fabrication of scaffold, cells, as well as clinical applications in vascular tissue engineering are presented herein.
 

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Background: Diabetes is known as one of the diseases that has imposed many health, social and economic problems on human societies and has spread widely in recent decades (1). Glucose metabolism and related disorders for the central nervous system (CNS) and astrocytes, which are the most important glial cells of the central nervous system; It is important. Therefore, disorders of the hypothalamus, cerebral cortex and hippocampus, vascular disorders of the brain, etc. are among the complications of diabetes on the central nervous system (3). Among the brain regions, the hippocampus is one of the most sensitive areas that is vulnerable to harmful factors such as ischemia, stress and especially diabetes, during which it undergoes neurophysiological, structural and molecular changes such as decreased neurogenesis 3 and atrophy. Hippocampus (4), which leads to one of the significant changes caused by diabetes, namely neuronal death in the hippocampus (5).
Due to the fact that insulin resistance and type 2 diabetes are characterized by hyperglycemia, hyperinsulinemia, increased plasma FFA levels, decreased fat oxidation ability and fat accumulation in body cells (6). And this increase in fat content has a high relationship with insulin resistance and the main cause of this accumulation of fat is mitochondrial dysfunction (7). Two mitochondrial enzymes that are important in the fat metabolism of cells in the body are Malonyl-CoA and CPT2. Malonyl-CoA, a coenzyme derived from malonic acid, plays an essential role in the transport of fatty acids into the mitochondria and in their synthesis. Are fatty acids (8). Accordingly, some evidence suggests that reducing the amount of malonyl coenzyme A reduces insulin resistance (10).In this regard, carnitine palmitol transferase 2 is a mitochondrial protein that is attached to the inner part of the mitochondrial membrane and plays a key role in the transport of fatty acids into the cell for beta oxidation (11). The regulation of CPT-2 activity by Malonyl-CoA or other metabolic mediators is not directly or indirectly known (12). One of the supplements that has been shown to facilitate beta oxidation of long chain fatty acids and participate in the metabolism of branched-chain amino acids and fix cell membranes is L-carnitine (14). Due to the fact that L-carnitine is able to transport the acetate group from the mitochondria to the cytoplasm, thereby reducing the ratio of acetyl coenzyme A to coenzyme A in the mitochondria, thereby increasing the activity of the enzyme pyruvate dihydrogenase and thus glucose catabolism. Give (15). Therefore, taking this supplement may be able to improve mitochondrial disorders caused by diabetes in various tissues, including nerve tissue.
On the other hand, in addition to nutrition and various supplements, physical activity and exercise have been proposed as a way to control diabetes disorders (16). In confirmation of this, exercise activity in diabetic rats by reducing blood sugar levels, causes cell proliferation and increases the synaptic plasticity of neurons in the hippocampus of the brain (17). In fact, exercise creates endogenous neuroprotection by reducing endogenous neurons and protecting them against diabetic neuropathy, and ultimately reducing diabetic cognitive and motor disorders (18), thus increasing activity. Regular exercise can improve the malleability of the brain (19), the antioxidant system (20), and the upregulation of neurotrophins (21).
Considering the above and considering the negative effects of diabetes on various body systems on the one hand and irreparable damage to society, researchers are always looking to discover the best way to prevent and treat this dangerous complication. Various studies have been performed on the effect of increased plasma L-carnitine on FFA intake or exercise endurance capacity following oral administration or intravenous injection; In this regard, some findings suggest that L-carnitine supplementation increases fat oxidation (25) decreases carbohydrate oxidation (26) improves exercise (27) and reduces recovery time following exercise (28) Leads. Given the above and differences in research results on the effect of aerobic exercise and L-carnitine on mitochondrial disorders on the one hand and the lack of research on the subject of research on the hippocampus on the other hand and discovering a way to minimize the negative effects of diabetes Specifically, the increase in cellular fat content in the hippocampus, the researcher seeks to answer the question of whether increased aerobic activity and consumption of L-carnitine have an effect on mitochondrial factors in the hippocampus of diabetic rats or not?
Methods: This research is of developmental type and its method is experimental. In which the ethical principles of working with laboratory animals, such as the availability of water and food, and proper storage conditions, and how to kill mice were observed.
The statistical population of the present study consisted of male Wistar rats in the weight range of 250 to 300 g and 6 to 8 weeks of age that were bred at the Razi Serum Laboratory Animal Breeding Center. From the statistical population, 45 rats were randomly selected as a statistical sample and randomly divided into 6 groups. Groups include 1) sham injection group (5 rats), 2) healthy control (8 rats), 3) diabetic control group (8 rats), 4) diabetic group receiving L-carnitine (8 rats), 5) The diabetic group was aerobic exercise (8 rats) 6) The diabetic group was aerobic exercise and received L-carnitine (8 rats). In the diabetic group, animals became diabetic by injecting streptozotocin (STZ) at 55 mg / kg body weight. 48 hours after STZ injection, hyperglycemia was confirmed by glucose oxidase assay with biosystem kit. Thus, rats with serum glucose above 300 mg / dL were considered diabetic. In the diabetic and exercise groups, the animals ran on a treadmill for six weeks after induction of diabetes. Rats receiving L-carnitine received 100 mg of L-carnitine (29, 30) orally daily for 6 weeks. Aerobic exercise groups also performed a training program including aerobic exercise on a treadmill, 5 days a week, from 9 am to 11 am, for 6 weeks (31).
Results: In the present study, the effect of aerobic exercise and consumption of L-carnitine on the mitochondrial CPT2 content of hippocampal tissue was observed (p= 0.008). However, there was no significant difference in the number of Malonyl-CoA mitochondria in the hippocampal tissue of diabetic rats as a result of aerobic exercise and L-carnitine administration (p= 0.227). The effect of aerobic exercise and alcarnitine consumption on Malonyl-CoA and CPT2 enzymes in the hippocampal tissue of diabetic rats was investigated. Based on the results of Tukey post hoc test, it was shown that diabetes is associated with a significant increase in Malonyl-CoA mitochondria of hippocampal tissue. Consistent with a study by Badiopada et al. (2006) that increased Malonyl-CoA levels and decreased fatty acid oxidation showed key abnormalities in insulin resistance in type 2 diabetic specimens (32).
 In general, exercise can stimulate lipid oxidation and inhibit lipid synthesis in the liver, a process that is mediated by activation of the AMPK pathway (33). However, as the results of the present study show, the response of Malonyl-CoA to exercise is different in hippocampal tissue, so it is possible that Malonyl-CoA levels in different tissues respond differently to exercise. The lack of significant change in Malonyl-CoA levels in the hippocampal tissue of diabetic specimens and the aerobic exercise program with L-carnitine can be attributed to changes in tissue insulin sensitivity and tissue oxidation. In the present study, the interaction between aerobic exercise and L-carnitine consumption had no effect on Malonyl-CoA hippocampus in rats. Although there are several mechanisms involved in supporting the effects of exercise on diabetes, the type of exercise and the dose of L-carnitine supplementation can also affect the results. Therefore, further studies are needed to discover the mechanism of Malonyl-CoA changes in the hippocampus, especially in diabetic specimens following L-carnitine exercise and consumption.
The present study showed that diabetes was associated with a significant decrease in hippocampal tissue CPT2 index and the results showed that aerobic exercise and L-carnitine consumption had no effect on rat hippocampal CPT2. But the interaction of aerobic exercise and supplementation significantly increased CPT2 in the rat hippocampus. The palmitoyl carnitine transferase (CPT) system contains two enzymes, CPT I and CPT II, and are involved in the transport of long-chain fatty acids into the mitochondrial compartment. The enzymes are CPT I in the outer membrane and CPT II in the inner membrane of the mitochondria (11). The results of Aminizadeh et al. (2017) on the regulation of cellular energy homeostasis in the skeletal muscle of male rats after four weeks of endurance training showed that the expression of carnitine palmityl transferase 1 beta gene in the endurance training group was significantly higher than the control group (34). However, the exact mechanisms of the effect of exercise on CPT II regulation in hippocampal tissue are not well understood. Also, the physiological significance of the natural inhibition of CPT II by malonyl coa has not been determined. However, due to the high sensitivity of CPT II to Malonyl-CoA, it can be stated that changes in CPT II level are dependent on the level of Malonyl-CoA (35).
Conclusion: Due to the effect of aerobic exercise and L-carnitine supplement alone and in interaction, using them in consultation with a physician is recommended for diabetics.