مجله دانشگاه علوم پزشکی گرگان
سال بیست و سوم شماره 2 (پیاپی 78، تابستان 1400)

Coronary heart disease (CAD) is one of the most important causes of death in most countries including Iran. Exercise training after coronary artery bypass grafting and the resulting adaptations increase the capillary density of skeletal and cardiac muscle along with the development of new capillaries and improve cardiovascular and functional ability due to increased mitochondrial biogenesis. This study was done to evaluate the effect of aerobic-resistance training on plasma levels of PGC1α (Peroxisome proliferator 1a) in post coronary artery bypass grafting (CABG) patients.

This clinical trial study was done on 30 male patients aged 45-60 years who underwent bypass surgery. The patients were randomly divided into intervention and control groups, respectively. Subjects in interventional group were received aerobic resistance training for eight weeks (3 sessions per week). Subjects in control group did not receive any intervention. To measure lymphocytes, fasting blood samples were taken 48 hours prior to the bigning of the first training session and also 48 hours after the last training session. PGC1α was measured using ELISA method.

Aerobic-resistance training caused a significant increase in plasma level of PGC1α in the training group compared to the control group (P<0.05). In intervention group, plasma level of PGC1α was significantly higher after the exercise than before the exercise (P<0.05).

Aerobic-resistance training exercise with increasing serum levels of PGC1α can play a role as an effective factor in initiating angiogenic processes and increasing capillary density and be used as an effective factor in various people, especially cardiovascular patients.

One of the most common complications of mild cognitive impairment is increased body sway and falls. This study was performed to evaluate the effect of Pilates training on control posture in patients with mild cognitive impairment.

This clinical trial study was performed on 30 women with mild cognitive impairment who referred to elderly Research Center in Kermanshah city, north-west of Iran during 2019. Subjects were randomly divided into two groups including Pilates Training and control groups. Pilates training group was trained for eight weeks, 3 sessions per week and duration for each session was one hour. The control posture of the subjects before and after the exercise was evaluated.

There was significant difference in obtained scores in the size and distance of the center of pressure area range with open and closed eyes in the intervention group, prior and after training (P<0.05). The mean postural control (the size and distance of the center of pressure area range with open and closed eyes) reduced after 8 weeks of Pilates exercises in the intervention group in compared to control group (P<0.05).

Pilates training is effective in improving postural control in patients with mild cognitive impairment.

Exercise in cardiac patients after coronary artery bypass grafting (CABG) improves cardiovascular function by increasing the capillary density of the myocardium. Platelet-derived growth factor and stromal cell-derived factor-1 play an important role in angiogenesis and cell proliferation and differentiation. This study was performed to determine the effect of eight weeks of combined training on plasma levels of Platelet-derived growth factor (PDGF) and stromal cell-derived factor-1 (SDF1) in CABG patients.

In this clinical trial study, 24 patients who underwent coronary artery bypass grafting operation were selected using convenience and purposeful sampling method and randomly divided into two combined training and control groups. Subjects in combined training group were received aerobic and resistance training protocols for eight weeks, three sessions per week. Before and after training program, body composition assessments and blood sampling were performed to measure Platelet-derived growth factor (PDGF) and stromal cell-derived factor-1 (SDF1). ELISA method was used to measure PDGF and SDF1.

The level of PDGF was significantly increased in intervention group in compared to control group (P<0.05). Although the level of SDF1 in the intervention group increased in intervention group in compared to control group; but this increase level of SDF1 was not significant.

This study showed that the eight weeks of combined rehabilitation training can promote desirable physiological adaptations in cardiovascular health by increasing the plasma levels of PDGF.

In recent years, psychological therapies increasingly used as complementary treatment of group psychotherapy. This study was done to evaluate the effectiveness of logotheraphy and cognitive-behavioral therapy on life expectancy among students with depression disorder.

This clinical trial study was performed on 45 students with depression disorder whom refered to consulting center in Rasht city, north of Iran during 2018-19. Subjects were randomly divided into three groups including logotheraphy, cognitive-behavioral and control groups. At first, students who were willing to participate in this course completed Miller Hope Scale (MHS) Scale (pre-test). Then, the interventional groups were received logotheraphy and cognitive-behavioral group counseling for 10 weeks (90 minutes each session, once a week). After completing the course of treatment, all three groups were retested and one month after the post-test, a follow-up test was performed.

The mean score of the life expectancy of students with depression in interventional groups (logotheraphy, cognitive-behavioral) were significantly increasd in compared to controls in post-test and one month after follow up (P<0.05). There was no difference between cognitive-behavioral therapy and logotheraphy in score of the life expectancy of students with depression in post-test and one month after follow up.

This study showed that the group counseling method of logotheraphy and cognitive-behavioral therapy can increase the life expectancy of students with depressive disorder by teaching concepts such as identifying negative spontaneous thoughts and cognitive distortions and techniques of their own techniques as a useful intervention method.

Genu varus is a deformity in frontal plane that in weight bearing position whiles the medial malleolus’s touch each other, the medial knee epicondyles far from each other. Genu varus is very prevalent in soccer players. This study was done to evaluate the effect of using knee brace and lateral wedge on muscular activity amplitude in male soccer players with genu varus during running.

This quasi-experimental study was done on 15 right-footed male soccer players with genu varus and 15 healthy soccer players. A wireless electromyography system with eight pairs of bipolar Ag/AgCl surface electrodes (20 mm center-to-center distance; input impedance of 100 MΩ; and common-mode rejection ratio of >110 dB) was used to record the activity of the tibialis anterior, gastrocnemius medialis, biceps femoris, semitendinosus, vastus lateralis, vastus medialis, and rectus femoris, and gluteus medius muscles of the right leg. Electromyography data were recorded by sampling rate of 1000 Hz in selected muscles during running at five conditions including: control, 10 degrees lateral wedge, 15 degrees lateral wedge, simultaneous using 30 degrees brace and 10 degrees lateral wedge, and simultaneous using 30 degree brace and 15 degrees lateral wedge.

Treatment intervention had reduction effect on muscular amplitude of biceps femoris and vastus lateralis during push-off phase (P<0.05). Muscular amplitude of biceps femoris and vastus lateralis during loading phase was reduced due to Treatment intervention (P<0.05).

Simultaneous using of lateral wedge and knee brace reduce the electromyography activity of vastus lateralis and biceps femoris muscles. This reduction may be associated with passive support of knee brace that in result could decrease the external knee adductor mowment.

Intrauterine growth restriction (IUGR) is an obstetrical complication. IUGR increases the chance of neonatal death and obstetrical complications in comparison with normal pregnancy. Timely diagnosis of this condition allows effective interventions that decrease the morbidity and mortality. This study was done to compare of superior vena cava to aorta diameter ratio in three vessel view in fetuses with intrauterine growth restriction and normal growth fetuses.

This case control study was performed on 60 mothers in 25 to 37 weeks of pregnancy who were referred to radiology department of a hospital in Iran during 2018-19. 30 patients were diagnosed with IUGR and were included as case group. 30 healthy fetuses were included as control group. Routine ultrasonography was performed for evaluating placenta, fetuse, and amniotic fluid. Also, colour Doppler sonography was performed on umbilical vessels along with superior vena cava and ascending aorta for definite diagnosis of IUGR. Demographic data regarding fetuse’s age, pregnancy status, number of parities, and age of mother were also accumulated. The superior vena cava/aorta ratio (SVC/AO) was compared in IUGR and healthy fetuses. Based on their amniotic fluid, fetuses were divided into normal and mild oligohydramnios.

There was a significant difference in SVC/AO diameter index between case and control groups (P<0.05). Mean SVC/AO ratio was significantly higher in IUGR fetuses in compared to healthy fetuses. There was no significant difference between normal and oligohydramnios fetuses either in case or control groups.

Implementation of SVC/AO diameter index in three vessels view sonography in screening programs for pregnant women can reduce neonatal morbidity and mortality.

Chronic hypertrophy of tonsils and adenoids is the most prevalent cause of sleep apnea in children, leading to multiple behavioral disorders. Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder caused by adverse biological, social and psychological conditions. This study aimed to evaluate the effect of adenotonsillectomy on ADHD symptoms in children with adenotonsillar hypertrophy before and six months after the surgery.

This descriptive-analytical study was performed on 37 children with adenoid hypertrophy in Gorgan, north of Iran during 2018. The data gathering tool was a two-part questionnaire; the first part contained personal data (age, gender), and the second part included the strengths and difficulties checklist. Patients were placed in three groups of hyperactivity, inattention and impulsivity based on 18 criteria of Diagnostic and Statistical manual of Mental disorders. The questionnaires were completed directly by the project performers. Information was collected from the parents. The strengths and difficulties questionnaire (SDQ) was used to assess children before and six months after the adenotonsillectomy surgery.

The average and standard deviation of scores in subscales of emotional symptoms, conduct problems, hyperactivity-inattention, peer relationship problems and prosocial behavior were improved, also a significant difference was observed between SDQ scores before and after adenotonsillectomy (P<0.05).

Adenotonsillectomy can significantly reduce the SDQ score. Therefore, in children with hyperactivity, a medical disorder such as adenoid hypertrophy can cause the onset, exacerbation and persistence of the disease. Proper treatment can be a major factor in controlling the severity of symptoms and even in improving the patient’s recovery.

The incidence of tuberculosis in Golestan province in northern Iran is 26.7 cases in 100000 persons. Lack of energy and nutrients is one of the reasons for the increased risk of tuberculosis. Malnutrition is an important cause of high mortality in the Tuberculosis (TB) population. With decreasing level of visceral proteins, anthropometric indices, and micronutrients increase the risk of mortality. This study was performed to determine the status of nutritional status of patients with Tuberculosis in Gonbad-e-Kavous, north of Iran during 2014.

This descriptive-analytical study was performed on 45 pulmonary tuberculosis patients with mean age of 57±20 living in Gonbad city, north of Iran during 2014. Demographic information and history of tuberculosis, body mass index, albumin, hemoglobin, total protein and blood cell count and food intake were recorded for each patient.

58% of patients were women. 52% of patient was resident in rural area. There was a significant difference in terms of body mass index and previous history of tuberculosis in patients with different disease intensities. Among patients with different disease intensities, the difference in the distribution of anemia severity was not significant. There was no significant difference between the two sexes in terms of disease severity distribution. According to the fitted regression model, the age variable, even in the presence of other variables, had a significant effect on disease severity (P<0.05).

With increasing disease severity, patientschr('39') BMI decreases and the severity of malnutrition and anemia increases. The severity of the disease increases with age. Tuberculosis patients need nutritional support.

Mood disorders such as depression, anxiety, stresses, and low sleep quality are common among overweight / obese people. Accumulating evidence support the role of diet quality in brain function and behavior. This study was done to determine the relationship between dietary energy density and indices of mental health in overweight and obese women.

This descriptive-analytical study was performed on 301 women, referring to Tehran health centers, with mean BMI 30.7±3.7 kg/m2 aged 18-56 years during 2017-18. Based on a semi-quantitative food frequency questionnaire, dietary energy density was calculated by dividing the total dietary energy intake from consumed food (kcal/d) by the total weight (g/d) of consumed foods (excluding beverages). Physical activity was measured using International Physical Activity Questionnaire (IPAQ). The questionnaire includes 7 items to assess the intensity of activities by the vigorous, medium, and light for at least 10 minutes during the last week. Mental health was assessed using the 21-question version of the Depression Anxiety Stress Scales (DASS-21) and the Pittsburgh Sleep Quality Index was applied for screening sleep quality. Weight, height, BMI, hip, and waist circumference were measured for all participants.

Women in the highest quartile of dietary energy density had higher systolic and diastolic blood pressure but lower serum triglyceride (P<0.05), compared with subjects in the first quartile. Univariate (95% CI: 1.01-4.56, P=0.04, OR=2.15) and multivariate (95% CI: 1.13-5.79, P=0.02, OR=2.56) logistic regression analysis, adjusted for age, BMI, and physical activity, showed that dietary energy density was significantly related to increased risk of stress. No significant association was detected between dietary energy density with sleep quality, depression, and anxiety.

Dietary energy density was directly associated with the presence of stress, but not depression, anxiety and low sleep quality.

Inactivity and physical inactivity can be one of the main causes of obesity, especially abdominal obesity, hypertension, cardiovascular disease. Abdominal obesity is a serious risk factor for cardiovascular disease which being inversely related to VO2 max (maximal oxygen consumption). This study was done to determine the non-invasive monitoring of cardiorespiratory fitness and its association with abdominal obesity in men.

In this descriptive-analytical study, men aged 20-60 years were selected by cluster sampling from different areas of the centers of the three provinces including Qazvin, East Azarbajan and Hamedan in Iran. In accordance with Morgan method, the sample size was 384 men from all provinces which were divided into four age groups. Aerobic power of subjects was assessed by utilizing Bruce, Rockport, Pedometer and International Physical Activity Questionnaire (IPAQ). Waist-to-height ratio (WHtR), Waist-to-hip ratio (WHR), Body adiposity index (BAI), Surface-Based Body Shape Index (SBSI) and body mass index (BMI) was measured for each subject.

Based on the results, in all three provinces as well as the provinces themselves, VO2 max was significantly different between different age groups (P<0.05). Also, in abdominal obesity indices, a significant difference was in abdominal obesity indices BMI, WHR, WHtR and BAI (P<0.05). There was a significant inverse correlation of the VO2 max with central obesity indices, except for the SBSI.

Reducing physical activity and consequent cardiorespiratory fitness led to an increase in abdominal obesity indices in different age groups that shows a significant inverse correlation of the VO2 max with central obesity indices, except for the SBSI.

Campylobacter is one of the most important pathogens causing bacterial gastroenteritis, which is usually transmitted through the food of animal origin. This study was done to evaluate the status of Campylobacter in diarrheal food outbreaks compared to other microbial agents.

This descriptive study was performed on 305 diarrheal swab samples from 102 food outbreaks during six months from spring to the end of summer 2018. Presence of Campylobacter species were assessed according to the protocol of the General Directorate of Laboratory Affairs.

Out of 305 samples, 8 (2.6%) were identified as Campylobacter species, 3 (37.5%) Campylobacter and 5 (62.5%) Campylobacter coli. The epidemiology of the outbreaks showed that female (54.5%), average age of 16-30 years (28.2%), consumption of salads and vegetables (16.1%) and living in the cities (59.7%) were the most cases.

This study showed that in addition to classic pathogens such as Salmonella, Shigella, Escherichia coli, attention also should be paid to Campylobacter bacteria. In addition, recognizing epidemiological factors can play an important role in preventing and controlling food outbreaks.

Foreign body aspiration is the cause of death in 7% of children under two year’s olds. Children’ molars teeth do not erupt and under devedoled ability to swallow food and generally likely to be distracted, playing or ambulatory while eating. This study was performed to determine the frequency of foreign body aspiration in children under ten years old in north of Iran.

This descriptive study was done on 50 children (21 boys, 29 girls) less than ten years old with the final detection of foreign body aspiration hospitalized in Taleghani hospital in Gorgan, north of Iran during 2016-17. Demographic characteristics, results of physical examination, radiography and bronchoscopy recorded in the file and the radiology report was collected by a pulmonologist and radiologist.

The common age of foreign body aspiration was between 1-3 years (58%) followed by over 3 years (24%) and under 1 years old (18%). Symptoms of patients with foreign body aspiration were including cough (64%), rhonchi (52%), respiratory distress (32%), wheezing (32%), choking (30%). Common physical examination findings were wheezing (40%), unilateral pulmonary sound (34%), stridor (20%), and rhonchi (6%). The most common findings in Chest X-Rays were unilateral air trapping (48%) in right lung, left mediastan shift (30%), right lung atelectasia (20%), pneumonia (16%). Just in one case (2%) was found the body of radio opac in right lung and in 32% of cases, the graghs were normal. In 70% of patients less 24 hours, in 26% between 1-15 Dayes and in 4% of cases more than 15 Dayes were taken to medical centers. The most common foreign body was nuts (32%) followed by plastic objects (26%), aspiration by sunflower seeds (14%) and beens (10%) and other foreign objects (18%).

The most common clinical signs of foreign body aspiration were cough, wheezing and right lung pneumonia.

One of the most important concerns in children is self- medication that may cause in delay the correct diagnosis, and increases morbidity and mortality. This study was performed to determine the frequency of self-medication of parents in children in need of medical care in Gorgan city.

This descriptive-analytical study was performed on 270 children referred to the pediatric clinic of Taleghani Hospital in Gorgan, northern Iran during 2018-19. Medications were given to the children by their parents arbitrarily without prescriptions by doctors during the recent week were evaluated.

58.5% and 41.5% of children were males and females, respectively. The average age of children was 5.79 ±4.15 years. Self-medication was the first choice of 60.4% of parents. In the recent week, 48.9% of parents had self-medicated to treat their childchr('39')s current illness, of which 31.8% reported antipyretic, 17.4% herbal medicines, 11.4% antibiotics and 23.5% other medicines. 91% of parents were unaware of correct dose of drugs and 96.3% did not have any knowledge about possible side effects of drugs, contraindications and precautions. There was a statistically significant association between parent job (self-employment) and self-medication (P<0.05).

48.9% of parents were performed self-medication on their children. Out of those parents 91% and 96.3% were not aware from the correct drugs dosage and of possible side effects, contraindications and potential risks respectively.

Late postpartum hemorrhage (PPH), as an unpredictable obstetrics emergency, is characterized as a leading cause of mortality and maternal complications worldwide. Uterine artery pseudoaneurysm (UAP) is a rare cause of PPH, which may develop after uncomplicated cesarean and Gynecologic surgeries, including dilatation and curettage, hysterectomy, and myomectomy. Uterine artery embolization has become a popular treatment for postpartum hemorrhage. In this case report, we present a patient with PPH due to UAP who was treated by endovascular embolization of the uterine artery. A 39-years-old woman was admitted 55 days after her third cesarean section due to massive vaginal bleeding resulting in severe hemodynamic derangements. After initial resuscitative measures, diagnostic studies revealed the UAP, and soon after, the coil embolization of the uterine artery was performed. When conservative managements fail to control massive late postpartum hemorrhage, angiography and embolization of the uterine artery can be the modality of choice, rather than hysterectomy (with its potential complications) which preserves the patientchr('39')s fertility.