مجله دانشگاه علوم پزشکی گرگان
سال بیست و چهارم شماره 4 (پیاپی 84، زمستان 1401)

Sports activities are hindered by the lack of clean air in large and industrialized cities, and the countless benefits of exercise are not considered. With the search of the literature, 89094 articles related to air pollution that have been published in SID, PubMed, and Web of Science until December 2021 were found. Ultimately, 80 articles were extracted after selecting the articles and narrowing the search to exercise inflammation and lung tissue. After removing out-of-date articles (not published between 2000 and 2021) and those without full text, 65 articles were included in the review. Based on the review, exposure to air pollution is associated with increased inflammation and decreased cellular immune function, which is characterized by the activation of toll-like receptors and downstream signaling pathways. Regular exercise improves the inflammatory status in different pulmonary diseases. People who exercise in polluted environments are at increased risk of respiratory and cardiovascular diseases due to the elevated amount of pollutants delivered to the lungs. However, studies did not take into account the potential anti-inflammatory effects of exercise training, which could inhibit the pro-inflammatory events induced by air pollution. It seems that regular exercise modifies pulmonary inflammatory responses and body mass and in part decreases the risk of pulmonary diseases.

The ankle is one of the most vulnerable joints in the body in terms of weight bearing. The pronate foot is the most common complication of the lower limbs that causes a decrease in the height of the internal longitudinal arch when bearing body weight. This study was conducted to compare the effect of exercises in water and with thera-band on loading rate, impulse, and free torque in people with pronation immediately and after eight weeks.

This clinical trial was conducted on 45 male students with pronate foot at the University of Mohaghegh Ardabili. The subjects were randomly divided into three groups of 15 people including control, thera-band, and water training. The intervention groups performed the exercises for eight weeks and the immediate and long-term effects of the exercises were compared.

The positive and negative peaks of free torque, vertical loading rate, and vertical impulse in the water training group after eight weeks decreased significantly compared to the pretest and immediately after exercise (P<0.05). Also, the internal-external direct impulse in the water training group increased significantly after eight weeks compared to the pretest and immediately after exercise (P<0.05). In addition, the positive peak of free torque and vertical impulse decreased significantly in the thera-band group after eight weeks compared to the pretest and immediately after exercise (P<0.05). Moreover, the loading rate decreased significantly immediately and after eight weeks in the thera-band group compared to the pretest (P<0.05).

Eight weeks of exercise in water and with thera-band can improve loading rate, free torque, and impulse in people with pronate foot during walking.

Breast milk has significant benefits for both mothers and babies. Counseling is a beneficial method for the continuity of exclusive breastfeeding. Remote counseling methods are currently being developed. This study was conducted to determine the effects of telephone counseling on the continuity and duration of exclusive breastfeeding among mothers who have had a cesarean section.

In this clinical trial, 154 mothers who have had cesarean section delivery were randomly divided into an experimental and a control group. The intervention group received seven sessions of telephone counseling for 1-3 months postpartum in addition to the routine breastfeeding training program. The control group only received the routine breastfeeding training program.

After 4 months postpartum, the average duration of exclusive breastfeeding in the intervention group (15.51±0.88 weeks) was longer than that in the control group (10.74±5.33 weeks) (P<0.05). At 3 months postpartum, exclusive breastfeeding in the intervention group was 10.45 times longer than in the control group (OR=10.455, CI=2.547-42.912, P<0.001).

Telephone counseling is effective in increasing the continuity and duration of exclusive breastfeeding in mothers who undergo a cesarean section.

Acrylamide is a neurotoxic agent that increases oxidative stress by creating an imbalance between the production and removal of free radicals, which in turn contributes to the pathogenesis of some neurodegenerative disorders. Thymoquinone extracted from Nigella satvia has prominent antioxidant effects. The objective of this study was to evaluate the effects of thymoquinone on hippocampal oxidative stress and neuronal density following acrylamide administration in male rats.

In this experimental study, 28 male Wistar rats aged 10-12 weeks and weighing 180-200 g were randomly divided into 4 groups of 7 rats: control, acrylamide, acrylamide + thymoquinone treatment (1 mg/kg), and acrylamide + thymoquinone treatment (5 mg/kg). For induction of brain injury, 50 mg/kg of acrylamide was injected intraperitoneally. Two days after the acrylamide injection, the rats were sacrificed, and malondialdehyde (MDA), glutathione (GSH), and catalase levels were measured in hippocampal homogenate. Evaluation of neuronal density in hippocampal CA1 region was also performed by Nissl staining.

Acrylamide injection significantly increased MDA level and reduced GSH content and catalase activity in comparison with the control group (P<0.05). Administration of 5 mg/kg thymoquinone significantly reduced MDA level (P<0.05) but improved GSH and catalase activity in comparison with the acrylamide group (P<0.05). In addition, neuron density of hippocampal CA1 region did not differ significantly between the groups.

Thymoquinone can attenuate oxidative stress markers in a dose-dependent manner.

Spirulina (Spirulina platensis) has numerous nutritional and therapeutic benefits. This experimental study aimed to investigate the effect of spirulina on changes in the levels of liver enzymes of male BALB/c mice exposed to a high dose of acetaminophen.

In this experimental study, 42 adult male BALB/c mice were divided into seven groups of six. The toxic dose of acetaminophen 600 mg/kg body weight was considered. The control group received only a standard diet and water. The sham group was gavaged with saline solution. The third to seventh groups were treated as: acetaminophen; spirulina 600 mg/kg/bw, spirulina 300 mg/kg/bw, spirulina 600 mg/kg/bw + acetaminophen, and spirulina 300 mg/kg/bw + acetaminophen, respectively. In all groups, mice were treated with acetaminophen and spirulina powder by gavage for 14 consecutive days. Twenty-four hours after receiving the last dose of medication and deprivation of food (the animals still had access to water), the animals were anesthetized and blood samples were taken from the heart. Activity of liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) was measured by spectrophotometry. Protein concentration was determined by the Lowry method. Catalase activity was assessed using hydrogen peroxide. The amount of malondialdehyde was measured and the total antioxidant capacity was determined by FRAP method by reducing ferric to ferro ions.

The levels of serum transaminases (ALT, AST, ALP) as well as the level of total antioxidant capacity and malondialdehyde of the acetaminophen-treated group increased significantly compared to the control group (P<0.05). The levels of these enzymes in the group treated with S. platensis 300 mg/kg/bw + acetaminophen decreased significantly compared to the group treated with acetaminophen (P<0.05). Catalase activity in the acetaminophen group was significantly decreased compared to the control group (P<0.05).In the group of S. platensis 300 mg/kg/bw + acetaminophen, catalase activity increased significantly compared to the acetaminophen group (P<0.05). The results of experiments in two groups of spirulina and acetaminophen showed that the active ingredients of the algae at a dose of 300 worked better than 600 mg per kg of body weight in response to oxidative stress.

Consuming 300 mg/kg of S. platensis along with a near toxic dose of acetaminophen increases resistance to oxidative stress and injuries caused by drug poisoning by affecting the activity of enzymes and the antioxidant defense system.

Vincristine is an important anticancer drug, which is highly toxic to the liver. It is a naturally occurring polyphenol found in many plants. Some studies have shown the anti-inflammatory and antioxidant effects of resveratrol. This study was conducted to determine the hepatoprotective and antioxidant effects of resveratrol against vincristine-induced toxicity in mice.

In this experimental study, 32 female NMRI mice weighing 25-30 grams were randomly divided into four groups (n=8): control, vincristine, vincristine + resveratrol, and resveratrol. The animals received vincristine intraperitoneally at a dose of 3 mg/kg/bw once a week for four weeks. They also received resveratrol at a dose of 30 mg/kg for 28 days through gastric gavage. At the end of the study, the activity of alanine transaminase (ALT) and aspartate transaminase (AST) were measured. The level of antioxidant enzymes including superoxide dismutase (SOD), glutathione peroxidase (GPX), malondialdehyde (MDA) as well as total antioxidant capacity (TAC) was measured in the liver tissue of mice.

The activities of ALT, AST, SOD, and GPX decreased in the vincristine group compared to the control group, while MDA level increased significantly (P˂0.05). Treatment with resveratrol in the vincristine + resveratrol group improved the evaluated parameters compared to the vincristine group (P˂0.05).

Resveratrol has protective and antioxidant effects against vincristine-induced oxidative damage in the liver of mice.

Considering the role of diet and the use of natural antioxidants in addition to exercise, the attention of researchers has been drawn to take further advantage of the effects of exercise to improve cellular metabolism. Despite the favorable role of exercise and antioxidants on heart health, the simultaneous effect of exercise and consumption of propolis (prepared by bees) is not yet known. This study aimed to investigate the effects of endurance training and propolis against oxidative and myocardial stress in diabetic ovariectomized rats.

This experimental study was conducted on 36 female Sprague Dawley rats aged 12-16 weeks and weighing 220-250 grams. Six rats were included in the healthy control group. Diabetes was induced in 30 overiectomized rats by intraperitoneal injection of streptozotocin (40 mg/kg). Then, the diabetic animals were divided into five groups of six including diabetic ovariectomized control, sham, propolis, endurance training, and endurance training + propolis. Rats in the training groups trained for eight weeks, five sessions per week, with 55-75% VO2 max. Moreover, propolis was administered 100 mg/kg/day by peritoneal injection. The level of Pro-oxidant-antioxidant balance (PAB) and expression of HSP72 and NF-κB genes were measured.

HSP72 expression was significantly higher in the propolis, endurance training, and endurance training + propolis groups. The levels of NF-kB and malonaldehyde were significantly decreased in the ovariectomized diabetic rats (P<0.05). Expression of HSP72 in the endurance training and endurance training + propolis groups were significantly higher than in the propolis group. Moreover, NF-kB in the endurance training and endurance training + propolis groups were significantly lower than in the propolis group (P<0.05). The value of PAB in the propolis and endurance training + propolis groups were significantly lower than in the ovariectomized diabetic rats (P<0.05).

Exercise and consumption of propolis seem to synergistically improve the protective HSP72 pathway and reduce oxidative stress in heart tissue following estrogen dysfunction and diabetes. However, the interaction of the two depends on endurance training.

Leptin is associated with metabolic disorders and promotes the development of liver steatosis to steatohepatitis. It selectively increases the secretion of Tumor-necrosis factor-α (TNF-a) in response to saturated fatty acid. The general purpose of this research was to determine the effects of eight weeks of continuous training and silymarin supplementation on the serum levels of TNF-α and leptin in Wistar rats with fatty liver disease.

In this experimental study, 40 male Wistar rats aged three weeks and weighting 159±3 grams were randomly divided into five groups: normal diet/saline, high-fat diet/saline (control), high-fat diet/supplemented, high-fat diet/exercise/saline, and high-fat diet/exercise/supplement. The rats were fed 10 grams per 100 grams of body weight (standard diet 13% fat and high-fat diet 41% fat) for eight weeks, and silymarin (140 mg per kilogram body weight) were given by gavage for 2 weeks. The continuous aerobic exercise protocol consisted 30 minutes of treadmill running at 70-75% of VO2max for eight weeks, five days a week. After sacrificing the animals, samples were taken and sent to the laboratory for histological analysis. The expression of leptin and TNF-α in the liver was measured using commercial ELISA kits.

The findings showed a greater decrease in hepatic leptin concentration in the high-fat diet + continuous exercise + supplement group (P<0.05) compared to the high-fat diet + continuous exercise + saline group (P<0.05). Tukey's post hoc test showed a greater decrease in the concentration of hepatic TNF-α in the high-fat diet + saline group (compared to the high-fat diet + supplement group) (P<0.05), and the high-fat + exercise + saline group (P<0.05). The weight of the rats in the normal diet + saline group differed significantly from other groups (P<0.05).

The results indicated that the combination of continuous training with silymarin supplementation can help reduce leptin and TNF-α in rats with a high-fat diet, an effect not observed by silymarin supplementation alone. Therefore, the combination of continuous aerobic exercises and silymarin supplementation can further oxidize fat and reduce inflammation in the body.

Elimination disorders such as nocturnal enuresis, urinary incontinence during the day, and fecal incontinence are common problems in childhood. This study aimed to evaluate the effectiveness of training mothers with the Adler-Dreikurs approach for reducing anxiety in children with elimination disorders.

This field trial was done in 2021 on the mothers of 20 children with elimination disorders who had been referred to the Pediatric Gastroenterology Clinic in Gorgan with a pretest, posttest, and follow-up approach. At the physician's discretion, the children's problem had no anatomical origin. Urinary incontinence and fecal incontinence in children were identified only by psychological symptoms and functional elimination disorders. The mothers were divided into an experimental group (n=10) and a control group (n=10). The experimental group received the Adler-Dreikurs training program in 12 sessions of 90 minutes. The research instrument was the Spence Children's Anxiety Scale – Parent (SCAS-P) (2001), which was completed by the mothers in three stages: pretest, posttest, and 2-month follow-up. Sub-components of anxiety including generalized anxiety, social phobia, obsessive-compulsive, specific phobia, and separation anxiety were also measured.

Mean general anxiety scores in the pretest, posttest, and follow-up stages were 69.1±4.04, 45.8±6.1, and 47.8±5.94 in the experimental group and 69±6.58, 67.8±4.89, and 67.6±5.59 in the control group, respectively. There was a significant difference in all subcomponents of child anxiety in the posttest and follow-up stages between the experimental group and the control group (P<0.05). This difference was also present during the follow-up period except for the obsessive-compulsive subcomponent.

Training mothers through the Adler-Dreikurs approach can reduce anxiety in children with elimination disorders.

Genu recurvatum deformity shifts the mechanical axis of the lower extremity posteriorly, which may disturb balance and stability. The goal of this study was to compare the balance and core stability of female students with and without genu recurvatum.

This case-control study was conducted on 25 female students with genu recurvatum (mean age: 14.88±0.6 years) and 25 healthy counterparts (mean age: 15±0 years) in city of Salmas (Iran). The criterion for genu recurvatum was a 5-degree knee hyperextension. To measure static and dynamic balance, we used the stork balance stand test and Y test, and to measure core stability, we used the Sorensen, plank, side plank, and 60-degree sitting tests.

The mean values of static balance of dominant (19.86±3.64) and non-dominant (17.16±4.67) leg of healthy students were significantly higher than that of students with genu recurvatum (14.44±2.03 and 10.53±1.66, respectively) (P<0.05). The median values of the dynamic balance of the dominant (32.04) and non-dominant (31.84) leg of healthy students were significantly higher than that of students with genu recurvatum (18.96 and 19.16, respectively) (P<0.05). The median values of central stability for the Sorensen (30.40), plank (30.58), lateral plank (31.04), and sitting (34.12) tests in healthy students were significantly better than the median values of central stability for the Sorensen (42.60), plank (20.20), lateral plank (19.96), and sitting (16.88) tests in students with genorcorvatum (P<0.05).

The balance and core stability of female students with genu recurvatum deformity is poor compared to their healthy counterparts.

Ventilator-associated pneumonia (VAP) is an important complication in intensive care unit (ICU) patients with endotracheal intubation. Finding potential early indicators of this condition can aid in reducing the disease burden. We aimed to investigate the relationship between VAP occurrence and serum levels of C-reactive protein (CRP), procalcitonin (PCT), and hemoglobin (Hgb) during ICU hospitalization of brain trauma patients.

This descriptive-analytical study was carried out on brain trauma patients (99 male, 39 female), referring to the 5th Azar hospital in Gorgan, Iran, in the course of 2017. The patients were hospitalized in ICU with endotracheal intubation and mechanical ventilation. The diagnosis of VAP was confirmed by a 12-score rating based on chest radiographs, body temperature, white blood cell count, and sputum culture. After admission, serum CRP, PCT, and Hgb were documented daily for 6 days.

According to the diagnostic criteria, VAP was confirmed in 41 patients (30%). Serum CRP and PCT levels on the 6th-day post-admission were significantly associated with VAP diagnosis, while Hgb levels did not differ significantly between VAP and non-VAP patients. Serum levels of CRP, PCT, and Hgb on the 6th day were not associated with age or sex.

Our results indicate that serum CRP and PCT levels are associated with the occurrence of VAP in ICU patients receiving mechanical ventilation. Therefore, these biomarkers could be utilized to warn physicians about the possibility of VAP, thereby reducing mortality rate and hospitalization length.

Breast cancer is the most common cancer among women and ranks second in terms of mortality rate. This study was conducted in order to determine the personal, clinical, and laboratory characteristics of women with breast lesions referred to the Dr. Beski Hospital in Gonbad-e Kavus, Iran.

This descriptive-analytical study was conducted on 130 women with breast lesions (benign and malignant) who were operated on in the Dr. Beski Hospital from March 2019 to March 2020. Demographic data (age, family history, and ethnicity) and pathology results (grade, lesion type, surgery type, location, and tumor size) were recorded.

Breast lesions were malignant in 51.53% of the patients. The most common malignant tumor was invasive ductal carcinoma (71.64%), and the most common benign tumor was fibroadenoma (69.84%). Most malignant cases were observed in patients aged 41-50 years (43.28%). Almost half of the studied population (49.15%) had no positive family history, and about a quarter of the patients had at least one first or second-degree relative with breast cancer. Most patients (44.78%) had grade II malignant tumors. In addition, 78.51% of the subjects had not undergone chemotherapy before breast surgery. About half of the patients (49.57%) did not undergo any adjuvant treatment after surgery; however, chemotherapy was the most common type of adjuvant treatment (13.68%) after surgery. Simultaneous chemotherapy and radiotherapy were performed for 24.78% of the patients after surgery. There were statistically significant relationships between age and type of lesion and adjuvant treatments after the operation, and involvement of lymph nodes was observed (P<0.05). There was a statistically significant relationship between age, tumor size, family history, and tumor malignancy (P<0.05). There was a significant correlation between age and tumor malignancy (P=0.02, F (2.48) = 4.19) so the degree of malignancy was higher in younger individuals.

The results of this study showed the young age of developing malignant breast lesions in the study area. Most malignant lesions are invasive ductal carcinoma and grade II. There is a positive relationship between a family history of cancer and the classification of breast tumors.

Celiac disease is a malabsorption disorder that could result in various psychological consequences if patients do not adhere to a gluten-free diet. This study aimed to determine the frequency of major depressive disorder and its relationship with adherence to a gluten-free diet among patients with celiac disease.

This descriptive-analytical study was conducted on 47 patients with celiac disease (30 women and 17 men) with an average age of 40.88 ± 10.7 years who had been referred to the Golestan Research Center of Gastroenterology and Hepatology during the summer of 2019. Patients were invited to complete a 13-item Beck Inventory. Celiac Dietary Adherence Test (CDAT) was used to assess adherence from the patients' point of view, and Standardized Dietician Evaluation (SDE) was used to evaluate adherence to the diet from the interviewer's perspective.

Overall, 28 people (59.6%) with celiac disease reported some degree of depression. Based on the SDE, the adherence rate of patients to a gluten-free diet was 83%. The association between adherence to a gluten-free diet and the prevalence of depression was not significant. There was also no significant association between the prevalence of depression and the gender and age of patients.

Based on the results, a high percentage of patients with celiac disease have symptoms of depression. However, there is no significant relationship between adherence to a gluten-free diet and the prevalence of depression.

Middle age is associated with various biopsychosocial changes. Sexual health is one of the most important aspects of health, which is less addressed in middle age. The study aimed to determine the relationship between sexual self-concept and sexual health in middle-aged women in Gorgan, Iran.

This descriptive-analytical study was carried out on 428 eligible married women (mean age: 46.38±5.46 years) who had electronic records in one of the comprehensive health centers of Gorgan, Iran. Data collection was done in 2019 using a demographic checklist, the Persian version of Snell’s multidimensional sexual self-concept questionnaire, and the sexual health of middle-aged women scale.

The mean score of sexual self-concept was 115.10±26.88 in the positive domain, 18.09±11.22 in the negative domain, and 39.92±11.88 in the situational domain. The mean score of sexual health was 129.18±18.71. There was a significant positive correlation between sexual health and the positive (r=0.67, P<0.001) and situational sexual self-concept (r=0.63, P<0.001). There was also a significant inverse correlation between sexual health and negative sexual self-concept (r=-0.48, P<0.001).

This study showed that the sexual health of married middle-aged women has a direct relationship with the positive sexual self-concept and an inverse relationship with the negative sexual self-concept.

Gene mutations leading to thrombophilic disorders and changes in blood coagulation factors during pregnancy play an important role in the occurrence of recurrent abortions. This study was conducted to determine the relationship between polymorphism of thrombophilic genes and coagulation factors in women with recurrent miscarriage.

In this descriptive-analytical study, 29 women with a history of recurrent abortions (at least three times) were investigated. Demographic data were collected. Total genomic DNA was isolated from peripheral blood. The presence or absence of mutation in factor II (G20210A), factor V Leiden (G1691A), factor V HR2 (H1299R), MTHFR C677T, and MTHFR A1298C polymorphisms were assessed by PCR.

Coagulation factors and thrombophilic mutations had no significant association with recurrent miscarriage.

The results obtained in this study showed that none of the studied polymorphisms could justify frequent abortions in women. Therefore, it is suggested to evaluate genetic factors in normal individuals or immediate and extended family of the study population with no miscarriage history.

Medicinal plants contain a high level of antioxidant compounds such as flavonoids, phenolic, carotenoids, and tannins, which can be used to eliminate excess free radicals in the body. This study aimed to determine the total phenolic and flavonoid content and to investigate the antioxidant and antibacterial effects of Berberis integerrima and Graminifolius tragopogon methanolic extracts on some Gram-positive and Gram-negative microorganisms.

In this descriptive-analytical study, methanolic extracts of B. integerrima and G. tragopogon were prepared using 80% methanol. Total phenol and flavonoid contents were determined by Folin–Ciocalteu and aluminum chloride colorimetric methods, respectively. The antioxidant capacity was assessed by 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging activity and reducing power methods. The antibacterial activity of the extracts of B. integerrima and G. tragopogon on Escherichia coli, Bacillus subtilis, Listeria monocytogenes, Staphylococcus aureus, and Salmonella typhimurium were determined by the disk diffusion method. Butylated hydroxytoluene and ciprofloxacin were used as positive controls for antioxidant activity and bacterial strains, respectively.

Total phenol and flavonoid compounds in the extracts of B. integerrima and G. tragopogon were 46.90±0.70 and 22.63±0.59 mg gallic acid per gram of extract and 5.61±0.01 and 46.74±0.81 mg quercetin per gram of extract, respectively. The extracts of B. integerrima and G. tragopogon showed significant antibacterial activity. B. subtilis and S. typhimurium showed the highest sensitivity and resistance to the extracts, respectively. Moreover, the extract of B. integerrima had the most potent inhibitory effect on the examined microorganisms.

B. integerrima extract exhibits higher phenolic content, antioxidant properties, and antimicrobial activity than G. tragopogon extract.