مجله دانشگاه علوم پزشکی گرگان
سال بیست و پنجم شماره 2 (پیاپی 86، تابستان 1402)

Neurofibromatosis (NF) is a heterogeneous group of tumor predisposition syndromes that lead to malignancy in the central and peripheral nervous systems. Neurofibromatosis type 1 (NF1), along with neurofibromatosis type 2 (NF2) and schwannomatosis (SCH), are the three main types of NF. As the most common form, NF1 is characterized by neurofibromas and Cafe-au-lait macules (CALMs) in early childhood. Neurofibromatosis type 1 is caused by mutations in the NF1 gene, which codes for neurofibromin, and mutations in NF2 and SMARCB1 gene lead to neurofibromatosis type 2 and schwannomatosis, respectively. In addition, most patients with neurofibromatosis type 2 have vestibular schwannoma, also associated with hearing problems and body imbalance. Recently, schwannomatosis has been proposed as a distinct genetic disorder because it shares many symptoms with neurofibromatosis types one and two, characterized by benign schwannoma around nerves. NF1 and NF2 may show symptoms in childhood, but schwannomatosis is often diagnosed in people in their thirties or older. This article reviews the latest scientific literature according to the keywords of neurofibromatosis, pathogenesis, treatment, NF1, and NF2 in Google Scholar, PubMed, and Web of Science online databases on the types of neurofibromatosis, molecular pathways, diagnostic criteria, clinical symptoms, condition management, treatments and drugs under development.

The rise in patients seeking corneal refractive surgery, despite having systemic autoimmune diseases, underscores the need for special considerations when treating these individuals. Recent studies have expanded our knowledge in identifying and evaluating autoimmune disorders and their potential side effects in the results of corneal refractive surgery with laser. This study briefly examines the pathogenic factors, clinical aspects, and possible complications in patients with systemic autoimmune disorders subjected to these surgeries. In total, 132 articles were selected for this research among the reviewed studies. Considering that the release of various cytokines caused by systemic autoimmune disorders can lead to destructive corneal consequences, the need for early diagnosis before any laser surgery for refractive errors seems essential. Although procedures such as LASIK and PRK are commonly performed on patients with autoimmune disorders, important considerations must be made. Studies have not yet confirmed definitive contraindications to laser refractive surgery for autoimmune disorders.

Diabetes leads to impaired blood supply to the peripheral nerves. Sema3A (Semaphorin 3A) is a denervated protein that increases in response to hyperglycemia caused by diabetes. Exercise and alpha-lipoic acid (ALA) supplements can protect against diabetes-induced denervation. This study was done to evaluate the effect of high and moderate-intensity interval training with alpha-lipoic acid supplementation on the expression of Sema3A protein in the soleus muscle of Induced diabetic rats.

In this experimental study, thirty-five male Wistar rats (weight range: 190-220 g, 6-8 weeks old) were randomly allocated into seven groups of five: healthy control, diabetic, diabetic supplement (S), diabetic high-intensity training (HIT), diabetic moderate-intensity training (MIT), diabetic high intensity+supplement (HIT+S), and diabetic moderate intensity training+supplement (MIT+S). Diabetes was induced by injection of streptozotocin (50 mg/kg/bw). The HIT and MIT protocols were performed five days a week for six weeks. ALA was administered orally at 20 mg/kg daily by gavage. Immunohistochemistry was used to evaluate the expression of Sema3A protein in the soleus muscle. Serum insulin was measured by the ELISA method.

Diabetes leads to increased level of glucose, Sema3A, and a significant decrease in insulin in the soleus muscle compared to healthy (P<0.05). HIT and MIT in combination with ALA, significantly showed lower expression of Sema3A Protein than in the diabetic group (P<0.05).

Although HIT and MIT can reduce the expression of Sema3A protein in the soleus muscle of diabetic rats, combining alpha-lipoic acid supplementation with exercise training is more effective in reducing the amount of denervation.

Due to the spread of the new coronavirus disease 2019 (COVID-19), the amount of physical activity and exercise in people’s lifestyles was greatly reduced to reduce interpersonal contact to control the infection. The current study aimed to investigate students’ physical fitness levels during the quarantine period of COVID-19, and the study examined its changes after four months of training at home.

This quasi-experimental study was done on thirty-two students (16 males and 16 females) in Shahrekord University, Iran during 2019-21. Physical fitness (swimming, Sit-ups, jumping rope, and flexibility) was measured and compared three times before the start of the Coronavirus, one year after the beginning of the Coronavirus, and after four months of exercise at home.

COVID-19 leads to a decrease in the level of physical fitness in the post-exam phase compared to the pre-exam phase. Due to the restrictions related to the quarantine period, students’ physical fitness levels showed a significant reduction in the post-corona period compared to the pre-corona period. In addition, four months of training at home showed a significant effect on physical fitness indicators, compared to the time of quarantine, in such a way that the average of physical fitness factors increased significantly (P<0.05). Therefore, growing measures are needed to motivate and support students to maintain a conscious level of physical fitness to avoid any threat to the population’s health, especially in quarantine conditions.

The quarantine period during the outbreak of COVID-19 caused a decrease in the physical fitness of the studied students, and performing four-month exercises at home increased their physical fitness.

Multiple sclerosis (MS) is an autoimmune disease that targets the central nervous system. Various studies have shown that several factors influence this disease’s occurrence and prevent its progress. Multiple studies have shown that several factors affect this disease’s occurrence and prevent its progress. Helicobacter pylori can be mentioned among these factors. This study was conducted to determine Helicobacter pylori infection in MS patients and healthy individuals.

This case-control study was conducted on 100 patients with MS (mean age: 36.99±9.87 years) and 100 healthy subjects (mean age: 38.05±11.38 years) in Golestan province, north of Iran during 2021. The case group included eighty relapsing-remitting cases and twenty secondary progressive cases. Blood samples were taken from both groups, and after separating the serum using the ELISA test, anti-Helicobacter pylori antibody (IgG) was detected by determining the antibody titer.

Helicobacter pylori IgG in the MS and control groups was 21% and 44%, respectively (P<0.05). The mean concentration of IgG in the case group was significantly lower than the control group (13.48±10.83 versus 19.78±16.14 AU/ml). The percentage of positive cases of IgG antibody against Helicobacter pylori in the relapsing-remitting and secondary progressive group of patients with MS was determined as 21.2% and 20%, respectively, and the difference between these two groups was not statistically significant.

The history of Helicobacter pylori infection is less than two times in patients with MS compared to healthy people probably indicate the protective role of this bacterium against this disease.

The diagnosis of inflammatory bowel disease (IBD) is performed by colonoscopy, sampling, and histopathology. Stool calprotectin is a test showing the presence of inflammation in the gastrointestinal tract. This study was done to determine the relationship between the calprotectin level in the feces and endoscopic findings in ulcerative colitis patients referred to the gastroenterology clinic in Gorgan, Iran.

This descriptive-analytical study was performed on 100 patients with ulcerative colitis referred to the gastroenterology clinic of Sayad Shirazi Hospital, Gorgan, north of Iran during 2020. The patients were asked to collect their stool samples one day before the procedure (just after taking the drug for bowel cleansing). Bowel cleansing was done by administering polyethylene glycol solution dissolved in water. The activity of ulcerative colitis was measured using the disease activity score. According to this criterion, a score greater than or equal to 5 is considered an active disease. Patients were classified into two groups: extensive or pan-colitis and left-sided colitis. Stool samples were evaluated for calprotectin in a single laboratory using a commercially available kit (Calprest- EuorociationspA. Trieste) at normal values of less than 50mg/g. The relationship between stool calprotectin with colonoscopic findings was evaluated.

The average duration of infection was 4±3.1 years in the time range of 1-14 years. The calprotectin level was less than 50 μg/g in 16 patients. Stool calprotectin less than 50 µg/g was seen in only 16 patients. There was no significant relationship between the level of calprotectin and the either age or gender of patients. Most patients (84%) had active disease based on colonoscopic findings. Left-sided involvement was seen in 60% of patients. Fecal calprotectin level was significantly higher in those with acute phase and those with severe disease (P<0.05). Additionally, the calprotectin level had no significant relationship with the location of bowel involvement, extension, and disease duration.

This study showed that the fecal calprotectin level in patients with ulcerative colitis had a significant relationship with the severity and activity of the disease in north of Iran.

Thyroid masses are one of the most common reasons for patients to visit endocrinology clinics. Fine needle aspiration (FNA) is used to reduce thyroid surgery for benign lesions. This study was done to determine the diagnostic accuracy of FNA of thyroid mass(s) compared with histological results in Medical Centers, Gorgan, Iran.

In this descriptive-analytical study, 102 patients (12 males and 90 females) were diagnosed with a thyroid mass and referred for surgery to Medical Centers, Gorgan, Iran during 2020-21. FNA was performed, and the samples were sent to the pathology department for examination. The result of cytology was recorded in the checklist. According to cytology results, some patients were referred for surgery. Then, the surgical pathology results were compared with the cytology findings. In addition, the sensitivity and specificity of the results of the cytology of thyroid masses were calculated compared to the results of pathology.

FNA, mass size, and the patient’s main complaint had a significant relationship with histological results (P<0.05). According to FNA findings compared to pathology, sensitivity was 74%, specificity was 88.1%, positive predictive value was 88.1%, negative predictive value was 74%, false positive rate was 12%, false negative rate was 26%, and accuracy was 80.4%.

FNA remains a key tool in evaluating thyroid nodule(s). Improving FNA techniques is necessary to increase the accuracy of FNA.

Considering hypertension as the most prevalent comorbidity among patients diagnosed with COVID-19, this study intended to investigate clinical characteristics and in-hospital mortality risk factors among COVID-19 patients with hypertension history.

This descriptive-analytical study was conducted on 527 hypertensive patients (277 male and 250 female) a mean age of 64.73±13.13 years infected with COVID-19 and hospitalized at Sayyad Shirazi Hospital, Gorgan Iran from February to September 2020. The patients’ data were extracted from the hospital information system and completed by patients’ medical records and telephone calls. The association between the risk factors and in-hospital mortality was identified by employing the logistic regression analysis in three various models, including model 1 (demographic data and patients’ history), model 2 (model 1 plus vital signs and pulse oximetry measurement at hospital admission) model 3 (model 2 plus laboratory findings at hospital admission). Each model individually described the odds ratios (ORs) with 95% confidence intervals (95% CIs) for every risk factor. Furthermore, a corrected area under the receiver-operating characteristics curve (AUC) was estimated to evaluate the model’s discriminatory power.

Among 527 hospitalized patients, 88 patients (16.6 %) died during 6.48 days of hospitalization, of which 47 patients were men. In model 1, opium consumption (CI95%=1.16-3.85, OR=2.11) and cognitive impairment at admission (CI95%=0.98-5.40, OR=2.30) were significantly associated with higher mortality (AUC=0.65). In model 2, after adding vital signs and oxygen saturation, cognitive impairment association lost its association, and only opium consumption (CI95%=1.09-3.19, OR=1.87) and oxygen saturation (CI95%=0.90-0.95, OR=0.93) were associated with in-hospital mortality. (AUC=0.73). In model 3, after incorporating laboratory findings, with an AUC of 0.79 (CI95%=0.70-0.90), each percent higher oxygen saturation at admission was associated with a 7% decrease in in-hospital mortality (CI95%=0.88-1.00, OR=0.93). Although opium consumption and higher creatinine level lead to higher mortality, the associations were not significant.

Regarding the association of oxygen saturation at admission with in-hospital mortality among hypertensive patients diagnosed with COVID-19, the pulse oximetry measurement data upon admission would be crucial in evaluating these patients.

Nutritional knowledge can affect food choices and, as a result, sports performance. The study of nutritional knowledge, attitude, and performance in athletes can play a fundamental role in choosing the type of training and adapting suitable dietary interventions. This study was done to evaluate the knowledge, attitude, and nutritional performance of male bodybuilding athletes in Gorgan, Iran.

This descriptive-analytical study was done on 104 male bodybuilding athletes over 18 years old with a history of at least three months of continuous bodybuilding who were randomly selected from 13 bodybuilding clubs in Gorgan, Iran during 2020. Parmenter and Wardle’s standard questionnaire measured athletes’ nutritional knowledge, attitude, and performance. The questionnaire was completed by the athletes with the guidance of the researcher. A trained nutritionist collected anthropometric and body composition data using an Omron BF511 device.

Poor nutritional knowledge, poor dietary attitude and poor nutritional performance was observed in 67.3%, 33.65% and 77.88% of the athletes respectively. A significant correlation was observed between nutritional knowledge with weight (r=0.23, P=0.02), BMI (r=0.27, P=0.01), and body fat percentage (r=0.22, P=0.02). Also A significant correlation was determined between nutritional performance with body weight (r=0.31, P<0.001), BMI (r=0.27, P<0.001), exercise time per week (r=0.22, P=0.02), and exercise timespan (r=0.32, P<0.001).

The level of knowledge, attitude, and nutritional performance of bodybuilding athletes was weak.

Staphylococcus aureus is one of the most common causes of bacterial keratitis and conjunctivitis. This study was done to determine the efficacy of fluoroquinolones on Methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from external ocular infections.

This descriptive-analytical study was conducted on 187 pateiants (2 months to 61 years old) with symptoms of conjunctivitis and keratitis who were hospitalized or referred to the emergency department of hospitals in Golestan and Mazandaran provinces, Iran during 2020-22. The samples were taken from the external infection of the patients’ eyes. Methicillin-resistant Staphylococcus aureus isolates were identified by standard phenotypic microbiological and molecular detection (PCR) methods. The broth microdilution method determined sensitivity to quinolones and the minimum inhibitory concentration (MIC) in the 0.06-64 μg/ml range.

The frequency of ocular MRSA isolates (n=52) was significantly higher in spring, females and patients aged 1-30 years (P<0.05). Among the MRSA isolates causing conjunctivitis, the highest rates of resistance were observed against ciprofloxacin (n=18, 48.64%), enoxacin (n=17, 45.95 %), and ofloxacin (n=17, 45.95%). The MIC of gemifloxacin that inhibited the growth of 90% of MRSA isolates from conjunctivitis (MIC90=0.25 μg/ml) was 32-fold lower than that of ciprofloxacin.

Depending on the season and age, staphylococcus aureus may be the most common cause of bacterial conjunctivitis and keratitis. Considering the in vitro antibacterial potential of gemifloxacin, this antibiotic can be used to treat the bacterial external eye infections.

Population growth and pollution caused by the discharge of all kinds of urban, industrial, and agricultural sewage, leachate from landfills, and surface water runoff cause an increase in pollution of water sources. The entry of heavy metals into the environment, especially aquatic ecosystems, due to entering the food chain and jeopardizing human health is one of the concerns of society. This study was conducted to determine the level of heavy metals in muscles of Cynoglossus arel and Pomadasys kaakan fishes in Boushehr coastal waters, north of the Persian Gulf.

This descriptive study was conducted on twenty pieces of Cynoglossus arel and twenty pieces of Pomadasys kaakan fishes take place from three coastal stations of Boushehr, north of the Persian Gulf, Iran during spring of 2022. The samples were randomly selected from the fish market. After preparation, bioassay, and digestion of fish muscle by concentrated nitric acid, the concentration of heavy metals including nickel, zinc, copper, lead, and cadmium (µg/g) in the muscle tissue was measured by ICP-OES device. The concentration of heavy metals in the fish muscle tissue for human consumption was compared with international standards (FAO, WHO, FDA, NHMRC, and UKMAFF). According to the method of the US Environmental Protection Agency for fish consumption, daily absorption estimates and heavy metal risk indicators were calculated.

The risk potential index for both species was less than one. The daily and weekly absorption of Cynoglossus arel (zinc > copper > nickel > lead > cadmium) and Pomadasys kaakan (copper > zinc > nickel > lead > cadmium) were determined. The mean concentration of heavy metals nickel, zinc, copper, lead, and cadmium in the muscle tissue of the studied species was determined to be 1.88±0.07, 27.16±8.11, 11.55±4.12, 1.14±0.06, and 0.19±0.03 µg/g, respectively. The highest amounts of studied metals in aquatic animals were zinc > copper > nickel > lead > cadmium. The concentration of metals in the analyzed samples was lower than the international standards.

Regarding toxicity, the concentration of metals in Cynoglossus arel and Pomadasys kaakan was evaluated as acceptable for human consumption. In addition, the amount of risk potential and risk index for non-cancerous diseases in adults and children in fish muscle tissue was less than 1, and the consumption of this fish does not cause any problems for human health.

Non-Governmental Organizations (NGOs) have been active in the field of health for a long time and have played a key role in it, but these organizations are less known to the public for the promotion of social health and are not much considered by the planners and managers of the health system. This study was conducted to determine the challenges of NGOs’ to promote social health in Iran.

In this qualitative study, 15 Iranian managers and scientific and executive experts of the Ministry of Health, Ministry of Interior, Governorate, and Universities of Medical Sciences of the country were selected by purposeful sampling during 2021. Data were collected using an interview guide and semi-structured in-depth interview methods. After recording and transcribing, the data were analyzed by content analysis.

The challenges of NGOs to promote social health in Iran were classified into six main themes of planning, organizing, functional, political, economic, and sociocultural challenges, and 33 sub-themes. Most of the participants emphasized the weak role of non-governmental organizations in improving social health and considered it a result of the mentioned challenges.

Empowering non-governmental organizations by formulating a strategic and operational plan and attracting financial resources from various government, private, and charitable sectors will greatly help to strengthen them to advance social health promotion programs.