Journal of Gorgan University of Medical Sciences

Effect of Repetitive Transcranial Magnetic Stimulation on the Treatment of Treatment-Resistant Amblyopia in Adult Patients: A Clinical Trial

Mohammad Sharifi

Background and Objective: The therapeutic outcomes of amblyopia after the age range of 8-10 years are poor, and amblyopia in older individuals is resistant to treatment. Repetitive Transcranial Magnetic Stimulation (rTMS), among the efforts intended to modulate cortical excitability in the treatment of psychiatric disorders, has been believed to be associated with a specific disease. This study aimed to determine the effect of rTMS on the treatment of treatment-resistant amblyopia in adult patients.
Methods: This clinical trial was conducted on 16 patients (12 males and 4 females) with unilateral amblyopia, with a mean age of 30±5 years referring to the clinics of Khatam al-Anbia Eye Hospital, Mashhad, Iran, during 2016-17. Patients were randomly selected from those with unilateral amblyopia (refractive, strabismic, or mixed) who had not responded to conventional treatments (patching or penalization). The healthy eye was considered a control. The therapeutic intervention consisted of four rTMS sessions at two-week intervals. Visual acuity and contrast sensitivity were measured and compared three times: Before the intervention, at the first session of intervention, and at the fourth session of intervention.
Results: The mean visual acuity at baseline (0.36±0.19) was not significantly different compared to the first treatment session (0.41±0.1); however, a significant increase was observed compared to the fourth session (0.45±0.23) (P<0.05). The mean contrast sensitivity at baseline (2.02±0.74) was not significantly different compared to the first (1.97±0.63) and the fourth (2.16±0.94) treatment sessions.
Conclusion: In most follow-ups, improvement in contrast was not observed in patients with treatment-resistant amblyopia at older ages using rTMS. Only an improvement in visual acuity was observed in the last follow-up compared to the baseline in the patient group.

Effect of Two Educational Approaches, with and without Short Message Service Reminder, on Adherence to Treatment Regimens in Patients with Acute Coronary Syndrome: A Clinical Trial

Gholam Reza Mahmoodi-Shan

Background and Objective: Non-adherence to treatment regimens is a significant factor contributing to the persistence of cardiovascular diseases and their complications. This study aimed to compare the effects of two educational methods, with and without short message service (SMS) reminder, on adherence to treatment regimens among patients with acute coronary syndrome (ACS).
Methods: This clinical trial was conducted on 111 patients with ACS divided into three 37-people groups: A control group (receiving routine education), the first intervention group (receiving education and a booklet), and the second intervention group (receiving education, a booklet, and SMS reminders). The study was conducted in patients at the coronary care units (CCUs) and post-CCUs of the following educational therapeutic centers: Shahid Sayyad Shirazi in Gorgan, the Fifth Azar in Gorgan, Amir Al-Momenin in Kordkuy, and Al-E-Jalil in Aqqala, Iran, during 2019. The research instrument consisted of the Treatment Adherence Perception Questionnaire (TAPQ) in three domains, including dietary regimen, medication regimen, and exercise and activity, which was completed at the time of discharge and two months later.
Results: The mean scores of adherence to treatment dietary in patients with ACS two months after discharge in the three domains of dietary regimen, medication regimen, and exercise and activity were significantly higher in the group receiving education and SMS reminders (105.54±75.8, 16.00±2.71, and 23.67±3.85, respectively) compared to the education group (84.73±5.02, 11.05±1.69, and 17.45±2.48, respectively) (P<0.05). Moreover, the scores in the three investigated domains were significantly higher in both intervention groups compared to the control group (82.68±13.54, 11.40±1.96, and 17.67±5.04, respectively) (P<0.05).
Conclusion: The use of education and a booklet along with SMS reminders to patients with ACS discharged from the hospital increased adherence to treatment. This adherence was higher in the intervention group receiving SMS reminders.

Effect of Eight Weeks of Corrective Exercises on Musculoskeletal Pain Level in 13-15 Year-Old Students: A Clinical Trial

Ali Shafizadeh

Background and Objective: Restrictions imposed during the coronavirus disease 2019 (COVID-19) pandemic led to a decrease in physical activity levels across various age groups, particularly among students. This study aimed to determine the effect of eight weeks of corrective exercises on musculoskeletal pain levels in 13-15-year-old students.
Methods: This clinical trial was conducted on 101 students (44 girls and 57 boys) aged 13 to 15 experiencing musculoskeletal pain in various body parts in Bandar Mahshahr, Khuzestan Province, during the second half of the academic year 2021-2022. Participants were selected based on the Adolescent Nordic Musculoskeletal Questionnaire (NMQ), considering only the first question regarding the presence or absence of pain in each of the nine body regions (neck, shoulder, elbow, hand, upper back, lower back, pelvis, knee, and ankle) in the past seven days. A score of 1 was assigned to the presence of pain and 0 to the absence of pain. Participants were randomly assigned to two groups of 60: A control group and an intervention group. The intervention group performed corrective exercises at home for eight weeks, with three sessions per week, each lasting 40 minutes. No intervention was provided to the control group. Musculoskeletal pain levels in the neck, shoulder, upper back, elbow-arm, wrist, lower back, knee, and ankle were then compared in the pre-test, post-test, and follow-up.
Results: The mean and standard deviation of the total pain scores for the intervention and control groups were 1.32±0.41 and 1.33±0.46 in the pre-test, 1.01±0.08 and 1.34±0.46 at the post-test, and 1.17±0.36 and 1.11±0.31 at follow-up, respectively. Results revealed that eight weeks of corrective exercises significantly reduced musculoskeletal pain levels in the students’ neck, shoulder, upper and lower back, elbow, knee, wrist, ankle, pelvis, and thigh (P<0.05); however, this improvement was not sustained at the follow-up.
Conclusion: Performing corrective exercises reduced musculoskeletal pain levels in the neck, shoulder, upper and lower back, elbow, knee, wrist, ankle, and pelvis and thigh of 13-15-year-old students; however, the benefits were not sustained when the exercises were stopped.

Effect of Four Weeks of Aerobic Exercise and Berberine Supplementation on the Expression of Dopamine 5 Receptor and Poly (Adenosin Diphosphat [ADP]-Ribose) Polymerase Genes in the Heart Tissue of Methamphetamine-Exposed Rats

Somayeh Rajabi

Background and Objective: Methamphetamine is a highly addictive drug associated with severe psychosocial consequences and is extensively abused. This study aimed to determine the effects of four weeks of aerobic exercise and berberine supplementation on the expression of dopamine 5 receptor and poly (adenosin diphosphat [ADP]-ribose polymerase (PARP) genes in the heart tissue of methamphetamine-exposed rats.
Methods: In this experimental study, 30 female Wistar rats were randomly allocated into five groups of six: Control, methamphetamine, methamphetamine + aerobic exercise, methamphetamine + berberine, and methamphetamine + aerobic exercise + berberine. Intraperitoneal injections of methamphetamine (10 mg/kg) and aerobic exercise and berberine consumption (100 mg/kg) were administered for 4 weeks during the withdrawal period. The expression levels of dopamine 5 receptor and PARP genes was measured using real-time polymerase chain reaction (PCR).
Results: There was no significant difference in PARP gene expression between the methamphetamine group (1.02±0.65) and the control group (1.02±0.24). Similarly, there was no significant difference in dopamine 5 receptor gene expression between the methamphetamine group (5.74±4.94) and the control group (4.76±2.63). The expression levels of PARP and dopamine 5 receptor genes following exercise (1.01±0.55 and 4.30±1.96, respectively), berberine supplementation (0.61±0.25 and 2.97±1.45, respectively), and the combined intervention (0.67±0.30 and 3.43±1.87, respectively) showed no significant differences between the groups.
Conclusion: Short-term methamphetamine induction did not induce significant changes in the expression of dopamine 5 receptor and PARP genes in the hearts of methamphetamine-exposed rats.

Effect of Short-Term Use of Anti-Pronation Insoles on Plantar Pressure Variables Following Anterior Cruciate Ligament Reconstruction with a Pronated Foot during Gait

Amir Ali Jafarnezhadgero

Background and Objective: Individuals with a history of anterior cruciate ligament (ACL) injury are at a higher risk of re-injury compared to healthy individuals. ACL-injured patients exhibit weaker longitudinal arches and increased foot pronation compared to healthy individuals. This study aimed to determine the effect of short-term use of anti-pronation insoles on plantar pressure variables following ACL reconstruction (ACLR) with a pronated foot during gait.
Methods: This quasi-experimental study was conducted on 15 male participants who had undergone ACLR with a pronated foot (mean age= 23.2±4.5 years) and 15 healthy males (mean age= 22.7±4.3 years) in Ardabil, Iran during 2022. Plantar pressure values during gait with and without the use of anti-pronation insoles were recorded and compared using a foot scanner (sampling rate: 300 Hz).
Results: The effect of the group factor on the big toe plantar pressure variable was statistically significant (P<0.05). Pairwise comparison results demonstrated a significant increase in pressure in the ACLR group (154.63±41.71 N/cm²) compared to the healthy group (126.54±26.57 N/cm²) (P<0.05). Intragroup comparison results revealed a significant decrease in pressure on the second to fifth toes (215.73±60.74 N/cm²) and the first plantar (420.58±107.56 N/cm²) when using anti-pronation insoles compared to the non-insole condition (the second to fifth toes (201.57±76.21 N/cm²) and the first plantar (400.78±118.20 N/cm²) in the ACL reconstruction group (P<0.05).
Conclusion: The use of anti-pronation insoles can effectively reduce plantar pressure after ACLR in individuals with a pronated foot during gait.

Evaluation of the Position and Dimensions of the Infraorbital Canal Based on Cone-Beam Computed Tomography

Farida Abesi

Background and Objective: The infraorbital canal (IOC) is located in the floor of the orbit and terminates at the infraorbital foramen below the orbital rim. The IOC is a crucial anatomical landmark for successful anesthesia in dentistry and oral and maxillofacial surgery. This study aimed to evaluate the position and dimensions of the IOC based on cone-beam computed tomography (CBCT).
Methods: This descriptive-analytical study was conducted on CBCT images of 250 individuals (105 males and 145 females) (mean age = 36.14±17.7 years) referring to a specialized oral and maxillofacial radiology clinic in Babol, Iran, during 2021-22. Three different types of IOC pathways from the sinus roof were measured: Completely located within the maxillary sinus roof (Type 1), located below the maxillary sinus roof (Type 2), and suspended from the maxillary sinus roof within the septum or lamella of the infraorbital ethmoid cell (Type 3). Additionally, the angles between the IOC and the infraorbital groove with the maxillary sinus roof, the angles between the IOC and the infraorbital groove, the lengths of the IOC and the infraorbital groove, and the distances of the IOC from various anatomical landmarks were measured. Distances of the IOC (mm) were evaluated from other anatomical landmarks according to gender and age groups.
Results: Overall, various pathways of the IOC from the sinus roof were 39.4% in Type 1, 53% in Type 2, and 7.6% in Type 3; the mean distance of the IOC to the infraorbital rim was 8.58±1.30 mm, and to the midpoint of the canine root was 10.16±0.81 mm. The mean length of the canal was 25.89±2.47 mm, and the infraorbital groove was 5.06±0.58 mm; and the mean angle between the IOC and the infraorbital groove was 153.20±3.28 degrees. In general, the distance of the IOC to the midpoint of the canine root on both the left and right sides was greater in males than in females, which was statistically significant on the left side (P<0.05). It was found that the length of the IOC and the angle between the IOC and the infraorbital groove on the left side had statistically significant correlations with age groups (P<0.05). The mean distance from the foramen to the infraorbital rim and the length of the IOC were proportional to the degree of nerve protrusion into the maxillary sinus; however, no significant correlation was found between the types of canals (degree of nerve protrusion) and gender.
Conclusion: Type 2 was the most common pathway of the IOC from the sinus roof. Although Type 3 was less common, due to the high risk associated with this type of canal, surgeons should be fully aware of the morphology and anatomical position of the IOC during sinus and orbital surgeries to reduce probable injuries.

Response Rate to Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer Based on Common Molecular Receptors

Seyed Reza Khandoozi

Background and Objective: Breast cancer has a high prevalence and mortality rate in the world and also in Iran. Neoadjuvant chemotherapy (NAC) is one of the treatment methods to improve patient survival. This study aimed to determine the response rate to NAC in patients with locally advanced breast cancer based on common molecular receptors.
Methods: This descriptive-analytical study was conducted on 100 patients with breast cancer (mean age= 41.14±10.06 years) referring to the surgical clinic of the Fifth Azar Educational and Therapeutic Center in Gorgan, Iran during 2013-18. Patients without distant metastasis underwent NAC treatment regimen followed by surgery. Demographic characteristics, types of drugs, and molecular receptor characteristics, and their response to treatment were recorded in a checklist. Treatment response and overall patient survival were evaluated.
Results: The mean tumor size before NAC was 3.01±2.47 cm (range= 0-8, median= 2) and 16% were determined to be grade one, 52% were determined to be grade 2, and 32% were determined to be grade 3. Thirty-six percent of patients had a positive family history. Forty-six percent were estrogen receptor (ER) positive, 40% were PR positive, 22% were human epidermal growth factor receptor 2 (Her-2) positive, and 78% were Her-2 negative. Thirty-six percent had a Ki-67 index greater than 30%. Eighteen percent of patients had a complete pathological response, and 82% had a partial or negative response. In terms of family history of breast cancer, Her2, ER, progestrone receptor (PR), Ki-67 receptor status, histological grade, tumor size, and axillary lymph nodes, there was a significant statistical difference between the two groups with and without complete pathological response (P<0.05).
Conclusion: The rate of complete pathological response to NAC in patients with locally advanced breast cancer was 18%.

Cytotoxic Effects of Purified Carbohydrates from the Hyaline Layer, Fluid, and Protoscolices of Hydatid Cysts on the Human Colorectal Cancer Cell Line (LS174T)

Sara Larki

Background and Objective: Colorectal cancer is the third most common cancer in men and the second most common in women. The use of parasites or parasite antigens is one of the newest therapeutic approaches for cancer, although it has not yet been used or approved in human trials. This study aimed to determine the cytotoxic effects of purified carbohydrates from the hyaline layer, fluid, and protoscolices of hydatid cysts on the human colorectal cancer cell line (LS174T).
Methods: This descriptive-analytical study was conducted on two sheep and two cow livers infected with hydatid cysts, and the human colorectal adenocarcinoma cell line (LS174T) purchased from the Pasteur Institute of Iran at the Faculty of Veterinary Medicine, Shahid Chamran University of Ahvaz, Iran during 2022. Cyst fluid, protoscolices, and the hyaline layer were isolated from the hydatid cyst-infected livers, and glycoproteins and glycolipids from different parts of the cyst were extracted using the chloroform-methanol method. Carbohydrates were purified using the beta-elimination method and their presence was confirmed using the phenol-sulfuric acid method. The cytotoxicity of purified carbohydrates on the LS174T cell line was evaluated using the methyl tetrazolium (MTT) assay for 24 hours.
Results: Concentrations of 0.5 and 0.25 of purified carbohydrates from glycoproteins and glycolipids of hydatid cysts significantly inhibited the growth of LS174T cells (P<0.05). Initial cytotoxicity evaluation showed that purified carbohydrates from glycoproteins of sheep cyst fluid (38.60±1.33%), glycoproteins of cow cyst hyaline layer (36.61±1.76%), glycolipids of cow cyst hyaline layer (38.94±2.99%), glycoproteins of cow cyst protoscolices (40.27±3.66%), and glycolipids of sheep cyst protoscolices (37.94±1.99%) had significantly more pronounced inhibitory effects (P<0.05). Subsequent screening with the MTT assay revealed that purified carbohydrates from glycoproteins isolated from sheep hydatid cyst fluid (52.35±10.24%), glycolipids isolated from cow hydatid cyst hyaline layer (53.40±7.88%), and glycolipids isolated from sheep hydatid cyst protoscolices (53.05±5.06%) had significantly more pronounced inhibitory effects on the growth of LS174T cancer cells (P<0.05).
Conclusion: Carbohydrates isolated from glycoproteins and glycolipids of the hyaline layer, fluid, and protoscolices of hydatid cysts have significant anticancer effects on the LS174T colorectal cancer cell line.

Clinical and Laboratory Manifestations of Patients with Liver Cirrhosis Infected with Coronavirus Disease

Alireza Norouzi

Background and Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a significant threat to both healthy individuals and those with chronic diseases, including liver cirrhosis. This study aimed to evaluate the clinical and laboratory manifestations and treatment outcomes of patients with liver cirrhosis who were infected with COVID-19.
Methods: This retrospective descriptive study was conducted on 9 patients (4 women and 5 men) with liver cirrhosis infected with COVID-19 hospitalized at Shahid Sayyad Shirazi Educational and Therapeutic Center in Gorgan, Iran during 2019-20. COVID-19 infection was diagnosed by a positive polymerase chain reaction (PCR) test. The Child-Pugh score was used to classify the severity of liver disease. Demographic and clinical data, including initial symptoms and complaints, laboratory results, need for intensive care unit (ICU) admission, length of hospital stay, and treatment outcomes, were extracted from patients’ medical records.
Results: The severity of liver disease was classified as Class B in 7 patients. Comorbidities included cardiovascular diseases and hypertension in 2 patients each, as well as diabetes and asthma in one patient each. Clinical manifestations at the time of COVID-19 diagnosis included ascites in 6 patients; fever in 5 patients; respiratory distress and anorexia in 4 patients each; cough, oxygen saturation less than 93%, and muscle pain in 3 patients each; nausea and vomiting in 2 patients; and abdominal pain and decreased level of consciousness in one patient each. Albumin levels were less than 4 g/dL in all patients. Hemoglobin was less than 12 g/dL in 7 patients. Thrombocytopenia was observed in 8 patients, leukocytosis in one patient, and leukopenia and pancytopenia in 4 patients each. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were higher than 40 U/L in 6 and 5 patients, respectively. Only one patient died, a 60-year-old woman with a history of fatty liver disease, cardiovascular disease, and uncontrolled Class C cirrhosis.
Conclusion: The most common clinical manifestations in patients with liver cirrhosis infected with COVID-19 consisted of ascites, fever, respiratory distress, and anorexia, and the most common laboratory manifestations were hypoalbuminemia and thrombocytopenia.

Closed, Irreducible Three-Part Posterior Shoulder Fracture Dislocation: A Case Report

Saeed Kokly

Posterior shoulder fracture dislocation (PSFD) is a rare and challenging injury. Early diagnosis and treatment can prevent serious complications and disability, reducing the risk of avascular necrosis of the humeral head and joint destruction. Several treatment options have been proposed, depending on the patient’s age, duration of dislocation, humeral head bone defect, length of the metaphysis attached to the reverse Hill-Sachs, osteopenia and functional demand, and concomitant diseases. Open anatomic reduction and internal fixation is a suitable option, particularly in young and active individuals. Humeral joint replacement is recommended for non-fixable 3- or 4-part fractures, particularly in elderly individuals with low demand and osteoporosis. This article reports a case of closed, irreducible PSFD that was treated with open reduction and internal fixation using a plate and deltopectoral approach.