Journal of Gorgan University of Medical Sciences

The Effects of Exercise on Inflammation and Oxidative Stress in Vitamin D Deficiency Status Accompanied by Obesity and Overweight: A Review of the Evidence

Masoumeh Habibian

Vitamin D deficiency affects a broad range of health-related factors. Both obesity and vitamin D deficiency are associated with the development of oxidative stress and systemic inflammation. Inflammation can culminate in decreased vitamin D levels through the induction of oxidative stress. Evidence suggests that exercise may improve vitamin D status. However, the effects of exercise interventions on inflammation and oxidative stress in the coexistence of vitamin D deficiency and obesity/overweight are not well-established. Therefore, this review aimed to evaluate the effects of exercise on inflammation and oxidative stress in vitamin D deficiency status accompanied by obesity/overweight. A search for articles from 2006 to 2023 was conducted in specialized databases of PubMed, Scopus, and state inpatient database (SID). The searched studies were original research articles, reviews, and clinical trials selected using the keywords of vitamin D deficiency, systemic inflammation, oxidative stress, chemokine, exercise, obesity, and overweight. According to the studies, regular exercise can inhibit the vicious cycle of oxidative stress-inflammation in vitamin D deficiency status accompanied by obesity/overweight by negatively regulating some inflammatory factors and chemokines, reducing lipid peroxidation levels, and increasing antioxidant status. Moreover, the increase in 25-hydroxyvitamin D levels resulting from exercise can be considered another mechanism for reducing oxidative stress-inflammation in vitamin D deficiency status accompanied by obesity/overweight.

Comparison of the Effects of Wearing Overminus Spectacles versus Patch Therapy in 3- to 8-Year-Old Children with Intermittent Exotropia: A Randomized Controlled Trial

Mohammad Sharifi

Background and Objective: Intermittent exotropia is the most common form of exotropia in children. Non-surgical treatments include refractive error correction, occasional patching of the normal eye in young children, prism therapy, and orthoptic exercises. This study aimed to compare the effects of wearing overminus spectacles versus patch therapy in 3- to 8-year-old children with intermittent exotropia.
Methods: This clinical trial was conducted on 30 children (9 boys and 21 girls) with intermittent exotropia aged 3 to 8 years with no previous treatment history referring to the strabismus clinic of Khatam-al-Anbia Hospital in Mashhad. Patients were randomly assigned to two groups: Patch therapy (n=20) and overminus (n=10). In the patch therapy group, the patient’s healthy eye was patched for 2 to 4 hours a day for 6 months. Overminus spectacles were selected based on cycloplegic refraction between 2 and 4 diopters. Astigmatism was fully prescribed. Patient follow-up time was 3 months and then 6 months. Finally, data, including the size of the deviation and the degree of deviation control, were collected and analyzed.
Results: The median spherical error of patients before intervention in the overminus group was +1 diopter in the right eye and +0.75 diopter in the left eye, and in the patch therapy group, +0.75 diopter in both the right and left eyes. Six months after the intervention, the median spherical error in the overminus group was +0.62 diopters in both the right and left eyes, and in the patch therapy group, +0.75 diopters and +0.62 diopters in the right and left eyes, respectively. No significant statistical difference was found between the study groups. The median deviation size of patients in the overminus group before intervention was +25 prism in distance vision and +25 prism in near vision, and 6 months after intervention, it was +22.5 prism in distance vision and +20 prism in near vision. Also, the median deviation size of patients in the patch therapy group before intervention was +25 prism in distance vision and +25 prism in near vision, and 6 months after intervention, it was +25 prism in distance vision and +25 prism in near vision. No significant statistical difference was found between the study groups. The median deviation control based on the Newcastle Scale Score (NSS) of patients before intervention was 3.5 in the overminus group and 4 in the patch therapy group, which was 1.5 in the overminus group and 3 in the patch therapy group 6 months after the intervention. Although there was a greater improvement in control based on the NSS in the overminus group compared to the patch therapy group.
Conclusion: Both overminus and patch therapy are effective in treating patients with intermittent exotropia. In patients using the overminus method, deviation control is higher compared to the patch therapy method.

Effect of Sand-Based Training on Ground Reaction Force Frequency Spectrum in Individuals with Anterior Cruciate Ligament Reconstruction and Pronated Feet during Gait: A Randomized Controlled Trial

Amir Ali Jafarnezhadgero

Background and Objective: Gait is a fundamental movement pattern influenced by various structures. This study aimed to determine the effect of sand-based training on ground reaction force frequency spectrum in individuals with anterior cruciate ligament (ACL) reconstruction and pronated feet during gait.
Methods: This clinical trial was conducted on 28 male students with pronated feet and ACL injuries aged 22-25 years at Mohaghegh Ardabili University. Participants were randomly assigned to two groups of 14: A control group and a sand-based training group. The ground reaction force variables were measured using a force plate in the pre-test and post-test.
Results: The number of necessary harmonics in the free moment component decreased by 15.95% in the post-test (16.48±4.14) compared to the pre-test (19.11±2.15) of the control group (P<0.05). The number of necessary harmonics in the mediolateral direction of the ground reaction force decreased by 23.34% in the post-test (15.59±3.92) compared to the pre-test (19.23±2.66) of the training group (P<0.05). Additionally, the number of necessary harmonics in the anteroposterior direction of the ground reaction force increased by 33.04% in the post-test (21.61±2.55) compared to the pre-test (14.47±4.11) of the training group (P<0.05).
Conclusion: Sand-based training was able to improve the gait mechanics of individuals with ACL reconstruction and pronated feet.

Effect of Theraplay-Based Play Therapy on Separation Anxiety in Elementary School Girls: A Randomized Controlled Trial

Nafiseh Hekmatipur

Background and Objective: School-age children often experience separation anxiety due to being away from their families. A therapeutic approach to address this issue is Theraplay-based play therapy. This study aimed to determine the effectiveness of Theraplay-based play therapy on separation anxiety in elementary school girls.
Methods: This randomized controlled trial involved 60 elementary school girls from Aliabad-e-Katoul County, Iran, divided into two groups of 30: A control group (mean age: 8.69±0.71 years) and an intervention group (mean age: 8.9±0.85 years) in 2023. Hahn et al.’s Separation Anxiety Assessment Scale (SAAS) (parental version, 2003) was administered as a pre-test and post-test to assess separation anxiety. The control group received no intervention. The intervention group participated in ten 45-minute Theraplay-based play therapy sessions with their mothers for 10 days.
Results: The mean total separation anxiety score in the pre-test was 82.2±9.27 in the intervention group and 83.53±8.8 in the control group, showing no statistically significant differences. Similarly, there were no significant differences between the two groups in pre-test scores for separation anxiety dimensions. However, the mean total separation anxiety score in the post-test was 78.36±7.87 in the intervention group and 84.03±9.01 in the control group. This difference was statistically significant (P<0.05). Furthermore, significant differences were observed in all dimensions of separation anxiety (P<0.05) except for the frequency of events in the intervention group before and after the intervention.
Conclusion: The results of this study indicate that the Theraply-based play therapy effectively reduces separation anxiety in elementary school girls.

Effects of Interleukin-10 (-1082/-819) and Interleukin-6 (-174) Gene Polymorphisms on Corpus Callosum Changes in Women with Multiple Sclerosis

Mohammad Jafar Golalipour

Background and Objective: Demyelinating lesions, widespread tissue damage, and neuronal connectivity impairments in white matter are associated with reduced cognitive decline in multiple sclerosis (MS) patients. These findings are particularly prominent in the corpus callosum of the brain. Interleukin-10 (IL-10) is an anti-inflammatory cytokine secreted by regulatory T cells (Tregs) with anti-inflammatory properties and can inhibit the production of pro-inflammatory cytokines produced by macrophages and T cells. IL-6 is a multifunctional cytokine involved in the immune system of autoimmune diseases. The IL-6 gene consists of 5 exons, 4 introns, and a proximal promoter region located on the 7p21 chromosomal locus in humans. This study aimed to determine the effects of IL-10 (-1082/-819) and IL-6 (-174) gene polymorphisms on corpus callosum changes in women with MS.
Methods: This case-control study was conducted on 40 women with MS aged 20-40 years referring to Golestan and Kowsar Magnetic Resonance Imaging (MRI) centers in Gorgan and 20 women without MS, autoimmune or inflammatory diseases over 40 years during 2015. Ten mL of blood was taken from the subjects for genotyping. Additionally, DNA extraction was performed using the phenol-chloroform method, and DNA genotyping was performed using the sequence specific primer-polymerase chain reaction (SSP-PCR) method. Brain MRI images of the subjects were employed to measure the corpus callosum and to investigate the relationship with the investigated polymorphisms.
Results: After performing the tests and obtaining different IL-6, IL-10 (-819), and IL-10 (-1082) genotypes, no significant statistical correlation was observed between IL genotypes in the case and control groups. Additionally, no significant correlation was observed between the different IL-6, IL-10 (-819), and IL-10 (-1082) genotypes and changes in the size of different parts of the corpus callosum, including rostrum width, splenium width, body width, the ratio of body length to anteroposterior length, and the ratio of body length to maximum height between the case and control groups. Reductions in the variables of rostrum width, splenium width, body width, the ratio of body width to anteroposterior length, and the ratio of body width to maximum height were significant in both case and control groups (P<0.05). Only the reduction in splenium width was significantly associated with the occurrence of MS (P<0.009, odds ratio [OR]=2.35, 95% confidence interval [CI]=4.51-1.22).
Conclusion: There was no relationship between the morphometric changes of reduced corpus callosum and the changes in IL-6, IL-10 (-819), and IL-10 (-1082) genotypes in patients with MS.

Prevalence of Internet Addiction among Medical Students and Its Association with Psychiatric Disorders during 2021

Aazam Sadat Heydari Yazdi

Background and Objective: In the post-coronavirus disease 2019 (COVID-19) era, messages and video calls with loved ones, family, and friends have brought individuals closer together and made social isolation more bearable. Although the utilization of these tools has numerous positive aspects, there are also negative ones. The present study was conducted to determine the prevalence of Internet addiction among medical students at Golestan University of Medical Sciences and its association with psychiatric disorders.
Methods: This descriptive-analytical study was conducted on 189 medical students (73 males and 116 females; mean age=23.35±3.03 years) at Golestan University of Medical Sciences in 2021. A convenience sampling method was used, and all students were taken into account as the statistical population. Data collection tools included Young’s Internet Addiction Test (IAT) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) short form, which were completed by the students.
Results: Fifty (26.45%) medical students were identified as being at risk of Internet addiction, and 3 (1.58%) students were classified as having Internet addiction. Less than 4% of the students had severe psychiatric disorders, while 9.5% to 19.6% exhibited various psychiatric disorders of moderate severity. Beyond the area of hypochondriasis symptoms, significant positive correlations were found between Internet addiction and increased psychiatric disorders in other areas, including depression (r=0.285, P<0.001), hysteria (r=0.170, P<0.019), psychopathy (r=0.338, P<0.001), paranoia (r=0.384, P<0.001), mania (r=0.336, P<0.001), psychasthenia (r=0.432, P<0.001), and schizophrenia (r=0.415, P<0.001). With increasing Internet addiction, the severity of psychiatric disorders also increased.
Conclusion: The prevalence of Internet addiction among medical students was shown to be at a low level, but the severity of psychiatric disorders increased with higher levels of Internet addiction.

Correlation of Sperm Parameters with Age and Body Mass Index in Infertile Men

Marziyeh Tavalaee

Background and Objective: Obesity and advancing age in men, in addition to numerous health problems, can negatively affect spermatogenesis and fertility potential. The present study aimed to determine the correlation of sperm parameters with age and body mass index (BMI) in infertile men.
Methods: In this descriptive-analytical study, semen parameters (concentration, motility, and morphology) of 7069 men referring to an infertility center in Isfahan were evaluated based on the 2010 World Health Organization (WHO) guidelines. BMI was calculated by dividing an individual’s weight (kg) by the square of their height (m).
Results: A weak positive correlation was observed between men’s BMI and age (P<0.001, r=0.07). Also semen volume (P<0.001, r=-0.02), sperm concentration (P<0.001, r=-0.02), and sperm count (P<0.001, r=-0.04) had a weak negative correlation with BMI. No statistically significant correlation was observed between sperm motility and BMI. Regarding men’s age, only a weak negative correlation was observed between this parameter and sperm motility (P<0.001, r=-0.04).
Conclusion: Increasing BMI and age in men may be associated with decreased sperm quality and fertility potential.

Prevalence of Narcotics-Induced Poisoning in Children under 18 Years of Age Referring to the Al-e-Jalil Educational and Therapeutic Center, Aq Qala, Golestan Province (2020-2022)

Mahsa Besharat

Background and Objective: Poisoning is one of the most common reasons for emergency department visits worldwide. Awareness of poisoning patterns helps identify risk factors and enables early diagnosis. In Iran, narcotics are among the main causes of poisoning in children. The current study aimed to determine the prevalence of narcotics-induced poisoning in children under 18 years old referring to the Al-e-Jalil Educational and Therapeutic Center in Aq Qala, Golestan Province.
Methods: This retrospective descriptive study was conducted on 36 children aged 1 month to 18 years (22 boys and 14 girls; mean age: 51.62±36.25 months) referring to the Al-e-Jalil Educational and Therapeutic Center in Aq Qala due to narcotics-induced poisoning from 2020 to 2022. Samples were included in the study using census. Patients’ medical records were reviewed and recorded in a checklist.
Results: The highest poisoning rate stemmed from the consumption of opium (69.4%), followed by methadone (25%). Decreased level of consciousness upon hospital admission was determined to be 66.7%. The interval between poisoning and hospital admission was 5.60±3.86 hours. The mean length of hospital stay was 1.25±0.80 days, and no patients died. Most children were male (61.1%), Turkmen (69.4%), and rural residents (86.1%). The highest cases of poisoning occurred in the summer (36.1%). The most common route of contact was oral (97.2%).
Conclusion: The poisoning rate with opium is higher compared to other narcotics. However, there is strong evidence of increased opium use among young people and some evidence of increased methadone use.

Anti-Fungal Effects of Aerial Part Extracts of Artemisia biennis, Artemisia ciniformis, and Artemisia turanica

Mahdi Mojarrab

Background and Objective: Dermatophytosis is a significant skin disease in both humans and animals. Its resistance to common treatments is on the rise. Allylamines, polyenes, and azoles are prominent groups of anti-fungal drugs used to treat dermatophytosis. Various species of Artemisia, which are widely distributed in Iran, are regarded as a rich source of natural compounds with valuable biological activities. This research aimed to determine the anti-fungal effects of aerial part extracts of Artemisia biennis, Artemisia ciniformis, and Artemisia turanica.
Methods: This descriptive study examined the petroleum ether, dichloromethane, ethyl acetate, ethanolic, and hydroalcoholic aerial part extracts of Artemisia biennis, Artemisia ciniformis, and Artemisia turanica against fungi causing dermatophytosis. The investigated fungi included Trichophyton rubrum, Trichophyton verrucosum, Epidermophyton floccosum, and Microsporum cannis. The minimum inhibitory concentration (MIC) test was performed based on the agar dilution method. The most active extracts were investigated in preliminary phytochemical tests.
Results: In the initial screening, Epidermophyton floccosum and Microsporum cannis exhibited the highest resistance (11 out of 15) and sensitivity (12 out of 15), respectively, to the tested extracts. Petroleum ether extracts from all three Artemisia species were the most active extracts used in the tests. Hydroalcoholic extracts showed the least anti-dermatophytic activity. The lowest MIC (78.1 μg/mL) was recorded for the petroleum ether extract of Artemisia ciniformis against Trichophyton rubrum. Preliminary phytochemical studies showed the common presence of terpenoids in all plant species extracts.
Conclusion: Some lipophilic compounds present in petroleum ether extracts of Artemisia biennis and Artemisia ciniformis, as well as dichloromethane extract of Artemisia biennis, exhibited significant in vitro anti-dermatophytic activities.

Trichotillomania Disorder in a Child with Intellectual Disability and the Efficacy of Habit-Reversal Training Techniques: A Case Report

Abolghasem Yaghoobi

Trichotillomania disorder, or hair pulling disorder, is a condition in which patients unconsciously engage in hair-pulling, which reinforces compulsive hair pulling behaviors, culminating in conscious and deliberate hair pulling. Behavioral therapy is a common treatment approach for this disorder. Habit-reversal training (HRT) is a particularly effective treatment method for children with intellectual disabilities who exhibit this disorder. This case report presents the efficacy of HRT in reducing trichotillomania-associated severity and distress. The patient was a 13-year-old girl with intellectual disability who met the diagnostic criteria for trichotillomania according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). She received eight sessions of HRT techniques over one month. The Massachusetts General Hospital Hair Pulling Scale (MGH-HPS) was employed to measure the severity and distress of the hair pulling behavior. Given the patient’s intellectual disability (intelligence quotient [IQ]=65) and limited ability to respond to self-report questions about the nature of self-interests, the parent-report version of the scale was used both during the treatment and the one-month follow-up. The effectiveness of the intervention was evaluated using visual analysis of graphs, percentage of improvement, effect size, and photographs of the eyebrow hair pulling before and after treatment. The results indicated that the HRT significantly reduced both the severity (effect size=1.75) and distress (effect size=1.77) of the trichotillomania disorder, and the patient exhibited a high percentage of improvement. The one-month follow-up demonstrated that the results were maintained.