Journal of Gorgan University of Medical Sciences

Game-Based Telerehabilitation on Motor Function in Stroke Patients

Ardalan Shariat

Stroke survivors often experience various motor complications, and sustained treatment is crucial for their recovery. Game-based telerehabilitation interventions appear to facilitate motor improvement in these patients by ensuring sustained treatment. Therefore, the present study aimed to evaluate game-based telerehabilitation on motor function in stroke patients. This narrative review involved a comprehensive search of the PubMed database up to August 2024, using the keywords "Game," "Games," "Serious games," "Telerehabilitation," and "Stroke," both individually and in combination. Out of 118 articles initially identified, duplicates and articles published before 2018 were excluded. Ultimately, 9 articles meeting the inclusion and exclusion criteria were selected for review. The full text of these English articles was then analyzed and compared in terms of study design and intervention outcomes on improving motor function. Of the 9 studies reviewed, 6 focused on improving upper extremity motor function, 2 on improving lower extremity motor function, and 1 on improving motor function in both upper and lower extremities. All 9 studies reported positive results regarding improving upper and lower extremity motor function through game-based telerehabilitation. However, most studies had small and varied sample sizes, and there was no consensus on the optimal frequency or duration of game use. Furthermore, the technology employed in these games was found to be expensive for less developed countries. Given the positive outcomes of this approach for stroke patients, developing affordable, localized games and integrating them into national rehabilitation programs could significantly benefit both patients and healthcare systems.

Various Exercise Protocols with and without the Use of Taping and Kinesio Taping in Individuals with Ankle Injuries

Mohsen Barghamadi

Studies indicate a significant impact of rehabilitation exercises on improving complications related to ankle injuries. This review aimed to evaluate the effects of various exercise protocols with and without the use of taping and kinesio taping, in individuals with ankle injuries. Article were searched in both Persian and English from 2007 to 2023 in the specialized databases of PubMed, Scopus, Science Direct, Web of Science (WoS), Google Scholar, Islamic World Sciences Citation (ISC), Civilica, State Inpatient Database (SID), and Magiran. The keywords used for article extraction included "Ankle ligament," "Ankle injury," "Ankle sprain," "Corrective exercises," and "Taping." Ultimately, 16 articles related to the effects of various exercise protocols with and without the use of taping following ankle injury were reviewed and analyzed. A review of 6 articles revealed that exercise protocols with the use of taping have reduced the likelihood of lower extremity injuries by increasing ankle muscle strength and improving selected kinetic variables, proprioception, and ankle function. Additionally, an examination of 3 articles on exercise protocols with the use of taping demonstrated that the application of taping had no significant effect on function. Furthermore, a review of 7 articles on exercise protocols without the use of taping demonstrated that performing such exercises culminated in the restoration of muscle strength and improved proprioception and static balance. The results revealed that various exercise protocols with and without the use of taping are significantly effective in preventing recurrent ankle ligament injuries; however, the application of taping may have a superior effect on ankle injury recovery.

Effectiveness of Neuromuscular Exercises on Static and Dynamic Balance in Male Adolescents with Genu Valgum Deformity

Mohammadhosein Alizadeh

Background and Objective: Given the prevalence of genu valgum deformity and its impact on static and dynamic balance in growing adolescents, this study aimed to determine the effectiveness of neuromuscular exercises on static and dynamic balance of male adolescents with genu valgum deformity.
Methods: This quasi-experimental study was conducted on 24 non-athlete students aged 12 to 14 years with genu valgum deformity. The participants were recruited from corrective exercise centers in District 1 of Velenjak and District 20 of the city of Rey in 2023. Subjects were divided into two groups of 12: A control group and an exercise group. The single-leg balance test and the Y-balance test were used to assess static and dynamic balance in various directions. The corrective exercise program consisted of 12 weeks of neuromuscular exercises, designed in three phases based on varying repetitions, sets, and intensities.
Results: The static and dynamic balance of the exercise group exhibited a statistically significant improvement in the anterior, posteromedial, and posterolateral directions compared to the control group (P<0.05).
Conclusion: The neuromuscular corrective exercise program led to an improvement in both static and dynamic balance in adolescents with genu valgum deformity.

Evaluation of Outcomes and Complications of Tibial Pilon Fractures Treatment in Six-Month Follow-Up

Saeed Kokly

Background and Objective: Various surgical techniques, including Open Reduction and Internal Fixation (ORIF), Minimally Invasive Plate Osteosynthesis (MIPO), and External Fixation (EF), have been proposed for the tibial pilon fractures treatment. However, limited comparative data exist regarding the outcomes of these three methods. Despite advancements in surgical procedures, the outcomes have not consistently been excellent, and patients often experience numerous complications. This study aimed to evaluate the outcomes and complications of the tibial pilon fractures treatment in a six-month follow-up.
Methods: This descriptive-analytical prospective cohort study was conducted on 22 patients (18 men and 4 women; mean age=39.4±10.8 years) who presented with tibial pilon fractures at the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, from April 2020 to March 2022. All 22 eligible patients agreed to participate. Following the necessary treatment determined by the attending physician, patients were examined after six months, and their outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) ankle score.
Results: The majority of fractures (54.5%) were of closed type. The surgical procedures performed included two-stage EF (40.9%), ORIF (31.8%), expert nailing (13.6%), and MIPO (13.6%), respectively. A total of 72.7% of patients experienced early or late postoperative complications. The most common postoperative complications were osteoarthritis and wound dehiscence, occurring at a rate of 18.2% each. The mean AOFAS score for patients was 82.3±11.2. AOFAS scores were classified as excellent in 4 patients (18.18%), good in 12 patients (54.55%), moderate in 4 patients (18.18%), and poor in 2 patients (9.09%). A statistically significant inverse correlation was observed between the mean surgical time and the AOFAS score (r=−0.661, P=0.001). Furthermore, a statistically significant direct correlation was found between the mean surgical time and the mean length of hospital stay (r=0.571, P=0.006). Surgical time for patients undergoing MIPO (68.3±7.6 minutes) was significantly shorter than that of the other three methods (P<0.05). For open fractures, the frequency of ORIF was significantly higher than that of other procedures (P<0.05). Osteoarthritis was observed as a treatment complication in both expert nailing and two-stage EF interventions. In contrast, non-union and wound dehiscence complications were exclusively observed following ORIF. Superficial infection and mal-union were only observed after two-stage EF, and all instances of deep infection occurred with MIPO.
Conclusion: Two-stage EF and ORIF were the most common surgical techniques employed for patients with tibial pilon fractures. Worse postoperative complications, including non-union and wound dehiscence, commonly occurred in ORIF procedures. However, there was no statistically significant difference in patient-reported outcomes based on the AOFAS self-report questionnaire among the various surgical techniques.

Comparing Two Treatment Regimens for Helicobacter pylori Eradication: Furazolidone or Clarithromycin?

Alireza Norouzi

Background and Objective: Clarithromycin-based quadruple treatment is a common treatment regimen for Helicobacter pylori (H. pylori) eradication in Iran. However, its success rate has been unsatisfactory in recent years due to increasing antibiotic resistance. This study aimed to compare the two treatment regimens, i.e., furazolidone and clarithromycin, for H. pylori eradication.
Methods: This descriptive-analytical retrospective study was conducted on the medical records of 100 symptomatic patients (54 females and 46 males; mean age=45.86±11.97 years) confirmed with H. pylori infection via urea breath test (UBT) or rapid urease test (RUT), who presented to Shahid Sayyad Shirazi Educational-Therapeutic Center in Gorgan, Iran, for endoscopy during 2019. Patients had been treated for two weeks with one of two routine oral quadruple drug regimens based on furazolidone and clarithromycin. The first quadruple drug regimen included bismuth subnitrate 240 mg twice daily, clarithromycin 500 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily. The second quadruple drug regimen involved bismuth subnitrate 240 mg twice daily, furazolidone 200 mg twice daily, omeprazole 20 mg once daily, and amoxicillin 1000 mg twice daily. H. pylori eradication rates were determined using a stool antigen test in patients who completed the entire course of treatment (four weeks after the end of the treatment regimen).
Results: The eradication rates for the furazolidone-based and clarithromycin-based quadruple regimens were determined to be 98% and 94%, respectively, showing no statistically significant difference. The odds ratio for H. pylori eradication was not statistically significantly associated with age, gender, or treatment regimen type.
Conclusion: Both two-week furazolidone-based and clarithromycin-based quadruple regimens were effective in eradicating H. pylori, with neither regimen demonstrating superiority over the other.

Evaluation of the Agreement of Advanced Corneal Explorer with Pentacam and Orbscan in Myopic Individuals with Healthy Corneas

Hadi Ostadimoghaddam

Background and Objective: Evaluating the agreement among various corneal imaging devices is crucial due to their varying technologies in diagnosing corneal parameters. This study aimed to assess the agreement of Advanced Corneal Explorer (ACE) with Pentacam and Orbscan in myopic individuals with healthy corneas.
Methods: This descriptive-analytical study was conducted on 45 myopic individuals (25 women and 20 men; mean age=30.37±6.13 years) referring to Al-Zahra Ophthalmology Hospital in Zahedan, Iran, during 2023. Anterior segment imaging was performed using three devices: ACE, Pentacam, and Orbscan. Corneal parameters, including topography, tomography, and corneal aberrations, were examined. The intraclass correlation coefficient (ICC) and 95% limits of agreement (LoA) were used to evaluate the agreement of ACE data with the data obtained from the other two devices.
Results: ACE exhibited good agreement with Pentacam for the mean power (ICC=0.97), maximum power (ICC=0.98), and minimum power of the anterior corneal surface (ICC=0.97) (P<0.05). Additionally, ACE exhibited good statistical agreement with Orbscan for the mean power of the anterior corneal surface due to an ICC of 0.98 (P<0.05). The ICC values for central corneal thickness and thinnest corneal thickness with the ACE and Pentacam devices were 0.99 and 0.95, respectively, indicating significant statistical agreement (P<0.05). White-to-white distance, pupil size, and corneal aberrations did not show good agreement among the three devices (ICC<0.75).
Conclusion: Topography values and corneal thickness measured with ACE showed good agreement with Pentacam; therefore, they can be used interchangeably. Other measured variables from ACE did not show good agreement with Pentacam and Orbscan and are not interchangeable.

Effect of Curcumin on Docetaxel-Induced Apoptosis in the DU145 (Prostate) Cell Line Using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide Assay

Elahe Gharehkhani

Background and Objective: Prostate cancer is one of the most common malignancies worldwide. Docetaxel (DTX) is proposed as a well-known compound for prostate tumor chemotherapy, and its function is based on inhibiting microtubule depolymerization, disrupting microtubule balance, and consequently delaying cell cycle progression. Complications of DTX include hypersensitivity reactions, red blood cell aggregation, neutropenia, neurological problems, such as paralysis, fluid retention, bronchospasm, refractory hypotension, ADRS, respiratory impairment, cardiac dysfunction, ventricular tachycardia, cystoid macular edema, optic nerve damage, conjunctivitis, and keratopathy. This study aimed to determine the effect of curcumin on DTX-induced apoptosis in the DU145 (prostate) cell line using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.
Methods: This descriptive analytical study was conducted on the DU145 (prostate) cell line, purchased from the National Genetic Resources Cell Bank, at the Cell Culture Laboratory of the F aculty of Pharmacy, Mazandaran University of Medical Sciences. Cells were passaged for exposure to the desired drugs. Groups included curcumin at concentrations of 2, 4, 6, 8, and 10 µg/mL and DTX at a concentration of 4.46 µg/mL. Cells were incubated in triplicate for 24 hours. For the MTT assay, the culture rate was 10⁴ cells per well. Apoptosis testing was designed for four groups (DTX at a concentration of 4.46 µM, curcumin at a concentration of 2 µM combined with DTX at an optimal concentration, curcumin at a concentration of 10 µM combined with DTX at an optimal concentration, and curcumin at a concentration of 10 µM alone), with the culture rate of 5×10⁵ cells per well in 6-well plates. After cell exposure, MTT and apoptosis determination assays were performed.
Results: DTX reduced the viability of DU145 (prostate) cells by approximately 50% (P<0.05). Groups treated with curcumin combined with DTX showed a dose-dependent decrease in cytotoxicity and an increase in the viability of DU145 (prostate) cells (P<0.05). Additionally, curcumin was able to reduce apoptosis in DU145 (prostate) cells by 90%.
Conclusion: Curcumin increases cell viability and reduces apoptosis in DU145 (prostate) cells.

Synergistic Effects of Carvacrol and Thymol on Docetaxel-Induced Cytotoxicity in the A549 Cell Line by Evaluating Cell Viability and Oxidative Stress

Samane Sadat Besharat

Background and Objective: Docetaxel is an effective chemotherapy drug for treating lung cancer, but its side effects and cytotoxicity limit its use. Natural compounds like carvacrol and thymol, known for their anti-cancer and anti-inflammatory properties, have gained attention as adjunct agents to reduce toxicity and enhance the efficacy of chemotherapy drugs. This study aimed to investigate the impact of carvacrol and thymol on cell viability and function in A549 cancer cells exposed to docetaxel.
Methods: This experimental study was conducted on the epithelial cell line derived from lung cancer tissue (A549), obtained from the Pasteur Institute of Iran at the Faculty of Pharmacy, Mazandaran University of Medical Sciences in the year 1042. In this research, A549 cells were pre-treated with various concentrations of carvacrol and thymol (5, 10, 20, 40, 80, 100, and 200 µg/mL) along with a cytotoxic dose of docetaxel (8.92 µg/mL) over a period of 48 hours. Cytotoxicity was assessed using the MTT assay. Additionally, the levels of reactive oxygen species (ROS) in cells were measured using the DA-DCFH reagent, and malondialdehyde (MDA) levels were determined using the thiobarbituric acid (TBA) reagent.
Results: Carvacrol and thymol significantly reduced the cytotoxic effects of docetaxel at concentrations ranging from 5 to 200 µg/mL (P<0.05). The evaluation of cytotoxicity indicated that at a concentration of 200 µg/mL, carvacrol and thymol exhibited a more pronounced enhancing effect (98.11±1.64%) compared to the concentration of 5 µg/mL (54.64±2.03%). Furthermore, these compounds significantly mitigated the oxidative stress induced by docetaxel by decreasing the production of reactive oxygen species (ROS) and malondialdehyde (MDA) (P<0.05). Specifically, at the concentration of 200 µg/mL, the levels of ROS and MDA were (13.57±0.09%) and (0.55±0.003%), respectively, in contrast to the levels at 5 µg/mL, which were (20.50±0.59%) and (0.98±0.01%). This demonstrates a notable inhibitory effect on the growth of cancer cells by carvacrol and thymol.
Conclusion: Carvacrol and thymol demonstrate high potential as compounds to improve cell function and reduce the cytotoxicity induced by docetaxel in A549 cancer cells. These findings suggest the potential enhancement of chemotherapy regimens for cancer treatment.

Fear of Childbirth among Pregnant Women of Various Ethnicities Referring to Comprehensive Health Service Centers in Gorgan, Iran (2023)

Akram Sanagoo

Background and Objective: Fear of childbirth is a common problem during pregnancy. Previous studies have shown that pregnancy outcomes and experiences can significantly vary across various ethnic groups. This study aimed to determine the prevalence of fear of childbirth among pregnant mothers of various ethnicities referring to comprehensive health service centers in Gorgan, Iran.
Methods: This descriptive-analytical study was conducted on 341 pregnant women of Fars, Turkmen, and Sistani/Baluch ethnicities using a random sampling method at comprehensive health service centers in Gorgan during 2023. Data collection instruments consisted of a demographic and pregnancy characteristics form and the Childbirth Fear Questionnaire (CFQ; Zar and Wijma).
Results: The mean fear of childbirth score in pregnant women was determined to be 69.88±20.19 (severe fear). Among all studied groups, mild fear (21 individuals), moderate fear (100 individuals), severe fear (147 individuals), and clinical fear (73 individuals) were identified in 6.2%, 29.3%, 43.1%, and 21.4% of the pregnant women, respectively. The combined prevalence of severe and clinical fear of childbirth among pregnant women of Sistani/Baluch, Turkmen, and Fars ethnicities was determined to be 73%, 73.3%, and 52.2%, respectively, and this difference was statistically significant (P<0.05). A statistically significant relationship was observed among the variables of age, gestational period, and the level of satisfaction with prenatal care received at comprehensive health service centers (P<0.05).
Conclusion: Severe and clinical fear of childbirth is more prevalent among pregnant women of Sistani/Baluch and Turkmen ethnicities compared to the Fars ethnicity.

Childhood Mortality Rate in the City of Aqqala in Golestan Province, Iran (2017–2022)

Mahsa Besharat

Background and Objective: Most Iranian provinces, including Golestan Province, have achieved the 2015 Sustainable Development Goals (SDGs) for childhood mortality. However, evidence suggests that mortality rates in some population groups within these regions remain high and concerning. This study aimed to determine the childhood mortality rate in the city of Aqqala in Golestan Province, Iran.
Methods: This descriptive study was conducted on 416 cases (243 males, 172 females, 1 ambiguous genitalia) of mortalities among children aged 0-18 years residing in rural and urban areas of the city of Aqqala from 2017 to 2022. All registered mortalities were extracted from the electronic health record system at Golestan University of Medical Sciences. Incomplete records or those with imprecisely documented causes of mortality were excluded from the study. The causes of childhood mortality were categorized based on the International Classification of Diseases (10^th Revision, 2016). Age divisions were regarded as 0-28 days, 1-12 months, 1-2 years, 2-6 years, 6-12 years, and 12-18 years for neonates, infants, toddlers, preschoolers, school-aged children, and adolescents, respectively.
Results: The overall mortality rate was determined to be 2.15 deaths per 1000 live births, with rates of 23.1 per 1000 live births for male children and 10.3 per 1000 live births for female children. This rate decreased from 22.7 deaths per 1000 live births in 2017 to 12.3 deaths in 2022. The neonatal mortality rate was determined to be 32.8 per 1000 live births, and the infant mortality rate was 5.5 deaths per 1000 live births. The primary causes of mortality, in order of frequency, included certain conditions originating in the perinatal period (28.2%), congenital malformations and chromosomal abnormalities (17.2%), and transport-related accidents (12%).
Conclusion: Despite a declining trend in the overall mortality rate of children under 18 years in the city of Aqqala in Golestan Province, the neonatal mortality rate in this region is alarmingly higher than the Iranian average, necessitating attention and appropriate measures for further evaluation and intervention.