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.

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.

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.

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.

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.

 

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.

The preservation of mahramiyyah (permissibility) in medical examinations has always been a challenging issue from the perspective of fiqh (Islamic jurisprudence). This matter becomes particularly significant in cases where medical necessities conflict with religious rulings. This analytical-research study, with a comparative approach, was conducted to provide a new framework to establish a balance between medical necessities and fiqh rulings. First, the theoretical foundations and research background were first extracted using reliable library sources, fiqh texts, and scholarly medical books and articles. Sources were searched in the following databases: PubMed, Scopus, Web of Science, Scientific Information Database (SID), Magiran, NoorMags, the Computer Research Center of Islamic Sciences (Noor), and the Comprehensive Jurisprudence Database. The keywords used included “Medical Mahramiyyah,” “Medical Fiqh,” “Medical Necessity,” “Non-Same-Sex Examination,” “Patient Privacy,” “Islamic Telemedicine,” and “Medical Religious Rulings” in Persian, English, and Arabic. Selected sources spanning the period during 1981-2024 were evaluated. The inclusion criteria comprised direct relevance to the topic, peer review, and appropriate content quality. The exclusion criteria included irrelevance to the topic, non-peer reviewed, replicate sources, studies with low quality or without valid data, public or news reports lacking scientific basis. Ultimately, 37 sources were selected and analyzed based on thematic analysis and fiqh deductive reasoning to identify common principles and points of conflict between the fiqh data and medical requirements. Emerging challenges in medical fields, such as telemedicine, were also evaluated. Although the primary principle in Shia fiqh is the prohibition of looking at (except for the face and hands up to the wrist) and touching a person of the opposite sex, whether for treatment or otherwise, there is a consensus among faqihs (Islamic jurists) that, in cases of necessity, this principle is suspended. As a result, examinations requiring touching and looking, even of the genitals, by a physician of the opposite sex are permissible. In both fiqh and medicine, necessity is defined as an urgent need for treatment or medical procedures that, if not performed, could lead to a serious threat to the patient's health. However, some faqihs, based on the rational rule of “Irtikāb Aqall al-Qabīḥayn” (committing the lesser of the two detestable things), deem direct touch and direct viewing to fall under the primary prohibition in instances where telemedicine and indirect examinations suffice for the aforementioned necessity. This research offers practical solutions to maximize the preservation of mahramiyyah in medical examinations, aiming to improve the quality of medical services in Islamic societies while adhering to religious principles.
 

Background and Objective: The co-infection of tuberculosis (TB) and coronavirus disease 2019 (COVID-19) presents a significant global health challenge. Golestan Province is considered one of the most important hubs for TB. This study was conducted to simultaneously evaluate the clinical epidemiology of TB and COVID-19 in patients admitted to the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran.
Methods: This retrospective, descriptive-analytical study was performed on 22 patients (12 men and 10 women) with active or old TB and COVID-19 admitted to the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, during 2020-2022. Clinical data and real-time polymerase chain reaction (RT-PCR) results were extracted from patients’ records in the hospital. These data, encompassing nasopharyngeal swab specimens from the upper respiratory tract, as well as tracheal aspirate specimens, were compiled into a checklist format.
Results: Of the 22 patients, 13 were deceased and 9 recovered. Patient hospitalization wards included the intensive care unit (ICU) (36%), respiratory isolation (36%), surgery (4.5%), and infectious diseases (23%). All patients ICU-admitted (100%) were in the deceased group (P<0.05). The clinical symptom of dyspnea was present in all 13 deceased patients (P<0.05). Laboratory results showed that alanine transaminase (ALT) and blood urea nitrogen (BUN) values were significantly higher in the deceased group than in the recovered group (P<0.05). Hematological indices, including white blood cell (WBC) count, hemoglobin (Hb), hematocrit (Hct), and mean corpuscular hemoglobin concentration (MCHC), were significantly higher in the recovered group compared to the deceased group (P<0.05).
Conclusion: The probability of death is higher in patients with TB and COVID-19 co-infection who experience dyspnea, require ICU admission, and have increased ALT and BUN laboratory values.
 

Background and Objective: Breast cancer is one of the most common diseases worldwide and the second leading cause of death among women. Immune responses play a critical role in inhibiting the onset and progression of this disease. Given the important role of T lymphocytes in identifying and preventing the spread of breast cancer tumor cells, this study was conducted to simultaneously evaluate the regulatory molecules CXC chemokine receptor 3 (CXCR3), programmed cell death protein 1 (PD-1), natural killer group 2 member D (NKG2D), and transforming growth factor beta 1 receptor II (TGF-βRII) on T lymphocytes of newly diagnosed breast cancer patients.
Methods: This case-control study was performed on 26 newly diagnosed breast cancer patients (mean age = 46.2±9.5 years) admitted to the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, and 12 non-breast cancer individuals (mean age = 42.9±9.9 years) selected from the staff and students of Golestan University of Medical Sciences during 2018-2019. First, blood sampling was performed and peripheral blood mononuclear cells (PBMCs) were isolated. Then, using flow cytometry, different cell populations were evaluated for the expression of CXCR3, PD-1, NKG2D, and TGF-βRII. Plasma levels of interferon gamma (IFN-γ) and major histocompatibility complex class I chain related gene-A (MIC-A) were measured by enzyme-linked immunosorbent assay (ELISA).
Results: The mean percentage of T lymphocyte population in newly diagnosed breast cancer patients was significantly lower compared to healthy individuals (P<0.05). Also, the mean percentage of T lymphocytes expressing PD-1 and TGF-βRII was higher in the case group compared to the control group, while the expression of NKG2D and CXCR3 showed lower levels (P<0.05). The results of comparing plasma concentrations of IFN-γ and MIC-A indicated that the case group had higher levels of MIC-A than the control group (P<0.05); however, no statistically significant difference was found regarding IFN-γ.
Conclusion: It seems that the increased expression of TGF-βRII and PD-1 along with the decreased expression of NKG2D and CXCR3 and the reduced level of MIC-A in newly diagnosed breast cancer patients may be related to upregulation and potent suppression of T lymphocyte immunity and their dysfunction in breast cancer disease.
 

Excessive weight gain during pregnancy is recognized as a global epidemic and is associated with complications, such as gestational diabetes. While a healthy diet and regular physical activity positively influence weight control and overall well-being, in-person consultations can be costly and time-consuming. The use of digital technologies, particularly smartphones, has increased for delivering lifestyle interventions and improving well-being. These technologies provide affordable access to health services for pregnant women, especially those in remote areas. This narrative review was conducted to evaluate the effect of telehealth on weight control and the promotion of a healthy lifestyle among pregnant women. A search was performed in the PubMed, Google Scholar, and Scopus databases. Of the 631 initial articles published during 2020-2024,
15 were selected and evaluated after excluding irrelevant articles, review articles, and those without full texts. The selected articles showed that mobile health (mHealth) could improve indicators, such as weight, body mass index (BMI), maternal and infant health, and lifestyle. However, certain limitations, including access issues, cultural barriers, and fluctuations in service quality, impacted their effectiveness. Based on the findings of these articles, it is suggested that personalized interventions be designed with continuous consultations and daily reminders. Forming virtual groups and providing timely feedback can strengthen the sense of belonging and promote adherence. These strategies are valuable for telehealth clinics and online counseling programs.
 

Background and Objective: Vitamin D deficiency is highly prevalent among obese individuals, with multiple underlying mechanisms contributing to this condition. This study aimed to determine the combined effects of high-intensity interval training (HIIT) and vitamin D supplementation on the levels of inflammatory markers, transforming growth factor beta 1 (TGF-β1) and tumor necrosis factor alpha (TNF-α), in young women with vitamin D deficiency.
Methods: In this clinical trial, 39 sedentary women with vitamin D deficiency were randomly assigned to three groups: A control group, a HIIT-based running group, and a combined group (training + vitamin D). The training program included 12 one-minute repetitions of running at 80% to 90% of maximum heart rate (HRmax) and one minute of active rest at 50% HRmax, performed three sessions per week. Vitamin D supplementation was used weekly at a dose of 50,000 IU. TGF-β1 and TNF-α levels were measured and compared before and after the intervention.
Results: After 8 weeks of HIIT-based running, with and without vitamin D supplementation, the levels of inflammatory markers, TGF-β1 and TNF-α, showed a statistically significant decrease compared to the control group (P<0.05). The mean percentage change in TGF-β1 and TNF-α was also significantly greater in the combined group than in the training group without vitamin D supplementation (P<0.05).
Conclusion: Following 8 weeks of HIIT-based running, both inflammatory markers, TGF-β1 and TNF-α decreased in the study subjects, and this reduction was more pronounced in the vitamin D-receiving group.

Background and Objective: One of the prominent challenges in the dental profession is patient complaints, many of which lead to legal and criminal prosecution. This study aimed to determine the prevalence and causes of patient complaints against dentists in Golestan Province.
Methods: This descriptive study was carried out on 96 complaint files against dentists in Golestan Province, Iran, using a census method during 2012-2022. The necessary information was extracted from the files and recorded in an information form.
Results: The most frequent complaints were related to prosthodontics (29.2%), surgeries (26%), and endodontics (18.8%). The dentists who received complaints were predominantly male (75%) and had a general dentistry degree (90.6%). In 33% of the complaints, the dentist was found liable. None of the complaints against specialists resulted in the practitioner being found at fault.
Conclusion: The most common complaints were in the fields of prosthodontics, surgeries, and endodontics. The dentists involved were mostly male general dentists. Moreover, 33% of the complaints led to a conviction. Complaints related to prosthodontics and surgeries primarily concerned cosmetic treatments and implant surgeries, highlighting the need to review the educational curriculum for general dentists.
 

Background and Objective: Chlamydia, a zoonotic bacterial agent, is a major concern for both human and avian public health. This bacterium belongs to the family Chlamydiaceae, with 11 identified species. The Chlamydia psittaci (C. psittaci) species is shared between animal hosts and humans. Ornamental birds are among the hosts of C. psittaci. This bacterium causes respiratory and gastrointestinal problems in these birds. This study aimed to determine the prevalence of chlamydial infection in ornamental birds in Urmia, Iran.
Methods: This descriptive study was conducted on 60 fecal swabs collected from 60 ornamental birds in Urmia. Giemsa staining and molecular polymerase chain reaction (PCR) testing, using genus-specific primers to amplify a 580-base pair (bp) fragment of the ompA gene, were performed on the samples.
Results: The Chlamydia molecule was detected in 11.7% of budgerigars with gastrointestinal symptoms and in 5.88% of apparently healthy budgerigars. Additionally, the infection was detected in 11.11% of cockatiels, 14.28% of mynahs, 20% of canaries, and 11.11% of finches, but not in other species.
Conclusion: The results of this study demonstrate the presence of the Chlamydia bacterium in ornamental birds in Urmia, which can be considered a source of infection for gastrointestinal diseases.
 

Background and Objective: Bariatric surgeries are among the most effective methods for treating obesity. A key postoperative challenge is insufficient weight loss or weight regain, which may be associated with eating disorders after surgery. This study was conducted to evaluate the prevalence of binge eating (BE) disorder following bariatric surgery in Gorgan, Iran.
Methods: This descriptive analytical study was performed on 133 patients (mean age = 42.65±9.78 years) who underwent bariatric surgery performed by a single surgeon for the treatment of obesity at Dr. Mousavi Hospital in Gorgan, Iran, during 2013-2019. Patients were invited for an interview, physical examination, and to complete a questionnaire via a phone call. After obtaining informed consent, participants' current height and weight were measured using a standard method, and the Binge Eating Disorder Scale (BEDS) was completed. Variables, such as the type of surgery and preoperative height and weight were extracted and recorded from patients' medical records. The prevalence of BE disorder was compared between patients with and without weight regain.
Results: Out of 133 participants, 44 (33.1%) experienced weight regain. Moderate or severe BE disorder was identified in 59 individuals (44.4%). The prevalence of BE disorder was significantly higher in patients with weight regain compared to those without (P<0.05). The odds of ratios (ORs) for weight regain were 3.7 and 3.9 times higher in individuals with moderate and severe BE disorder, respectively, compared to those without the disorder. No statistically significant association was observed between BE disorder and variables, such as gender, education, occupation, and marital status. However, among individuals who experienced weight regain, being a housewife had a statistically significant association with the disorder (P<0.05).
Conclusion: BE disorder is a significant factor in patient weight regain in the years following surgery, particularly among housewives.
 

Influenza is an acute viral respiratory disease with diverse clinical manifestations. Despite extensive research, ambiguities remain regarding its prognostic factors. In this cross-sectional retrospective study, conducted during 2021 on 993 samples (546 males 447 females) from patients with suspected acute viral respiratory infections who were hospitalized in hospitals of Golestan Province, we evaluated the clinical and laboratory findings of patients with influenza. The samples were sent to the provincial molecular diagnostics laboratory for real-time polymerase chain reaction (PCR) molecular testing. All samples were also tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Test results, along with demographic, clinical, and laboratory data, were collected using a standardized questionnaire. Of the 993 samples tested for influenza, 174 were reported as positive. All, but one, of these positive cases were influenza A. From 993 tests for SARS-CoV-2, 271 cases were also reported as positive. Additionally, 11 patients had influenza and SARS-CoV-2 co-infection. The mean age of influenza patients hospitalized in the intensive care unit (ICU) was determined to be 55.60±15.11 years, while in other wards, it was 37.51±12.1 years (P<0.05). Regarding gender, the ICU-hospitalized male-to-female ratio was 3 times and 1.35 times in other wards (P<0.05). In ICU-hospitalized patients, the highest percentage of clinical symptoms belonged to fever, cough, chills, and anorexia, and in patients hospitalized in other wards, the highest percentage belonged to fever, followed by cough, chest pain, and chills. There was a statistically significant difference between ICU-hospitalized patients and those hospitalized in other wards for symptoms, such as anorexia, arthralgia, myalgia, sore throat, cough, nausea, headache, and chills (P<0.05). Blood factors, such as white blood cell (WBC) count, neutrophil and lymphocyte percentages, hemoglobin, erythrocyte sedimentation rate (ESR), and platelets, were evaluated, and no statistically significant difference was observed between the two patient groups. Biochemical factors, including blood urea nitrogen (BUN), creatinine, sodium, potassium, liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), and direct and indirect bilirubin, were also examined, and no significant difference was found between the two patient groups. Additionally, other factors, such as oxygen and carbon dioxide saturation percentages, bicarbonate, and blood pH were assessed, and a statistically significant difference was found between the two groups for oxygen and carbon dioxide saturation percentages (P<0.05). Based on the findings of this study, age and gender are effective factors in the severity of influenza. Men and older adults are at particular risk for ICU hospitalization. The high prevalence of influenza A and cases of SARS-CoV-2 co-infection also highlight the importance of accurate diagnosis and appropriate treatment. Given the increased risk of infection and disease severity among the elderly, implementing preventive programs, such as annual influenza and coronavirus disease 2019 (COVID-19) vaccinations, is essential for this group. Additionally, attention to laboratory findings like blood oxygen levels can be effective in the early identification of high-risk patients.