Background and Objective: Paraquat toxicity can damage organisms through mechanisms that are not yet fully understood. Evidence shows that regular exercise and appropriate antioxidant supplements can help reduce the complications caused by paraquat toxicity. This study aimed to evaluate the effect of aerobic exercise training, along with piperine supplement, on the liver levels of tumor necrosis factor-alpha (TNF-a) and interleukin-10 (IL-10) in Wistar rats induced with paraquat.
Methods: In this experimental study, 40 adult Wistar rats were randomly placed into 5 groups of 8, including 1) sham, 2) negative control-paraquat, 3) paraquat + training, 4) paraquat + training + piperine, and 5) paraquat + piperine. Aerobic training included 7 weeks of walking on a treadmill (5 sessions per week for 30-40 min per session, at a speed of 10-18 m/min). Paraquat was administered to the rats by intraperitoneal injection at a dose of 5 mg/kg of body weight. The piperine supplement was daily gavaged at a dose of 10 mg/kg of body weight. The concentration of TNF-a and IL-10 was measured in the liver tissue.
Results: A significant increase in IL-10 and a decrease in TNF-a concentrations were observed between the paraquat-negative control groups compared to the sham, paraquat + exercise, paraquat + piperine, and paraquat + exercise + piperine groups (P<0.05). There was a significant difference between the mean concentrations of TNF-a in the liver tissue between the two negative control groups - paraquat with paraquat + piperine supplement (P<0.05), paraquat + exercise + piperine (P<0.05), paraquat + exercise (P<0.05), and sham (P<0.05). There was a significant difference in concentrations of IL-10 in the liver tissue between the two negative control groups - paraquat with paraquat + piperine supplement, paraquat + exercise + piperine, paraquat + exercise), and sham (P<0.05).
Conclusion: The concentration of TNF-a and IL-10 in male rats induced with paraquat were significantly decreased and increased, respectively, compared to paraquat + piperine supplement, paraquat + exercise + piperine, paraquat + exercise, and sham groups. Therefore, it seems that performing aerobic exercise, along with piperine supplementation, can be a proper way to reduce the inflammation caused by paraquat.

The visual processing disorder is broadly observed among individuals with autism. This study was conducted to develop an integrated rehabilitation program based on vibroacoustics and virtual reality and to assess its effectiveness on the visual processing of autistic children. This experimental case report was conducted using an Aberrant Behavior Checklist (ABC) design on 5 children with autism referred to Zehnara Rehabilitation Clinic in the second half months of 2021. First, the integrated program was implemented for ten 30-minute sessions on 2 subjects randomly selected from among the samples. After determining the program validity, 3 more subjects were entered into the study. The sensory profile questionnaire-2 was used. The questionnaires were filled out at the baseline stage, at the end of each intervention session, and at the one-month follow-up stage. The visual analysis, the percentage of recovery, the percentage of non-overlapping data (PND), and the percentage of overlapping data (POD) were used for data analysis. The implemented intervention was evaluated to be effective for all five subjects so that for Subjects No. 1, 2, 3, 4, and 5, the PND rates were obtained to be 90%, 90%, 70%, 100%, and 90%, respectively. The results of this study demonstrated that the integrated sensory rehabilitation program could be used to improve the visual processing of children with autism.

Background and Objective: Oxidative stress can harm cells, proteins, and DNA and play a role in the aging process. The present study was conducted to determine the impacts of six weeks of Pilates exercises and Lycium barbarum supplement on oxidative stress indices of saliva and body composition of inactive elderly females.
Methods: This field trial was carried out on 49 inactive elderly females. The subjects were selected in a purposeful manner and were randomly assigned to 4 groups, including control, supplement, exercise, and exercise plus supplement. The exercise program protocol was implemented for six weeks, three 45-60 minute sessions per week with an intensity of 50-70% maximum heart rate. The Lycium barbarum supplement group used 14 g of supplement daily. Oxidative stress indices of saliva and body composition were compared. The individuals’ physical activity level was determined using the Kaiser Physical Activity Survey (KPAS) and the samples’ health status was specified using the Physical Activity Readiness Questionnaire (PAR-Q).
Results: The amount of malondialdehyde had a statistically significant reduction in the exercise plus supplement group compared to the control group, the exercise group, and the supplement group (P<0.05). The amount of malondialdehyde was not statistically significant in the exercise group and the supplement group compared to the control group. The amount of salivary catalase was not statistically significant in the exercise group plus supplement group compared to the control group, the exercise group, and the supplement group. The amount of salivary catalase had a statistically significant increase in the exercise group compared to the control group and the supplement group (P<0.05). The amount of glutathione peroxidase had no statistically significant difference in the exercise plus supplement group compared to the control group but had a statistically significant increase compared to the supplement group (P<0.05). The amount of glutathione peroxidase had a statistically significant increase in the exercise group than in the supplement group (P<0.05).
Conclusion: Regular exercise with moderate intensity and Lycium barbarum supplement resulted in improved antioxidant function and body composition in inactive elderly females.

Background and Objective: Ensuring suitable access to hemodialysis, which provides high-quality dialysis over an extended period, is a significant challenge for patients with End-Stage Renal Disease (ESRD). One crucial aspect of this is maintaining the performance of hemodialysis catheters. Our study, which aimed to evaluate the one-year performance of long-term catheters in chronic hemodialysis patients in Golestan Province, is a critical step toward improving patient care in this population.
Methods: This descriptive-analytical study was conducted on 99 patients (34 men and 65 women) with ESRD who were candidates for starting or continuing dialysis with a catheter in the educational and therapeutic centers of Golestan Province, Iran during 2021-22. Transjugular catheters were placed for the patients, and after one year, variables such as age, gender, history of diabetes, history of hypertension, catheter placement site (right or left jugular), and antiplatelet medication use were evaluated concerning the performance of long-term catheters in providing adequate flow for hemodialysis.
Results: In 91 patients (91.9%), the one-year catheter performance was assessed as satisfactory. The age of 61.6% of the patients were over 60 years old. Sixty-nine patients (69.7%) had a history of hypertension, and 58 patients (58.6%) had a history of diabetes. Fifty-seven patients (57.6%) received antiplatelet medication. The catheters were placed on the right side in 82 patients (82.8%). Catheter performance in patients taking antiplatelet medication was non-significantly higher than in those not taking antiplatelet medicines.
Conclusion: The performance of long-term catheters in chronic hemodialysis patients with ESRD showed no significant correlation with age, gender, diabetes, hypertension, antiplatelet medication use, or the side of the jugular vein where the catheter was placed.

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%.

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.

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.

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.

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: Breast cancer is the most common cancer among women, causing the death of many worldwide each year. Given the importance of determining prognosis and the role of biomarkers, this study aimed to determine the expression level Ki-67 biomarker and its relationship with metastasis time and location in breast cancer patients.
Methods: This descriptive-analytical study was conducted on 154 breast cancer women admitted to the Fifth Azar Educational-Therapeutic Center in Gorgan, Iran, during 2009-2019. Upon admission, Ki-67 expression levels in tissue were determined using immunohistochemistry (IHC). Other required information, including demographic characteristics, disease stage, time interval from diagnosis to metastasis, and metastasis location, were identified and evaluated.
Results: Most of the patients (63%) were in the 40-60 age group. Ki-67 levels were determined to be below 15% in 45 patients (29.2%) and above 15% in 109 patients (70.8%). A statistically significant relationship was observed between Ki-67 expression levels and the time interval from diagnosis to metastasis (P<0.05). No statistically significant relationship was found between Ki-67 expression levels and age group, metastasis location, or disease stage.
Conclusion: The results of this study demonstrated that individuals with tissue Ki-67 levels above 15% experienced metastasis within a shorter period of time.
 

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.
 

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.