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Background & Objective: Hepatitis B virus (HBV) infection is one of the most important health problems all over the world. This study was conducted to determine the co-infection of hepatitis C virus (HCV), hepatitis D virus (HDV) in HBV infected patients in Golestan province of Iran. Materials & Methods: This population based cross sectional study was done in 2004. 139 HBsAg positive cases were assessed for co-infection with HCV and HDV. Serologic tests were done by ELISA method using available kits. Data were analyzed by SPSS-12 and STATA8 software. P-values of less than 0.05 were considered as significant. Results: Sixty eight (48.9%) of 139 cases were males and 71 (51.1%) were females. The mean (±SD) of participant's age was 41.89 (±11.3) years (range: 25-64 years). Anti-HCV and Anti-HDV antibodies were positive in 17 (12.3%) and 8 (5.8%) cases, respectively. Females were more infected with HCV and HDV than males. But the differences were not significant. Conclusion: The prevalence of co-infection with HCV and HDV in HBV infected cases is relatively high and notable in Golestan province of Iran. Because of negative effects of these co-infections in clinical outcome of the disease, it is recommended to assess possible HCV and HDV infection in individuals with HBV infection. This may result in more efficient management of the disease.

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Background and Objective: Esophageal and gastric cancers are among the most common and fatal cancers. These are diagnosed at the latest phase and the prognosis is too poor. Due to the importance and high incidence rate of the upper gastrointestinal cancers in Golestan province, this study was conducted to explore the overall survival rate of these patients in rural area of this region. Materials and Methods: In this descriptive cross-sectional study, a total of 121 pathologically confirmed esophageal or gastric cancers, with rural place of residence, were retrieved from the cancer registry at the health department in Gorgan. After conducting interview with patients or their relatives, analysis of their sociodemographic and clinicopathologic features was performed. The median survival rate was compared regarding age groups and gender using Kaplan-Meier statistical test. Results: Male to female ratio in esophageal and gastric group were 1.2 to 1 and 3.8 to 1, respectively. Short-term survival rates were 54.76% and 26.2% for esophageal cancer and 66.6% and 37.5% for gastric cancer. Collected information regarding patients’ sociodemographic and clinicophathologic factors did not have significant association with patients’ survival in both esophageal and gastric cancers. The mean survival rate in patient with gastric and esophageal cancers according to age and gender was not significant. Conclusion: This study showed that the overall short-term survival rates for upper gastrointestinal cancers are very low in Golestan province. Therefore the need for intervention the need and allocating more diagnosis and therapeutic resources for upper gastrointestinal cancers are required.

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Background & Objective: Health evaluation and growth monitoring of the infant is a visual diagram of growth and primary health services are based on it. In the best option, these indices must be provided separately for each community. This study was done to evaluate growth indices of newborns in Gorgan- Northern Iran. Materials & Methods: In this observational descriptive study which was carried out during (Oct-Nov 2003), all healthy infants without any major abnormality born within 25-42 weeks of gestational age were evaluated in Dezyani Hospital, Gorgan growth indices (head circumference, length and height) were measured in 1011 infants. Gestational age was defined by Balard scoring and delivery type was recorded, too. After entering data into SPSS-10 software, data were analyzed using chi-square, t-test and correlation bivariate. Results: Mean gestational age (±SD) was 39.86±1.72 weeks and most of them were born by vaginal delivery. Amongst them, 3.2% were premature (less than 37 weeks), 4.4% were low birth weight and 0.69% were very low birth weight. Correlation between growth indices and gestational age was significantly positive in all cases (p<0.05). Conclusion: This study showed that growth indices are lower than other parts of Iran. Further investigations needed, especially longitudinally and cross-sectional, to determine the growth indices in this region and in other parts of country.

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Background and Objective: Colorectal cancer is the third common malignancy in the world. Personal habits including life style and nutrition have been proposed as risk factors of colorectal cancer. We conducted this study to assess the nutritional characteristics in colorectal cancer patients in Golestan province of Iran.

Materials and Methods: This case-control study was done on 47 colorectal cancer cases, diagnosed during 2004-05 and 47 healthy controls. A questionnaire containing socio-demographic and nutritional characteristics (FFQ) was filled for each of the participants. Chi square test was used to assess the relationship between variables.

Results: In each of the two groups, 40.4% were females and 59.6% were males. The mean±SD age of age in cases and controls were 52.4±13.4 and 52.1±13.1 years, respectively. Total energy expenditure of higher than 1837.5 Kcal/ day was significantly related to colorectal cancer (OR=3.8 95% CI: 1.2-11.3). Colorectal cancer risk was higher in individual with frying cooking method (OR=3 95% CI: 0. 8-11.1). The risk of colorectal cancer was 6.5 times higher in individuals with fat consumption of higher than 118.5 grams/day (95% CI: 1.5-28.8). No significant relationship was seen between vegetables consumption and the risk of colorectal cancer.

Conclusion: This study showed that high total energy expenditure, high fat consumption and using frying method for cooking are risk factors of colorectal cancer in Golestan prevince in Nothern of Iran.

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Background and Objective: Esophageal and gastric cancers are among the most prevalent cancers in the world which cause a high mortality rate annually. Several risk factors are supposed for them. Water hardness is considered as a protective factor against above cancers. This ecologic study was designed to determine the correlation between water hardness and upper gastrointestinal cancers. Materials and Methods: In this ecological study data on water components in Golestan's urban areas were obtained during 2004-05 and the averages were reported. All cases of esophageal and gastric cancers resided in urban areas which were diagnosed during this period were recruited to estimate the incidence and age standardized rates (ASR). The province was divided into low, intermediate and high incidence, based on 33% and 66% quartiles of both cancers. Pearson correlation coefficient test and regression model were used to analyze the data. Results: The water hardness was in the normal standard range permitted for the drinking water, and did not have any relation with the risk of esophageal and gastric cancers. Conclusion: This study showed that water hardness has no effect on the incidence of esophageal and gastric cancer in this area.

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Background and Objective: Opium usage for sedating/relieving from diarrhea or cough causes a public health problem. In the northeast of Iran (Golestan province), opium is used widely for symptomatic therapy of routine illnesses in young children. It may cause severe intoxication and even death. This study was done to determine the toxification with opium in five years old children in Golestan Privine in Iran. Materials and Methods: This cross-sectional study was performed in collaboration with “Adverse Drug Reaction (ADR) Committee” in Golestan University of Medical Sciences. All members of ADR committee in pediatric centers trained to complete a certain valid questionnaire in children under 5-years-old, which either referred or admitted for opium intoxication (September 2006 to February 2007). Data analyzed by Chi-square and Fisher exact tests. Results: In this survey, 67 opium-intoxicated children were recruited. Minimum age of the subjects was 6 days and maximum was 5-years-old. In 41.3% of subject. The opium was given by the mother with low awakness and 61.2% of in toxicated children reside with rural area. More that 80% of the parant had the educational level below. The highschool diploma in 63.6% of cases the pure form of opium were consumed, diarrehea anxiety, were the two main cause for consuming the opium. In this study four subjects decleard dead due to toxification of the opium. Conclusion: Opium intoxication has a high prevalence among children under 5-years-old in our area. Therefore it is suggested that the intoxicated children accompanied with parant ambigious explanation opium toxification should be taken seriously.

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Background and Objective: Destructive effects of thyroid diseases in pregnancy and fetal frowth is well established subclinical autoimmune thyroid diseases can double the rate of preterm labor, abortion and postpartum thyroiditis. This study was done to compare thyroid function and autoimmunity derangment in goiterous and non-goiterous pregnant women. Materials and Methods: This case – control study was done on 100 healthy and 100 goiterous pregnant women in Dezyani hospital located in Gorgan, Northern Iran during 2005. Five mililiter of blood sample was obtained from each subject to measure thyroid hormones concentration including T3/ T4/ TSH/ T3 RUP and thyroid autoantibodies (Anti Tg/Anti TPO). Thyroid hormone and auto antibodies were measured using IRMA and ELISA techniques. Results: Thyroid volume was enlargel twice and tripl of its orginal size in 34% and 66% goitrious pregnant women respectively. Mean serum TSH in cases and controls were 1.81+/-1.33 microU/ml and 1.84+/-1.4 microU/ml respectively. The mean of Anti TPO and Anti Tg in cases were 373.91+-197.36 U/ml and 248.80+-70.59 U/ml respectively. The same indecs for controls were 79.52+-63.99 U/ml and 248.80+-70.59 U/ml respectively. In pregnant women with goiter 36% had high Anti TPO and 9% had high Anti Tg, but in control group 16% and 4% of controls had elevated Anti TPO and Anti Tg, respectively. Conclusion: According to thyroid function tests there were elevation of antibody in 20% of the healthy subjects and 45% of the goiterous subjects, therefore it is advisable to measure thyriod function tests accompanied with thyriod antibodies in all pergnant women either with or without goiter in order to prevent feto-maternal disorders.

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Background and Objective: Golestan province, located in north of Iran has been known as a high risk area for esophageal cancer. The relationship between esophageal cancer and Selenium (Se) has been assessed in previous studies. This study was conducted to assess the relationship between Soil selenium levels and development of esophageal cancer in Golestan province of Iran. Materials and Methods: In this ecologic study, Golestan province in northern Iran was divided into 135 blocks based on geographical altitude and longitude on the map. One Soil sample was collected from the center of each block. Selenium level in Soil samples was determined by flame atomic absorption spectrometry. Statistical analysis was performed by Pearson correlation and T-Student tests. Results: The mean±SD of Soil Selenium level in Golestan province was 3.7±1.61 mg/kg. There was a positive correlation between Soil level of Selenium and esophageal cancer rates in this area (P=0.03), (Pearson correlation coefficient=0.19). The Soil Selenium level for high risk and low risk area for esophageal cancer were (4.13 mg/kg) and (3.39 mg/kg) respectively (P=0.01). Conclusion: This study showed that there is high Soil Selenium level in Golestan province in north of Iran. Also it is found to be a significant positive relationship between Soil Selenium level and esophageal cancer rate in this area.

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Background and Objective: Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease (IBD). Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody.

Materials and Methods: In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml.

Results: Among 127 referred patients, serum samples of 102 patients were collected. Mean±SD of age was 36.17±15.2 years and 48% were males. Ulcerative colitis, Crohn’s disease and other colitis were observed in 76 (74.5%), 7 (6.9%) and 19 (18.6%) of patients, respectively. Tissue trans-glutaminase antibody was positive (19.8 U/L) in one 46-years-old male patient with ulcerative colitis.

Conclusion: Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients.

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Background and Objective: Floater is defined as dark and vague spots and lines, which presents in visual fields of patients. Etiologies are various and life threatening, due to the serious complications resulted from floaters, this study was designed to assess ophthalmic disorder among patients with floater Gorgan, Iran (2009). Materials and Methods: This cross-sectional study,was done on 164 patients (105 female, 59 male) with floater or photopsia in Gorgan, North of Iran during 2009. Findings of ophthalmic examination and demographic characteristics were recorded in a questionnaire for each patients. Results: The prevalency of floater was higher among patients over sixty years old. 57.2% women with floater were during monopausal period. Myopia (32.9%) and cataract (32.9%) were the most associated ophthalmic diseases. Posterior vitreous detachment and retinal bleeding in patients with floater was 84.1% and 6.1%, respectively. Retinal detachment was not seen in patients. Conclusion: This study showed that posterior retinal detachment is the most frequent associated ophthalmic disorder in patients with floater. Older age, gender, myopia and cataract are considered to be the related risk factors in floater.

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Background and Objective: Nausea and vomiting are the most frequent complications in the first trimester of pregnancy. Herbal medicine is among the traditional effective treatments. Ginger and Chamomile are hypothesized to be useful in decreasing the signs. This study was done to determine the effect of Ginger and Chamomile capsules on nausea and vomiting in pregnancy.

Materials and Methods: This triple-blind randomized placebo-controlled trial was carried out on 105 pregnant women in 6-16 weeks of gestational age with a mild to moderate nausea and vomiting, whome referred to the prenatal care clinic in Dezyani hospital and health centers, Gorgan, Northern Iran during 2009-10. Rhodes index questionnaire had been given to all participants to be completed before bed-time for two weeks. In the first week no intervention was done and prescribing the capsules was started the following week. Subjects randomly divided into 3 groups: In group 1, ginger capsules were consumped twice a day for one week, in group 2 twice daily chamomile capsule and in placebo group, glucose capsule was prescribed. Scores were calculated and all data were entered into the SPSS-16 software, analysis was done using variance analysis, Will-Cockson, paired T and Fisher-exact tests.

Results: The mean of Rhodes index before intervention in plasbo, Ginger and Chamomile groups were 12.71±5.88, 10.42±0.76 and 11.19±5.51, respectively. Also, the mean of Rhodes index after intervention in plasbo, Ginger and Chamomile groups were 11.47±6.43, 7.28±3.74 and 5.73±4.32, respectively (P<0.05). Bonferroni test indicated that there is no difference about scor chang (after and before) between Ginger and Chamomile and Ginger and plasbo, but this difference was significant between Chamomile and plasbo group (P<0.05).

Conclusion: This study showed that Chamomile capsule was more effective on nausea and vomiting during pregnancy compared to Ginger.

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Background and Objective: Liver enzyme tests are usually normal or slightly increased during pregnancy. Abnormal liver enzyme tests are seen in 3% of pregnancies and should be evaluated immediately. Early detection and timely treatment is the key to successful treatment. This study was carried out to determine the prevalence of abnormal liver enzymes and pregnancy outcome in women admitted to Sayyad-e-Shirazi hospital in Gorgan-north of Iran.
Methods: This descriptive, cross-sectional study was carried out on 73 hospitalized pregnant women out of 6680 pregnant women in the Sayyad Shirazi hospital, in north of Iran during April to September 2015. Clinical information was including laboratory tests, final diagnosis and complications postpartum of 73 women with impaired liver enzymes.
Results: The most common cause of abnormal liver enzymes were pre-eclampsia in pregnant women (16 patients 21.9%) which occured in the third trimester. HELLP syndrome was observed in 9 (12.3%) of patients which occurred in the third trimester. Also in 3 cases (4.1%) eclampsia was reported in the third trimester.
Conclusion: Due to the high incidence of pre-eclampsia and HELLP syndrome in women with impaired liver enzymes, careful examination of patients, especially in the third trimester of pregnancy is essential.

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In December 2019, the new acute respiratory disease spread in China presented with fever and dry cough known to be resulted from the new Corona Virus as the COVID-19. In Iran, the first case was reported on 20th of February 2020. Our management team in Golestan University of Medical Sciences held an immediate meeting to decide how to manage the cases suspected to the COVID-19.The two main hospitals had been selected as the Corona center in the Golestan province, northern Iran. Admitting patients other than COVID-19 has been stopped in these hospitals, and all patients had been transferred to the other hospital in Gorgan city and those in the recovery state had been transferred to a hotel prepared for this purpose. The capacity of Sayyad-e-Shirazi hospital was 300 bed for admission and 25 ICU beds that had been increased to 44 ICU beds (30 percent increases) to be prepared for COVID-19 admission. Clinical groups and specialists had been organized with special duty for each part. After 3 months of COVID-19 crisis, Sayyad-e-Shirazi hospital with 300 beds is in a good shape and admission of severe cases has been decreased.

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Background and Objective: Stroke has a high prevalence and is associated with a high premature mortality rate. Thus, it is important to identify the effective factors in increasing the incidence of stroke. The aim of this study was to investigate the role of seasonal changes and environmental factors in the occurrence of stroke.
Methods: This descriptive-analytical study was done on 3,639 patients including 3,102 (85.3%) with ischemic stroke, 472 (12.9%) with intracerebral hemorrhage and 65 (1.9%) with subarachnoid hemorrhage patients. After measuring environmental factors such as air temperature, air pressure, humidity and geomagnetic field, admission data of stroke patients between 2015-2019 were extracted from the Sayyad Shirazi Hospital information system.
Results: The mean occurrence of intracerebral hemorrhage was highest in winter, especially in January and March, and lowest in summer, especially in July and August. Intracerebral hemorrhage had a positive significant correlation with air pressure (P=0.001, r=0.452) and a negative correlation with ambient temperature (P<0.001, r= - 0.457). Subarachnoid hemorrhage and ischemia were not related to the season or the month. It was also found that ischemic stroke had a significant positive correlation with geomagnetic field fluctuations. Subarachnoid hemorrhage was not associated with any of the variables, but intracerebral hemorrhage was significantly positively associated with air pressure and inversely associated with temperature.
Conclusion: This study illustrated that winter, low temperature, high air pressure and high geomagnetic fluctuations are associated with a higher risk of stroke. Therefore, the underlying physiopathological causes of this relationship should be carefully investigated in future studies.
 

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Background and Objective: Celiac disease is a malabsorption disorder that could result in various psychological consequences if patients do not adhere to a gluten-free diet. This study aimed to determine the frequency of major depressive disorder and its relationship with adherence to a gluten-free diet among patients with celiac disease.
Methods: This descriptive-analytical study was conducted on 47 patients with celiac disease (30 women and 17 men) with an average age of 40.88 ± 10.7 years who had been referred to the Golestan Research Center of Gastroenterology and Hepatology during the summer of 2019. Patients were invited to complete a 13-item Beck Inventory. Celiac Dietary Adherence Test (CDAT) was used to assess adherence from the patients' point of view, and Standardized Dietician Evaluation (SDE) was used to evaluate adherence to the diet from the interviewer's perspective.
Results: Overall, 28 people (59.6%) with celiac disease reported some degree of depression. Based on the SDE, the adherence rate of patients to a gluten-free diet was 83%. The association between adherence to a gluten-free diet and the prevalence of depression was not significant. There was also no significant association between the prevalence of depression and the gender and age of patients.
Conclusion: Based on the results, a high percentage of patients with celiac disease have symptoms of depression. However, there is no significant relationship between adherence to a gluten-free diet and the prevalence of depression.
 

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Background and Objective: The diagnosis of inflammatory bowel disease (IBD) is performed by colonoscopy, sampling, and histopathology. Stool calprotectin is a test showing the presence of inflammation in the gastrointestinal tract. This study was done to determine the relationship between the calprotectin level in the feces and endoscopic findings in ulcerative colitis patients referred to the gastroenterology clinic in Gorgan, Iran.
Methods: This descriptive-analytical study was performed on 100 patients with ulcerative colitis referred to the gastroenterology clinic of Sayad Shirazi Hospital, Gorgan, north of Iran during 2020. The patients were asked to collect their stool samples one day before the procedure (just after taking the drug for bowel cleansing). Bowel cleansing was done by administering polyethylene glycol solution dissolved in water. The activity of ulcerative colitis was measured using the disease activity score. According to this criterion, a score greater than or equal to 5 is considered an active disease. Patients were classified into two groups: extensive or pan-colitis and left-sided colitis. Stool samples were evaluated for calprotectin in a single laboratory using a commercially available kit (Calprest- EuorociationspA. Trieste) at normal values of less than 50mg/g. The relationship between stool calprotectin with colonoscopic findings was evaluated.
Results: The average duration of infection was 4±3.1 years in the time range of 1-14 years. The calprotectin level was less than 50 μg/g in 16 patients. Stool calprotectin less than 50 µg/g was seen in only 16 patients. There was no significant relationship between the level of calprotectin and the either age or gender of patients. Most patients (84%) had active disease based on colonoscopic findings. Left-sided involvement was seen in 60% of patients. Fecal calprotectin level was significantly higher in those with acute phase and those with severe disease (P<0.05). Additionally, the calprotectin level had no significant relationship with the location of bowel involvement, extension, and disease duration.
Conclusion: This study showed that the fecal calprotectin level in patients with ulcerative colitis had a significant relationship with the severity and activity of the disease in north of Iran.

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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.
 

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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.

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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.

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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.