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.

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.

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.

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.

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.

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.
 

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: 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: 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.