Background and Objective: Non-Governmental Organizations (NGOs) have been active in the field of health for a long time and have played a key role in it, but these organizations are less known to the public for the promotion of social health and are not much considered by the planners and managers of the health system. This study was conducted to determine the challenges of NGOs’ to promote social health in Iran.
Methods: In this qualitative study, 15 Iranian managers and scientific and executive experts of the Ministry of Health, Ministry of Interior, Governorate, and Universities of Medical Sciences of the country were selected by purposeful sampling during 2021. Data were collected using an interview guide and semi-structured in-depth interview methods. After recording and transcribing, the data were analyzed by content analysis.
Results: The challenges of NGOs to promote social health in Iran were classified into six main themes of planning, organizing, functional, political, economic, and sociocultural challenges, and 33 sub-themes. Most of the participants emphasized the weak role of non-governmental organizations in improving social health and considered it a result of the mentioned challenges.
Conclusion: Empowering non-governmental organizations by formulating a strategic and operational plan and attracting financial resources from various government, private, and charitable sectors will greatly help to strengthen them to advance social health promotion programs.

Background and Objective: Nutritional knowledge can affect food choices and, as a result, sports performance. The study of nutritional knowledge, attitude, and performance in athletes can play a fundamental role in choosing the type of training and adapting suitable dietary interventions. This study was done to evaluate the knowledge, attitude, and nutritional performance of male bodybuilding athletes in Gorgan, Iran.
Methods: This descriptive-analytical study was done on 104 male bodybuilding athletes over 18 years old with a history of at least three months of continuous bodybuilding who were randomly selected from 13 bodybuilding clubs in Gorgan, Iran during 2020. Parmenter and Wardle’s standard questionnaire measured athletes’ nutritional knowledge, attitude, and performance. The questionnaire was completed by the athletes with the guidance of the researcher. A trained nutritionist collected anthropometric and body composition data using an Omron BF511 device.
Results: Poor nutritional knowledge, poor dietary attitude and poor nutritional performance was observed in 67.3%, 33.65% and 77.88% of the athletes respectively. A significant correlation was observed between nutritional knowledge with weight (r=0.23, P=0.02), BMI (r=0.27, P=0.01), and body fat percentage (r=0.22, P=0.02). Also A significant correlation was determined between nutritional performance with body weight (r=0.31, P<0.001), BMI (r=0.27, P<0.001), exercise time per week (r=0.22, P=0.02), and exercise timespan (r=0.32, P<0.001).
Conclusion: The level of knowledge, attitude, and nutritional performance of bodybuilding athletes was weak.

Background and Objective: Multiple sclerosis (MS) is an autoimmune disease that targets the central nervous system. Various studies have shown that several factors influence this disease’s occurrence and prevent its progress. Multiple studies have shown that several factors affect this disease’s occurrence and prevent its progress. Helicobacter pylori can be mentioned among these factors. This study was conducted to determine Helicobacter pylori infection in MS patients and healthy individuals.
Methods: This case-control study was conducted on 100 patients with MS (mean age: 36.99±9.87 years) and 100 healthy subjects (mean age: 38.05±11.38 years) in Golestan province, north of Iran during 2021. The case group included eighty relapsing-remitting cases and twenty secondary progressive cases. Blood samples were taken from both groups, and after separating the serum using the ELISA test, anti-Helicobacter pylori antibody (IgG) was detected by determining the antibody titer.
Results: Helicobacter pylori IgG in the MS and control groups was 21% and 44%, respectively (P<0.05). The mean concentration of IgG in the case group was significantly lower than the control group (13.48±10.83 versus 19.78±16.14 AU/ml). The percentage of positive cases of IgG antibody against Helicobacter pylori in the relapsing-remitting and secondary progressive group of patients with MS was determined as 21.2% and 20%, respectively, and the difference between these two groups was not statistically significant.
Conclusion: The history of Helicobacter pylori infection is less than two times in patients with MS compared to healthy people probably indicate the protective role of this bacterium against this disease.

Background and Objective: Considering hypertension as the most prevalent comorbidity among patients diagnosed with COVID-19, this study intended to investigate clinical characteristics and in-hospital mortality risk factors among COVID-19 patients with hypertension history.
Methods: This descriptive-analytical study was conducted on 527 hypertensive patients (277 male and 250 female) a mean age of 64.73±13.13 years infected with COVID-19 and hospitalized at Sayyad Shirazi Hospital, Gorgan Iran from February to September 2020. The patients’ data were extracted from the hospital information system and completed by patients’ medical records and telephone calls. The association between the risk factors and in-hospital mortality was identified by employing the logistic regression analysis in three various models, including model 1 (demographic data and patients’ history), model 2 (model 1 plus vital signs and pulse oximetry measurement at hospital admission) model 3 (model 2 plus laboratory findings at hospital admission). Each model individually described the odds ratios (ORs) with 95% confidence intervals (95% CIs) for every risk factor. Furthermore, a corrected area under the receiver-operating characteristics curve (AUC) was estimated to evaluate the model’s discriminatory power.
Results: Among 527 hospitalized patients, 88 patients (16.6 %) died during 6.48 days of hospitalization, of which 47 patients were men. In model 1, opium consumption (CI95%=1.16-3.85, OR=2.11) and cognitive impairment at admission (CI95%=0.98-5.40, OR=2.30) were significantly associated with higher mortality (AUC=0.65). In model 2, after adding vital signs and oxygen saturation, cognitive impairment association lost its association, and only opium consumption (CI95%=1.09-3.19, OR=1.87) and oxygen saturation (CI95%=0.90-0.95, OR=0.93) were associated with in-hospital mortality. (AUC=0.73). In model 3, after incorporating laboratory findings, with an AUC of 0.79 (CI95%=0.70-0.90), each percent higher oxygen saturation at admission was associated with a 7% decrease in in-hospital mortality (CI95%=0.88-1.00, OR=0.93). Although opium consumption and higher creatinine level lead to higher mortality, the associations were not significant.
Conclusion: Regarding the association of oxygen saturation at admission with in-hospital mortality among hypertensive patients diagnosed with COVID-19, the pulse oximetry measurement data upon admission would be crucial in evaluating these patients.

The rise in patients seeking corneal refractive surgery, despite having systemic autoimmune diseases, underscores the need for special considerations when treating these individuals. Recent studies have expanded our knowledge in identifying and evaluating autoimmune disorders and their potential side effects in the results of corneal refractive surgery with laser. This study briefly examines the pathogenic factors, clinical aspects, and possible complications in patients with systemic autoimmune disorders subjected to these surgeries. In total, 132 articles were selected for this research among the reviewed studies. Considering that the release of various cytokines caused by systemic autoimmune disorders can lead to destructive corneal consequences, the need for early diagnosis before any laser surgery for refractive errors seems essential. Although procedures such as LASIK and PRK are commonly performed on patients with autoimmune disorders, important considerations must be made. Studies have not yet confirmed definitive contraindications to laser refractive surgery for autoimmune disorders.

Background and Objective: Thyroid masses are one of the most common reasons for patients to visit endocrinology clinics. Fine needle aspiration (FNA) is used to reduce thyroid surgery for benign lesions. This study was done to determine the diagnostic accuracy of FNA of thyroid mass(s) compared with histological results in Medical Centers, Gorgan, Iran.
Methods: In this descriptive-analytical study, 102 patients (12 males and 90 females) were diagnosed with a thyroid mass and referred for surgery to Medical Centers, Gorgan, Iran during 2020-21. FNA was performed, and the samples were sent to the pathology department for examination. The result of cytology was recorded in the checklist. According to cytology results, some patients were referred for surgery. Then, the surgical pathology results were compared with the cytology findings. In addition, the sensitivity and specificity of the results of the cytology of thyroid masses were calculated compared to the results of pathology.
Results: FNA, mass size, and the patient’s main complaint had a significant relationship with histological results (P<0.05). According to FNA findings compared to pathology, sensitivity was 74%, specificity was 88.1%, positive predictive value was 88.1%, negative predictive value was 74%, false positive rate was 12%, false negative rate was 26%, and accuracy was 80.4%.
Conclusion: FNA remains a key tool in evaluating thyroid nodule(s). Improving FNA techniques is necessary to increase the accuracy of FNA.

Background and Objective: Because of tissue variety, signs, symptoms, and higher mortality and morbidity, central nervous system (CNS) tumors are of special importance in diagnosis and treatment. Knowledge of the epidemiology of these tumors helps with health system planning. This study aimed to obtain more data on the epidemiologic specifications of these neoplasms.
Methods: This descriptive-analytical study focuses on 141 patients (58 Male and 83 female) with CNS tumors who visited the 5th Azar Hospital, Gorgan, Iran, during 2013-17. All the data were obtained from hospital medical records in the Neurosurgery and Oncology Department. All demographic data were recorded, such as age, sex, tumor type, signs, symptoms, and risk factors. In cases with incomplete data, the files were completed with interviews and phone calls.
Results: The tumors in 94 (66.6%) patients were benign, and 47 (33.3%) patients had malignant and metastatic tumors. The most common signs were headache (n=43, 30.5%) and convulsion (n=24, 17%). No relationship was found between CNS tumors, diabetes mellitus, hypertension, and hyperlipidemia.
Conclusion: Regarding the high mortality of CNS tumors, early adequate attention to signs and symptoms helps earlier diagnosis. However, more studies on larger samples are needed to find more risk factors.

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.