Journal of Gorgan University of Medical Sciences

Effects of L-Arginine and L-Nitro-Arginine Methyl Ester (L-NAME) on the Diameter and Number of Pulmonary Alveoli in Female Sprague-Dawley Rats

Atarodalsadat Mostafavinia

Background and Objective: Impairment in nitric oxide (NO) production can culminate in pathological conditions, such as pulmonary hypertension, acute respiratory distress syndrome (ARDS), and chronic obstructive pulmonary disease (COPD). The present study aimed to investigate the effects of L-arginine and L-nitro-arginine methyl ester (L-NAME) on the diameter and number of pulmonary alveoli in female rats.
Methods: In this experimental study, 32 female Sprague-Dawley rats, aged 8 weeks and weighing 200–250 g, were randomly divided into four groups of eight. Group 1 received normal saline (2 ml/kg body weight [BW]), Group 2 received L-arginine (200 mg/kg BW), Group 3 received L-NAME (20 mg/kg BW), and Group 4 received a combination of L-arginine (200 mg/kg BW) and L-NAME (20 mg/kg BW) via intraperitoneal injection for two weeks. The animals were then anesthetized, and their lungs were excised. After fixation and tissue processing, histological sections were stained with hematoxylin and eosin (H&E) to evaluate the resulting changes. To obtain quantitative data regarding the diameter and number of alveoli, ImageTool III software was utilized.
Results: Injection of L-NAME and L-Arginine led to a non-significant decrease in the mean diameter of pulmonary alveoli. L-Arginine exerted the greatest effect and L-NAME had the least effect on the number of pulmonary alveoli; however, these changes were not statistically significant.
Conclusion: Injection of L-Arginine and L-NAME had no significant effect on the diameter and number of pulmonary alveoli in female rats.

Effects of the Aqueous Extract of Launaea acanthodes Aerial Parts on Antioxidant and Renal Indices in Alloxan-Induced Diabetic Male Rats

Raheleh Rahbarian

Background and Objective: Diabetic nephropathy initiates with chronic hyperglycemia and the manifestation of significant alterations in renal indices. This stage represents a critical turning point between the onset of early diabetic nephropathy symptoms and renal damages. The present study aimed to evaluate the effects of the aqueous extract of Launaea acanthodes aerial parts on antioxidant and renal indices in alloxan-induced diabetic male rats.
Methods: In this experimental study, 32 adult male Wistar rats were randomly divided into four groups of eight animals each: A control group, a diabetic control group, and two treatment groups receiving the aqueous extract of Launaea acanthodes stems and leaves (100 and 300 mg/kg BW). Following a 16-hour fasting period, an experimental model of diabetes was induced in the diabetic control and treatment groups via a single intraperitoneal injection of alloxan monohydrate (120 mg/kg BW). Following the confirmation of experimental diabetes, the alloxan injection process was maintained every other day for 30 days. Thirty days after the induction of diabetes, the treatment process was performed intraperitoneally every other day using Launaea acanthodes extracts at concentrations of 100 and 300 mg/kg. Twelve hours after the completion of the 30th day, the animals were anesthetized, blood samples were collected via the left ventricle, and the kidney tissue was then excised. Blood plasma was separated from the blood samples, and blood urea nitrogen (BUN), urea, uric acid, and creatinine levels were measured. The Bradford assay was utilized to determine the total protein concentration. Glutathione S-transferase (GST) was assayed using a ZellBio kit, and catalase (CAT) activity was evaluated based on the decomposition of hydrogen peroxide. Additionally, superoxide dismutase (SOD) activity and malondialdehyde (MDA) levels were assessed.
Results: A significant increase in fasting blood glucose (FBG) and MDA levels, alongside a significant decrease in antioxidant enzymes, including SOD, GST, and CAT, was observed in the diabetic control group compared to the healthy control group (P<0.05). Dose-dependent administration of the aqueous extract at concentrations of 100 and 300 mg/kg BW led to a significant reduction in FBG and MDA levels, as well as a significant increase in antioxidant enzymes, including SOD, GST, and CAT, compared to the diabetic control group (P<0.05). Biochemical evaluations indicated a significant increase in blood urea, BUN, uric acid, and creatinine in the diabetic control group compared to the healthy control group (P<0.05). Dose-dependent administration of the extract at concentrations of 100 and 300 mg/kg BW resulted in a significant decrease in blood urea, BUN, uric acid, and creatinine (P<0.05).
Conclusion: It appears that the aqueous extract of Launaea acanthodes aerial parts dose-dependently attenuates hyperglycemia, oxidative stress, and renal indicators in alloxan-induced diabetic rats.

Effects of Fennel and Valerian on Relieving Primary Dysmenorrhea-Induced Pain: A Clinical Trial

Mansoureh Mahmoudi

Background and Objective: Conventional treatments for primary dysmenorrhea are often associated with adverse effects, including nausea, headache, and dizziness, and may be contraindicated in certain cases. In Iranian traditional medicine texts, fennel is recommended for pain relief and the induction of menstruation; it also exhibits antiemetic and antinauseant effects. Valerian is a traditional Indian medicinal plant that has been utilized as a sedative, antispasmodic, and hypnotic agent. The present study aimed to determine the effects of fennel and valerian herbal medicines on relieving primary dysmenorrhea-induced pain.
Methods: This clinical trial was conducted on 120 single girls with primary dysmenorrhea who referred to healthcare centers in Khomein, Iran, in 2019. The subjects were selected via a convenience sampling method and randomly allocated into the control, first intervention, and second intervention groups. The control group received mefenamic acid capsules (250 mg), the first intervention group received fennel capsules (30 mg of sweet fennel essential oil), and the second intervention group received valerian capsules (350 mg of plant root) over two consecutive menstrual cycles. Pain severity was measured using the visual analog scale (VAS) during two consecutive menstrual cycles prior to the intervention and two consecutive menstrual cycles following the initiation of the intervention (a total of four cycles).
Results: At the end of the study, the primary dysmenorrhea-induced pain severity significantly decreased in all three studied groups (P<0.05); however, this pain relief was significantly greater in the valerian-receiving group (the first intervention group) compared to the fennel-receiving (the second intervention group) and mefenamic acid-receiving (the control group) (P<0.05). The odds ratio (OR) of experiencing higher pain severity in the first and second intervention groups compared to the control group was determined to be 0.23 (95% CI: 0.07-0.72, P=0.013) and 0.51 (95% CI: 0.28-0.93, P=0.028), respectively.
Conclusion: Valerian and fennel herbal medicines can be utilized as effective alternatives with fewer adverse effects compared to mefenamic acid for relieving primary dysmenorrhea-induced pain.

Interactive Effect of Obesity and Pronated Foot on the Frequency Spectrum of Lower Extremity Muscle Activity in Men During Running

Amir Ali Jafarnezhadgero

Background and Objective: Pronated foot is one of the lower extremity deformities, and obesity is considered a major dilemma in modern society. The present study aimed to determine the interactive effect of overweight and pronated foot on the frequency spectrum of lower extremity muscle activity in men during running.
Methods: This quasi-experimental study was conducted on 40 male students aged 21–35 years, who were assigned non-randomly into four groups of 10: Normal weight with normal foot, obese with pronated foot, obese with normal foot, and normal weight with pronated foot. The activity of selected muscles, including the tibialis anterior, medial gastrocnemius, vastus lateralis, vastus medialis, rectus femoris, biceps femoris, semitendinosus, and gluteus medius, was recorded during running using electromyography (EMG).
Results: The frequency spectrum of the electrical activity of the biceps femoris muscle was significantly lower in the “obese with normal foot” group compared to the “normal weight with pronated foot” group (P<0.05). The interactive effect of fatigue and group was not statistically significant.
Conclusion: In the “obese with pronated foot” group, the observed increase in muscle activity may reflect the neuromuscular system's attempt to manage biomechanical loads. Furthermore, individual differences in movement patterns, fitness levels, and compensatory strategies may contribute significantly to variations in muscle activity.

Effect of Fatigue on Mechanical Values of Impulse and Center of Pressure in Obese Male Students with Pronated Feet During a Landing Maneuver

Amir Ali Jafarnezhadgero

Background and Objective: Obesity is a major public health concern worldwide. Evidence suggests that fatigue can lead to significant alterations in mechanical components among obese individuals compared to their healthy counterparts. The present study aimed to determine the effect of fatigue on the mechanical values of impulse and center of pressure (COP) in obese individuals with pronated feet during a landing maneuver.
Methods: This quasi-experimental study was conducted in Ardabil Province, Iran, on 16 male students with healthy feet and normal body mass indices (BMIs<25) and 15 obese male students (BMI>30) with pronated feet. During the test, mechanical variables were recorded for both groups before and after implementing the fatigue protocol, utilizing a force plate (sampling rate: 1000 Hz) during a landing maneuver.
Results: In the between-group comparison, the mechanical impulse values along the anteroposterior axis were significantly higher in the “healthy feet with normal BMIs” group (34.69±17.9) compared to the “obese with pronated feet” group (9.41±2.07) (P<0.05). In the within-group comparison of “obese students with pronated feet”, no statistically significant differences were found before and after the fatigue protocol during a landing maneuver for the mechanical variables of vertical impulse, anteroposterior impulse, mediolateral impulse, mediolateral COP, and anteroposterior COP.
Conclusion: In the mechanical components of impulse, the “obese with pronated feet” group exhibited a statistically significant decrease compared to the “healthy feet with normal BMIs” group during a landing maneuver; however, the fatigue protocol did not alter the impulse values.

Effects of Eight Weeks of Aerobic Exercise Training on Pulmonary Function Indices, Inflammatory Markers, and Vascular Endothelial Growth Factor in Active Young Females

Marefat Siahkouhian

Background and Objective: Regular physical activity can improve the function of various body systems and exert significant effects on pulmonary function, inflammation, and vascular growth factors. The present study aimed to determine the effects of eight weeks of aerobic exercise training on pulmonary function, C-reactive protein (CRP), creatine phosphokinase (CPK), and vascular endothelial growth factor (VEGF) in active young females.
Methods: This field trial was conducted on 20 active young females aged 19 to 24 years at University of Mohaghegh Ardabili in 2024. The subjects were randomly assigned to two groups of 10, including an intervention group and a control group. The intervention group performed a regular aerobic exercise training program for eight weeks (three sessions per week) at an intensity of 70% of their maximum heart rate (HRmax) for 40 minutes per session, whereas the control group had no specific physical activity. Pulmonary function indices, including forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), as well as CRP, CPK, and VEGF levels, were measured before and after the training period.
Results: Following 8 weeks of aerobic exercise training, the intervention group demonstrated a significant increase in FVC (3.11±0.61) and FEV1 (3.10±0.58) compared to the control group (P<0.05), alongside a statistically significant decrease in CRP (1.6±0.61) (P<0.05). However, changes in CPK levels were not significant. Additionally, VEGF (9.74±2.3) significantly increased post-intervention compared to the control group (P<0.05). Between-group comparisons revealed no significant differences at the pre-test stage. Conversely, a statistically significant difference in CRP levels was observed between the groups at the post-test stage (P<0.05).
Conclusion: Eight weeks of moderate-intensity aerobic exercise training (at 70% of HRmax) was effective in improving pulmonary function, reducing CRP, and increasing VEGF in active young females.

Evaluation of Liver Enzyme Alterations and Non-Alcoholic Fatty Liver Disease Improvement Rates 6 Months Following Sleeve Gastrectomy and Gastric Bypass Surgeries

Farhad Kor

Background and Objective: Morbid obesity is a growing global health concern, affecting more than 400 million individuals worldwide. In cases where dietary interventions, lifestyle modifications, and pharmacotherapy fail, bariatric surgery (such as sleeve gastrectomy [SG] and gastric bypass [GB] surgeries) remains the most effective therapeutic option. In addition to inducing weight loss, these surgical procedures ameliorate comorbidities such as diabetes, hypertension, and fatty liver disease (FLD). The present study aimed to evaluate liver enzyme alterations and non-alcoholic FLD (NAFLD) improvement rates six months following SG and GB surgeries.
Methods: This retrospective cohort study was conducted on 120 patients (62.2% female) with morbid obesity (mean age = 35.2±11.13 years) who underwent bariatric surgeries at Falsafi Hospital in Gorgan, Golestan Province, Iran during 2021-23. Patients with a body mass index (BMI) greater than 40 kg/m², or greater than 35 kg/m² with underlying comorbidities, were included. Exclusion criteria consisted of excessive alcohol use, a history of hepatic surgery, and early pregnancy post-surgery. Liver enzyme levels (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]), as well as serum albumin (ALB) levels, were measured at baseline and 6 months post-surgery.
Results: A total of 95 patients presented with FLD. After 6 months, the fatty liver grade decreased in 57 patients, increased in 4, and remained unchanged in 34 (P<0.05). Specifically, reductions of 35%, 45%, and 82% were observed in grades I, II, and III, respectively. ALT, AST, and ALP decreased by 6.1 U/L, 12.8 U/L, and 9.58 U/L, respectively (P<0.05). ALB levels showed no statistically significant change. Type 2 diabetes, hypertension, advanced age, or a higher BMI had no significant effect on the reduction of liver enzymes.
Conclusion: Bariatric surgery improved FLD and significantly reduced liver enzymes (ALT, AST, and ALP).

Changes in the Index of Cardio-Electrophysiological Balance During the Tilt Table Test in Patients with Altered Level of Consciousness

Seyed Mehran Hosseini

Background and Objective: The tilt table test is a diagnostic modality used to evaluate patients presenting with altered levels of consciousness (ALOC) or orthostatic symptoms. The autonomic nervous system's response to postural changes induces alterations in sympathovagal tone, subsequently altering various electrocardiographic (ECG) parameters. The index of cardio-electrophysiological balance (iCEB) is calculated based on the ratio of the QT interval to the QRS duration, serving as a non-invasive measure of the cardiac impulse wavelength. The present study aimed to evaluate changes in the iCEB during the tilt table test in patients with ALOC.
Methods: This case-control study was conducted using a convenience sampling method on the medical records of 40 patients selected from among 390 patients with ALOC who visited the tilt table Laboratory at Ayatollah Taleghani Educational and Medical Center in Gorgan, Golestan Province, Iran. The participants were divided into two groups of 20 (10 males and 10 females per group). Based on medical records, 20 patients with a positive tilt table result were initially selected, followed by the random selection of 20 patients with a negative tilt table result, who were age- and sex-matched with the first group. The data related to patients’ ECG, blood pressure, and pulse rate were recorded and compared prior to the test (baseline conditions), during tilt, and during recovery.
Results: The mean and standard deviation of iCEB in the positive tilt table group at baseline, tilt, and recovery phases were determined to be 6.04±1.48, 6.18±1.85, and 6.81±1.72, respectively. In the negative tilt table group, these values were 4.67±2.01, 4.46±2.07, and 4.48±2.19, respectively. Between-group comparisons revealed a statistically significant increase in the iCEB among patients with positive tilt table results compared to those with negative tilt table results during the baseline, tilt, and recovery phases (P<0.05). However, the values were not statistically significant for the corrected iCEBc.
Conclusion: Baseline values of the iCEB may serve as useful predictors for tilt table test results in patients presenting with ALOC.

Protective Effects of Vitamin E and Aqueous Extract of Thymus vulgaris Leaves Against Amiodarone-Induced Cytotoxicity in Non-Cancerous Human Lung Fibroblast (HLF) and Human Lung Cancer (A549) Cell Lines

Mohammad Shokrzadeh

Background and Objective: Amiodarone is an effective antiarrhythmic drug used for cardiac arrhythmias. Due to the presence of iodine in its structure, it tends to accumulate in lipophilic tissues, including the lungs, leading to lung injury and other major adverse effects. The present study aimed to determine the protective effects of vitamin E and the aqueous extract of Thymus vulgaris (T. vulgaris) leaves against amiodarone-induced cytotoxicity in non-cancerous human lung fibroblast (HLF) and human lung cancer (A549) cell lines.
Methods: This descriptive-analytical study was conducted on HLF and A549 cell lines obtained from the Pasteur Institute of Iran in the cell culture laboratory at the Faculty of Pharmacy, Mazandaran University of Medical Sciences. The grouping for non-cancerous HLF and A549 cell lines included a negative control group, a positive control group (amiodarone at its inhibitory concentration [IC₅₀]), treatment groups receiving T. vulgaris and vitamin E at concentrations of 10, 20, and 50 μM, and single-treatment groups receiving T. vulgaris and vitamin E at 50 μM. All experiments were performed in triplicate with an initial cell density of 10⁴ cells per well. To evaluate amiodarone-induced cytotoxicity (5.6 μM), methylthiazolyldiphenyl-tetrazolium bromide (MTT) (48 h), reactive oxygen species (ROS) (6 h), and lipid peroxidation (LPO) (48 h) assays were performed.
Results: The addition of amiodarone to both A549 and non-cancerous HLF cells culminated in a significant decrease in cell viability percentage in the MTT assay (at a concentration of 50 µM T. vulgaris and vitamin E in the normal cell line, and
20 µM T. vulgaris and vitamin E in the A549 cell line). Moreover, it led to a significant increase in ROS (at concentrations of 20 and 50 µM T. vulgaris and vitamin E in the normal cell line, and 20 µM T. vulgaris and vitamin E in the A549 cell line), as well as malondialdehyde (MDA) levels in the LPO assay (at concentrations of 20 and 50 µM T. vulgaris and vitamin E in the normal cell line, and 20 µM T. vulgaris and vitamin E in the A549 cell line) (P<0.05). Furthermore, adding a combination of vitamin E and extract of T. vulgaris leaves in amiodarone-intoxicated non-cancerous HLF cells led to a significant increase in cell viability against IC₅₀ toxicity, alongside a significant reduction in ROS and MDA levels (P<0.05).
Conclusion: The addition of amiodarone to both A549 and non-cancerous HLF cell lines induces cytotoxicity in these cell lines. Concomitant treatment with vitamin E and extract of T. vulgaris leaves in amiodarone-treated cells culminates in a reduction in oxidative damage and an increase in cell viability in non-cancerous HLF cells.

Non-Surgical Treatment of an Unstable Terrible Triad Injury of the Elbow: A Case Report

Saeed Kokly

The terrible triad of the elbow consists of an elbow joint dislocation (ulnohumeroradial and radiocapitellar), a fracture of the radial head or neck, and a fracture of the coronoid process. Since these injuries are highly prone to persistent pain, poor painful functional outcomes, and common complications—including instability, elbow stiffness, and osteoarthritis—their treatment is predominantly surgical to achieve stability and initiate early mobilization. However, non-surgical treatment may occasionally be appropriate in carefully selected, compliant patients under close clinical and radiographic surveillance. The present study reports a case of an unstable terrible triad of the elbow that was initially a candidate for surgery. However, due to the patient's cardiomyopathy, following initial reduction in the operating room, a long arm splint was applied at 100 degrees of flexion because of instability and re-dislocation. The patient was prescribed Indomethacin 25 mg 2–3 times daily, along with Omeprazole. On the first postoperative day, finger movements and isometric contractions of the forearm and arm muscles were instructed. The splint was removed after 2 weeks, and a splint at 90 degrees of elbow flexion stopping proximal to the wrist was applied until the end of the 6th week. Upon observing satisfactory radiographs at a 45 degrees angle, active motion was permitted from full flexion to 45 degrees of flexion. After 4 weeks, following acceptable radiographs at 30 degrees of flexion, motion was allowed from full flexion to 30 degrees of flexion. At the 6-month follow-up, the patient was satisfied and demonstrated healing of the radial neck fracture. The coronoid process fracture healed via fibrous union but remained asymptomatic. There was no evidence of elbow osteoarthritis, ulnar neuropathy, or heterotopic ossification. The patient exhibited a 20 degrees elbow flexion contracture.