Journal of Arak University of Medical Sciences

The Effect of Backward Gait Training Protocol on Postural Sway and Balance in Elderly Men with a History of Fall

Ali Jalalvand

Introduction: This study aimed to investigate the effect of the backward gait training protocol on postural sway and balance in elderly men with a history of falls.
Methods: A total of 28 healthy elderly individuals with a history of falls participated in this research. The backward gait protocol was considered the independent variable, and the mean parameters of postural sway, including range, center of pressure displacement, center of pressure velocity, and center of pressure acceleration, were examined as dependent variables. A Kistler force platform was used to assess postural sway. A mixed-design repeated measures ANOVA was performed at a significance level of 0.05.
Results: No significant differences were found in the anterior-posterior amplitude and medio-lateral acceleration of the center of pressure between healthy elderly individuals and those with a history of falls (P > 0.05). However, individuals with a history of falls exhibited greater medio-lateral amplitude, anterior-posterior displacement, anterior-posterior velocity, and anterior-posterior acceleration of the center of pressure (P = 0.001). Conversely, they demonstrated lower medio-lateral displacement (P = 0.001) and medio-lateral velocity of the center of pressure (P = 0.005).
Conclusions: Changes in center of pressure parameters may predict fall risk in the older adults. These parameters have varying sensitivities for detecting subtle differences in postural control. The responses of various parameters are influenced by compensatory mechanisms, weaknesses, and balance disorders. The backward gait protocol serves as a targeted intervention to improve balance and stability in elderly individuals at risk of falls.

Studying the Effectiveness of a Combined Motor and Cognitive – Behavioral Intervention Program on Balance and Balance Confidence in people with Multiple Sclerosis (PwMS)

Daryoush Khajavi

Introduction: Multiple sclerosis (MS) is the most common neurological disorder in young adults and balance problems due to MS may result in disturbances in upright posture, limitations in walking and turning, and ultimately falls in patients. The aim of this study was to investigate the effects of a combined physical exercises and cognitive-behavioral stress management intervention program on static, dynamic balance and balance confidence in PwMS.
Methods: The statistical population included MS patients (aged 20–60 years with Expanded Disability Status Scale [EDSS] scores of 2–4) referred to the Arak MS Association. Thirty participants were selected via convenience sampling and randomly assigned to experimental and control groups. Participants underwent pretests using the Timed Up and Go (TUG) test, single-leg stance test, and the Activities-Specific Balance Confidence (ABC) Scale. Then, they participated in the combined motor and cognitive intervention program, and finally performed a post – test. Data were analyzed by Independent and Paired Student T-tests.
Results: According to the results, the mean score of the experimental group in the TUG test (P ≤ 0.002), and standing on one-foot tests increased significantly in the post-test (P ≤ 0.001). There were no significant differences in mean ABC scores between the experimental and control groups on the post-test (P ≤ 0.153).
Conclusions: The findings suggest that a combined motor and cognitive intervention program can effectively improve agility, dynamic and static balance in people with MS. Improving balance confidence may require a longer duration of training due to its subjective nature.

Studying of INV2nt-124A/G Polymorphism (rs5030772) in FASL Gene and Susceptibility to Thyroid Tumor in East Azerbaijan province

Nasser Pouladi

Background: Thyroid cancer is one of the most common types of endocrine malignancies. FASL is one of the most important apoptosis ligands expressed by tumor-infiltrating lymphocytes. This death ligand plays an important role in the elimination of cancer cells by inducing apoptosis in the Fas/FasL pathway, and its disruption induces tumorigenesis. This study investigated the association of the FASL gene polymorphism - INV2nt-124A/G (rs5030772) with the risk of thyroid cancer in the East Azerbaijan region.
Materials and Methods: In this case-control study, 115 patients with thyroid cancer and 125 healthy individuals without a family history of cancer from Tabriz city were studied. Five milliliters of peripheral blood were collected from each of these participants. Proteinase K method was used for DNA extraction and FASL gene polymorphism (rs5030772) was analyzed by ARMS-PCR technique. The results were analyzed using Javastat statistics package online software.
Results: The genotype frequencies of AA, AG and GG were 40.35%, 49.12% and 10.53% in patients and 41.6%, 52.8% and 5.6% in the control group, respectively. Genotypic and allelic frequencies did not show significant differences between the patient and control groups (p>0.05). By examining the clinicopathological characteristics of the patients, no significant relationship was seen between the clinical characteristics of the patients and the distribution of the genotypes of this polymorphism (p<0.05).
Conclusion: The results of this study indicate that the FASL gene polymorphism - INV2nt-124A/G (rs5030772) cannot be considered as a risk factor for thyroid cancer in the studied population in in East Azerbaijan province.

Attitude of Dentists Regarding the "Parental Presence/Absence Technique" During Pediatric Dental Treatmen

Hamid Sarlak

Introduction: Considering parents' preferences and opinions is an important factor in dentists' choice of treatment techniques. Despite the relatively low attitude of parents towards the use of the "parental presence/absence" technique, dentists still use this technique during pediatric dental treatment. The present study was conducted with the aim of simultaneously investigating the dentists' attitudes regarding the "presence/absence of parents" technique during the treatment of 4-10-year-old children and determining the factors affecting this attitude.
Methods: In this cross-sectional study, the attitudes of 83 dentists regarding the "presence/absence of parents" technique were evaluated using an investigator-designed questionnaire. The questionnaire scored dentists' attitudes regarding the above technique and evaluated the background factors affecting the child's attitude. Data were analyzed with a significance level of 0.05.
Results: The mean attitude score of the participants was 60.61±12.99. Also, 55.4% of participants considered this technique "unsuccessful". The factors "type of treatment", "child's age", "child's behavior", "parental behavior" and "implementation of the presence/absence technique", significantly affected the participants' attitudes.
Conclusions: Dentists do not hold a highly positive attitude toward the "presence/absence of parents" technique. According to dentists working in pediatric dentistry, this technique has low success in guiding children’s behavior.

The Effect of Kinesiotype and Ankle Strengthening Exercises with Bosu Ball on Pain, Balance and Big Toe Angle in Women with Hallux Valgus

Shahnaz Shahrjerdi

Introduction: Hallux valgus is a common foot deformity causing lateral deviation of the first toe and progressive subluxation of the first metatarsophalangeal joint. The purpose of this study was to investigate the effect of kinesiotype and ankle strengthening exercises with a bosu ball on pain, balance and big toe angle in women with hallux valgus.
Methods: This clinical trial study used a pre-test and post-test design. First, forty-five women with hallux valgus and flat feet were selected via convenience sampling and randomly assigned to three groups: a kinesiotape group (four weeks, three sessions/week, 24-hour tape application per session), a kinesiotape with Bosu ball ankle strengthening exercises (four weeks, three sessions/week, 30 minutes of exercises and 24-hour tape application per session), and a control group (no intervention). Pain, balance, and hallux valgus angle were measured using the Visual Analogue Scale (VAS), stork test, and goniometer, respectively. Data were analyzed using one-way ANOVA at a significance level (P ≥ 0.05).
Results: After performing the exercises, comparing the data between the two groups before and after 4 weeks revealed a significant difference in pain, balance, and hallux valgus angle in the two groups of kinesiotape and kinesiotape along with the strengthening exercises of Boussou bathop compared to The control group showed (P = 0.001).
Conclusions: A combined program of kinesiotape and Bosu ball ankle strengthening exercises may improve pain, balance, and hallux valgus alignment in women.

Designing a Good Governance Model in Iran's Healthcare System Using a Mixed Approach of Thematic Analysis and Partial Least Squares (PLS) Method

Mohsen Mohammadian Saravi

Introduction: Good governance, as one of the fundamental concepts in healthcare system management, plays a key role in enhancing the efficiency, effectiveness, and equity of healthcare services. This concept, Emphasizing principles such as transparency, accountability, participation, and legality, has been considered as a framework for improving policymaking and management in Iran's healthcare system.
This study conducted in 2024 aimed to design and present a model of good governance in the healthcare system using a mixed approach of thematic analysis and Partial Least Squares (PLS) method.
Methods: The research method included both qualitative and quantitative components. The qualitative phase, involved managers, health policy experts, specialists from the Ministry of Health and Medical Education, and academic scholars. Sampling was done using purposive and snowball sampling methods, with 17 participants selected until theoretical saturation was reached. In the quantitative phase, the Partial Least Squares (PLS) method was used for model fitting. The statistical population for this section included all experts and managers in Iran's healthcare sector, with a minimum sample size of 384 determined based on Cochran's formula.
Results: The results of thematic analysis of the qualitative data and model fitting showed that the final good governance model in the healthcare system consists of seven main dimensions: effectiveness, efficiency, equity, transparency and accountability, participation, legality, and leadership. Each dimension comprised specific components, and the importance of each was confirmed in strengthening good governance.
Conclusions: This study presents a comprehensive good governance model for the healthcare system, offering a framework for improving policymaking, management, and performance in this sector. The proposed model can be used as a strategic decision-making tool and improving management structures.

Comparison of Digital Subtraction Angiography with Doppler Ultrasound in Assessment of Carotid Artery Stenosis Severity

Rezvan Noruzzadeh

Introduction: Imaging of the vascular system supplying the brain parenchyma is a diagnostic tool in the evaluation of stroke patients. This study aimed to compare the results of digital subtraction angiography with color Doppler ultrasound of the carotid arteries in patients with ischemic stroke.
Methods: In this cross-sectional-analytical study, the medical records of patients with ischemic stroke admitted to Imam Khomeini Hospital from July 1401 to July 1402 were reviewed to collect data. Demographic information, along with the results of color Doppler ultrasound and digital subtraction angiography of the patients, were extracted and evaluated.
Results: This study included 48 patients with ischemic stroke with a mean age of 12.8 ± 0.67 years. Hypertension was present in 68.8%, diabetes mellitus in 20.8%, and smoking in 25% of patients. Based on the results of digital subtraction angiography and color Doppler ultrasound, the most common vascular abnormality was plaque (79.2%). Vascular stenosis and occlusion were present in 91.7% of patients. Color Doppler ultrasound in examining the right and left internal carotid arteries had a sensitivity of 94.9% and 92.8%, specificity of 66.7% and 38.9%, positive predictive value of 92.1% and 70.3%, and negative predictive value of 75% and 77.8%.
Conclusions: Color Doppler vascular ultrasound demonstrated high sensitivity and specificity in detecting the presence and severity of stenosis in internal carotid arteries of ischemic stroke patients, supporting its use as a non-invasive and cost-effective method in clinical practice.

The Effect of Metformin on Thyroid Nodules

Afsaneh Talaei

Introduction: Thyroid nodules are highly prevalent. The role of insulin resistance in thyroid nodule formation has recently gained attention. While several studies have explored the relationship between metformin and insulin resistance, limited research has assessed the effect of metformin therapy on thyroid nodule volume and number. This study investigated the effect of metformin on the size and number of thyroid nodules.
Methods: A total of 240 euthyroid women with thyroid nodules were divided into four groups. Group 1 received levothyroxine 100 μg/day, Group 2 received metformin 500 mg twice daily, Group 3 received a combination of both drugs for three months, and Group 4 served as the control group with no treatment. Thyroid ultrasound was performed at baseline and after three months. Statistical analyses included the Kruskall–Wallis, Wilcoxon, and Chi-square tests, examined the differences of the size of thyroid nodules and the mean of thyroid hormones levels between groups, for Each group included 60 people and to compare the percentage of differences between the groups, respectively. Also P value less than 0.05 was considered meaningful.
Results: Results showed no statistically significant differences in thyroid hormone levels after treatment among the three groups except the levothyroxine group. Additionally, only the levothyroxine group showed a significant post-treatment decrease in TSH and increase in T4. Thyroid nodule size significantly decreased in the levothyroxine group and the levothyroxine-metformin combination group compared to the metformin-alone and control groups.
Conclusions: This study indicates that metformin does not reduce the size of thyroid nodules, contradicting studies suggesting its potential antineoplastic effects on the thyroid. However, the study duration may be insufficient for definitive conclusions, necessitating further high-quality studies with larger sample sizes and longer follow-up periods.

A Review on the Attitude Toward Childbearing Based on Islamic Sources

Seyed Abdollah Mahmoodi

Introduction: Today, declining birth rates and families’ reluctance to have children for various reasons pose challenges for both individuals and societies. One of the key factors influencing fertility is individuals’ attitudes toward this issue, with religious beliefs being among the most fundamental perspectives. The Islamic faith, in particular, has addressed this matter in numerous verses and narrations. This study aims to explore Islamic religious sources’ viewpoints regarding fertility.
Methods: The research is based on an extensive review of authentic library documents and data from various databases such as PubMed, Scopus, ScienceDirect, as well as search engines like Google Scholar. The findings indicate that, in addition to several verses in the Quran, Islamic texts related to the Imams, such as Nahj al-Balagha and Sahifa Sajjadiya, explicitly encourage childbearing and population growth, while condemning population decline. These sources identify four general factors—individual, economic, political system, and social-cultural status—that influence population increase or decrease.
Conclusions: Given the valuable Islamic resources regarding childbearing and the existing challenges in societies related to population decline and aging, it is possible to take significant steps to improve individuals’ and families’ attitudes toward childbearing by reinforcing Islamic lifestyles and religious beliefs.

Anaesthesia in Craniotomy Surgery with Full Wakefulness: A Case Report

Hesameddin Modir

Introduction: Some intracranial surgeries must be performed while the patient is awake. Awake craniotomy is an intracranial surgical procedure in which the patient remains in a state of controlled consciousness while the surgery is performed. The aim of this study was to present a case of intracranial surgery to remove a tumor in the right frontal cortex using awake craniotomy.
Case Report: This report describes the anesthetic management of a 22-year-old male undergoing craniotomy with a fully awake technique. This was the first case of craniotomy performed entirely awake (from the beginning to the end of the operation) at Arak University of Medical Sciences and Valiasr Hospital in Arak, After preoperative preparation and evaluation, scalp nerve blocks targeting the cranial nerves innervating the scalp and head muscles were administered at specific sites. Mild sedation was provided using oxygen supplementation, followed by surgical incision. The lesion was examined intraoperatively while the patient remained awake, and the tumor was safely excised under full wakefulness. A combination of local and regional anesthesia and light intravenous sedation was utilized. Two types of local anesthetics, lidocaine 1.5% and bupivacaine 2.5%, were used for anesthesia, as well as intravenous sedatives and anesthetics such as propofol, remifentanil, and dexmedetomidine were administered for sedation. Throughout the operation, the patient was awake and breathing spontaneously, and the function of the brain nerves during the operation could be evaluated. Finally, the patient's surgery was performed without any complications and in stable condition, and the patient was transferred to the intensive care unit in good general condition, awake and fully alert.
Conclusions: Although maintaining analgesia and hemodynamic and adequate ventilation during fully awake craniotomy poses challenges, this technique is critical for intraoperative monitoring of cranial nerve function and preventing neurological deficits. By precisely administering scalp nerve blocks and carefully titrating sedatives (propofol, remifentanil, dexmedetomidine), we successfully performed the procedure under full wakefulness. With this method, potential surgical complications are prevented, and the patient also experiences satisfactory painlessness. Applying this technique was satisfactory for our patient.