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Introduction: Physical activity is one of the important lifestyle factors that can have positive or negative effects on the reproductive system, and more research is needed to reflect the effect of inactivity on fertility in order to provide safe lifestyle recommendations to help couples achieve pregnancy is required. Therefore, this study was conducted with the aim of describing and comparing the physical activity status of fertile and infertile men in Arak city in 2022.
Methods: The present study is a case-control study that was conducted on 220 fertile and infertile men (22 to 40 years old) referred to Arak University Jihad infertility centers that were selected through available sampling. Participants completed self-test questionnaires on socio-demographic characteristics, lifestyle, physical activity, and sedentary behaviors. Anthropometric characteristics and body composition were also measured. Multivariate logistic regression was used to analyze the association of infertility with physical activity level, sedentary behavior, and body composition.
Ethical Considerations: This study was approved by the Ethics Committee of the University of Arak University (Code: IR.ARAKMU.REC.1401.046).
Ethical Considerations: The present research has been registered with the code IR.ARAKU.REC.1401.015 in the Ethics Committee of Arak University.
Results: In this study, it was observed that the amount of physical activity (P=0.02) and body composition (P=0.001) in fertile men is more favorable than infertile men. In men with a low level of physical activity, the risk of infertility increases 2.97 times (odds ratio 2.97 and 95% CI: 1.03, 8.61, and P=0.04). On the other hand, in men with moderate level of physical activity, the risk of infertility decreases (odds ratio 0.27 and 95% CI: 0.08, 0.92, and P=0.03). Also, in men who sit for more than 6 hours a day, the chance of infertility increases by 3.02 times (odds ratio 3.02 and 95% CI: 1.28, 7.10, and P=0.01). An increase in body mass index increases the risk of infertility by 1.61 times in men (odds ratio 1.61 and 95% CI: 1.23 and 2.11 and P=0.001).
Conclusions: Since obesity, physical inactivity and infertility in Iranian men are increasing at the same time, so there should be more focus and seriousness on the issue of lifestyle modification and especially physical activity regarding reproductive health.

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Introduction: The current research was conducted with the aim of "investigating the role of medical staff in health policies during the corona virus pandemic".
Methods: This research is practical in terms of purpose and exploratory research in terms of method.
Results: The statistical population of this research is all the medical staff of Arak city Since access to all these people is not possible; Therefore, the sampling method is used. The data collection tool in this research was a questionnaire. This research was done using the factor analysis model.
Conclusions: The data and information extracted from the factor analysis test showed that: establishing proper communication with patients, interacting with citizens and the government, paying attention to the laws and encouraging others to comply with them, learning specialized training to contain the corona virus, explaining the situation to worried people, Adhering to health protocols and informing others, perception of organizational justice, alignment between individual and organizational goals, transfer of sense of responsibility to the work environment, existence of an efficient evaluation system and encouragement to inject vaccines are the most important role of the medical staff in health policies. They were during the corona disease pandemic.
 

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Abstract
Background and aim: Attention deficit hyperactivity disorder is very common in athletes. This study aims to investigate the impact of transcranial electrical stimulation of alternating current on response inhibition and selective attention in athletes with ADHD.
 Materials and methods: The present study was quasi-experimental with a pretest, posttest, and follow-up design with the control group. The statistical population was 160 elite athletes with ADHD aged 9 to 11 years (60 girls and 100 boys). Of these, 120 athletes with ADHD were randomly selected and assigned to three groups of 40: control, sham, and tACS. First, a pretest was done, and then all subjects in the sham and experimental groups received F3(Anodal) and F4(Cathodic) fake and real stimulations, respectively, with a current of 1 mA (10 Hz) for 15 minutes in 10 sessions. The control group did not receive any intervention, then each group was re-examined. A follow-up test was done after two weeks. The Continuous Performance Test (CPT) and Stroop were used in this study. For data analysis, Mixed Anova, one-way ANOVA, and Benferroni's post hoc test were used with using Spss version 21 statistical software (p≤0.05).
Ethical considerations: This study is approved sport sciences Reserch Institute with ethical registration code IR.SSRI.REC.1401.1361.Parents gave written informed consent form.
Results: The results showed that tACS was effective in the response inhibition and selective attention of athletes with ADHD and led to the improvement of response inhibition and selective attention of these subjects.
Conclusion: Based on the findings, the tACS protocol of 1 mA can be used as an effective treatment to improve inhibition and selective attention of athletes with ADHD.
 

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Introduction: Despite the adverse consequences of cesarean delivery, its incidence rate is increasing in many provinces of the country, especially Ilam city. For this reason, it is important to identify the causes of the increase in cesarean delivery in order to reduce it. Therefore, the present study was conducted with the aim of determining the frequency of cesarean section and its causes in primiparous women in Ilam city in 2016.
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Methodology: The present study was conducted cross-sectionally in the second half of 2016 in Ilam city, and the study population was all primiparous women referred to a single specialty maternity hospital (Ayatollah Taleghani Hospital). The sampling method was census and all cesarean deliveries were recorded in Ayatollah Taleghani Hospital. The inclusion criteria included all primiparous women. The data of the study was collected using a researcher-made questionnaire that included demographic and midwifery information. After collecting the data, the data was entered into the SPSS version 16 software Central indices were used to describe data in quantitative variables, and absolute and cumulative frequency and percentage of dispersion frequency were used for qualitative variables.
Findings: According to the findings of this study, out of 1738 births, 867 (49.88%) were natural births and 871 (50.12%) were cesarean. Among the natural births, 427 (49.25%) and among the cesarean births, 296 (33.98%) were primiparous. Among the maternal factors, lack of progress and among the fetal factors, fetal distress and among the maternal-fetal factors, head-to-pelvis disproportion was one of the most important causes of cesarean delivery in primiparous women. In general, fetal factors with more than 67% were the most important causes of caesarean section in primiparous women.

Conclusion: According to the findings of the study, 33.98% of cesarean births were primiparous. Considering the high statistics of caesarean section, especially cesarean section for first births , It is necessary to reduce the number of elective cesarean sections by increasing the number of physiological births and painless births, as well as increasing the awareness of families about birthing methods and the advantages and disadvantages of each of them.
 

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Abstract
Introduction: Insomnia and sleep disorders are related to a decrease in physical and mental health and quality of life. The purpose of this study was to investigate the effect of sleep deprivation on blood sugar, cortisol and insulin levels in athletes compared to non-athletes.
Methods: In this semi-experimental study, 14 healthy men participated in two groups of athletes (7 people) and non-athletes (7 people). One night of sleeplessness (8 hours) was applied to the subjects of both groups. According to the objectives of the research, blood samples were taken from all the subjects in two stages. The data were analyzed using the dependent t test for intra-group comparison and independent t test for inter-group comparison at a significance level of 5%. In conducting the research, the principles of the Declaration of Helsinki, the general guidelines for ethics in research with human subjects and the regulations governing it were observed and the code of ethics was issued by the ethics committee of Lorestan University.
Findings: Insomnia did not lead to a significant difference between the blood sugar and insulin levels of athletes and non-athletes when faced with a (p≤0.05). Also, insomnia did not cause a significant difference in the amount of cortisol between two groups of athletes and non-athletes (p≤0.05). Conclusion: It seems that changes in blood sugar, cortisol and insulin are related to the duration of insomnia and are not affected in short-term and intermittent insomnia.

Keywords: Insomnia, blood sugar, cortisol, insulin, athlete, non-athlete
 

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On average, patients suffering from non-alcoholic steatohepatitis after about seven years, their disease turns into fibrosis and reversibility at this stage becomes very difficult because this disease is an irreversible stage of the disease. Fatty liver is non-alcoholic (2). Researches have come to the conclusion that liver inflammation and insulin resistance decrease and insulin sensitivity increases with sports activity (3). TNF-α has a high inflammatory effect; So that different agents and species of this family and their receptors play a role in NASH disease and liver fibrosis (5). However, exercise increases prostaglandins and cAMP. The mentioned hormones inhibit the function of TNF-α (6). On the other hand, anti-inflammatory cytokines increase due to exercise and inhibit the increase of TNF-α. With the increase in production and secretion of TNF-α, other inflammatory factors such as TGF-β1 signaling are activated and fibrosis signaling will start in liver cells (5). TGF-β1 (Transforming growth factor beta 1) is one of the members of the large family of transforming growth factors beta (TGF-β) and a key cytokine in obesity and insulin resistance (7). In a research, during 48 weeks of applying a high-fat diet to rats, they found that steatosis occurs in the liver of rats from the eighth week onwards, and the amount of TGF-β1 in them increased significantly. In the end, they came to the conclusion that this factor can be one of the main characteristics of determining the degree of liver fibrosis in patients with NASH (10). High-intensity interval training (HIIT) is one of the new training models whose positive effects have been identified in a variety of metabolic diseases (13). On the other hand, there are very few researches about the effect of aquatic environment and swimming on the improvement of metabolism and inflammation in NASH patients. Based on the results of a systematic review in 2018, it was shown that endurance exercise in water improved systemic inflammation and weight control (18). Despite the conflicting results in this field and the beneficial effects of exercise in water and also human's innate interest in water, the effect of high-intensity interval exercise in water in patients with non-alcoholic steatohepatitis has not been observed by the researchers of this study. Therefore, the effect of eight weeks of high-intensity interval training in water on inflammatory factors in patients with non-alcoholic steatohepatitis was investigated.
Materials and methods
In this study, eight-week-old rats were divided into two groups: healthy (n=20) and high-fat diet (HFD) (n=20). After eight weeks and proof of disease induction, the HFD group was randomly divided into two groups: control-disease (n=9) and exercise-disease (n=9); Also, the healthy group was divided into two groups: control-healthy (n=9) and exercise-healthy (n=9). The rats in the training group performed HIIT swimming training, including 20 times of 30 seconds of swimming with 30 seconds of rest between each time, for eight weeks (three days a week). One-way ANOVA and Bonferroni's post hoc test (P<0.05) were used to determine the difference between groups.
Ethical Considerations
The proposal of this study has been approved by the Ethics Committee of Shiraz University of Medical Sciences (IR.SUMS.REHAB.REC.1400.008).
Findings:
As shown in diagram 1; Based on the results of the one-way analysis of variance test, it can be said that there was a significant difference between the mean TNF-α blood serum (P=0.001). According to the results of Bonferroni's post hoc test, these differences in blood serum TNF-α variable between the control-healthy and control-disease groups (P=0.001), exercise-disease (P=0.001) and exercise-healthy (P=0.002), control-disease with exercise-disease (P=0.012) and exercise-healthy (P=0.001), exercise-healthy with exercise-disease (P=0.002) was.
According to graph 2, it can be seen that there is no significant difference in TGFβ1 variable in all four groups (p=0.068). However, by comparing the averages, it is found that the amount of TGFβ1 protein has decreased by 49.1968% in the patient-exercise group after high-intensity intermittent swimming exercise compared to the control-patient group. Meanwhile, this protein in the exercise-healthy group was reduced by 45.2741% compared to the control-patient. Figure 1 shows the protein bands related to TGFβ1 protein.
Discussion and conclusion: The results of the present research showed that high-intensity intermittent swimming exercises reduce inflammatory and fibrotic factors, and in general, it can be concluded that eight weeks of high-intensity intermittent swimming exercises improve the inflammatory and fibrotic factors associated with non-alcoholic steatohepatitis. . However, to obtain a definitive result, this type of exercise should be studied in human studies in this patient community.
Appreciation and thanks: This article is taken from the master's thesis in sports physiology (first author) of Zand Institute of Higher Education, Shiraz, with ethics code IR.SUMS.REHAB.REC.1400.008. In the end, we sincerely thank all friends and colleagues who helped us during the stages of this research.
Conflict of interest:The authors of this article have no mutual benefit from its publication.
Authors' share (participation rate): All four authors participated in the preparation of this article.
Key words: high-intensity swimming interval training, non-alcoholic steatohepatitis, tumor necrosis factor alpha, transforming growth factor beta

 

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Background and Aim: Diabetes is a type of metabolic disease and one of the most common endocrine diseases. Oxidative stress and inflammation play an important role in the development and progression of diabetes. mTOR signaling pathway play an important role in glucose homeostasis and proliferation of pancreatic beta cells. In the present study, the therapeutic effects of p-cymene on oxidative stress markers and expression of the mTOR gene in diabetic male Wistar rats were investigated.
Materials and Methods: Diabetes was induced by injecting 55 mg/kg body weight of streptozotocin. Biochemical analyses of pancreatic tissue and real-time PCR were done to investigate the effects of metformin (55 mg/kg body weight) and p-cymene (25, 50, and 100 mg/kg body weight) on the activities of catalase and glutathione peroxidase enzymes and mTOR gene expression.
Findings: Streptozotocin decreased catalase and glutathione peroxidase enzymes and decreased the expression of the mTOR gene in pancreatic tissue. Treatment with metformin or p-cymene improved the activities of catalase and glutathione peroxidase enzymes and the expression of the mTOR gene in a dose-independent manner.
Conclusion: Results indicate that p-cymene has antioxidant properties and can regulate the mTOR signaling pathway. Therefore, p-cymene may be effective for the treatment of diabetes alone or in combination with metformin.

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Introduction: Anti-cytokine considerations in COVID-19 patients can play a significant role in preventing death, therefore, physical activity by reducing risk factors, as well as saffron with anti-inflammatory and antioxidant properties, are considered as anti-cytokine solutions. Therefore, the purpose of this research is to investigate the effect of saffron supplementation and endurance training on the concentration of interleukin-6, interleukin-10 and L-cysteine in outpatients with coronavirus.
Methods: The statistical population of this research is outpatients with coronavirus, 36 of whom were randomly selected. Cytokines and L-cysteine were measured using a special kit and ELISA method. The research hypotheses were checked at a significance level of P < 0.05 using ANOVA test with repeated measurements with between-group factor.
Results: The results showed that endurance activity and saffron supplementation caused a significant decrease in IL-6 levels and the ratio of interleukin 6 to interleukin 10 (P ≥ 0.05). Also, endurance activity along with saffron supplementation caused a significant increase in serum L-cysteine concentration (P = 0.035). The results showed that there is no interaction effect between the measurement stages and the group, as well as intra-group and inter-group differences in interleukin-10 variables (P = 0.511).
Conclusions: The levels of IL-6 and IL-10 decrease due to saffron supplementation and endurance training, and the amount of L-cysteine increases, which helps the recovery of COVID-19 patients.

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Introduction: Head lice (Pediculus capitis) infestation is considered an important hygienic problem in developing countries. The aim of study was to compare 1% permethrin shampoo and 4% dimethicone lotion effects for treatment of infected head lice students in primary girl schools in Gotvand County, Khuzestan province.
Methods: The studied population was first- to sixth-grade students in elementary schools. Positive cases with head lice after identification (304 persons) were randomly divided into two treatment groups. Permethrin shampoo and dimethicone lotion were allocated for the first and the second groups, respectively. The drug therapeutic effects were studied after 7, 14 and 21 days after treatment. Data were analyzed by Chi-square test using SPSS software.
Ethical Considerations: This study was approved by the Ethics Committee of Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1399.778).
Results: In total, 304 students participated in the study. The age of students ranged between 7 and 12 years which 47.7% of them were between 7 and 8 years. Also 60.9 and 39.1% of them were in urban and rural schools, respectively. The drug effectiveness were 46.1, 69.5 and 100, and 77.6, 85.3 and 100% for permethrin and dimethicone in the first, second and third intervals after treatment, respectively. There was a significant difference between the effect of drugs in the first interval (P = 0.00) after treatment but there was not a significant difference between the second (P = 0.084) and the third (P = 0.43) intervals after treatment.
Conclusions: It is recommended the use of dimethicone lotion and permethrin shampoo as the first and second option, respectively in eliminating the head lice infestation in primary girl schools.

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Introduction: Nurses have a prominent position in providing healthcare services. There is an undeniable relationship between nurses' professional self-concept and providing care to patients. This study was conducted to investigate the relationship between professional self-concept and the lifestyle of nurses in selected hospitals of Mazandaran cities.
Methods: This descriptive study was conducted using a stratified sampling method with a proportional allocation of 200 nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in 2015. Data collection tools included a demographic information form, a nurse professional self-concept questionnaire, and a nurses' lifestyle questionnaire. Data analysis was done with a significance level of P ≤ 0.05. Pearson's correlation coefficient was used to determine the relationship between professional self-concept and nurses' lifestyle.
Results: The mean score of nurses' professional self-concept and a lifestyle was 156.55 ± 19.37 and 216.42 ± 5.88, respectively. There was also a significant direct relationship between professional self-concept and nurses' lifestyle.
Conclusions: Considering the confirmation of positive correlation between professional self-concept and the lifestyle of nurses, nursing managers can promote healthy lifestyles in nurses by promoting professional self-concept.

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Introduction: The present study findings aimed to investigate the effect of exercises based on the American National Academy of Sports Medicine principles (NASM) on walking kinetics in piriformis syndrome in middle-aged men.
Methods: The current research was semi-experimental and laboratory-type. The statistical sample of the present study was 30 men with piriformis syndrome. Subjects were equally and randomly placed in two intervention and control groups. The intervention group performed NASM exercises for eight weeks. Before and after the exercises, the ground reaction force variables were measured using a Bartek force plate device with a sampling rate of 1000 Hz. Kinetic data were smoothed using a fourth-order Butterworth filter with a frequency cutoff of 20 Hz. For statistical analysis, analysis of variance and paired T-test were utilized at the significance level of P < 0.05.
Results: The findings of the present study showed that the effect of time on the FxHC and FyHC components at the peak of the forces and the FyHC component at the time of reaching the peak of the ground reaction force increased in the post-test compared to the pre-test. P > 0.025;
d = 0.64 - 0.96. The effect of the time factor in the FyPO component at the peak of the ground reaction force in the post-test was less than the pre-test (P < 0.025; d = 1.64-0.96). The interaction effect of the time × group in the FxPO component at the peak of the force and the FzHC component at the time of reaching the peak of the ground reaction force had a significant difference (P < 0.048; d = 0.87-0.83).
Conclusions: The NASM exercises used in this research can have a clinical and therapeutic effect that can reduce damage to the lower limbs and improve the quality of walking in people with piriformis syndrome.

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Introduction: Considering the synthesis and release of myokines from muscle tissue during exercise and the relationship of myokines with the development of strength and increase in muscle volume, the purpose of this study is to investigate 12 weeks of resistance training on the serum levels of myonectin and FGF- There were 21 middle-aged men.
Methods: In a semi-experimental study, 40 middle-aged men of Arak city (mean age 38.27 ± 6.02 years, weight 77.12 ± 11.23 kg, height 174.05 ± 7.22 cm) were selected and randomly placed in two resistance training groups (20 people) and control (20 people). The training group performed 12 weeks of resistance training 3 times a week with an intensity of 65-80% of maximum strength. Blood was taken from all the subjects 48 hours before and after the intervention, and serum levels of myonectin and FGF-21 were checked by the ELISA method. After checking the normality of the data, they were analyzed by the correlation t-test and independent t-test at a significance level of less than 0.05.
Results: Resistance training caused a significant increase in the serum level of myonectin (P = 0.001) and the serum level of FGF-21 (P = 0.001) and also decreased the percentage of fat (P = 0.417) in middle-aged men.
Conclusions: According to the results of this study, it seems that resistance training can have positive adaptation by increasing the serum levels of myonectin and FGF-21 in the regulation of muscle mass, hypertrophy process, angiogenesis process, and Improve the body's metabolism.

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Introduction: One of the problems during adolescence is the existence of conflict with parents, which creates object relationships and feelings of shame and guilt in them. This research was conducted to determine the effectiveness of treatment based on the mentalization of object relations and feelings of shame and guilt in conflicting mother-child relationships.
Methods: This research method was semi-experimental and pre-test-post-test with a control group. The statistical population of this research included all mothers and adolescents with conflicting relationships who were referred to counseling centers in Shiraz in 2022. By using the available sampling method, 30 people from the mentioned community were selected as a sample and were randomly divided into two experimental (15 people) and control (15 people) groups. Asadi et al.'s parent-child conflict questionnaires (2010), Bell's object relations (1995), and Cohen et al.'s (2011) feelings of shame and guilt were used to collect information. The experimental group underwent executive function training for 13 sessions twice a week for 60 minutes, and the control group did not receive any training. The research data was analyzed using correlation.
Results: The mean ± standard deviation of the experimental group in the post-test in the variable of object relations from 1.5 ± 1.37 to 28.6 ± 4.3 and in the variable of shame and guilt from 5 ± 1.60 to 5.60 ± 3. 51.2 ± 9.1 decreased. The results showed that in the post-test stage, the mean scores of object relations and feelings of shame and guilt in the experimental group decreased significantly compared to the control group (P < 0.01).
Conclusions: Treatment based on mentalization was effective in improving object relationships and reducing feelings of shame and guilt. Therefore, this treatment can be suggested to reduce the conflict between adolescents and mothers.

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Introduction: Sociodemographic factors and perceived anxiety have a significant impact on the development of somatic symptom disorder. This study aimed to investigate the role of demographic characteristics, social isolation, and perceived anxiety in predicting somatic symptom disorder.
Methods: In a cross-sectional descriptive study among adults aged 18 to 60 in Tehran in 2023, 437 participants were selected based on convenience sampling. The participants completed the Somatic Symptom Disorder Questionnaire (SSEQ), Social Isolation Questionnaire, and Perceived Anxiety Questionnaire. Data were analyzed using Pearson’s correlation and multiple regression analysis.
Results: The results indicated that social isolation and perceived anxiety have a positive and significant correlation with somatic symptoms disorder (P < 0.01). There was no correlation between demographic characteristics (age, gender, marital status, education, and employment status) and somatic symptoms (P  <0.01). Multiple correlation and regression coefficients among research variables were statistically significant (P < 0.01).
Conclusions: The examined model was almost able to predict 22% of the somatic symptoms of the disorder. The results have implications for formulating interventions based on social isolation and perceived anxiety in controlling somatic symptoms. It is essential to pay attention to social isolation and perceived anxiety in the formulation and implementation of interventions and educational programs for the prevention and improvement of somatic symptom disorder.

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Introduction: Considering the synthesis and secretion of irisin and BDNF from muscle tissue during exercise and the possible relationship of these factors with improving muscle strength and performance, the present study aimed to investigate the effect of 12 weeks of strength training on muscle strength, body fat percentage, irisin, and BDNF in inactive middle-aged women.
Methods: In a semi-experimental study, 20 inactive middle-aged women (mean age 37.70 ± 5.91 years, weight 79.80 ± 5.82 kg) were selected and randomly assigned to two strength training groups (n = 10) and control groups (n = 10). The training group performed 12 weeks of strength training, three sessions per week at an intensity of 65 to 80% of maximum strength. Then, blood samples were taken using ELISA to measure irisin and BDNF. Independent t-test and Pearson correlation test were used to analyze the data. The significance level (P ≤ 0.05) was considered.
Results: Strength training significantly increased serum irisin concentration (P = 0.035) and serum BDNF concentration (P = 0.058) and also considerably decreased body fat percentage (P = 0.058) in middle-aged women. There was also a positive and significant relationship between lower body strength and serum irisin levels (P = 0.040). The Results from the Pearson correlation test indicate a significant positive relationship between BDNF and upper body strength (P = 0.038).
Conclusions: Based on the results of the present study, it seems that increased secretion of serum irisin and BDNF hormones is related to increased muscle strength following strength training in middle-aged individuals.

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Introduction: Novel antidiabetic medications are employed to manage glycemic control and mitigate the long-term complications of type 2 diabetes. This study aimed to investigate the prevalence of adverse events, including hypoglycemia, associated with these novel antidiabetic agents in a cohort of patients with type 2 diabetes.
Methods: This cross-sectional analytical study was conducted on 157 patients with type 2 diabetes mellitus attending the Endocrinology Clinic at Imam Khomeini Hospital, Urmia, during the summer of 2024. A convenience sampling method was employed to recruit participants. Data on demographics, the incidence of hypoglycemia, and reported adverse drug reactions were collected from all eligible patients through a structured interview. Subsequently, patients were stratified into three treatment groups based on the specific novel antidiabetic medication they received.
Results: In patients receiving sitagliptin, the most prevalent adverse events included arthralgia and rheumatic problems (26.31%), dermatological manifestations (36.84%), and allergic reactions (21.06%). Nausea (52.94%) and abdominal pain (17.65%) were the most frequent adverse events observed in patients treated with liraglutide. Polydipsia (28.72%), weakness and lethargy (26.6%), and dry mucous membranes (27.66%) were commonly reported in patients receiving empagliflozin. Hypoglycemia was observed predominantly in male patients aged 51-55 years receiving sitagliptin.
Conclusions: The findings of this study demonstrate a low incidence of hypoglycemia among patients treated with modern antidiabetic medications. Prevalent short-term adverse events observed included gastrointestinal disturbances, allergic reactions, and dermatological manifestations.