Tehran University Medical Journal

Primary pyogenic spinal infection: a review article

Sepideh Khodaparast

Primary pyogenic spinal infection, also known as spondylodiscitis or vertebral osteomyelitis, is a serious and potentially debilitating condition involving a bacterial or fungal infection of the intervertebral disc space and adjacent vertebral bodies. While relatively uncommon, with an estimated incidence of 2.4 per 100,000 population per year, it is a medical emergency that requires prompt diagnosis and treatment to prevent permanent spinal damage and neurological complications. The most common causative organisms are Staphylococcus aureus, which accounts for up to 50% of cases, followed by Gram-negative bacteria such as Escherichia coli, and mycobacterial infections like Mycobacterium tuberculosis. Risk factors for developing primary pyogenic spinal infection include intravenous drug use, a weakened immune system, recent spinal surgery or instrumentation, and contiguous spread from an infection elsewhere in the body, such as a urinary tract infection or endocarditis. Patients typically present with severe, localized back pain, fever, and general malaise, which can easily be mistaken for more common spinal conditions. Prompt diagnosis is critical and involves a thorough medical history, physical examination, laboratory testing, and advanced imaging studies such as magnetic resonance imaging (MRI). Blood cultures and, in some cases, image-guided biopsy may be necessary to identify the causative organism and guide appropriate antimicrobial therapy. The mainstay of treatment is the prompt initiation of targeted antibiotic or antifungal therapy, often requiring intravenous administration for several weeks. Surgical intervention may be necessary in some cases, such as to drain an abscess or provide spinal stabilization. A multidisciplinary approach involving infectious disease specialists, spine surgeons, and rehabilitation providers is essential for optimal management and outcomes. Despite advances in diagnosis and treatment, primary pyogenic spinal infection remains a challenging condition. Delays in diagnosis and treatment can lead to devastating complications, including permanent spinal deformity, paralysis, and even death. With timely and appropriate management, however, most patients are able to achieve a good clinical outcome, though some may experience residual pain or neurological deficits.

The effect of dexamethasone on controlling nausea and vomiting after cesarean surgery

Seyedeh Fatemeh Hosseini Nejad

Background: Postoperative nausea and vomiting (PONV) is a common challenge in cesarean surgeries, on the other hand, the use of dexamethasone has been proposed as an effective prophylaxis in the management of these complications. This study evaluated the effect of dexamethasone in reducing PONV.
Methods: This study was conducted as a randomized and double-blind clinical trial from April 2022 to September 2023 at Razi Hospital of Jundishapur University of Medical Sciences, Ahvaz. Elective cesarean section patients under spinal anesthesia were divided into two groups of 30 people. In this research, there were two groups: a group that received 0.1 mg/kg dexamethasone (Iran company) and a placebo group that received normal saline. The injections were done before the start of anesthesia, and both groups had received 500 cc of normal saline serum before drug injection. During the surgery and after that at specific time intervals, parameters such as blood pressure, heart rate, and the occurrence of nausea and vomiting were recorded through the V&N scoring table and shivering through the shivering scoring table. Recorded 1/2/4/6/12 after surgery.

Results: In this study the investigated variable is postoperative nausea and vomiting (PONV), since the investigated variable is a qualitative/nominal variable, to calculate the sample size from the formula P1- P2 ∕√P(1-P) used. The significance level of the tests is considered to be less than 0.05 and data analysis was done with SPSS type 23 software. Although no significant difference was observed between dexamethasone and placebo in the first hour after the operation, in the following hours, dexamethasone significantly reduced nausea and vomiting, on the other hand, heart rate and blood pressure decreased faster in the groups receiving dexamethasone.
Conclusion: Dexamethasone is significantly effective in reducing nausea and vomiting after cesarean surgery. It also has a positive role in reducing the heart rate and blood pressure and This drug is particularly effective in controlling complications after spinal anesthesia after the operation.

Investigating the role of ultrasound in diagnosing malignant axillary lymph nodes in patients with breast cancer in patients referred to Golestan Hospital in Ahvaz

Azim Motamedfar

Background: Breast cancer ranks as one of the most prevalent cancers among women worldwide and remains a major cause of mortality. The axillary lymph node (ALN) status, especially in the absence of distant metastasis, is a significant prognostic indicator in breast cancer management. Non-invasive methods, such as ultrasound, have gained prominence in the diagnostic landscape, particularly for evaluating dense breast tissue where traditional imaging may have limitations. This study was conducted to assess the diagnostic accuracy of ultrasound in detecting malignant ALNs among breast cancer patients.
Methods: This descriptive-analytical study was conducted on 150 women diagnosed with breast cancer who visited Golestan Hospital in Ahvaz, Iran, between 2021 and 2022. Patients were initially examined clinically, and subsequently, ALN evaluations were performed using a GE S6 logic ultrasound machine. Key radiologic parameters including lymph node size, morphology, cortical thickness, and vascular distribution were assessed. Stata software was used for data analysis, and pathology results were considered the gold standard to determine ultrasound’s sensitivity and specificity in detecting malignancy.

Results: We found 77.7% of the 150 patients had metastatic ALNs, indicating a high rate of lymphatic spread in this population. Ultrasound showed a sensitivity of 86.09% and a specificity of 51.52% in detecting malignant nodes. Radiological signs of cancer, like abnormal morphology and increased cortical thickness, were strongly linked to positive pathological findings. This shows that ultrasound is a useful tool for diagnosis.
Conclusion: The results indicate that ultrasound, as a non-invasive and accessible modality, can serve as a valuable diagnostic tool for identifying malignant ALNs in breast cancer patients. Integrating ultrasound with physical examination could enhance diagnostic precision, potentially reducing the need for invasive procedures such as biopsies. However, more research is necessary to establish the role of ultrasound in clinical protocols and investigate its potential to guide customized treatment strategies. Such advancements could optimize patient outcomes, enhance resource allocation, and ultimately contribute to more effective breast cancer management.

Comparison of 2% dexmedetomidine and lidocaine in analgesia control and hemodynamic changes in cataract surgery with local anesthesia

Fatemeh Eftekharian

Background: Cataract surgery is the most common surgery in the world. The prevalence of age-related cataract increases with age, and its prevalence increases with each decade of age after forty years. Various drugs are used to control analgesia and hemodynamics in patients undergoing cataract surgery. The purpose of this study is to compare dexmedetomidine and 2% lidocaine in the control of analgesia and hemodynamic changes in cataract surgery with local anesthesia.
Methods: In this double-blind clinical trial study, 52 patients with anesthesia class I and II underwent cataract surgery. Patients were randomly assigned to two groups: lidocaine (three cc) and dexmedomedin (five μg/kg + lidocaine). The information collection checklist in this study included: age, gender, history of aspirin use, systolic and diastolic blood pressure, heart rate, intraocular pressure, postoperative complications, and postoperative pain.

Results: The Mann-Whitney U test showed that the Dex-Metomedin group had less pain than the Lidocaine group in the first hour after the intervention (P=0.012). Two hours after the intervention, the dexmedemodin group had less pain than the lidocaine group (P=0.001). In the investigation of IOP after retrobulbar block in the dexmedetomidine group, we saw a significant increase in IOP from 16.56±3.12 to 17.96±2.68 mmHg compared to before the block (P=0.001). In the lidocaine group, we also saw a significant increase in IOP from 16.18±3.66 to 19.66±4.67 mm Hg compared to before the block (P=0.001). Before and after retrobulbar block, there was no significant difference between the two groups (P=0.694 and P=0.108, respectively). To investigate the effect of these interventions more precisely, the amount of IOP pressure change was also compared between the two groups, and we saw a greater increase in the lidocaine group than in the dexmedetomidine group (P=0.002).
Conclusion: The results of the present study showed that dexmedetomidine + lidocaine in retrobulbar form compared to lidocaine was able to control the pain level of patients after surgery and systolic and diastolic blood pressure during surgery. It is suggested to use this drug as local anesthesia in cataract surgery.

Investigating the relationship between mother's vitamin D serum level and neonatal outcomes in Imam Khomeini Hospital

Mojtaba Fazel

Background: Vitamin D deficiency is common among pregnant women and can lead to maternal and fetal complications during pregnancy. This study was conducted with the aim of investigating the relationship between the mother's vitamin D serum level and the infant's anthropometric indices and neurodevelopment.
Methods: This prospective cohort study was conducted on a group of pregnant women who visited Imam Khomeini Hospital in Tehran from September to March 2020. Demographic information and anthropometric characteristics of the newborn were collected using the medical record. Blood samples were collected at the time of delivery to evaluate the mother's vitamin D status, and serum vitamin D levels were measured using standard laboratory procedures. The neurodevelopment of infants was assessed at the age of 6 months through the Ages and Stages Questionnaires (ASQ). Data analysis included using descriptive statistics to summarize maternal and neonatal characteristics. The relationships between maternal serum vitamin D levels, neonatal anthropometric indicators, and neurodevelopmental outcomes were examined through Spearman's rank correlation and Mann-Whitney U tests.

Results: In total, 123 pregnant women participated in this study, with a mean age of 31.41 years (±5.75). The mean birth weight, height, and head circumference of the neonates were 3208.33 grams (±706.05), 34.32 cm (±3.91), and 50.33 cm (±2.30), respectively. Statistical analysis showed no significant correlations between maternal serum vitamin D levels and the infants' weight (P=0.318), height (P=0.531), or head circumference (P=0.241). Furthermore, there was no significant association between maternal vitamin D levels and any of the assessed neurodevelopmental domains at six months (P > 0.05).
Conclusion: While this study did not find a positive correlation between the mother's vitamin D serum level and the anthropometric indices and neurodevelopmental domains of infants at six months, it is important to interpret these results cautiously due to the study's limitations. Thus, it is advisable to conduct prospective cohort studies with large sample sizes in diverse demographics nationwide.

Comparing the effectiveness of compassion-focused treatment and emotion-focused treatment of female students with suicide attempts in high school

Fariborz Bagheri

Background: Considering the significant increase in suicidal tendencies and attempts during puberty, this study aims to investigate the effectiveness of compassion-focused therapy compared to emotion-focused therapy in increasing the resilience of female students who attempted suicide in the past has been was evaluated.
Methods: semi-experimental research was used with a pre-test and post-test design. The target population was female students of the first and second grade of high school who attempted suicide and referred to the counseling center of the General Directorate of Education, and the research was conducted from the time of data collection to the time of implementation from May 2022 to June 2023 was conducted in the counseling center under the supervision of the science and research department of Islamic Azad University, Tehran branch, was conducted and the available sampling method was selected and randomly and a total of 30 people were divided into two experimental groups (15 people) and control groups (15 people). First, Connor and Davidson's resilience questionnaire (2003) was taken from all three groups. The experimental group underwent eight 90-minute sessions of emotion-focused compassion therapy, while the control group received no intervention. After the end of the treatment sessions, the resilience questionnaire of Connor and Davidson (2003) was administered again and repeated after one month of follow-up. The collected data were analyzed using statistical tests (multivariate analysis of covariance and analysis of variance).

Results: The results obtained from the data analysis showed a significant difference in the pre-test, post-test and follow-up resilience averages in the three groups. Resilience scores for the experimental groups were significant at P < 0.05, which indicates a significant difference. Additionally, the compassion-focused therapy group showed greater improvements in resilience compared to the emotion-focused group.

Conclusion: These findings confirm the positive effect of both types of treatment on the resilience of female students who have previously attempted suicide, and compassion-focused therapy was more effective than emotion-focused therapy

Assessment of male infertility causes in patients treated at Ahvaz's Imam Khomeini Hospital infertility center

Maryam Farzaneh

Background: Infertility is defined as the inability to achieve conception after one year of unprotected intercourse. This study aimed to explore the factors associated with infertility in men referred to the infertility center at Imam Khomeini Hospital in Ahvaz.
Methods: This descriptive study utilized a cross-sectional questionnaire during March 2016 to September 2019, involving 800 infertile couples with complete records. We extracted demographic data, including age, occupation, duration of infertility, smoking habits, surgical history, semen analysis, and sperm condition and quality from the files of these men referred to the IVF department. The collected details were systematically entered into an information form. Quantitative results are presented as mean±standard deviation, with differences of p<0.05 between groups deemed statistically significant.

Results: In this study, the average age of the men referred for evaluation was 33.5 years. The analysis of semen quality revealed a mean semen volume of 2.34 mL, which falls within the acceptable range for normal ejaculate volume, typically defined as being greater than 1.4 mL. The average sperm count recorded was 16,365,000 per mL. Additionally, our study demonstrated that only 5.8% of the sperm exhibited normal morphology. Sperm motility, another key factor in male fertility, averaged at 9.24%, significantly lower than the normal standard. Regarding employment status, a significant majority of participants were employed (89%), while 11% were unemployed. The surgical history among the referred men primarily included varicocelectomy (n=108), hemorrhoid surgery (n=29), urinary tract procedures (n=28), testicular hernia repairs (n=23), and appendectomies (n=18). Additionally, 24% of the subjects reported drug use, with a notable distinction made between smoking and other forms of drug use.
Conclusion: The findings from this study underscore significant concerns regarding male fertility among the referred men, particularly in terms of sperm count, motility, and morphology. These metrics suggest that many individuals may face challenges in achieving conception without medical intervention. Understanding these factors is crucial for developing effective treatment plans and improving reproductive outcomes for men facing infertility issues.

A systematic review of effects of colostrum supplementation on the immune system of athletes

Ghazaleh Eslamian

Background: Athletes are seeking ways to enhance sports performance and protect themselves from the long-term effects of exercise. One potentially effective solution is the administration of colostrum supplements. Evidence suggests that it can support immune system function by maintaining the integrity of the intestinal barrier. The aim of this study is to evaluate the impact of colostrum supplementation on athletes' immune system performance.
Methods: This systematic review searched English and Farsi databases including Medline, Scopus, Embase, ScienceDirect, Scientific Information Database, Islamic World Science Citation, Cochrane, and Google Scholar website without a time limit until November 2023. Eighteen randomized clinical trials, following the Cochrane protocol, were analyzed to assess the effects of colostrum supplementation on athletes' immune systems. The studies measured various factors, such as the amount of cytokines, concentration of serum immunoglobulins, salivary immunoglobulin, white blood cell count, neutrophil oxidative reactions, and the rate of respiratory system-related diseases in athletes during the consumption of colostrum supplements or its derivatives. The potential risks of bias in the studies were evaluated using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.

Results: The findings of these studies indicate that daily consumption of 3.2 grams of colostrum for 24 weeks can decrease the production of inflammatory cytokines caused by exercise and increase anti-inflammatory cytokines. Additionally, a daily intake of 20 grams of colostrum supplement can protect against the reduction of neutrophil function and immune responses resulting from long-term exercise. The group receiving colostrum experienced fewer upper respiratory tract diseases compared to the placebo group in studies that investigated this indicator. No significant effects on leukocyte count were observed with any dosage of supplementation, and the results of studies on other immune indicators were inconsistent.
Conclusion: Bovine colostrum can improve athletes' immune system performance by regulating immune parameters and mitigating the negative effects of intense exercise. However, the contradictory results of existing studies call for further research that examines different doses of colostrum in various sports.

Clinical manifestations of Hirschsprung in infants in Iran

Razieh Sangsari

Background: Hirschsprung's disease is a major cause of functional intestinal obstruction, mainly affecting the distal region of the large intestine. Risk factors for this disease include a family history of the disease, being male, and the presence of other conditions such as cardiac or chromosomal abnormalities.
Methods: Infants admitted to Children's Medical Center Hospital, Tehran university of medical science between April 2017 to April 2021 with a diagnosis of Hirschsprung's disease were included in this study. Demographic information, clinical and radiological findings, and complications were recorded on customized forms.

Results: In this study, 29 neonates were included. The clinical manifestations of Hirschsprung in this study were failure to defecation in the first two days of birth, abdominal distention, and bilious vomiting. The most common complaint at the time of visit was constipation and vomiting, and the most common clinical finding at the time of hospitalization was abdominal distension. The most common radiological manifestation in the simple X-ray of affected neonates was the dilation of the intestinal loops and in the barium enema transitional zone. In the delayed X-ray, the delay in emptying the barium was observed. in neonate with Hirschsprung's disease Heart disease was a common comorbidity (27.2%). The most common heart disease was Atrial Septal Defect (ASD). The most histological involvement was in the rectal and rectosigmoid areas. The most common complication of Hirschsprung in the follow-up of neonates until at least 6 months of age was poor weight gain, constipation and fecal incontinence. We had three deaths, one case with Small intestine, one case with heart disease and one case with multiple anomalies.
Conclusion: The results of this study are consistent with previous research showing that genetic variations do not have a major impact on the clinical presentation of newborns with Hirschsprung's disease. While diagnostic methods like x-ray and contrast enema can be useful, biopsy is the most reliable way to confirm a diagnosis of Hirschsprung's disease. Physicians should consider performing a biopsy when evaluating a suspected case of this condition.

Dermatophytosis caused by Trichophyton indotineae, a clinical and laboratory emergency: a letter to editor

Shahram Mahmoudi