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Comparison of 2% dexmedetomidine and lidocaine in analgesia control and hemodynamic changes in cataract surgery with local anesthesia
Reza Sahraei, Ahmad Bostani , Mousa Zare, Navid Kalani, Fatemeh Eftekharian,
Volume 82, Issue 3 (6-2024)
Abstract
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.

Primary pyogenic spinal infection: a review article
Seyed Hasan Emami Razavi , Mohammadreza Salehi, Hooshang Saberi , Mohammad Zarei, Babak Mirzashahi, Pegah Afarinesh, Sepideh Khodaparast,
Volume 82, Issue 3 (6-2024)
Abstract
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.

Investigating the incidence and severity of pruritus in intrathecal fentanyl injection in opium-addicted patients in lower limb orthopedic surgeries: a double-blind randomized clinical trial study
Seyedeh Roya Mousavi , Parvaneh Ebrahimzadeh, Sepideh Yazdanpanah , Nasim Alsadat Mousavi, Mansour Deylami ,
Volume 82, Issue 4 (7-2024)
Abstract
Background: Today, addiction is a major problem in modern society, which affects the management of patients during anesthesia. In patients with long-term use of opioids, higher doses of opioids are needed to create analgesia and control pain during and after surgery. Also, addicted patients have more resistance to local anesthetic drugs when they are used to perform peripheral and central nerve blocks. Therefore, many drugs are added to local anesthetics to enhance their analgesic properties, one of the most common of which is narcotic compounds. Itching caused by opium may be generalized and often occurs shortly after injection. Therefore, this study aims to investigate the amount of itching caused by intrathecal injection of fentanyl in opium addicts who undergo elective orthopedic surgeries of the lower limbs with spinal anesthesia. have been taken, designed and established.
Methods: This study was a double-blind clinical trial conducted on 68 patients who were candidates for elective lower limb orthopedic surgeries under spinal anesthesia and referred to 5 Azar Hospital in Gorgan in 2023. Patients were divided into two groups using random numbers table, Intervention (a group of addicted patients who received intrathecal marcaine together with fentanyl for spinal anesthesia) and control (a group of addicted patients who received only intrathecal marcaine for spinal anesthesia). Pruritus, nausea and vomiting were measured in both groups. Data analysis was done using descriptive statistics and inferential statistical tests.
Results: In terms of age, gender, and BMI, there was no statistically significant difference between the intervention and control groups. There was no statistically significant difference in the incidence of nausea and vomiting between the two groups. The incidence of itching was zero in the bupivacaine group and 17.6% in the fentanyl and bupivacaine group, of which 3% required anti-itch medication for treatment.
Conclusion: The results of this study showed that due to the low incidence of pruritus in the group using fentanyl along with bupivacaine, its use is beneficial in people with drug addiction.

Association between cesarean scar defect and adenomyosis in patients with abnormal uterine bleeding
Fatemeh Shakki Katouli , Jayran Zebardast, Zahra Tavoli, Leila Bayani, Fahimeh Zeinalkhani, Reza Mardani , Fahimeh Azizinik,
Volume 82, Issue 4 (7-2024)
Abstract
Background: The prevalence of cesarean section (CS) has recently increased dramatically. Cesarean scar defect (CSD) is one of the most common complications of CS. This study aims to investigate and compare the depth and volume of the CSD in symptomatic patients with and without uterine adenomyosis.
Methods: This retrospective case-control study was done from November 2020 to November 2022 at our referral women's hospital. The patients who underwent sonohysterography with a previous history of one or two CS for at least one year ago and chief complaints of abnormal uterine bleeding were included in our study. The patients with myometrial or endometrial pathology were excluded from the study. The symptomatic patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were obtained from the patient’s documents and archived images. In sonohysterography, CSD features, including the length, depth, width, volume, RMT (Remained Myometrial Thickness), AMT (Adjacent Myometrial Thickness), and RMT/AMT were measured. To analyze the variables, t-tests, and chi-square were used.
Results: Among 310 symptomatic women with a history of previous cesarean section underwent sonohysterography, 160 patients met the inclusion criteria (case group with adenomyosis: 82 patients and control group without adenomyosis: 78 patients). The chief complaints were post-menstrual bleeding (43.8%), prolonged bleeding (34.3%), and intermenstrual bleeding (21.9%). In the case group, 25.6% had CSD with RMT<2mm, but in the control group (without adenomyosis), only 6.4% had RMT<2mm. CSD depth and volume were significantly larger in patients with underlying adenomyosis (P-value of 0.002 and 0.038, respectively). Also, the mean RMT and RMT/AMT ratio were significantly lower in the case group (P-values of 0.004 and 0.00, respectively).
Conclusion: Our study demonstrated a strong association between the presence of adenomyosis and larger CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.

Relationship between sarcopenia and postoperative complications in bladder cancer patients undergoing radical cystectomy
Solmaz Ohadian Moghadam , , Mohsen Ayati, Erfan Amini , Faeze Salahshour, Mohsen Shiraghaei ,
Volume 82, Issue 5 (8-2024)
Abstract
Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC.

Determining the diagnostic reference levels (DRL) of CT scan imaging in Saveh Hospitals: a brief report
Mohamad Sarkheil, Mehran Mohseni, Akbar Ali Asgharzadeh , Ali Rasouli Bozcheloie ,
Volume 82, Issue 5 (8-2024)
Abstract
Background: Based on the recommendation of the European Committee and ICRP, DRL values should be determined at the local, national and regional levels for CTDIvol (Computed Tomography Dose Index volume) and DLP (Dose Length Product) dose indicators. According to the radiation protection guidelines, it is essential study has determined DRL in Saveh hospitals
Methods: This study was conducted with two methods based on the results and calculations obtained from the annual Quality Control (QC) reports and the Data Collection (DC) method related to patient scans. In this study, by referring to the annual reports of each device and using radiation components during dosimetry and determining CTDIair or CTDIw, the correction factor was obtained. Using this factor and existing equations, DLP and CTDIvol were calculated based on quality control standards. The second quartile or the median was determined as DRL for head, sinus, chest and abdomen/pelvis imaging protocols and its values were compared with each other and other studies. This study was conducted in February and March 2023 in three hospitals in Saveh city.
Results: The diagnostic reference levels of CTDIvol index were obtained in both QC and DC methods for head (32.76 and 32.36), sinus (11.73 and 9.89), chest (6.06 and 5.11) and abdomen/pelvis (11.86 and 10.56) imaging. The highest DRL values of DLP index in both QC and DC methods are for head, abdomen/pelvis, chest and sinus CT scans, respectively. In the QC method, these values were (603.99), (478.15), (187.15), and (132.65) respectively, and in the DC method, the values were (601.84), (427.76), (219.01), and (114.81) mG.cm.
Conclusion: According to the results of this study and the lack of significant difference between the DRL values of CTDIvol and DLP indicators in both QC and DC methods, it is recommended that the centers, if they have the acceptance criteria for annual quality control, can determine the DRL by referring to the device console information from the DC method.

Evaluation of the impact of blue light blocking filters on visual quality after PRK surgery
Saeed Rahmani, Aliakbar Shafiee, Abbas Riazi , Alireza Akbarzadeh Baghban , Alireza Jafari , Maryam Dashti,
Volume 82, Issue 6 (9-2024)
Abstract
Background: Problems related to blue light exposure are among the various issues experienced by individuals who have undergone Photorefractive Keratectomy (PRK).Given the growing concerns regarding blue light’s effects on visual health, this study aimed to thoroughly investigate the impacts of blue blocker filters on the improvement of vision in patients post-refractive surgery of the PRK type. The primary objective was to evaluate the overall effectiveness of these filters in enhancing visual quality and in reducing complications associated with the surgery, which can significantly affect a patient’s quality of life.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
Results: A total of thirty-four participants, comprising 73.5% females and 26.5% males, with an average age of 32.6 years, were incorporated into the study. Post-surgery, the average refraction measured in the right and left eyes was documented as   -0.42±0.16 D and -0.30±0.16 D, respectively. Notably, visual acuity in both eyes significantly improved with the use of the blue light blocking filter (P<0.005) Moreover, contrast sensitivity at varying spatial frequencies of 1.5, 6, and 18 cycles per degree (c/d) also exhibited significant enhancement (P<0.005).
Conclusion: The incorporation of blue blocker filters for individuals with a history of PRK surgery has led to noteworthy improvements in visual acuity and enhanced contrast sensitivity. These findings underscore the critical importance of integrating blue light protection in the post-operative care of patients, as it significantly elevates the overall visual experience and may contribute to better long-term outcomes following refractive surgery.

Evaluation of frequency and factors associated to cerebrospinal fluid circulation disorder after decompressive craniectomy
Majid Jahanshahi , Morteza Taheri , Seyyed Abdollahadi Daneshi , Mostafa Haji Rezaei ,
Volume 82, Issue 6 (9-2024)
Abstract
Background: Decompressive craniectomy (DC) is a therapeutic approach for patients with raised intracranial pressure and cerebral edema. Although DC is not a complicated procedure, it is associated with significant complications and morbidities that significantly affect clinical outcomes. This study investigates the frequency of cerebrospinal fluid (CSF) circulation disorders after DC and evaluates related factors.
Methods: This cross-sectional analytical study was conducted on 79 patients who underwent DC at Shohadaye Haftome Tir Hospital, one of the main trauma centers in Tehran. The patients' files and the Picture Archiving and Communication System (PACS) were reviewed to collect demographic, clinical, and radiologic data. After identifying patients with post-operative (after DC) CSF circulation disorders, the relevant factors were determined using multivariate logistic regression.
Results: Overall, seventy-nine patients were studied. The mean age of patients was 40.56±12.64 years and 82.3% were male. Forty-seven patients (59.5%) underwent DC due to traumatic causes and thirty-two patients (40.5%) due to vascular pathologies. In total, 36.7% (nineteen) of patients were affected by some degree of subdural hygromas of which 13 patients (44.8%) progressed to clinical and radiologic hydrocephalus. 19% (fifteen patients) developed hydrocephalus within the first six months after surgery. Considering the clinical variables, the GCS of patients was the only one that showed a significant relationship with CSF circulation disorders. Regarding radiological variables, the presence of intraventricular hemorrhage (IVH) was the only relevant factor. In addition, from the surgical perspective, performing duraplasty (autograft or allograft) and reoperation demonstrated significant relationships with CSF circulation disorders. The results of multivariate logistic regression showed that having intraventricular hemorrhage (OR, 6.15-6.9414: CI95%, P=0.003) and reoperation (75.91: OR, 3.88-3.6, 1485/43: CI95%, P=0.004) were two independent factors associated with hydrocephalus in DC patients.
Conclusion: In patients who have undergone decompressive craniectomy, intraventricular hemorrhage (IVH) and reoperation can be independent risk factors for CSF circulation disorders. Although the incidence and presence of IVH cannot be controlled, careful and meticulous surgical technique and skill can significantly improve the outcome of decompressive craniectomy by reducing the need for reoperation

The effects of preoperative prophylactic administration of enoxaparin on intraoperative and postoperative bleeding in hip fracture surgeries
Mohammad Golparvar, Fatemeh Moghadassi ,
Volume 82, Issue 7 (10-2024)
Abstract
Background: Intraoperative bleeding is an unwanted and common complication in orthopedic surgeries, which can be aggravated by the preventive administration of anticoagulants to prevent deep vein thrombosis. The present study examines the effect of prophylactic enoxaparin to prevent thromboembolism on the amount of bleeding in femoral head surgeries where it is not possible to use a tourniquet.
Methods: A prospective descriptive-analytical study was conducted from July to March 2017 in Kashani Hospital, Isfahan, in 120 patients without a history of coagulation disorders who were candidates for reconstructive surgery for femoral head and neck fractures. Inclusion criteria involved age over 18, BMI less than 30, no history of coagulation disorders, no preoperative use of anticoagulant drugs, normal PT, PTT, and INR before starting enoxaparin. The patients didn’t have any coagulation disorder and all of them were under prophylactic dose of enoxaparin before surgery. The patients were subjected to spinal anesthesia with the same method. Signs related to degree of bleeding recorded during surgery and recovery care.  Data were collected and entered into SPSS software version 20, and central tendency and dispersion indices were calculated for quantitative variables. Descriptive tables and charts were utilized for qualitative variables. Correlation coefficient and linear regression analyses were performed for the final interpretation of results.
Results: There was a significant relationship between mean arterial pressure and intraoperative bleeding (p-value=0.001). The dose of enoxaparin prescribed was associated with the volume of fluids received, the amount of bleeding, the amount of tranexamic acid, phenylephrine, labetalol, TNG and fentanyl administered during the operation with a p-value of less than 0.05. Also, there is a significant relationship between the prescribed dose of enoxaparin and the duration of surgery and duration of recovery care (p-value less than 0.05).
Conclusion: The study examines the impact of prophylactic enoxaparin on intraoperative bleeding, finding a significant correlation with dosage and duration. No notable difference in bleeding was observed in patients with a GFR below 30. Enoxaparin administration correlated with increased bleeding, MAP levels, fluid volume, tranexamic acid use, and hypotension medications during surgery.

Investigation the effect of nitric oxide on biofilm-producing uropathogenic Escherichia coli strains isolated from patients
Fateh Rahimi , Sanaz Khashei,
Volume 82, Issue 7 (10-2024)
Abstract
Background: Biofilm producing uropathogenic Escherichia coli (UPEC) strains are of major concern in clinical settings which display increased resistance to conventional antimicrobial therapy. Nitric oxide (NO) has shown to exhibit anti-biofilm effects in a variety of bacterial species. In this study we aimed to evaluate the effectiveness of NO on the formation and eradication of biofilm of UPEC strains isolated from patients with urinary infection (UI) in Tehran.
Methods: During May 2022 to April 2023, a total of 3814 suspected isolates of UPEC were collected from a pathobiology laboratory in Tehran and confirmed as E. coli strains using specific primers for elongation factor Tu (tufA) gene. All strains were screened for the ability to form biofilm by the microtiter plate (MTP) and Congo red agar (CRA) assays, and also the presence of biofilm genes were detected among biofilm producing strains. Moreover, the effect of NO on biofilm formation and its dispersal was evaluated by the high (30 mM) and low (125 nM) concentrations of sodium nitroprusside (SNP) as NO donor.
Results: All collected isolates were confirmed by the polymerase chain reaction (PCR) using specific primers, in which 1309 strains (34%) were able to form colonies with red, dry and rough (rdar, curli and cellulose positive) (n=682, 52%), brown, dry and rough (bdar, curli positive and cellulose negative) (n=353, 27%) and pink, dry and rough (pdar, cellulose positive and curli negative) (n=274, 21%) morphotypes on CRA and selected as biofilm positive strains. Furthermore, 228 (17%), 402 (31%) and 679 (52%) strains were able to form a weak, moderate, and strong biofilm, respectively, and csgA, csgD, yedQ, and bcsA genes were found among 87, 98, 100 and 79% of biofilm-positive strains, respectively. The 30 mM concentration of SNP significantly decreased the biofilm formation (17-40%) and increased biofilm dispersal (20-45%) among UPEC strains.
Conclusion: These findings confirmed the applicability of nitric oxide as an anti-biofilm agent for UPEC strains. These findings contribute to the development of novel strategies for fighting biofilm-associated infections.

Defecation habits in children with rectal prolapse: a retrospective analysis
Mohadeseh Shad, Ali Samady Khanghah , Reza Shojaeian, Khashayar Atqiaee,
Volume 82, Issue 7 (10-2024)
Abstract
Background: Rectal prolapse, characterized by the extrusion of the rectal mucosa through the anal sphincter, is a relatively rare condition in children. This condition can be attributed to several anatomical and functional factors. This study aimed to investigate defecation habits in children with rectal prolapse.
Methods: This retrospective study was conducted from 2017 to 2021 in Akbar and Sheikh children's hospitals. The study population included 50 children under the age of 14 who were diagnosed with rectal prolapse and visited the hospitals. Data were collected using pre-prepared checklists and analyzed using SPSS version 24. Inclusion criteria were children under 14 years diagnosed with rectal prolapse, while exclusion criteria included incomplete data or other severe unrelated health conditions.
Results: The results showed that 67.4% of the sample were boys, and the most affected age group was children under 2 years (38.8%). A total of 57.1% of the children had daily bowel movements, and 68.2% reported consistently hard stools. Additionally, 48% of the children experienced pain or burning during defecation.
Conclusion: The findings of this study indicate that children with rectal prolapse often face challenges related to stool consistency and defecation pain, despite having frequent bowel movements. These results emphasize the need for targeted interventions to improve stool consistency and manage pain to effectively prevent and treat rectal prolapse.

Examining the frequency of expression of HER2 marker and its associated factors in urothelial carcinomas
Atoosa Gharib, Elham Gholipour Khateer ,
Volume 82, Issue 8 (11-2024)
Abstract

Background: Urothelial cancer is the ninth most common cancer in the world and is known as the seventh most common malignancy in men. Clinically, non-muscular urothelial carcinomas (N-mUC) account for 70-75% of bladder cancers. Various factors have been investigated in Relationship with the diagnosis of urothelial cancers, one of the most useful of them is Human epidermal growth factor receptor-2 (HER2) marker, whose relationship with breast, stomach and esophagus cancers has been evaluated in many studies. The aim of this study was to investigate the frequency of expression of HER2 marker and its accompanying factors in urothelial carcinomas.
Methods: All patients with urothelial carcinoma with history of Transurethral Resection of Bladder Tumor (TURBT) and radical cystectomy surgery in Modares Hospital in Tehran from April 2020 to March 2023 enrolled in this cross-sectional study. Paraffin blocks of patients were extracted and checked by a pathologist to ensure correct diagnosis. Then by HER2 marker with IHC method, were tested.
Results: A total of 84 people participated in this study, of them 74(88.1%) were male and 10(11.9%) were male. Most of the studied patients (94.0%) had urothelial carcinoma without squamous differentiation. In terms of tumor grade, 84.5% of patients have high tumor, and in terms of tumor stage, PT1 has the highest frequency and PT4a has the lowest frequency. 44 & 56 patients have performed TURT and Radical Cystectomy, respectively. HER2 marker expression was positive in 19% of the examined samples.
Conclusion:HER2 expression may provide additional prognostic information for patients with urothelial carcinoma. The consensus of the HER2 immunohistochemical scoring algorithm is crucial to ensure that it is a good first-line biomarker to determine the selection of patients for molecular studies and ultimately their selection for targeted therapy.


Evaluation of the epidemiological, clinical, paraclinical characteristics, and clinical outcomes of hospitalized patients with positive blood cultures for Brucella
Maedeh Afshar, Mahboubeh Haddad , Aliakbar Heydari, Majid Khadem Rezaiyan ,
Volume 82, Issue 8 (11-2024)
Abstract

Background: Brucellosis is the most frequently encountered zoonosis and one of the most important health challenges, especially in developing countries. This disease can be accompanied by bacteremia and may result in severe complications. A definitive diagnosis may be made by culture of the organism from blood, body fluids or tissues, although serum agglutination test is often recognized as the reference test. While bacteremic brucellosis is not uncommon, research on this topic remains limited. The present study was conducted to determine the epidemiological, clinical, and para-clinical characteristics of patients hospitalized with bacteremic brucellosis.
Methods: This retrospective cross-sectional study evaluated the epidemiological, clinical, and para-clinical characteristics, and clinical outcomes of patients hospitalized with bacteremic brucellosis from March 2011 to February 2021 at Imam Reza and Ghaem hospitals in Mashhad, Iran. A list of adult patients with confirmed brucellosis was assembled from microbiology laboratory records. The inclusion criterion was a positive blood culture for Brucella, regardless of the Brucella serology results. According to the laboratory report, the BACTEC culture medium was used to identify the organism, and the reported results did not specify the Brucella species. Demographic data, clinical presentations, paraclinical findings (including Wright, 2ME Wright, and Coombs Wright), and clinical outcomes were extracted from archived medical records.

Results: The mean age was 38.8±18 years, and 17 patients (53.1%) were male. Cardiac diseases were the most common underlying disease, and 15.7% of patients were immunocompromised. Fever and mono-arthritis were the most common symptoms and signs, respectively. Serologic investigations were negative in 12 patients (37.5%). 84.4% of patients had anemia. There was no mortality among patients.
Conclusion: A significant property of patients with positive blood culture for Brucella may not be identified with serologic assays, so if there is strong clinical suspicion of brucellosis, blood culture should also be considered. According to this study, bacteremic brucellosis is not accompanied by mortality, and the patients respond well to common antibiotic regimens.

Investigating the effect of insect body extracts (their products) and some arthropods in inhibiting the growth of cancer cells or tumours (breast cancer cell line/MCF7)
Bahar Rostamizadeh, Alireza Jalali-Zand , Kamran Qhaedi, Rozita Nasiri,
Volume 82, Issue 8 (11-2024)
Abstract
Background: Insects and arthropods, along with their products, have been used as medicinal sources since ancient times, that is called entomotherapy. Cancer is one of the major problems in medical science, for which a drug has not yet been discovered to control it quickly and accurately. Arthropods have been medicinal sources since ancient times and they especially Insects have a high potential for insect therapy because of the biodiversity. This research investigates the effect of insect body extracts and arthropods in inhibiting the growth of cancer cells or tumours, specifically on the breast cancer cell line, MCF7002E
Methods: The basic and applied study was conducted in Isfahan from 2018 to 2023. In this research, six species of insects, namely Gryllotalpa sp., Polyrhachis sp., Dolichovespula sp., Apis mellifera, Periplaneta americana, Drosophila melanogaster, and one species of Chilopoda, Scolopendra sp., were used. The samples were washed with distilled water and 70% alcohol, then frozen and powdered and prepared in 1% DMSO at eight concentrations of 62.5, 125, 250, 500, 1000, 2000, 4000, 8000 μg/ml and were evaluated for the control of two lines of breast cancer cells MCF-7 by the MTT test was performed to check the effect of doses. The affected doses of insects and centipedes were performed in 6 replicates and three times to MCF-7 cells. IC50 and LD50 were calculated by Prism version six software to check the effect of concentrations determine the effective dose and choose the best extract to control the growth of MCF-7 breast cancer cells.
Results: Scolopendra sp., Drosophila melanogaster, Periplaneta americana, Polyrhachis sp., Apis mellifera, and Gryllotalpa sp. are the most effective species, respectively, in inducing apoptosis and cell death in MCF-7 cancer cell line. Dolichovespula sp. had the least effect. Scolopendra sp. at a concentration of 500 μg/litre induced cell death in more than 50% of MCF-7 cancer cells.
Conclusion: The results of the application of seven different genera of arthropods and insects showed that these genera have excellent therapeutic potential, particularly in the treatment of MCF-7 cancer cells.
 

The relationship between chronic pains and risk factors for cardiovascular disease in diabetic elderly people
Fatemeh Rasouli Amiri , Khadijeh Ezoji, Seyed Reza Hosseini, Ali Bijani , Kayvan Latifi ,
Volume 82, Issue 8 (11-2024)
Abstract
Background: People with chronic pain have a shorter life expectancy than the general population, in part as a result of excess mortality from cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between chronic pain and risk factors of cardiovascular diseases.
Methods: In this study, 400 elderly diabetic patients in phase one of the Amirkola Elderly Cohort Study (AHAP), which was conducted between April 2011 to March 2016, were divided into two groups of 200 people, with chronic pain and without chronic pain. Then, the risk factors for cardiovascular diseases that are available in this plan such as physical activity level, body mass index, blood sugar levels, blood lipid profile status, Hypertension and smoking were examined.
Results: In the study of baseline variables in the elderly with and without pain with diabetes, it was found that women reported more pain with 54.4% than men with 45.6% that there is a significant difference between the two sexes (P=0.0001). Education level was also associated with having pain so that 67.8% of the elderly with having pain were illiterate and this relationship was significant (P=0.006). 82.5% of the elderly with higher physical activity had less pain than the elderly with less physical activity. This indicates the effect of physical activity in reducing pain and the observed relationship was significant (P=0.001). Triglyceride levels and history of underlying disease were lower in painless elderly (P=0.009 and P=0.002). Physical activity in the elderly without pain was higher than the elderly who had pain and this significant difference was reported (P=0.002).
Conclusion: The results of this study indicate a high prevalence of chronic pain in the elderly in Amirkola. In the elderly without chronic pain, there were lower triglyceride levels, more physical activity and fewer underlying diseases. Attention to chronic pain features among elderly to identify vulnerable groups and providing better care can increase the quality of life in this group.
 

Acute pulmonary embolism after hysterectomy surgery: a case report
Reza Sahraei, Fatemeh Eftekharian, Navid Kalani , Hajar Taghizadeh,
Volume 82, Issue 8 (11-2024)
Abstract
Background: Pulmonary embolism (PE) occurs when a blood clot blocks a pulmonary artery or its branches. Complications after a hysterectomy can include bleeding, infection, thrombosis, damage to surrounding structures and bowel or bladder problems. This study reports a case of acute pulmonary embolism after hysterectomy surgery.
Case Presenetation: A 52-year-old woman who was a candidate for Total Abdominal Hysterectomy (TAH)+Bilateral Salpingo-Oophorectomy (BSO) due to vaginal bleeding for 3 weeks. During the surgery, the patient's hemodynamics were normal. The surgery lasted about one and a half hours. The patient's bleeding and urine output were normal. At the end of the surgery, the patient was released from muscle relaxation with neostigmine and atropine. The patient woke up and had stable hemodynamics during recovery and was transferred to the women's ward. The next day, the patient started walking in the ward when he suddenly had syncope. The cardiopulmonary resuscitation team immediately arrived at the patient's bedside. Due to the patient's poor breathing, the patient was quickly intubated and resuscitation with cardiac massage and appropriate medications was initiated. A cardiologist and radiologist were consulted urgently and they arrived at the patient's bedside. During cardiopulmonary resuscitation, echocardiography showed a clot in the proximal right and left pulmonary arteries, and an appropriate dose of Reteplase was administered with a diagnosis of extensive pulmonary embolism. Unfortunately, despite the medical team's efforts, the patient died.
Conclusion: Based on the results of the present study, patients who undergo hysterectomy with a history of previous bleeding are at risk of acute pulmonary embolism; therefore, these patients should be closely monitored after surgery and receive appropriate medications after surgery to prevent pulmonary embolism as ordered by the Physians. 

Comparison of changes in right ventricular echocardiographic indices in pregnant women in the third trimester and non-pregnant women
Mohammad Haji Aghajani , Mohammad Parsa Mahjoob , Reza Miri , Roxana Sadeghi , Fatemeh Omidi , Maryam Roozitalab,
Volume 82, Issue 9 (12-2024)
Abstract
Background: Changes in the heart during pregnancy, especially changes in the left side of the heart, have been evaluated in various studies. However, alterations in the right ventricle have not been well studied. Thus, the present study aimed to investigate the changes in echocardiographic indices of the right ventricle in the second trimester of pregnancy.
Methods: In this cross-sectional study, 30 pregnant women, as case group, in their second trimester who were referred to the perinatology clinic of Imam Hossein Hospital, Tehran, were examined by trans-thoracic echocardiography From April 4, 2023, to April 10, 2024. The results of the control group were compared with 30 age-matched non-pregnant and healthy women, as the control group. Exclusion criteria included multiple gestation, maternal age > 40, underlying cardiovascular disease, and significant obstetric or fetal complications. Hemodynamics and demographic data including age, height, weight, and body mass index were recorded and compared. Also, the anatomical and functional indices of the right ventricle were evaluated and compared.
Results: 60 participants were enrolled in this study. The two investigated groups were similar in terms of age, but the weight, height, and BMI were significantly different in the two groups; Such that weight and body mass index were significantly higher in pregnant women and height in non-pregnant women (p<0.05). Comparison of echocardiographic indices showed that tricuspid regurgitation gradient (TRG) and fractional area change (FAC) were significantly different in the two groups (in pregnant women, TRG index was higher and FAC index was lower (p<0.05)). Right atrium area, RV length, base of RV, mid of RV, and Tricuspid annular plane systolic excursion showed no significant differences between case and control group.
Conclusion: FAC and TRG indices were significantly different between pregnant women and the control group. Paying attention to the changes in the normal values of these variables in pregnant women can be useful in improving the diagnosis of disorders and preventing the occurrence of cardiac events during pregnancy.
 

Investigating the level of anxiety in elective cataract surgery candidates
Pourya Adibi , Mehrdad Sayadinia, Parnia Dabiri , Majid Vatankhah, Mehrdad Malekshoar, Tayyebeh Zarei , Bibi Mona Razavi,
Volume 82, Issue 9 (12-2024)
Abstract
Background: Preoperative anxiety assessment allows for better analgesia in the postoperative period and a better experience for the patient. Previous studies have investigated anxiety factors specific to cataract surgery, reporting vision problems, particularly blindness, among the main preoperative fears. However, there is little research that fully and accurately investigates the causes and factors of anxiety in this population. Therefore, in this study, the factors related to anxiety in the elective eye patients.
Methods: In this descriptive-analytical study, the comparison of the level of anxiety in elective eye patients of Shahid Mohammadi Bandar Abbas Hospital in the spring and summer of 2023 was investigated. Patients referred to Bandar Abbas Shahid Mohammadi Hospital were included in the study according to the entry criteria and obtaining informed consent. In this study, after the approval of the research committee of the university, the necessary information was made by the researcher's checklist, which includes gender, age, causes of anxiety, patient's level of education, previous history of eye surgery, previous history of non-eye surgery and other underlying diseases. Was collected and the level of anxiety was measured in 2 stages before and after eye surgery based on VAS criteria.
Results: In this study, 85 (47.2%) patients were male and 95 (52.8%) were female. Also, most of the patients had a diploma-level education. Most patients mentioned a non-ocular surgery history (18.3%). Also, most of the patients (52.8%) noted an unknown cause as an anxiety-causing factor, and the least frequent among the anxiety-causing causes mentioned by the patients was the fear of death due to surgery. The level of anxiety in patients who had a history of non-ocular surgery was significantly lower. Patients who mentioned the unknown cause, the surgery itself, and financial problems as the cause of their anxiety experienced significantly higher preoperative anxiety and postoperative anxiety.
Conclusion: The level of anxiety in patients who have a history of eye and non-eye surgery is significantly lower. Preoperative anxiety and postoperative anxiety are significantly higher in patients who mention the unknown cause, the surgery itself, and financial problems as the cause of their anxiety.

Predictive value of early changes in serum β-HCG levels for treatment failure with single-dose methotrexate in tubal ectopic pregnancy
Afsaneh Amirabi, Samira Mashhadi Alipouri , Elghar Khanchi,
Volume 82, Issue 10 (1-2025)
Abstract
Background: Ectopic pregnancy (EP) is a leading cause of maternal mortality globally. Early diagnosis and treatment has been associated with reduction in maternal mortality and has shifted treatment to conservative methods. The most widely used drug for Medical treatment is methotrexate (MTX). This study aimed to investigate the predictive value of early changes (day 1/4) in serum β-HCG levels in managing tubal pregnancy with single-dose MTX.
Methods: In this cross-sectional analytical study, 135 eligible women with tubal pregnancy who received a single dose of methotrexate, were included. Methotrexate was administered intramuscularly (50 mg/m²), and serum β-HCG levels were measured on days 1, 4, and 7 following the injection. The percentage change in serum β-HCG levels compared to the initial values was calculated. Treatment failure was defined as the need for surgery and/or additional dose of methotrexate.
Results: The treatment success rate was 67% while the treatment failure rate was 33%. Among patients whose β-HCG levels increased on day 4 compared to day 1, the treatment failure rate was 86%. In contrast, for patients with decreased β-HCG levels, the failure rate was only 19%. The changes in β-HCG levels from day 1 to day 4 indicated that a decrease of less than 20% in β-h-CG levels on day 4 compared to day 1 was associated with a sensitivity of 72.2% ( CI95%: 62.2% to 82.4%) and a specificity of 80% (CI95%: 66.18% to 89.1%). This change in β-HCG levels also exhibited a positive predictive value of 60% and a negative predictive value of 88% for predicting treatment failure.
Conclusion: Based on the findings of this study, changes in β-HCG levels on days four and seven may serve as predictive factors for the failure of single-dose methotrexate treatment in patients with tubal pregnancy.

Evaluation of the accuracy of MAGIC polymer gel dosimeter in measuring dose in small electron fields in radiotherapy
Soraya Ahmadian Mask , Abbas Haghparast,
Volume 82, Issue 10 (1-2025)
Abstract
Background: Recent advances in modern radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS) have significantly increased the need for accurate and reliable dosimetry in radiation therapy. Accurate dose delivery is particularly critical in small electron fields, which are increasingly used in targeted treatments. However, these fields pose unique challenges due to factors such as electron disequilibrium, increased lateral scatter, and steep dose gradients. These physical characteristics can introduce significant uncertainties in dose distribution, thereby reducing the effectiveness and safety of the treatment if not properly accounted for. Traditional dosimeters often struggle to maintain accuracy under such conditions. The aim of this study was to evaluate the performance of MAGIC polymer gel as a three-dimensional (3D) dosimeter in small electron fields and to compare its dosimetric characteristics with standard dosimeters including diode, semiflex, and pinpoint.
Methods: This experimental and applied study was conducted at the Radiotherapy Department of Imam Reza Hospital, Kermanshah, Iran, over a one-year period from December 2022 to December 2023. Five electron field sizes (2×2, 2.5×2.5, 3×3, 4×4, and 5×5 cm²) were generated using an Elekta linear accelerator at two electron beam energies of 6 and 9 MeV. MAGIC polymer gel phantoms were irradiated accordingly and scanned with a 1.5 Tesla MRI system to obtain three-dimensional dose distributions. These were compared to measurements obtained from diode, semiflex, and pinpoint dosimeters.
Results: The depth dose curves of MAGIC gel exhibited greater agreement with diode measurements compared to those from semiflex and pinpoint detectors. As field size decreased and beam energy increased, discrepancies in absorbed dose readings between different dosimeters became more apparent. These results underscore the importance of selecting appropriate dosimetric tools for accurate dose evaluation in small-field electron beams.
Conclusion: MAGIC polymer gel demonstrated strong potential as a reliable 3D dosimeter for small electron field dosimetry, showing the highest compatibility with the diode dosimeter.

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