Search published articles
Showing 2319 results for HA
Kosar Hajati, Behnaz Deihim ,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Leishmaniasis is one of the most significant parasitic diseases and is susceptible to secondary bacterial infections, which can result in increased inflammation, delayed tissue repair, and increased drug resistance. Given the importance of this phenomenon, the present study was designed to identify bacterial agents and determine their antibiotic resistance patterns in lesions of patients with cutaneous leishmaniasis.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
Moslem Taheri Soodejani , Roghayeh Torkpour ,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Autism spectrum disorder (ASD) represents one of the most significant neurodevelopmental disorders in early childhood, where early diagnosis, particularly in children under five years of age, is crucial for effective interventions. Although global autism incidence has risen due to improved awareness, enhanced screening programs, and broader diagnostic criteria, epidemiological data from middle-income countries like Iran remain limited, especially for children under five. This study aimed to examine autism incidence trends among Iranian children under five from 1990 to 2021, stratified by sex and province.
Methods: This ecological study was conducted from October 2024 to March 2025, analyzing data extracted from the Global burden of disease (GBD) database (1990-2021). Age-specific incidence data for children under five were obtained by sex and province. Incidence rates per 100,000 population were calculated for gender and provincial comparisons. Joinpoint regression analysis assessed annual trends and identified significant inflection points. Heat maps illustrated geographical distributions, while trend graphs stratified by sex and province were generated using GraphPad Prism.
Results: The incidence rate of autism in children under five gradually increased from 1990 to 2005, followed by a sharp rise between 2005 and 2009, reaching its peak during this period. A subsequent decline was observed from 2009 to 2021. The male-to-female ratio remained consistently stable at approximately 3:1 throughout the study period and across all provinces. Notable provincial disparities were observed, with border provinces exhibiting greater fluctuations compared to central regions.
Conclusion: In contrast to the continuous global increase, autism incidence among Iranian children under five demonstrated an initial rise followed by a sustained decline after 2009. This trend may be attributed to declining birth rates, demographic shifts, evolving diagnostic criteria, improved prenatal care, and persistent challenges in early screening and case registration, alongside regional disparities in access to diagnostic services. These findings emphasize the need for enhanced early-screening programs, equitable resource distribution, and evidence-based child mental health policies in Iran.
Methods: This ecological study was conducted from October 2024 to March 2025, analyzing data extracted from the Global burden of disease (GBD) database (1990-2021). Age-specific incidence data for children under five were obtained by sex and province. Incidence rates per 100,000 population were calculated for gender and provincial comparisons. Joinpoint regression analysis assessed annual trends and identified significant inflection points. Heat maps illustrated geographical distributions, while trend graphs stratified by sex and province were generated using GraphPad Prism.
Results: The incidence rate of autism in children under five gradually increased from 1990 to 2005, followed by a sharp rise between 2005 and 2009, reaching its peak during this period. A subsequent decline was observed from 2009 to 2021. The male-to-female ratio remained consistently stable at approximately 3:1 throughout the study period and across all provinces. Notable provincial disparities were observed, with border provinces exhibiting greater fluctuations compared to central regions.
Conclusion: In contrast to the continuous global increase, autism incidence among Iranian children under five demonstrated an initial rise followed by a sustained decline after 2009. This trend may be attributed to declining birth rates, demographic shifts, evolving diagnostic criteria, improved prenatal care, and persistent challenges in early screening and case registration, alongside regional disparities in access to diagnostic services. These findings emphasize the need for enhanced early-screening programs, equitable resource distribution, and evidence-based child mental health policies in Iran.
Fatemeh Eftekharian, Arnoosh Ghodsian, Reza Sahraei,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Dermatomyositis is a rare inflammatory muscle disease with systemic manifestations, in which muscle weakness, dysphagia, and pulmonary and cardiac involvement are common problems. The aim of this report is to examine the challenges and management of general anesthesia in a patient with dermatomyositis with the rare complication of buried bumper syndrome after PEG placement and gallbladder surgery.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
Epidural initiation time based on fetal head position criteria in painless labor: a letter to editor
Banafsheh Mashak, Reza Taghvaei, Reza Payami , Mohammad Hossein Shakeri Goki , Fatemeh Javaheri, Roya Bolhassani,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Ayoub Tavakolian, Shapour Badiee, Mahdi Mohammadi, Elahe Pourahmadi, Samaneh Sabouri, Navid Kalani , Mahdi Foroughian ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
| Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers. Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay. Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care. Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care. |
Ardeshir Ebrahiminejad Shahroudi, Abbas Akhavan Sepahi , Anna Meyfour, Abbas Yadegar, Sedigheh Mehrabian,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing gastrointestinal disorder characterized by persistent inflammation of the intestinal mucosa, disruption of epithelial barrier function, and dysregulation of the immune system. Its pathogenesis involves complex interactions among genetic predisposition, environmental factors, gut microbiota, and host immune responses. Dysregulated cytokine signaling plays a central role, with elevated levels of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-12, and interferon-gamma (IFN-γ), contributing to tissue damage, epithelial barrier dysfunction, and clinical manifestations such as diarrhea, bleeding, and weight loss. Conversely, anti-inflammatory cytokines, including interleukin-10 (IL-10), IL-35, and IL-37, counteract these inflammatory responses, inhibit excessive immune activation, and maintain mucosal homeostasis. Probiotics, particularly Lactobacillus strains, have emerged as promising adjunctive therapies for IBD due to their capacity to restore microbial balance, modulate immune responses, and enhance gut barrier integrity. Among them, Lactobacillus brevis has demonstrated significant immunoregulatory and anti-inflammatory effects. Various strains, including AL0035, SBC8803, Bmb6, HY7401, and KU15152, reduce pro-inflammatory cytokines, upregulate tight junction proteins such as ZO-1, regulate Th1/Th2/Th17 responses, and inhibit NF-κB and MAPK signaling pathways. L. brevis-derived metabolites, notably long-chain polyphosphates, attenuate fibrosis, reduce TGF-β1 and collagen expression, and protect epithelial cells from oxidative stress. Heat-killed L. brevis strains also retain immunomodulatory activity, allowing therapeutic use even when live bacteria cannot effectively colonize the gut. Preclinical studies demonstrate that oral administration of L. brevis improves disease activity indices in experimental colitis models, reduces mucosal immune cell infiltration, restores epithelial integrity, and prevents ulceration, bleeding, and goblet cell depletion. Clinical evidence, although limited, suggests that L. brevis supplementation can enhance gut microbiota diversity, increase beneficial bacterial populations, and modulate serum cytokines, further supporting intestinal homeostasis. Furthermore, L. brevis influences metabolite profiles, such as serotonin and polyamines, which are linked to gut motility, epithelial repair, and immune regulation, highlighting its multifaceted role in gut health. In this review article, for the first time, we discussed the beneficial effects of L. brevis in inflammatory bowel disease, highlighting its clinical effects and therapeutic prospects.
Aref Teymurinejad, Hossein Seidkhani , Zahra Mohebinejad, Amirreza Eidypou , Hamed Azadi ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Kidney stones are the third most common urinary tract disorder after prostate disease and infection. Painful attacks are the most common clinical manifestation, which is known as renal colic. The aim of the present study is to determine the effect of pethidine, pethidine and ketorolac, and ketorolac in patients with primary renal colic.
Methods: Renal colic patients at Imam Khomeini Hospital in Ilam from April 2023 and March 2023. were divided into three groups of 36 people. The first group received pethidine 25 mg, the second group received ketorolac 30 mg, and the third group received a combination of 2 drugs. A questionnaire included demographic information of the patients, heart rate, systolic and diastolic blood pressure, respiratory rate, oxygen saturation, side effects, pain intensity, length of hospitalization, and type of treatment received.
Results: After receiving the drug, the average heart rate increased in all three groups. But in group A, this increase was less than two groups, B and C, and this difference was not statistically significant (P=0.34). The average systolic blood pressure before receiving the drug was significantly higher in the three studied groups (P=0.006), which decreased after receiving the drug, but this decrease in systolic blood pressure in the three groups was not statistically significant (P=0.98). The average pain intensity before receiving the drug was 8.56 ± 1.2 in group A, 9.17 ± 0.878 in group B, and 8.86 ± 0.961 in group C. There was no significant difference between the three groups in terms of initial pain intensity (P=0.45). While the average pain intensity after receiving the medicine was significantly reduced and there was a significant difference (P<0.000).
Conclusion: Overall, the obtained results showed that ketorolac and pethidine have a faster effect and power compared to pethidine and ketorolac alone in controlling the pain of patients with renal colic, and the need for life-saving treatment is also less in this drug, and according to numerous studies, its side effects are also less.
Elham Shafighi Shahri , Akram Ehsasatvatan, Sara Rigy Nejad ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Phenylketonuria (PKU) is a genetic metabolic disorder that, if left untreated, leads to irreversible cognitive, behavioral, and neurological damage. Sistan and Baluchestan and West Azerbaijan provinces are among the regions that have reported high rates of the disease due to specific ethnic characteristics. This study aims to compare the frequency and pattern of clinical symptoms in the two provinces of Sistan and Baluchestan and West Azerbaijan. Methods: This cross-sectional descriptive-analytical study was conducted on 60 patients with PKU who had been referred to Imam Ali Hospital (Zahedan) and Urmia Hospital during the past ten years. Data were collected from medical records and structured interviews. Results: The mean age of the patients was 5.67 ± 6.98 years. The mean height, weight, and head circumference were 30.28 ± 113.08 cm, 13.22 ± 25.13 kg, and 1.83 ± 43.36 cm, respectively. The mean serum phenylalanine level at the time of diagnosis was 13.58 ± 14.65 mg/dL. Of the 60 patients, 31 (51.7%) were male and 29 (48.3%) were female. The difference between the two sexes in the occurrence of clinical symptoms was not statistically significant (p<0.05). Psychiatric disorders were reported in 20 (33.3%) of the patients. The prevalence of these disorders was significantly higher with increasing age (p = 0.041). Conclusion: This study indicates the existence of significant regional differences in the clinical manifestations of phenylketonuria; such that patients from Sistan and Baluchestan province experienced a higher rate of psychiatric and neurological symptoms than patients from West Azerbaijan. The severity of symptoms increased with increasing age and duration of illness, emphasizing the importance of early diagnosis and continuous therapeutic follow-up. It was also noteworthy that some patients still had severe clinical symptoms despite having lower phenylalanine levels at diagnosis. Overall, the findings of this study emphasize the need for early diagnosis, equitable access to health services, and sustained metabolic control to improve outcomes for PKU patients in the country. |
Mohammad Mehdi Khatib Shahidi, Ali Sadoogh Abbasian , Maliheh Safari ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Cisplatin is one of the most effective chemotherapy agents; however, its nephrotoxicity remains the primary dose-limiting factor. This study aimed to determine the prevalence and clinical course of acute kidney injury (AKI) in patients receiving high-dose cisplatin therapy.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results: Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion: High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results: Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion: High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.
Sara Memarian, Narges Mostajabi, Behdad Gharib, Parastoo Rostami , Mohammad Taghi Majnoon , Farzaneh Abbasi, Reihaneh Mohsenipour,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Type 1 diabetes mellitus, with its increasing prevalence in the pediatric population, has a significant impact on the mental health, quality of life, and lifestyle of patients.. The onset of the disease in childhood and its association with the child during school and adolescence, and during the growth and development process, has numerous effects on the growth process and mental experiences of patients.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Moghgan Samet Zadeh , Sahar Nikouzad Shahraki , Mohammad Ghasem Hanafi ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
|
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases worldwide and is closely associated with metabolic syndrome and insulin resistance. Growing evidence suggests a link between NAFLD and cardiovascular diseases, independent of traditional risk factors. Coronary computed tomography angiography (CCTA) is a reliable noninvasive method for evaluating coronary artery disease (CAD) and identifying high-risk coronary plaque characteristics. However, data regarding the association between NAFLD and high-risk coronary plaques remain limited, particularly in Iran. This study aimed to evaluate the prevalence of NAFLD in patients with high-risk coronary plaques detected by CCTA. Methods: In this cross-sectional study, 200 patients who underwent CCTA for the evaluation of coronary plaques in outpatient clinics or the emergency department of Golestan Hospital in ahvaz ,1403 ,were enrolled. Demographic data, including age, sex, weight, and body mass index (BMI), along with clinical characteristics and cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking status, and medical history were collected. Patients with a history of alcohol consumption or known liver disease were excluded. NAFLD was assessed based on imaging findings. Statistical analyses were performed to compare variables between patients with and without NAFLD. Results: The mean age of patients with NAFLD was 57.89 ± 9.72 years, compared with 55.77 ± 8.97 years in patients without NAFLD, with no statistically significant difference. The prevalence of NAFLD was slightly higher in women than men; however, this difference was not significant. Patients with NAFLD had a significantly higher mean weight than those without NAFLD (85.21 ± 12.12 kg vs. 79.62 ± 11.85 kg; p = 0.001). Additionally, the prevalence of NAFLD increased significantly with higher BMI categories, particularly in obese individuals. Conclusion: Age and gender were not significantly associated with NAFLD prevalence in patients with high-risk coronary plaques. In contrast, increased body weight and higher BMI, especially obesity, were independently associated with a higher risk of NAFLD in this population. |
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: The duration of hospitalization of patients is considered an important indicator in health resource management and patient evaluation. This study investigated the frequency and causes of readmission in cardiovascular patients
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Hadi Khorsand Zak, Seyed Hasan Seyed Sharifi , Yaser Abbasi , Rasul Nikdel,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Intestinal lymphangiomatosis is a rare benign disorder of the gastrointestinal tract characterized by abnormal proliferation and dilatation of lymphatic channels within the intestinal wall and mesentery. It accounts for less than 1% of gastrointestinal tumors and predominantly affects the small intestine, particularly in pediatric patients. Clinical manifestations vary widely depending on the size, location, and extent of the lesions, ranging from asymptomatic presentations to acute complications. Due to its rarity and nonspecific features, early diagnosis is often difficult. Imaging modalities, especially ultrasonography, computed tomography, and magnetic resonance imaging, are crucial for initial evaluation and preoperative planning.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
Mohammad Saadatnia , Faezeh Sharifi, Fariborz Khoroush,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Subarachnoid hemorrhage (SAH) is a life-threatening emergency condition often accompanied by severe, sudden-onset headache. The main causes are head trauma and aneurysm rupture. Pain management in these patients remains challenging, typically requiring opioids which carry significant adverse effects. As anti-neuropathic agents, gabapentin and pregabalin may serve as suitable alternatives to opioids. This systematic review aimed to evaluate the efficacy and safety of gabapentin and pregabalin in managing SAH-associated headaches.
Methods: Following PRISMA guidelines, we conducted comprehensive searches in PubMed, SCOPUS, Web of Science, and EMBASE through May 2025. Key search terms included "Gabapentin," "Pregabalin," "Subarachnoid Hemorrhage," and "Headache." After initial screening, we selected English or Persian-language articles investigating these medications' effects on SAH-related headache. After removal of duplicates and screening, four eligible studies (including randomized controlled trials and cohort studies) were included for final analysis. Data on study type, sample size, type of interventions, headache management-related outcomes, as well as safety and tolerability profiles were extracted.
Results: Pregabalin demonstrated significant efficacy, showing a statistically significant reduction in pain intensity compared to placebo before anesthesia induction (P≤0.004) and up to 24 hours post-operatively (P=0.007). Additionally, patients receiving pregabalin required significantly fewer rescue analgesics (P≤0.005). In contrast, gabapentin did not produce a statistically significant reduction in pain intensity or morphine equivalent requirements compared to placebo, although a non-significant trend toward decreased pain was observed. Safety profiles were favorable for both medications; no serious adverse events leading to drug discontinuation were reported.
Conclusion: Pregabalin appears to be an effective, safe, and well-tolerated option for managing SAH-related headache, significantly reducing both pain intensity and opioid requirements. Current evidence for gabapentin remains limited and inconclusive, warranting further large-scale, randomized controlled trials to confirm its potential role in this setting.
Methods: Following PRISMA guidelines, we conducted comprehensive searches in PubMed, SCOPUS, Web of Science, and EMBASE through May 2025. Key search terms included "Gabapentin," "Pregabalin," "Subarachnoid Hemorrhage," and "Headache." After initial screening, we selected English or Persian-language articles investigating these medications' effects on SAH-related headache. After removal of duplicates and screening, four eligible studies (including randomized controlled trials and cohort studies) were included for final analysis. Data on study type, sample size, type of interventions, headache management-related outcomes, as well as safety and tolerability profiles were extracted.
Results: Pregabalin demonstrated significant efficacy, showing a statistically significant reduction in pain intensity compared to placebo before anesthesia induction (P≤0.004) and up to 24 hours post-operatively (P=0.007). Additionally, patients receiving pregabalin required significantly fewer rescue analgesics (P≤0.005). In contrast, gabapentin did not produce a statistically significant reduction in pain intensity or morphine equivalent requirements compared to placebo, although a non-significant trend toward decreased pain was observed. Safety profiles were favorable for both medications; no serious adverse events leading to drug discontinuation were reported.
Conclusion: Pregabalin appears to be an effective, safe, and well-tolerated option for managing SAH-related headache, significantly reducing both pain intensity and opioid requirements. Current evidence for gabapentin remains limited and inconclusive, warranting further large-scale, randomized controlled trials to confirm its potential role in this setting.
Babak Choobi Anzali , Leila Tighi, Hamidreza Mehryar ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Subarachnoid hemorrhage is a life-threatening neurological emergency that requires rapid diagnosis to reduce morbidity and mortality. Acute headache is the most common presenting symptom of Subarachnoid hemorrhage; however, it overlaps with many benign conditions, making early differentiation difficult in emergency departments. Although brain computed tomography is the diagnostic gold standard, readily available laboratory markers may assist clinicians in early risk stratification. Complete blood count (CBC) derived inflammatory indices are inexpensive, rapidly obtainable, and routinely measured in emergency settings. This study aimed to evaluate the diagnostic value of CBC derived indices in distinguishing Subarachnoid hemorrhage from other causes of acute headache.
Methods: This study is a retrospective study conducted on patients who presented with acute headache to the emergency department of the educational and therapeutic hospital affiliated with Urmia University of Medical Sciences. Medical records of patients presenting with acute headache between January 2018 and December 2022 were reviewed. A total of 1,025 patients were included. Demographic data and initial laboratory parameters, including white blood cell count (WBC), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), were collected. Patients were classified into Subarachnoid Hemorrhage and non-Subarachnoid Hemorrhage groups based on brain CT scan findings and complementary diagnostic evaluations when required. Comparative analyses were performed, and the diagnostic performance of CBC derived indices was assessed using Receiver operating characteristic (ROC) curve analysis.
Results: Among the study population, 22 patients (2.1%) were diagnosed with Subarachnoid Hemorrhage. Patients with Subarachnoid Hemorrhage demonstrated significantly higher mean WBC counts and neutrophil percentages, along with significantly lower lymphocyte percentages, compared with non-Subarachnoid Hemorrhage patients (P<0.001). The mean NLR was higher in the Subarachnoid Hemorrhage group (7.23±4.92) than in the non-Subarachnoid Hemorrhage group (3.67±3.51, P<0.001). ROC curve analysis showed that NLR and neutrophil percentage had the highest diagnostic accuracy, each yielding an Area under the curve (AUC) of 0.76, indicating moderate discriminative ability.
Conclusion: CBC derived inflammatory indices, particularly NLR and neutrophil percentage, may serve as useful adjunctive screening tools for early identification of SAH in patients presenting with acute headache. However, these parameters should complement, rather than replace, definitive neuroimaging methods.
Methods: This study is a retrospective study conducted on patients who presented with acute headache to the emergency department of the educational and therapeutic hospital affiliated with Urmia University of Medical Sciences. Medical records of patients presenting with acute headache between January 2018 and December 2022 were reviewed. A total of 1,025 patients were included. Demographic data and initial laboratory parameters, including white blood cell count (WBC), neutrophil percentage, lymphocyte percentage, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR), were collected. Patients were classified into Subarachnoid Hemorrhage and non-Subarachnoid Hemorrhage groups based on brain CT scan findings and complementary diagnostic evaluations when required. Comparative analyses were performed, and the diagnostic performance of CBC derived indices was assessed using Receiver operating characteristic (ROC) curve analysis.
Results: Among the study population, 22 patients (2.1%) were diagnosed with Subarachnoid Hemorrhage. Patients with Subarachnoid Hemorrhage demonstrated significantly higher mean WBC counts and neutrophil percentages, along with significantly lower lymphocyte percentages, compared with non-Subarachnoid Hemorrhage patients (P<0.001). The mean NLR was higher in the Subarachnoid Hemorrhage group (7.23±4.92) than in the non-Subarachnoid Hemorrhage group (3.67±3.51, P<0.001). ROC curve analysis showed that NLR and neutrophil percentage had the highest diagnostic accuracy, each yielding an Area under the curve (AUC) of 0.76, indicating moderate discriminative ability.
Conclusion: CBC derived inflammatory indices, particularly NLR and neutrophil percentage, may serve as useful adjunctive screening tools for early identification of SAH in patients presenting with acute headache. However, these parameters should complement, rather than replace, definitive neuroimaging methods.
Kourosh Karimi Yarandi , Majid Pourfahraji Fakhrabadi , Siavash Anbaei, Shayan Dabbagh, Mohammad Mahdi ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Congenital scoliosis (CSC) and Idiopathic scoliosis (ISC) are complex spinal disorders that may involve neurological components affecting bladder function. Surgery remains the primary treatment for significant deformity, and in selected cases, correction of an associated tethered cord is also required. Given the potential interaction between spinal pathology and lower urinary tract function, this study examined changes in urodynamic findings before and after treatment in patients with CSC and ISC.
Methods: This retrospective cross-sectional study included patients with scoliosis who were presented to the Neurosurgery Clinic at Sina Hospital between September 2016 and September 2018. Preoperative and postoperative urodynamic study (UDS) results were reviewed, and statistical analyses were performed using SPSS version 24.
Results: Thirty-one patients were analyzed, consisting of 10 males (32.2%) and 21 females (67.7%), with a mean age of 14.18 years (median: 13 years). Among the 12 patients with CSC, 10 (83.3%) showed abnormal UDS prior to surgery. In contrast, 13 of 19 patients with ISC (68.4%) demonstrated normal baseline UDS. Following treatment, normalization occurred in 10 CSC patients (83.3%) and in 14 ISC patients (73.7%) (P=0.008). Before surgery, 15 of the 23 patients without a tethered cord (65.2%) had normal UDS, whereas all 8 patients with a tethered cord exhibited abnormal findings. Of the 12 patients with abnormal preoperative UDS, 3 (25%) showed no postoperative change, while 12 patients demonstrated normalization and 4 continued to show abnormal results (McNemar test, P=0.039). Improvement was also observed in 7 of the 8 patients (87.5%) with a tethered cord (P=0.57).
Conclusion: Scoliosis surgery, particularly when combined with tethered cord release, was associated with meaningful improvement in urodynamic function. Urodynamic abnormalities were more common among CSC patients before intervention, and the presence of a tethered cord contributed to greater urinary dysfunction across both scoliosis types. These findings highlight the importance of thorough preoperative urodynamic assessment to guide management and anticipate postoperative outcomes.
Aakar Sofineai , Abbas Ghaisouri, Ali Zeinyvand,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: The COVID-19 epidemic is predicted to cause another NCDs epidemic. The fact that hypertension, as well as other forms of cardiovascular disease, is frequently seen in COVID-19 patients has led to the fact that most patients with SARS-COV-2 are treated with angiotensin converting enzyme inhibitors (ACEIs) and blockers. Angiotensin receptor (ARB) be treated. So far, no study has been conducted on the prevalence of hypertension in patients with coronary heart disease and its relationship with pulmonary involvement. Let's do it.
Methods: This retrospective cross-sectional comparative study is performed on the records of patients admitted to Shahid Mostafa Khomeini Hospital in Ilam with a diagnosis of COVID-19. It was carried out in the summer of 2021 to the summer of 2023. At the time of hospitalization, patients' blood pressure is calculated and recorded according to standard criteria. The degree of hypoxia is also assessed using a pulse oximeter according to the set criteria.
Results: In this study, the mean age of patients aged 54.65 years in the age range of 18-95 years. The correlation coefficient of systolic blood pressure is directly related to pulmonary involvement, but this relationship is not statistically significant. At the age of less than 60 years, the correlation coefficient between systolic blood pressure and pulmonary involvement with age is positive and significant, but at the age of more than 60 years, this relationship is inverse and not significant. The relationship between systolic blood pressure and pulmonary involvement is direct and significant. A linear correlation coefficient was reported between systolic blood pressure and pulmonary involvement with a history of direct hypertension.
Conclusion: In the present study, the prevalence of hypertension was 19.5% and using Pearson linear correlation test, it was shown that there is a direct relationship between blood pressure correlation coefficient with pulmonary involvement, but this relationship was not statistically significant. This relationship was reported to be direct and significant for the age group under 60 years. It was also direct and significant in men.
Methods: This retrospective cross-sectional comparative study is performed on the records of patients admitted to Shahid Mostafa Khomeini Hospital in Ilam with a diagnosis of COVID-19. It was carried out in the summer of 2021 to the summer of 2023. At the time of hospitalization, patients' blood pressure is calculated and recorded according to standard criteria. The degree of hypoxia is also assessed using a pulse oximeter according to the set criteria.
Results: In this study, the mean age of patients aged 54.65 years in the age range of 18-95 years. The correlation coefficient of systolic blood pressure is directly related to pulmonary involvement, but this relationship is not statistically significant. At the age of less than 60 years, the correlation coefficient between systolic blood pressure and pulmonary involvement with age is positive and significant, but at the age of more than 60 years, this relationship is inverse and not significant. The relationship between systolic blood pressure and pulmonary involvement is direct and significant. A linear correlation coefficient was reported between systolic blood pressure and pulmonary involvement with a history of direct hypertension.
Conclusion: In the present study, the prevalence of hypertension was 19.5% and using Pearson linear correlation test, it was shown that there is a direct relationship between blood pressure correlation coefficient with pulmonary involvement, but this relationship was not statistically significant. This relationship was reported to be direct and significant for the age group under 60 years. It was also direct and significant in men.
Amir Naddaf, Vafa Ghorban Sabbagh , Ghazaleh Rasti, Raheleh Moradi, Mobina Taghva Nakhjiri ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Neonatal hypoglycemia is a common metabolic disturbance during the first days of life, particularly in infants with risk factors such as prematurity, perinatal stress, intrauterine growth restriction, or maternal diabetes. Early onset thrombocytopenia within the first 72 hours is often attributed to placental insufficiency and reduced platelet production, whereas persistent hypoglycemia beyond this period may indicate sepsis, necrotizing enterocolitis, or hyperinsulinemic states. Given that perinatal stress and asphyxia can predispose to both hypoglycemia and thrombocytopenia, simultaneous presentation of these conditions may complicate diagnosis and management. This case report describes a neonate with persistent hypoglycemia and thrombocytopenia unresponsive to standard therapies, ultimately attributed to transient hyperinsulinism.
Case Presentation: This case was managed and documented at Valiasr Hospital, Tehran University of Medical Sciences, in April 2023. A late preterm female infant born at 36+2 weeks via emergency cesarean section for intrauterine growth restriction and fetal distress presented with hypotonia and hypoglycemia (38 mg/dL) at 15 hours of life. Despite intravenous dextrose infusion up to 13 mg/kg/min, recurrent hypoglycemia persisted. Concurrently, severe thrombocytopenia (26,000/µL) was noted, unresponsive to platelet transfusion and intravenous immunoglobulin. Maternal platelet count was normal, excluding autoimmune etiologies. On day six, a glucagon stimulation test demonstrated a rise in glucose from 44 to 78 mg/dL, confirming hyperinsulinemic hypoglycemia. Laboratory evaluation revealed elevated insulin levels with absent ketones. Glucagon infusion was initiated, followed by diazoxide therapy (15 mg/kg/day) beginning on day ten. After two doses, glucose levels stabilized above 50 mg/dL, allowing gradual reduction of intravenous fluids. Remarkably, platelet counts normalized within five days of diazoxide initiation. Diazoxide was tapered and discontinued by day 27, and the infant was discharged on day 31 with stable glucose levels and normal platelet counts.
Conclusion: This case highlights the coexistence of transient hyperinsulinemic hypoglycemia and thrombocytopenia in a neonate, both of which responded to diazoxide therapy. The temporal relationship suggests a potential modulatory effect of insulin or diazoxide on platelet dynamics. Further clinical and mechanistic studies are needed to clarify this association.
Case Presentation: This case was managed and documented at Valiasr Hospital, Tehran University of Medical Sciences, in April 2023. A late preterm female infant born at 36+2 weeks via emergency cesarean section for intrauterine growth restriction and fetal distress presented with hypotonia and hypoglycemia (38 mg/dL) at 15 hours of life. Despite intravenous dextrose infusion up to 13 mg/kg/min, recurrent hypoglycemia persisted. Concurrently, severe thrombocytopenia (26,000/µL) was noted, unresponsive to platelet transfusion and intravenous immunoglobulin. Maternal platelet count was normal, excluding autoimmune etiologies. On day six, a glucagon stimulation test demonstrated a rise in glucose from 44 to 78 mg/dL, confirming hyperinsulinemic hypoglycemia. Laboratory evaluation revealed elevated insulin levels with absent ketones. Glucagon infusion was initiated, followed by diazoxide therapy (15 mg/kg/day) beginning on day ten. After two doses, glucose levels stabilized above 50 mg/dL, allowing gradual reduction of intravenous fluids. Remarkably, platelet counts normalized within five days of diazoxide initiation. Diazoxide was tapered and discontinued by day 27, and the infant was discharged on day 31 with stable glucose levels and normal platelet counts.
Conclusion: This case highlights the coexistence of transient hyperinsulinemic hypoglycemia and thrombocytopenia in a neonate, both of which responded to diazoxide therapy. The temporal relationship suggests a potential modulatory effect of insulin or diazoxide on platelet dynamics. Further clinical and mechanistic studies are needed to clarify this association.
Mohammad Hossein Shakeri Goki , Reza Payami , Farzaneh Jadidi, Fateme Javaheri, Mobin Ghanipour, Melika Omidvar ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Related Websites
Site Keywords
Cardiology, Anatomy, Biology, Epidemiology, Immunology, Neuroscience, Physical therapy, Physiology, Dermatology, Endocrinology and metabolicSite Statistics
- Registered users: 8217 users
- Online users: 0 users
- Guest users: 730 users
- All visits: 37866597 visits
- Visits in 24 Hours: 37360 visits
- Total articles: 12033 articles
- Published articles: 5086 articles
© 2026 , Tehran University of Medical Sciences, CC BY-NC 4.0
Designed & Developed by : Yektaweb