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Effect of cardiac rehabilitation on endothelial function in smoker patients with ischemic heart disease
Ahmad Reza Assareh , Marzieh Jafarpor, Mohammad Hossein Haghighzadeh, Nehzat Akiash,
Volume 80, Issue 6 (September 2022)
Abstract
Background: smoking enhances the risk of cardiac events in patients with coronary artery disease. So, it is necessary to evaluate the effects of exercise-based cardiac rehabilitation on endothelial function and functional capacity among smoker patients.
Methods: This randomized clinical trial study was conducted on 56 non-diabetic smokers with a history of percutaneous coronary intervention or coronary artery bypass graft surgery in Imam Khomeini Hospital from May to August 2015. Based on cardiac rehabilitation, patients were divided into intervention and control groups. Before rehabilitation, fasting blood sugar (FBS), lipid profile (LDL, HDL, triglyceride, and total cholesterol), and Ankle-Brachial Index (ABI) were measured for endothelial function. Besides, METs were measured based on the Duke activity status index. After 24 rehabilitation sessions (3 sessions of 1 hour each week for 2 months), all values were checked again and compared with the initial values.
Results: The mean age of the subjects in the cardiac rehabilitation and control groups were 61.18 and 52.32, respectively. Before the intervention, there were no significant differences between the two groups in terms of the ABI variables, BMI, systolic and diastolic blood pressure, LDL, triglyceride, total cholesterol and FBS; only HDL and  METs showed significant differences. After exercise-based cardiac rehabilitation, the mean rate of ABI changes was +0.078 on the right side of the body and +0.084 on the left side of the body. In the control group, these values were 0.002 and 0.003, respectively (P=0.001). The amount of changes in increasing METs as well as decreasing body mass index (BMI), and systolic and diastolic blood pressure in the rehabilitation group were statistically significant compared to the control group. In addition, there were no significant differences in terms of FBS and lipid profiles either (P>0.05).
Conclusion: Two months of cardiac rehabilitation with regular exercise was associated with improved ABI as an indicator of endothelial function and prognosis of cardiovascular disease, as well as improved cardiac functional capacity among smoker patients.

Frequency of cardiopulmonary resuscitation levels in the neonates delivered in Moheb Yas hospital of Tehran
Mahbod Kaveh, Mohammad Kaji-Yazdi , Mohsen Jafari, Armen Malekiantaghi, Seyed Yousef Mojtehedi , Kambiz Eftekhari,
Volume 80, Issue 7 (October 2022)
Abstract
Background: The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.
Methods: This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.
Results: There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery.
Conclusion: If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Frequency and risk factors for GI bleeding in children admitted to the PICU of bahrami children's hospital
Kambiz Eftekhari, Armen Malekiantaghi, Neda Habibi ,
Volume 80, Issue 9 (December 2022)
Abstract
Background: Gastrointestinal bleeding (GIB) associated with stress is an important complication in critically ill children admitted to the Intensive care unit (ICU), which can lead to serious complications and in some cases death. Only a limited number of studies have been conducted on the risk factors of gastrointestinal bleeding in Pediatric Intensive care unit (PICU), most studies have been conducted in the adults and neonates, therefore, the aim of this study was to evaluate the frequency of risk factors related to gastrointestinal bleeding in children admitted to the PICU.
Methods: This was a cross-sectional study. In this study, in a period of three years from (March 2016 to March 2019), all patients admitted to the PICU of Tehran Bahrami Children's Hospital were examined. The sample size was calculated 380. Demographic information, diagnosis during hospitalization, underlying disease, and initial tests during the first 24 hours of hospitalization were recorded in the checklist. To evaluate the demographic findings between patients with and without UGIB, chi-square and Fisher tests were used. A p-value of less than 0.05 was considered significant.
Results: 462 patients were studied, of which about (58%) were male. The mean age of the samples was 48 months and the average length of hospital stay in PICU was ten days. In general, (21.21%) of patients had gastrointestinal bleeding on the first day and (12.12%) on the second day of hospitalization. Gastrointestinal bleeding occurred in 50 patients (10.82%). Use of ventilator, pulmonary diseases, coagulation and blood diseases were significantly more common in patients with gastrointestinal bleeding than in children without gastrointestinal bleeding. Cardiac, neurological, hepatic, and renal disease were not significantly different in patients with gastrointestinal bleeding compared to children without gastrointestinal bleeding.
Conclusion: The occurrence of gastrointestinal bleeding in critically ill patients admitted to the PICU is a serious risk. The most important risk factor for upper gastrointestinal bleeding is mechanical ventilation. Other risk factors of gastrointestinal bleeding are lung disease, coagulation diseases, hematologic and oncologic disease.

Microbiota and probiotics, a new approach in the prevention and treatment of breast cancer: a review article
Saeedeh Keyvani-Ghamsari , Kiana Nouri, Ali Khaleseh Nejad , Shokoufeh Hassani,
Volume 81, Issue 11 (February 2024)
Abstract
Today, despite vast advances in cancer diagnosis and treatment, breast cancer is still the leading cause of cancer-related deaths in women. Various factors such as race, age, family history, mutation in the BRCA1/2 gene, diet, inactivity, alcohol consumption, and estrogen levels have been identified as risk factors for breast cancer. In recent years, microbiota has also been recognized as a new risk factor in breast cancer. In fact, the change in the microbial balance that occurs due to many environmental and internal factors of the body can be effective in the spread of cancer by affecting the intracellular pathways and signals. Studies have shown that intestinal dysbiosis affects the spread of breast cancer by affecting the metabolism and production of estrogen, or mechanisms unrelated to estrogen, such as the production of microbial metabolites that affect the immune system and lead to chronic inflammation. In addition, it has been proven that the breast tissue also has its microbiota, the types of which are different in healthy people, patients, even in different stages of breast cancer, and its subgroups. In such a way that a large amount of Proteobacteria, Firmicutes, Lactobacillus, and Actinobacteria are observed in healthy breasts, while their ratio changes in cancerous tissues. Considering the relationship between microbiota and breast cancer, maintaining a healthy microbiota is a new and significant approach to reducing the risk of developing, spreading, and managing this cancer. In this regard, compounds such as probiotics that can affect the balance of intestinal microbiota are considered as an effective approach to prevent and treat breast cancer. Probiotics can stimulate the growth of beneficial bacteria and inhibit the growth of harmful bacteria by causing physicochemical changes and affecting the metabolism of the intestinal microbiota. Furthermore, the consumption of probiotics can prevent the proliferation of cancer cells and reduce the tumor size by balancing the immune system, reducing inflammation, and inducing apoptosis in the cancer cells. This study describes the importance of microbiota in breast cancer, the difference between microbiota in a healthy person and a sick person, and the role of probiotics in the treatment of breast cancer.

Comparison of fibrosis-4 index and severity of hepatic fibrosis by fibroscan in rheumatoid arthritis patients under treatment with methotrexate
Majid Salmanian Mashhadi , Anoushe Haghighi, Nahid Kianmehr, Marjan Mokhtare, Sara Zarasvandnia, Parna Hosseini Meigoni , Seyede Maryam Mirghorbani ,
Volume 82, Issue 4 (July 2024)
Abstract
Background: Liver fibrosis is a major concern associated with long-term side effects among patients with rheumatoid arthritis (RA) treated with methotrexate. The aim of the present study was to compare the fibrosis-4 (FIB-4) index and the results of liver fibrosis severity derived from FibroScan device in rheumatoid arthritis patients who were treated with methotrexate.
Methods: The present cross-sectional study was conducted in 70 RA patients referred to rheumatology clinic of Hazrat Rasool Akram Hospital, Tehran, from July 2022 to July 2023. First, FIB-4 was calculated and the data from transient elastography, which was performed using a FibroScan device to diagnose liver fibrosis for each patient, will be compared with the results of the FIB-4 of each patient. Furthermore, the correlation between FIB-4 index and FibroScan grade with demographic characteristic, methotrexate dose and disease duration was also evaluated.
Results: The average age of patients was 59.59±11.75 and most of them (74.3%) were women. Most patients (75.71%) with a normal to mild FIB-4 index stage had a normal to mild elastography stage. of patients had normal to mild liver fibrosis. FibroScan grade were not related to the age, gender, body mass index, methotrexate dose and duration of the disease (P>0.05). The average FIB-4 was 1.25±0.6, which was not significantly related to gender, body mass index, disease duration and methotrexate dose but directly related to the age of patients (P<0.001, (CL95%, 0.51-0.53)).The correlation between FIB-4 and FibroScan grade of the patients showed a positive association, which was not statistically significant (P=0.594, r=0.06, CL95%, -0.24-0.4). The FIB-4 in normal to mild grade was 85% rejecting the moderate to severe grade in FibroScan but none of them were statistically significant (P=0.146).
Conclusion: Overall, the FIB-4 was incapable of predicting the FibroScan result. On the contrary, this case was also inconclusive and the results of FibroScan did not justify FIB-4 results of the patients. The FIB-4 cannot replace in RA patients. It is recommended to conduct future studies with a larger sample size in RA patients.

Relation between Helicobacter pylori Infection and gastrointestinal cancer by IL-21, and IL-23: a review article
Fatemeh Kiaee, Kiyana Bahani, Heshmat Shahi,
Volume 82, Issue 11 (February 2025)
Abstract
Background: Helicobacter pylori (H. pylori) infection is the most common infection worldwide and results in chronic gastritis, and rarely gastric carcinoma. Chronic inflammation, which is a major engine of disease development. Is dominantly controlled by adaptive and humoral immunity. This study reveals the intricate IL-21 and IL-23 relationship in H.pylori associated diseases as well as inflammatory GI disorders, as the crtically govern the differentiation and activity of T helper 17 (TH17) cells in the gastric mucosa. Understanding these cytokines pathways is essential for comprehending the immune pathogenesis of H. pylori infection and its outcome.
Methods: A literature search was conducted in the PubMed database using the MESH keywords "Helicobacter pylori" "Interleukin 21," "Interleukin 23," and "gastric cancer" to identify relevant English-language studies. Articles that were reviews, case reports, or letters to the editor were excluded.
Results: IL-23 significantly exacerbates both intestinal and gastric inflammatory responses by stimulating T cells particularly Th17 cell subsets, through the mediation of STAT3 signaling pathways and reducing IL-10 production, while T cells lacking the IL-23 receptor promote Treg expansion and intestinal homeostasis. IL-21 is implicated in chronic inflammation of the gastric and intestinal mucosa, with elevated levels observed in ulcerative colitis patients, contributing to the recruitment of inflammatory cells, increased inflammation, and angiogenesis. This particular cytokine plays an essential role in the recruitment of inflammatory cells, the increase of tissue inflammation, and the promotion of pathological angiogenesis. Moreover, IL-21 exerts influence over B cell differentiation and the production of antibodies, establishing a connection to humoral immune responses within chronic inflammations.
Conclusion: CD4+ T helper 17 (Th17) cells exhibit both antimicrobial and pathogenic immune functions in the gastrointestinal environment. These processes are interconnected, as cytokines such as IL-21 and IL-23 are essential for Th17 cell maintenance and support humoral immune responses. A comprehensive understanding of the dynamic immunological interactions in H. pylori-related and inflammatory gastrointestinal diseases may facilitate the development of novel immunology-based therapeutic interventions.
 
Association of bisphenol a with outcomes of assisted reproductive technologies: a systematic review
Fatemeh Habibollahi, Ghazaleh Eslamian, Kiana Hasibi , Sepehr Khoshbaf Khiabanian , Bentolhosna Dehghan Nayeri , Aref Adeli Mosabbeb ,
Volume 82, Issue 12 (March 2025)
Abstract
Background: Infertility is defined as the failure to achieve pregnancy after one year or more of regular unprotected sexual intercourse. Assisted reproductive technologies (ART) represent a key therapeutic approach for infertile couples. Bisphenol-A (BPA), a compound found in plastic polymer products, has been associated with increased infertility risk. This systematic review addresses whether BPA affects ART outcomes.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.

Investigating the effect of dexmedetomidine and ketamine as adjuvants in supraclavicular block in orthopedic surgeries of the forearm in reducing postoperative pain
Artadokht Khoshooei, Seyedeh Fatemeh Hosseini Nejad , Armin Kia , Nadia Zergani ,
Volume 83, Issue 4 (July 2025)
Abstract
Background: Nowadays, there is an increased emphasis on using safer and more modern anesthetic drugs. The addition of adjuvants not only enhances the anesthetic effect of the medication but also reduces the required dosage, thereby improving the safety margin. Effective postoperative pain control is a critical component in enhancing recovery and improving outcomes for orthopedic patients. Proper pain management not only facilitates early mobilization but also reduces complications and increases patient satisfaction. This study aimed to evaluate the impact of dexmedetomidine and ketamine as adjuvant drugs in supraclavicular nerve block for reducing postoperative pain following forearm orthopedic surgery.
Methods: This randomized, triple-blind clinical trial was meticulously conducted between April 2024 and March 2025 at Razi Hospital, a major teaching facility affiliated with Jundishapur University of Medical Sciences in Ahvaz, Iran. A total of 102 eligible patients were carefully enrolled and randomly assigned to three distinct groups: dexmedetomidine, ketamine, and control. Each patient received a standardized supraclavicular block using 2% lidocaine combined with the designated adjuvant drug to enhance analgesic efficacy. Vital signs, including heart rate, oxygen saturation, and Mean arterial pressure (MAP), were closely monitored every 15 minutes during surgery. Postoperative pain intensity was assessed using the Visual analog scale (VAS) at 1, 2, 6, 12, and 24 hours after surgery.
Results: Patients in the dexmedetomidine group showed significantly lower heart rate, MAP, and pain intensity compared to both ketamine and control groups at all measured time points (P<0.001). Ketamine also demonstrated better pain control and hemodynamic stability than the control group, although it was less effective than dexmedetomidine. Most differences in mean values between groups were statistically significant, confirming the superior performance of dexmedetomidine.
Conclusion: Dexmedetomidine, when used as an adjuvant in supraclavicular block for forearm orthopedic surgery, resulted in superior pain relief and greater hemodynamic stability compared to ketamine and standard care. These findings support its clinical use as an effective adjunct in regional anesthesia protocols.
 
Effects of using autologous fibrin sealant in functional endoscopic sinus surgery: a randomized controlled clinical trialbackground
Ehsan Nasirai, Mehdi Bakhshaee, Bashir Rasoulian, Daryoush Hamidi Alamdari, Kiana Ketabi, Imaneh Roshanzamir,
Volume 83, Issue 5 (August 2025)
Abstract
Background: To improve hemostasis and optimize the healing process, autologous fibrin sealant (FS) has been introduced in selected cases. However, the clinical benefits of FS in sinonasal surgery remain controversial and require further evaluation. This study aimed to investigate the effects of autologous FS on hemostasis, mucosal healing, postoperative clinical outcomes, and recurrence in patients undergoing bilateral FESS, compared with normal saline as the control.
Methods: This randomized clinical trial included 32 patients who underwent bilateral FESS at Ghaem and Imam Reza University Hospitals in Mashhad, Iran, between 2019 and 2021. For each patient, autologous FS was applied to one nasal cavity, while the contralateral cavity received normal saline. Postoperative outcomes including bleeding, crusting, adhesion formation, and infection were assessed at 1 week, 1 month, and 3 months after surgery. In addition, sinonasal symptom burden and endoscopic findings were evaluated using the Sinonasal Outcome Test (SNOT-22) and the Lund-Kennedy endoscopic score, respectively, both recorded preoperatively and three months postoperatively.
Results: Application of autologous FS significantly reduced immediate postoperative bleeding, and no further bleeding events were noted during follow-up. Pain severity was comparable between the two sides. No statistically significant differences were observed in crust formation, adhesion, infection, recurrence, or changes in Lund-Kennedy scores between the FS and control sides (p=0.08, p=0.8, p=0.17, and p=0.14, respectively).
Conclusion: Autologous fibrin sealant reduced early postoperative bleeding without adversely affecting pain control, mucosal healing, or recurrence after FESS. Larger randomized trials with extended follow-up are recommended to determine its definitive clinical value and potential for routine use in surgical practice.

The complicated relation of iron homeostasis and helicobacter pylori infection in the pediatric population: a review article
Heshmat Shahi , Fatemeh Kiaee ,
Volume 83, Issue 6 (September 2025)
Abstract
Helicobacter pylori is one of the most common chronic bacterial infections worldwide, with acquisition often occurring in childhood. While its role in the pathology of gastroduodenal diseases in adults is well-established, its impact on the pediatric population presents a unique set of clinical and pathophysiological challenges. This comprehensive review examines the complex and bidirectional relationship between Helicobacter pylori infection and host iron metabolism in pediatric and infant populations. For this review, the PubMed database was utilized for studies published from April 1979 through December 2024. Studies based on English language were included using the MESH terms "Helicobacter pylori," "iron," and "ferritin." According to the inclusion criteria, studies related to H. pylori infection and iron condition in patients under 18 years old were selected. Articles such as review articles, case reports, letters to the editor, and animal or in vitro studies were excluded. The main aim of this study was to illuminate the critical role of iron as an essential micronutrient and factor for both the host and the pathogen, examining the multifaceted mechanisms involved in H. pylori-induced iron homeostasis disruption in children.
The findings indicate a multifaceted relationship: virulent Helicobacter pylori strains are significantly and inversely associated with true body iron stores, leading to Iron deficiency anemia (IDA). However, chronic inflammatory states can paradoxically elevate ferritin levels, masking underlying iron deficiency. Complex interaction between bacterial infection, host inflammatory responses, and iron deficiency is an important factor influencing both the severity of the damage caused by this bacterial infection and its chronicity in the pediatric population. Identification and comprehensive understanding of these complex mechanisms is of great importance for the effective management of iron deficiency anemia in children with H. pylori infection. Considering, increase in the incidence of H. pylori infection in childhood, it is essential that H. pylori infection be evaluation in children with unknown reasons IDA. Finally, screening methods for H. pylori infection in children is recommended, as this could improve long-term health outcomes.

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