Showing 663 results for MM
Mohammad Masud Khubiari , Simin Najafgholian, Bahareh Abbasi, Ramin Parvizrad, Reza Aghbozorgi,
Volume 82, Issue 5 (August 2024)
Abstract
Background: Emergency Departments (EDs) visits reflect medical needs and demands or the only care available to patients. Many ED visits are potentially preventable with access to high-quality, community-based health care. Given the higher incidence of emergency conditions in patients with cancer the global increase in cancer will pose a challenge for emergency services. Therefore, this study was conducted with the aim of epidemiological investigation of emergency department visits by cancer patients in several centers.
Methods: In this cross-sectional study, the triage form and hospital file of known patients with various cancers, who visited in Eds of valiasr and Amir al Momenin hospitals in Arak, Hazrat Rasool Akram and Lolagar hospitals in Tehran, and Shahid Sadouqi and Shah vali hospitals in Yazd, From April to September 2017. To measure the urgency of ED visits, the emergency severity index and triage form were used, and the outcome of the emergency visit was extracted from the patient's file and recorded in the data collection checklist. Multivariate logistic regression analysis was used to examine the association of patient, hospital and potentially preventable factors.
Results: In this study, 1107 patients, 550 men (%49.7) and 577 women (%50.3) with cancer were were studied. Age 65 and older had the most emergency visits. The most common reason for patients to visit was: pain in different organs (18.2%), fever (8.7%), weakness and malaise (7.5%). A total of 617 (55.7%) visits were potentially preventable. Age 17 years and younger (OR, 3.172; 95% (CI), 2.409-4.021) and presence of more than 1 comorbidity (OR, 3.610; 95% (CI), 3.611-4.521) were positively associated with potentially preventable visits.
Conclusion: In this study, 50.7% of ED visits among patients with cancer were identified as potentially preventable, and the most common reason for patient visits was general and non-specific symptoms such as pain, weakness, and malaise. These findings highlight the need for palliative care and evidence-based interventions in outpatient settings.
Mohammad Hossein Rabbani , Parvin Farzanegi, Mohammad Ali Azarbayjani ,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Aerobic exercise and the consumption of certain supplements, such as ursolic acid, may reduce sarcopenia and osteoporosis by activating or inhibiting specific genes and signaling pathways. This study aimed to investigate the effects of aerobic exercise and ursolic acid supplementation on the expression of genes related to inflammatory and autophagy pathways in type 2 diabetes.
Methods: This experimental study was conducted from May 2023 to October 2023 at Islamic Azad University, Sari Branch. A total of 30 male Wistar rats (12 months old, mean weight 390 g) were randomly assigned to five groups: 1) healthy (normal), 2) diabetic, 3) diabetic+exercise, 4) diabetic+supplement, 5) diabetic+exercise+ supplement. Diabetes was induced via intraperitoneal injection of streptozotocin (50 mg/kg body weight). The aerobic exercise protocol was performed five days a week for eight weeks. The supplement groups received a daily intraperitoneal injection of ursolic acid (250 mg/kg body weight).
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Results: Data analysis showed that there was a statistically significant difference between the groups in the expression levels of LC3, Becline-1, TNFα, IL-1β Akt, and FOXO3 genes (P=0.000). The results of the post hoc test also showed that the expression level of LC3, Becline-1, TNFα, IL-1β genes in the model group increased significantly compared to the normal group (P=0.000). A significant difference was observed between intervention groups (P<0.05). The results of the follow-up test also showed that the level of expression of Akt genes in the model group was significantly decreased compared to the normal group (P=0.000). No significant difference was observed between intervention groups (P<0.05).
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Conclusion: The results of the study showed that regular aerobic training and Ursolic acid consumption can affect inflammatory and autophagy pathways. These effects reduce cell atrophy through changes in some biological signals and help improve muscle function in type 2 diabetes. Therefore, aerobic training and Ursolic acid consumption can serve as an effective strategy for improving metabolic status and preventing cellular damage in this patient population.
Ehsan Roshan Nasab , Farzaneh Hematian, Ahmad Shamsizadeh Hayatdavodi, Mohammadreza Mirkarimi , Mohsen Ali Samir , Mandana Izadpanah,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Vancomycin resistance in intensive care units has significant complications and additional costs. Given the need for rational use of this antibiotic to prevent the occurrence of antibiotic resistance, the present study was designed to evaluate how to prescribe the antibiotic vancomycin consumption pattern in a pediatric subspecialty hospital.
Methods: This cross-sectional descriptive-analytical study was conducted over a 3-month period (February, May, and June) in 2021 at the Pediatric Hospital of Jundishapur University of Medical Sciences, Ahvaz. All patients hospitalized in the intensive care unit and infectious disease ward with vancomycin prescription were included in the study. Patients who were hospitalized for less than three days or had no desire to enter the study were excluded from the study. Vancomycin prescription by clinical pharmacist was reviewed based on the latest version of Lexicomp from Wolters Kluwer and the National Health Service (NHS) guidelines.
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Results: Of the 91 hospitalized patients, 70.3% (64 cases) were prescribed vancomycin without performing an antibiogram culture based on experience and 29.7% (27 cases) were based on an antibiogram culture. In 96.7% (88 cases) , the duration of intravenous vancomycin infusion did not comply with the protocol. Red Man Syndrome was observed in 8.8% (8 cases). In 91.2 % (83 cases), no adverse effects were reported. In 65.9% (60 cases), the drug dose was determined based on the correct renal function Glomerular filtration rate (GFR) and in 34.1%, the drug dose was determined regardless of the renal function of the patients. Vancomycin doses were lower and higher than the guidelines in 6 and 25 patients, respectively. Out of all patients, eighty four cases recovered and seven cases died.
Conclusion: In almost half of the patients, Vancomycin were prescribed based on experience and without performing an antibiogram test. Use of guidelines, Serum level monitoring programs and continuous medical education for doctors can be effective in rational use of antibiotics.
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Pourya Mashategan, Mohammad Reza Ghane , Ali Bahramifar, Mahdi Raei ,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Intubation is normally conducted in an emergency or prior to surgery. A cuffed tracheal tube is fitted, whose inflated cuff exerts pressure on the tracheal wall. Such pressure should, therefore, be monitored every day by use of pressure gauge devices. The general guideline in this regard is that the pressure of the cuff must lie between 20 and 30 cm of water. The exaggerated pressure may cause tissue ischemia, wound, and necrosis of the tracheal wall; if it is too low, this could result in air leakage and oropharyngeal secretions, increasing the risk of insufficient ventilation and aspiration pneumonia. This study aimed at comparing the cuff pressure of an endotracheal tube inflated with alkaline lidocaine versus air for any post-extubation complications and cuff pressure changes.
Methods: This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.
Results: The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.
Conclusion: Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.
Fateme Sadat Zendehdel, Seyyed Abdolhamid Angaji , Behnaz Beikzadeh, Behzad Narouie , Mahdi Mohammadi,
Volume 82, Issue 6 (September 2024)
Abstract
Background: Clear renal cell carcinoma (ccRCC) is the most common malignant kidney tumor and has a high mortality rate. The pathogenesis of this cancer is complex and efficient biomarkers for its diagnosis and prediction are limited. This study aimed to identify predictive genes in ccRCC through analysis and laboratory validation ccRCC is the most common malignant kidney tumor and has a high mortality rate.
Methods: The present study was a case-control study in which samples were taken from patients and healthy individuals from Labafi Nejad Hospital in Tehran between October 2012 and April 2014, and laboratory tests were performed on the samples.
First, genes with differential expression in ccRCC patients were identified by bioinformatics using gene expression profile data from the Gene Expression Omnibus (GEO) database with accession number GSE213324. Data analysis was performed using Galaxy web server, protein-protein interactions were checked using Cytoscape and STRING app software, and finally two genes were selected for real-time PCR testing.
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Results: Analysis identified 4,065 genes with differential expression in RCC tissues compared to healthy tissues. These genes are involved in immune responses and renal disease pathways, suggesting their potential role in disease development. After constructing the protein-protein interaction network and identifying differentially expressed genes in kidney tissue and blood, two genes, MTTP and CALCA, were selected for further investigation. In the Mann-Whitney U test, the expression of the CALCA gene decreased significantly in the patient group (P<0.05). On the other hand, the MTTP gene showed a decrease in expression, but not significantly. The AUC calculated to evaluate the diagnostic accuracy for the CALCA gene was 0.64 and significant (P<0.05), demonstrating its potential as a useful biomarker for ccRCC diagnosis. However, the AUC for the MTTP gene was not significant.
Conclusion: The reduction in CALCA expression could serve as a useful biomarker for diagnosing ccRCC.
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Mohammad Golparvar, Fatemeh Moghadassi ,
Volume 82, Issue 7 (October 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.
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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.
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Mohammad Parsa Mahjoub , Naser Kechuian, Mohammad Haji Aghajani , Hossein Aghamiri , Ainaz Samadi, Fateme Omidi ,
Volume 82, Issue 7 (October 2024)
Abstract
Background: Cardiovascular surgery is sometimes associated with brain consequences such as cognitive disorders. Diagnosis of cognitive disorders risk factors in cardiovascular patients is important for increasing patient satisfaction and success after (CABG). In the present study, the frequency of cognitive disorders in cardiovascular patients and its effective factors were investigated.
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Methods: In the current cross-sectional study that was conducted from September 2019 to the February 2022, 60 cardiovascular patients undergoing CABG surgery were selected by convenience sampling method. Demographic, clinical, and intraoperative information was recorded for participants in the data collection form. Mini–Mental State Examination quesionary.
Results: The results showed that 15% of participants had cognitive impairment. Gender and age were the actual variables on the incidence of cognitive disorders after CABG surgery. The frequency of cognitive disorders in women was 14 times higher than men and 6.5 times higher in the elderly. Elderely population was considered as 65 years old or above. The clinical variables such as blood transfusion under surgery and ejection fraction<40% were effective factor for incidence of cognitive disorders in cardiovascular patients.
Conclusion: The CABG surgery may be associated with cognitive disorders in cardiovascular patients, which is more common in women and the elderly. Further studies are recommended to confirm the results of the present study and identify the related risk factors.
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Mohammad Gholami , Alireza Mahmoudabadi, Maryam Moradi , Hossein Nezami, Hamideh Mohammadzadeh ,
Volume 82, Issue 7 (October 2024)
Abstract
Background: Androgenetic alopecia is the most common cause of hair loss, and its prevalence increases with age. Different studies have reported different results regarding the association of cardiovascular diseases with androgenetic alopecia. The present study aimed to The present study aimed to Investigating the relationship between androgenetic alopecia and the thickness of the intima media of the carotid artery in the referrals to the specialized skin and hair clinic of Allameh Bohlool Gonabadi Hospital.
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Methods: This case-control study was conducted from October 2021 to June 2022 on 100 patients referred to the Skin and Hair Clinic of Allameh Bahloul Hospital in two groups of 50 cases and controls, aged less than 40 years. The subjects were matched in terms of age and gender. Patients with alopecia were classified into three categories: mild, moderate, and severe based on the diagnosis of the treating physician. The thickness of the intima-media layer of the carotid artery was measured using ultrasound.
Results: There were 37 males and 13 females in both the case and control groups. The mean age in the case group was 29.50 and 30.28 years, respectively. In addition, the duration of alopecia in the case group was 6.9 years. Although the results indicated that the carotid artery intima-media thickness was higher in patients with androgenetic alopecia, no statistically significant relationship was found between androgenetic alopecia and carotid artery intima-media thickness (P=0.66). There was also a statistical relationship between the carotid artery intima-media thickness and the duration of alopecia (P=0.03).
Conclusion: Considering the relationship between the thickness of the intima media of the carotid artery and the duration of alopecia, it can be said that there is a possible relationship between alopecia and atherosclerosis, but to prove it, studies with a larger sample size are needed.
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Mozaffar Jan Faza, Mohammad Rahman Rahimi ,
Volume 82, Issue 7 (October 2024)
Abstract
Background: The aim of our study was to evaluate the effect of 8 weeks of aerobic exercise with vitamin D supplementation on indulin-1 and nitric oxide in patients with hypertension aged 30 to 50 years.
Methods: This study was conducted as a semi-experimental pre-test and post-test design, and was conducted from June 1401 at Seyyed Shohada Hospital in Urmia. 40 eligible men and women were randomly divided into four groups (supplement group, placebo + exercise group, a supplement + exercise group, and a control group). The training program of the experimental groups included eight weeks of aerobic exercise running on a treadmill (3 sessions/8 weeks). Blood sampling to evaluate biochemical variables was performed 48 hours before and after the intervention in a fasting state with a volume of 10 cc.
Results: The results of the study show that after 8 weeks of aerobic exercise, vitamin D, BMI, NO, ET-1 and weight were significantly affected (P < 0.05) and systolic blood pressure in the supplement, supplement + exercise and exercise + placebo groups changed compared to the control group(P < 0.05).
Conclusion: Based on the results of the present study, the results showed that taking eight weeks of vitamin D supplements along with aerobic activity reduced blood pressure indices in the subjects. Also, taking vitamin D supplements along with physical activity reduced BMI and increased NO, reduced ET-1 and body weight in the subjects in the study.
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Atoosa Gharib, Sahar Yazdanparast, Peyman Mohammadi Torbati ,
Volume 82, Issue 8 (November 2024)
Abstract
Background: It is necessary to determine the morphological type of invasive urothelial carcinoma and their invasive behavior to surrounding tissues. What we will discuss in the present study will be the examination of the types of urothelial carcinoma variants and its relationship with the invasion of the muscularis propria.
Methods: In this descriptive study, the study population included: all patients with ureteral carcinoma and other bladder malignancies with a history of hospitalization in Labafinezhad and Modares hospitals from April 2019 to March 2023. To collect data, after approval by the university ethics committee, files of patients with ureteral carcinoma and other bladder malignancies were extracted from the pathology department archives of Labafinezhad and Modares hospitals. Background information, clinical characteristics, laboratory and pathological data of the patients were collected and recorded by reviewing their archive files. Divergent differentiation and morphology of various variants of carcinomas included in the study were evaluated and the percentage of each was determined. Also, cases with muscularis propria invasion were identified and the frequencies of each type of invasion in different variants were determined.
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Results: A total of 1243 patients participated in this study. The mean and standard deviation of the age of the patients were 65.2 and 11.2 years, respectively. 152 people (12.3%) were women and 1091 people (87.7%) were men. Patients with PT1 stage constitute more than 50% of cases. PT4 stage patients account for only 2.7% of cases. The highest frequency is in low grade papillary urothelial carcinoma.
Conclusion: The present study showed that about 27% of patients had Muscularis Propria invasion. In the high grade invasive urothelial carcinoma variant compared to other variants, muscularis propria invasion has been observed in a higher proportion of patients, and in the low grade papillary urothelial carcinoma variant, the lowest proportion of muscularis propria invasion has been seen.
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Parvin Taghavinejad, Mohammad Ghasem Hanafi , Ahmad Fakhrizadeh ,
Volume 82, Issue 8 (November 2024)
Abstract
Background: This cross-sectional study aims to evaluate the association between patellofemoral joint alignment measurements and patellofemoral cartilage defects using MRI images.
Methods: A retrospective and cross-sectional study was conducted on 530 knee MRI images from Golestan and Imam Khomeini hospitals in Ahvaz, Khuzestan, Iran. The images were obtained from individuals experiencing non-traumatic knee pain and were selected based on their age, with subjects over 30 years of age being included in the study. This survey was conducted over the period from March 2023 to March 2024. The parameters of femoral groove angle (SA), femoral groove depth (SD), lateral patellofemoral angle (LPFA), tibial-trochlear tubercle groove distance (TT-TG), lateral patellar displacement (LPD), patellar inclination angle, and patellar height were evaluated. In addition, the Caton-Deschamps index and the degree of focal cartilage defect (from 0 to III) in the knee joint were evaluated.
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Results: Regarding body mass index, 15.7% of the patients studied were underweight, 42.3% were of normal weight, 31.1% were overweight, 10.4% were obese, and 0.6% were extremely obese. There was a significant relationship between body mass index and patellar-lateral articular cartilage defects in the lateral tibia and lateral femur. There was a significant relationship between age and patellar-lateral articular cartilage defects in the lateral femur. There was a significant relationship between lateral patellar articular cartilage defects and lateral patellar dislocation, lateral patellofemoral angle, tibial prominence-skeletal groove distance, and patellar inclination angle. In addition, there was a significant relationship between medial patellar articular cartilage defects and knee groove angle.
Conclusion: Patellofemoral misalignment is multivariately associated with knee articular cartilage defect. The results of this study will be of use to medical professionals, and the early diagnosis of knee osteoarthritis can prevent the development of the condition. It is recommended that similar studies and surveys be conducted in other provinces of Iran so that the statistical population is highly vulnerable.
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Dorna Yazdan Panah , Mohammad Arish ,
Volume 82, Issue 9 (December 2024)
Abstract
Background: The thickness of the lamina, especially the lamina cribrosa and prelamina, can be important indicators of optic nerve damage and the severity of glaucoma. Changes in the thickness of these tissues after treatment can indicate improvement or reduction in intraocular pressure (ICP) and nerve protection. ICP produces a different response in the treatment of patients with closed-angle glaucoma (CAG) and open-angle glaucoma (OAG). The aim of this study was to compare the thickness of prelamina and lamina cribrosa tissue before and after treatment in CAG and OAG patients.
Methods: The present study is a descriptive-analytical study conducted on 56 glaucoma patients referred to an Al Zahra Eye Hospital (Zahedan) who had undergone trabeculectomy or laser iridotomy treatment from April to March 2022. Patients were divided into two equal groups, including CAG patients (n=28) and OAG patients (n=28), and at the beginning of the study, in terms of demographic variables, visual acuity, ratio of cup diameter to disc size (C/D), anterior segment depth (ACD), central corneal thickness (CCT), intraocular pressure (IOP) and prelamina and lamina cribrosa tissue thickness were investigated. the thickness of the lamina cribrosa tissue was measured as the distance between the anterior and posterior borders of the highly reflective area in the EDI-OCT horizontal section at the optic nerve head. The measurement of the thickness of the lamina cribrosa tissue was also measured to the extent of safety in the center where there were less vessels. Then CAG patients underwent laser iridotomy and OAG patients underwent trabeculectomy surgery. Before the treatment and after 1 month, 3 months and 6 months after the treatment, the patients underwent FU with the help of ONH OCT and the thickness of the prelamina and lamina cribrosa tissue was checked.
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Results: After 6 months, the thickness of the lamina cribrosa in patients with CAG increased from 160.21 ± 30.21 µm to 201.73 ± 40.07 µm, and in the OAG group, it increased from 173.71 ± 39 µm to 182.86 ± 46.39 µm. The thickness of the prelamina tissue in patients with CAG increased from 155.46 ± 42.14 µm to 170.03 ± 35.31 µm, and in the OAG group, it increased from 172.57 ± 41.91 µm to 180.07 ± 32.06 µm (P<0.05 for all). Before treatment, the thickness of the prelamina tissue and the lamina cribrosa in patients with CAG was significantly less than in patients with OAG (P<0.05). After 6 months, the lamina cribrosa thickness in patients with CAG (201.73 ± 40.07 µm) was significantly greater than in patients with OAG (182.86 ± 46.39 µm) (P= 0.023).
Conclusion: The increase in the thickness of prelamina tissue and lamina cribrosa tissue after surgery in CAG and OAG patients using OCT imaging is different and the amount of increase in the thickness of lamina cribrosa tissue is more in CAG patients.
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Seyed Mohammad Reza Hadavi , Maryam Zahedi, Navid Kalani, Naeimeh Ossadat Asmarian , Reza Sahraei ,
Volume 82, Issue 9 (December 2024)
Abstract
Background: Shoulder labral repair surgery is associated with significant postoperative pain and restricted mobility. Inadequate pain management may lead to delayed rehabilitation, increased risk of chronic pain development, and higher opioid consumption. This study aimed to compare postoperative pain intensity during the first two weeks following shoulder labral repair between patients receiving interscalene block alone versus those receiving interscalene block combined with intravenous morphine.
Methods: In this randomized, double-blind, parallel-group clinical trial, 120 patients undergoing open rotator cuff repair at Chamran Hospital, Shiraz (June-December 2024) were allocated using balanced block randomization. Group 1 received preoperative interscalene block with 30 mL of 0.5% ropivacaine, while Group 2 received the same block plus intravenous morphine (1% mg/kg). Data analysis was performed using descriptive statistics such as mean and percentage and appropriate statistical tests such as Repeated measurement and Anova using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). The significance level was considered to be (P<0.05).
Results: Demographic characteristics (age, sex, weight, ASA class) showed no significant intergroup differences (p>0.05). Pain scores were significantly lower at all time points in the combination therapy group compared to the block-only group (p<0.05).
Conclusion: The results of the present study showed that the combination of interscalene block with morphine was significantly more effective in reducing pain after rotator cuff surgery than interscalene block alone. This finding suggests that the use of morphine as an additional analgesic can enhance the analgesic effects of interscalene block and provide better pain relief. The combination of these two methods may cause a positive interaction in pain relief and reduce the need for other medications, which consequently prevents the side effects caused by additional analgesic drugs, and patients who receive the combination of these two treatment methods experience greater comfort and better functional improvement. However, it is recommended that further studies focusing on the precise dosage and timing of drug combinations be conducted to obtain more precise results regarding the optimization of pain management after rotator cuff surgery. Also, examining the long-term effects of this treatment method could help to better understand its advantages and disadvantages.
Mohammad Haji Aghajani , Mohammad Parsa Mahjoob , Reza Miri , Roxana Sadeghi , Fatemeh Omidi , Maryam Roozitalab,
Volume 82, Issue 9 (December 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.
Mehrdad Malekshoar, Bibi Mona Razavi, Mehrdad Sayadinia, Saeed Kashani, Nadia Mohammadi, Majid Vatankhah,
Volume 82, Issue 10 (January 2025)
Abstract
Background: This study was designed to compare the effects of using a laryngeal mask airway (LMA) and endotracheal intubation on airway resistance and compliance in patients undergoing orthopedic surgery under general anesthesia. Evaluating these two methods is crucial for improving respiratory quality and reducing complications related to airway management in patients.
Methods: This analytical cross-sectional study was conducted on 50 patients undergoing orthopedic surgery under general anesthesia at Hospital in Bandar Abbas between May and September 2024. The patients were equally divided into two groups: the first group received a laryngeal mask airway (LMA), while the second group underwent endotracheal intubation under general anesthesia. The primary variables, including airway resistance and compliance, were measured at 0, 15, 30, and 60 minutes after anesthesia induction. Demographic characteristics such as age, gender, and ASA class were also recorded. Data analysis was performed using SPSS version 21, with descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistical tests (Mann-Whitney U test and Chi-square test), considering a significance level of P<0.05.
Results: The findings of the present study showed no statistically significant differences between the two groups regarding age distribution and ASA class. A comparison of airway resistance and compliance between genders revealed no significant differences at 0, 15, 30, and 60 minutes. There was no significant difference between the two anesthesia groups (laryngeal mask airway and endotracheal tube) in terms of age distribution. There was no statistically significant difference in ASA classification between the two anesthesia groups. At minute 0 of anesthesia, airway resistance was significantly higher in the endotracheal intubation group compared to the LMA group (P<0.001). At 30 and 60 minutes of anesthesia, airway resistance remained significantly higher in the endotracheal intubation group (P<0.001). Airway compliance was significantly higher in the LMA group at all measured time points (0, 15, 30, and 60 minutes) compared to the endotracheal intubation group (P<0.001).
Conclusion: The results of this study demonstrated that using a laryngeal mask airway (LMA) compared to endotracheal intubation leads to improved airway compliance and reduced airway resistance during anesthesia. These findings may influence the selection of anesthesia methods and enhance postoperative care quality.
Ali Mohammad Mosadeghrad,
Volume 82, Issue 10 (January 2025)
Abstract
Mojtaba Ghaedi, Mojtaba Sohrabpour , Gholamreza Motazedian, Navid Kalani , Reza Sahraei , Mohammad Sadegh Sanie Jahromi,
Volume 82, Issue 11 (February 2025)
Abstract
Background: Hemodynamic instability is a significant perioperative complication that can threaten surgical outcome through various mechanisms: exacerbating intraoperative bleeding, compromising visibility of the surgical field, and elevating immediate and delayed postoperative complication risks. In septorhinoplasty, a procedure with challenging hemodynamic control due to the nasal anatomy's complexity of vessels, these effects are particularly relevant. This study examines the modulation of important hemodynamic parameters (SBP, DBP, MAP, HR, and SpO₂) by intravenous dexmedetomidine while ensuring cardiovascular stability and dose-dependent effects and optimal timing of administration at different phases of surgery. The findings aim to offer evidence-based recommendations for hemodynamic control in rhinoplasty surgery, which can reduce rates of complications and improve recovery profiles.
Methods: A randomized, double-blind clinical trial was conducted involving 50 eligible patients (aged 18-45 years) scheduled for septorhinoplasty at Ostad Motahari Hospital, Jahrom, during May-September 2023. Participants were randomly allocated to either a dexmedetomidine or control group. Collected data encompassed demographic characteristics (age, gender, BMI=Body mass index) and hemodynamic parameters (systolic/diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation). The data were analyzed using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean, standard deviation, percentage, count, and frequency) and inferential statistical tests (Mann-Whitney U test and independent t-test) were applied. A significance level of P < 0.05 was considered for all statistical analyses.
Results: The dexmedetomidine group demonstrated statistically significant variations in hemodynamic parameters (SBP, DBP, MAP, HR) from pre-induction through post-recovery phases (p<0.001). Significant between-group differences in blood pressure metrics were observed at all measured intervals following induction (1, 5, 15, 30, 60 minutes) and during recovery periods (p<0.05), with the dexmedetomidine group consistently showing lower values. Comparison between the intervention and control groups revealed no statistically significant differences in heart rate and oxygen saturation (O₂ sat) levels (except during recovery time).
Conclusion: The results of this study indicate that dexmedetomidine administration had a significant effect on reducing systolic blood pressure, diastolic blood pressure, and MAP compared to the control group, with this reduction being evident at all measured time points from post-induction to post-recovery. These findings suggest that dexmedetomidine can be effectively used as a blood pressure-lowering agent during surgery without significantly affecting heart rate or the patient's blood oxygen levels.
Neda Faraji, Mahbobeh Alizadeh, Asghar Ghorbani, Hadiseh Hosami Roodsari , Samane Akbarpour , Mohammad Arefi,
Volume 82, Issue 11 (February 2025)
Abstract
Background: This study aimed to evaluate serum amylase levels in hospitalized COVID-19 patients and investigate its association with disease prognosis. Elevated serum amylase levels have been reported in some COVID-19 patients, particularly in severe cases. This increase may indicate pancreatic involvement (pancreatitis) due to viral infection. This cross-sectional study aimed to evaluate the role of serum amylase levels as a prognostic marker in COVID-19 patients.
Methods: This descriptive cross-sectional study was conducted on 150 hospitalized patients with confirmed COVID-19 at Baharloo Hospital, Tehran, over a one-year period (July 2021–July 2022). The results showed that 20% of patients (30 out of 150) had elevated serum amylase levels. Patients with high amylase levels had significantly longer hospital stays (mean 14 days vs. 8 days) and higher mortality rates (15% vs. 5%). Additionally, these patients were more likely to require intensive care (25% vs. 10%). Statistical analysis revealed that elevated serum amylase levels were independently associated with poorer clinical outcomes.
Results: These results have important clinical implications for patient management. Routine measurement of serum amylase at admission could help identify high-risk patients who may benefit from closer monitoring and early intervention. Further research is needed to determine whether specific treatments for pancreatic involvement could improve outcomes in these patients.
Conclusion: These findings suggest that measuring serum amylase levels at admission can serve as a simple and accessible marker for identifying high-risk patients. Elevated amylase in COVID-19 patients is an important biological indicator of multi-organ involvement (pancreas and kidney) and severe inflammation, which is associated with worse prognosis and higher mortality. Monitoring this marker may aid clinical decision-making and improve patient outcomes
Mahmoud Khodabandeh, Mohammadreza Abdolsalehi , Mojtaba Gorji,
Volume 82, Issue 11 (February 2025)
Abstract
Background: Congenital tuberculosis is a rare but serious disease in neonates and infants that often presents with nonspecific respiratory symptoms. Pulmonary involvement in tuberculosis can have similar manifestations to bacterial pneumonia with common microorganisms. In case of failure to respond to treatment in pneumonia, tuberculosis infection should be considered. The aim of this study was to present a two-month-old infant suspected of bacterial pneumonia, who was ultimately diagnosed with tuberculosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress. Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.
Ali Mohammad Mosadeghrad, Parvaneh Isfahani,
Volume 82, Issue 11 (February 2025)
Abstract
