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Zakieh Vahedian Ardakani , Mehran Zarei-Ghanavati , Hamid Riazi-Esfahani , Seyed Mehdi Tabatabaei , Mohammad Reza Mehrabi Bahar, Sadegh Ghafarian, Ahmad Masoomi,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Artificial intelligence (AI) has emerged as a transformative force in modern medicine, with ophthalmology standing at the forefront of its clinical integration. Among ophthalmic disorders, glaucoma—a leading cause of irreversible blindness worldwide—presents unique opportunities and challenges for AI-based solutions due to its chronic, progressive nature and reliance on multimodal data, including structural and functional assessments. This review article offers a comprehensive synthesis of the current and emerging roles of AI in the detection, monitoring, and management of glaucoma. AI algorithms, particularly deep learning and machine learning models, have demonstrated exceptional capabilities in interpreting fundus photographs, optical coherence tomography (OCT) images, and visual field data to identify glaucomatous damage. These systems often approach or even exceed the diagnostic performance of human experts. Moreover, AI has shown significant promise in facilitating large-scale population-based screening, improving early detection rates, and addressing disparities in access to subspecialty care, particularly in low-resource and remote settings. In the monitoring of disease progression, AI tools are being developed to detect subtle structural or functional changes over time, predict future visual outcomes, and support more precise and individualized treatment decisions. Despite these advancements, the widespread clinical adoption of AI in glaucoma care faces several critical barriers. Key limitations include poor generalizability of models across diverse populations, imaging devices, and clinical settings; scarcity of well-annotated, high-quality, and demographically representative datasets; and a lack of transparency and interpretability in algorithmic decision-making—commonly referred to as the “black box” problem. Ethical concerns, regulatory uncertainty, integration challenges within existing healthcare infrastructures, and medico-legal accountability also require thoughtful resolution before AI can be reliably deployed in clinical practice. This review critically evaluates the strengths, limitations, and real-world potential of AI technologies in glaucoma. It provides clinicians, researchers, and healthcare policymakers with a balanced and up-to-date perspective, highlighting promising avenues for future research, including explainable AI, federated learning, multi-modal data integration, and longitudinal validation studies. By fostering a deeper understanding of both the opportunities and challenges associated with AI, this article aims to guide the responsible, equitable, and evidence-based integration of AI into comprehensive glaucoma care.
Tahereh Parsajam , Behnam Reza Makhsoosi, Ali Najafpour, Kimia Fathi,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Thyroid hormones play a key role in the development of various organs of the body. The breast and thyroid are hormone-responsive organs that are closely related to changes in endocrine activity and glandular diseases. Breast cancer is the most common cancer in women and the second leading cause of cancer-related death. Due to the inconsistencies in the relationship between breast cancer and thyroid diseases and the lack of regional data, the present study was designed and conducted with the aim of investigating the prevalence of various thyroid disorders in patients with breast cancer and its relationship with the type of breast cancer and age.
Methods: In this prospective study, we examined 50 women with breast cancer who had undergone surgery after surgery. The location of this study was Imam Reza Hospital in Kermanshah and the duration of this study was 12 months from the beginning of March 2023 to the end of March 2024. Patient information included: age, histopathological type of cancer, and thyroid test results including serum TSH, FT4, and ATPO levels, were recorded and reviewed.
Results: Based on the results obtained, it was shown that the average age of people with thyroid disorders in patients with breast cancer was 42.88 and the standard deviation was 11.313. Also, there was no significant difference between the age of people and thyroid disorders in patients with breast cancer (P-value < 0.89). In the study of thyroid disorders in patients with breast cancer, it was shown that there was a significant relationship between patients with breast cancer and the amount of TSH and the amount of FT4. This means that people with breast cancer had an increase in the amount of TSH and the amount of FT4. However, there was no significant relationship between patients with breast cancer and the amount of ATPO (P-value < 0.319).
Conclusion: Thyroid disorders are more prevalent in patients with breast cancer than in the normal population, and given the relationship between the types of thyroid disorders and the type of breast cancer histopathology, these results can be used and screening methods can be used more effectively in those who have risk factors for breast cancer for early diagnosis and treatment of the disease.
Methods: In this prospective study, we examined 50 women with breast cancer who had undergone surgery after surgery. The location of this study was Imam Reza Hospital in Kermanshah and the duration of this study was 12 months from the beginning of March 2023 to the end of March 2024. Patient information included: age, histopathological type of cancer, and thyroid test results including serum TSH, FT4, and ATPO levels, were recorded and reviewed.
Results: Based on the results obtained, it was shown that the average age of people with thyroid disorders in patients with breast cancer was 42.88 and the standard deviation was 11.313. Also, there was no significant difference between the age of people and thyroid disorders in patients with breast cancer (P-value < 0.89). In the study of thyroid disorders in patients with breast cancer, it was shown that there was a significant relationship between patients with breast cancer and the amount of TSH and the amount of FT4. This means that people with breast cancer had an increase in the amount of TSH and the amount of FT4. However, there was no significant relationship between patients with breast cancer and the amount of ATPO (P-value < 0.319).
Conclusion: Thyroid disorders are more prevalent in patients with breast cancer than in the normal population, and given the relationship between the types of thyroid disorders and the type of breast cancer histopathology, these results can be used and screening methods can be used more effectively in those who have risk factors for breast cancer for early diagnosis and treatment of the disease.
Ali Mohammad Mosadeghrad, Shabnam Afraz,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Shahram Shafa, Mehrdad Sayadinia, Bibi Mona Razavi, Tayyebeh Zarei , Maryam Ziyaei , Mansour Deylami,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Controlling patients' anxiety before surgery reduces the possibility of postoperative problems and increases the possibility of patient participation and cooperation in the postoperative care and treatment plan.
Methods: This study uses a review approach to investigate non-pharmacological methods of anxiety management in patients undergoing orthopedic surgery. The systematic search involves several key steps. Literature search: A thorough search was conducted in PubMed, Sciences Direct, Scopus, Magiran, Sid, and Google Scholar databases. The search was refined using keywords such as “aromatherapy,” “music therapy,” “massage,” “educational intervention,” “educational film,” and “sound of the Quran” and their English equivalents to identify relevant studies published in the past ten years. Inclusion criteria included studies on orthopedic surgery, Persian and English articles, and original articles. Exclusion criteria included studies outside the specified time frame or studies that deviated from the defined focus. In this review, we conclude by summarizing key aspects of the review process, emphasizing the rigorous approach applied in study selection, data extraction, and synthesis.
Results: The results of the present study showed that the non-pharmacological methods used to control or reduce anxiety in orthopedic surgery include methods; Music therapy, the sound of the Quran, relaxation techniques, back massage, educational intervention, educational video, awareness and training before surgery and aromatherapy (chamomile, lemon, rose, valerian, cardamom, cinnamon, calendula, lavender, lemon sour).
Conclusion: The results of numerous and reputable research findings clearly show that the use of non-pharmacological methods plays an effective role in reducing the level of anxiety of patients before, during and after orthopedic surgery. These methods, which are generally low-cost, low-complication, and applicable in various clinical settings, include techniques such as preoperative education, music therapy, breathing and relaxation techniques, mindfulness-based interventions, psychological support, and the creation of a calm and reassuring environment. Since anxiety is a known factor in weakening the immune system, increasing postoperative pain, prolonging the recovery period, and reducing overall patient satisfaction, its management is of great importance. Therefore, by integrating and utilizing such non-invasive methods into nursing care protocols and holistic patient care programs, the detrimental and undesirable effects of anxiety after orthopedic surgery can be significantly reduced and faster recovery, a better patient experience, and more favorable clinical outcomes can be achieved.
Mohsen Ghoryani, Mohsen Ahmadi, Mahdi Atabaki, Jalil Tavakkol-Afshari , Mojgan Mohammadi,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by persistent inflammation, progressive joint destruction, functional disability, and systemic complications. Key inflammatory mediators, such as tumor necrosis factor-alpha (TNF-α) and interleukin-17 (IL-17), play critical roles in disease progression and tissue damage. Mesenchymal stem cells (MSCs) have recently gained attention as a therapeutic approach for autoimmune diseases because of their abilities in self-renewal, immune modulation, and tissue repair. Considering the role of pro-inflammatory cytokines in the pathogenesis of RA, this study investigated the effect of autologous bone marrow-derived MSCs (ABMSCs) on the gene expression of TNF-α and IL-17A in patients with refractory RA.
Methods: The study utilized archived RNA from the research team's previous clinical trial. In this study, 13 patients with refractory RA who underwent MSC transplantation (MSCT) at an intravenous dose of 1×10⁶ ABMSCs per kilogram of body weight were evaluated at baseline and at 1, 6, and 12 months post-injection. Between November 2023 and March 2024, archived RNA samples were converted into cDNA at the Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Then, the expression levels of TNF and IL-17A were analyzed using SYBR Green-based real-time PCR.
Results: TNF-α gene expression declined significantly 1 month after MSCT (mean±SEM: 1.00±0.00 at baseline vs. 0.38±0.11 at 1 month, P=0.045). However, no significant differences were observed at 6 months (1.21±0.38) or 12 months (0.61±0.18) compared to baseline (P>0.05). IL-17A gene expression remained statistically unchanged across all time points (baseline: 1.00±0.00; 1 month: 0.87±0.31; 6 months: 1.19±0.42; 12 months: 1.79±0.92; P>0.05).
Conclusion: The results of this study suggest that ABMSCs may exert an anti-inflammatory effect by modulating TNF-α in patients with refractory RA. However, the findings related to IL-17A do not support the hypothesis that ABMSC injection exerts anti-inflammatory effects through modulation of IL-17A gene expression in these patients.
Methods: The study utilized archived RNA from the research team's previous clinical trial. In this study, 13 patients with refractory RA who underwent MSC transplantation (MSCT) at an intravenous dose of 1×10⁶ ABMSCs per kilogram of body weight were evaluated at baseline and at 1, 6, and 12 months post-injection. Between November 2023 and March 2024, archived RNA samples were converted into cDNA at the Department of Immunology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Then, the expression levels of TNF and IL-17A were analyzed using SYBR Green-based real-time PCR.
Results: TNF-α gene expression declined significantly 1 month after MSCT (mean±SEM: 1.00±0.00 at baseline vs. 0.38±0.11 at 1 month, P=0.045). However, no significant differences were observed at 6 months (1.21±0.38) or 12 months (0.61±0.18) compared to baseline (P>0.05). IL-17A gene expression remained statistically unchanged across all time points (baseline: 1.00±0.00; 1 month: 0.87±0.31; 6 months: 1.19±0.42; 12 months: 1.79±0.92; P>0.05).
Conclusion: The results of this study suggest that ABMSCs may exert an anti-inflammatory effect by modulating TNF-α in patients with refractory RA. However, the findings related to IL-17A do not support the hypothesis that ABMSC injection exerts anti-inflammatory effects through modulation of IL-17A gene expression in these patients.
Majid Vatankhah, Saeed Kashani, Mohsen Sarafikhah, Bibi Mona Razavi, Mehrdad Sayadinia, Mehrdad Malekshoar,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Aspiration pneumonia is a significant and potentially preventable cause of morbidity and mortality in critically ill ICU patients. Prophylactic pharmacological interventions, particularly antiemetics like metoclopramide (a prokinetic agent) and ondansetron (a 5-HT3 receptor antagonist), are commonly employed to reduce gastric aspiration and subsequent pneumonia. Despite their widespread use, comparative efficacy data remains limited. This randomized controlled trial was specifically designed to rigorously compare the effectiveness of these two distinct antiemetic strategies in preventing aspiration pneumonia among high-risk, mechanically ventilated patients, aiming to provide evidence-based guidance for clinical practice.
Methods: This double-blind randomized clinical trial involved 116 individuals admitted to the ICU at Shahid Mohammadi Hospital, Bandar Abbas from March 2024 to March 2025. Subjects were randomly assigned to metoclopramide or ondansetron groups. Enrollment criteria consisted of patients between 17 and 70 years old in the ICU requiring intubation and mechanical ventilation. Monitoring continued for 72 hours, with evaluation utilizing the Clinical Pulmonary Infection Score (CPIS), chest X-ray (CXR) results, and physical assessments. Data were analyzed with SPSS version 21 employing descriptive statistics (mean, standard deviation, percentage, frequency) and inferential tests with significance set at P<0.05.
Results: Chi-square analysis indicated no statistically significant gender difference between groups (P=0.947). Mean age was 30.6±10.5 years for metoclopramide recipients and 32.9±6.12 years for ondansetron recipients. Further analysis revealed no significant differences in age or BMI between cohorts. No significant difference emerged between metoclopramide and ondansetron groups regarding aspiration pneumonia occurrence, with similar incidence rates in both arms. Multiple logistic regression demonstrated that statistically, no variables influenced aspiration pneumonia development.
Conclusion: The results of this randomized trial clearly demonstrate no statistically significant difference in efficacy between metoclopramide and ondansetron for preventing aspiration pneumonia in intubated ICU patients. Both agents showed comparable effectiveness in our study population, suggesting that either drug represents a clinically acceptable prophylactic option. This finding provides clinicians with valuable therapeutic flexibility based on individual patient characteristics, drug availability, and cost considerations. However, further multicenter studies with larger sample sizes are recommended to confirm these findings across diverse patient populations and settings.
Sepideh Mahdavi, Mohammad Hassan Emamian , Zahra Kordi, Mansooreh Fateh, Mostafa Enayatrad,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Stomach cancer is the fifth most common cancer worldwide. This study aimed to investigate the trend in the incidence of stomach cancer in Shahroud and Meyami districts over a thirteen-year period.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
Saeed Kafrashi, Hamidreza Norouzi, Malihe Safari,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: In this study, Botox method is compared with sleeve gastrectomy as one of the endoscopic methods in the treatment of obesity for patients who are not effective in lifestyle and drug modification methods and do not have the interest or necessary conditions for bariatric surgery.
Methods: This Cross-sectional study was conducted in eligible patients who were outpatients at the gastroenterology clinics of Amir al-Momenin Hospital, Arak, in June 2014 for one year in the gastroenterology clinic after obtaining informed consent, demographic information, and anthropometric measurements. After 12 weeks, patients in both groups were visited again. In patients in group A (Botox group), endoscopy was performed by an experienced gastroenterologist under sedation after a 10-hour fast, and in patients in group B (sleeve gastrectomy) under general anesthesia, a partial and longitudinal gastrectomy was performed. The BAROS questionnaire was used to assess the quality of life of patients.
Results: The mean age of the subjects in the endoscopic botulinum neurotoxin group was 30.88±11.89 years and the sleeve gastrectomy group was 29.88±11.06 years. In this study, 12 subjects (24.0%) were male and 38 subjects (76%) were female. There was a significant difference in the mean body mass index and weight at four measurements in the two study groups (endoscopic botulinum neurotoxin and sleeve gastrectomy). There was no statistically significant difference in the mean blood pressure, laboratory results, and mean quality of life in the study groups.
Conclusion: Endoscopic botulinum injection in the stomach is an effective and safe method for short-term weight loss, but its long-term effect on weight and the occurrence of complications or metabolic effects requires long-term follow-up.
Methods: This Cross-sectional study was conducted in eligible patients who were outpatients at the gastroenterology clinics of Amir al-Momenin Hospital, Arak, in June 2014 for one year in the gastroenterology clinic after obtaining informed consent, demographic information, and anthropometric measurements. After 12 weeks, patients in both groups were visited again. In patients in group A (Botox group), endoscopy was performed by an experienced gastroenterologist under sedation after a 10-hour fast, and in patients in group B (sleeve gastrectomy) under general anesthesia, a partial and longitudinal gastrectomy was performed. The BAROS questionnaire was used to assess the quality of life of patients.
Results: The mean age of the subjects in the endoscopic botulinum neurotoxin group was 30.88±11.89 years and the sleeve gastrectomy group was 29.88±11.06 years. In this study, 12 subjects (24.0%) were male and 38 subjects (76%) were female. There was a significant difference in the mean body mass index and weight at four measurements in the two study groups (endoscopic botulinum neurotoxin and sleeve gastrectomy). There was no statistically significant difference in the mean blood pressure, laboratory results, and mean quality of life in the study groups.
Conclusion: Endoscopic botulinum injection in the stomach is an effective and safe method for short-term weight loss, but its long-term effect on weight and the occurrence of complications or metabolic effects requires long-term follow-up.
Masoome Pourmokhtari , Shahram Shafa, Nasim Nabizadeh, Reza Sahraei, Hasan Zabetian, Mansour Deylami, Navid Kalani,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Spinal anesthesia is an effective method for providing analgesia in surgery and a safe alternative to general analgesia; But despite its benefits, in many cases it is not free of side effects, including unwanted cardiovascular events such as hypotension and bradycardia. Ondansetron effectively reduces the incidence of nausea, vomiting, and bradycardia associated with spinal anesthesia Thus, the present study aimed to assess intravenous ondansetron's efficacy in preventing post-spinal hypotension among patients scheduled for lower extremity orthopedic surgery at Peymanieh Hospital in Jahrom, Iran.
Methods: This randomized double-blind clinical trial included 60 patients undergoing lower limb orthopedic surgery at Peymanieh Hospital, Jahrom, Iran, from March 2021 to February 2022. Patients were randomly allocated into two groups: the intervention group (receiving 8 mg intravenous ondansetron) and the control group (receiving distilled water). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured before pre-spinal anesthesia, after spinal anesthesia and then every two minutes for the first ten minutes and at 15, 30, 45, 60 and 90 minutes after surgery. After spinal anesthesia, the patient was asked about pruritus every 10 minutes. Nausea and vomiting during surgery in case of incidence, recording and nausea after spinal anesthesia, the patient was asked every 10 minutes.
Results: The chi-square test indicated no significant differences between the study groups regarding age and sex distribution(P>0.05). Time before anesthesia, immediately after anesthesia, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, and 90 minutes after anesthesia, significant difference between ondansetron and placebo groups from There was no mean SBP and DBP and HR (P <0.05). No significant difference between ondansetron and placebo groups in the incidence of pruritus and nausea and vomiting at different times (p <0.05).
Conclusion: Dose of 8 mg of ondansetron in lower limb orthopedic surgery has no significant effect on hemodynamic symptoms as well as the prevention of postoperative nausea, vomiting and pruritus in these patients. Therefore, to achieve more results regarding the transient effect of this drug, it can be compared with other drugs in the class of HT3-5 receptor antagonists.
Mandana Pouladzadeh, Fatemeh Khazaei, Saeid Bitaraf, Hossein Karimpourian, Mahsa Mombeyni, Mohammad-Reza Mahmoudian-Sani ,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Breast cancer is the most prevalent malignancy among women and remains a leading cause of cancer-related mortality worldwide. Early detection can markedly improve patient survival, yet existing screening methods often lack sufficient accuracy and sensitivity. lncRNA KCNQ1OT1 has been implicated in the initiation and progression of tumors in several cancers, including breast cancer. This study aimed to evaluate the diagnostic potential of serum lncRNA KCNQ1OT1 expression as a biomarker for early detection of breast cancer.
Methods: This case-control study was conducted at Ahvaz Jundishapur University of Medical Sciences, Shafa Hospital, Ahvaz, Iran, between September 2024 and March 2025. Serum samples were obtained from 30 patients with histologically confirmed breast cancer and 30 healthy women serving as controls. Total RNA was extracted from 500 µL of serum, and cDNA was synthesized using oligo (dT) primers. Real-Time PCR was performed in triplicate, with GAPDH as the internal control. Relative gene expression was calculated using the 2^-ΔΔCt method, and data were analyzed using the Mann-Whitney U test and ROC analysis.
Results: The patient and control groups were homogeneous for most demographic parameters, but showed significant differences in age (P=0.023) and ethnicity (P=0.004). Most patients were in stage I of the disease. The median expression of serum KCNQ1OT1 was significantly lower in patients (0.024, IQR 0.013-0.033) than in controls (0.039, IQR 0.027-0.051), indicating marked downregulation in the patient group (P=0.0003). The ROC analysis yielded an AUC of 0.82 (95% CI: 0.67-0.96, SE=0.07, P=0.0005). At an optimal cutoff value of >0.031, the sensitivity was 70%, the specificity was 95%, and the positive likelihood ratio (LR⁺) ≈ was approximately 14, demonstrating strong discriminative ability.
Conclusion: Serum KCNQ1OT1 exhibits promising diagnostic performance for identifying early-stage breast cancer and may serve as a reliable noninvasive biomarker. Larger multicenter studies incorporating molecular subtyping and tissue correlation are required to validate its clinical applicability and strengthen diagnostic accuracy.
Ali-Akbar Shafiei , Saeed Rahmani , Abbas Riazi, Alireza Akbarzadeh Baghan ,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: This study investigates the use of color filters, which represent a scientific and standardized approach to assist individuals with visual impairment. Although there is no fixed protocol for prescribing color filters, these filters, which are often prescribed by ocular care providers in a trial-and-error manner today, help improve visual performance, control glare, and enhance motor skills in affected individuals. Given the absence of formal guidelines and standardized protocols in this area, this study tested common diseases leading to visual impairment against various color filters.
Methods: The study population consisted of patients visiting the Optometry Clinic of Labbafi Nejad Hospital. Participants were voluntarily referred from retinal and corneal departments to this clinic. This quasi-experimental study evaluated acuity at distance and near and contrast sensitivity function with and without color filters, and compared the results. After analysis, filter(s) suitable for each participant were identified and applied clinically, with one-month monitoring and re-evaluation.
Results: A total of 99 participants (54 male, 45 female) with a mean age of 32.19±15.41 years were included. The results showed that after using color filters, distance visual acuity (BCVA) improved significantly in most diseases (P<0.001). However, in albinism and diabetic retinopathy patients, there was no significant improvement in distance vision. At near distance, there was generally a significant improvement in near vision in most diseases after applying the filters (P=0.001). Exceptions included albinism and glaucoma, where no significant difference was observed (P=0.073). For contrast sensitivity (CSF), most patients showed improvement and increased contrast sensitivity (P<0.001), but this increase was not significant in albinism and glaucoma (P=0.483).
Conclusion: The study suggests that the use of certain color filters in visually impaired patients leads to significant improvements in both distance and near acuity and contrast sensitivity function, potentially enhancing quality of life. Based on the quantitative results, selecting the appropriate filter should be disease-specific and done with greater precision. However, the diversity and severity of diseases, the degree of vision loss, and genetic differences among individuals require greater attention to practical experiences and statements from this patient group. Additionally, patients with more than one ocular condition often changed the type and color of the filter.
Methods: The study population consisted of patients visiting the Optometry Clinic of Labbafi Nejad Hospital. Participants were voluntarily referred from retinal and corneal departments to this clinic. This quasi-experimental study evaluated acuity at distance and near and contrast sensitivity function with and without color filters, and compared the results. After analysis, filter(s) suitable for each participant were identified and applied clinically, with one-month monitoring and re-evaluation.
Results: A total of 99 participants (54 male, 45 female) with a mean age of 32.19±15.41 years were included. The results showed that after using color filters, distance visual acuity (BCVA) improved significantly in most diseases (P<0.001). However, in albinism and diabetic retinopathy patients, there was no significant improvement in distance vision. At near distance, there was generally a significant improvement in near vision in most diseases after applying the filters (P=0.001). Exceptions included albinism and glaucoma, where no significant difference was observed (P=0.073). For contrast sensitivity (CSF), most patients showed improvement and increased contrast sensitivity (P<0.001), but this increase was not significant in albinism and glaucoma (P=0.483).
Conclusion: The study suggests that the use of certain color filters in visually impaired patients leads to significant improvements in both distance and near acuity and contrast sensitivity function, potentially enhancing quality of life. Based on the quantitative results, selecting the appropriate filter should be disease-specific and done with greater precision. However, the diversity and severity of diseases, the degree of vision loss, and genetic differences among individuals require greater attention to practical experiences and statements from this patient group. Additionally, patients with more than one ocular condition often changed the type and color of the filter.
Yaser Sharafi, Mohammad Talebpour, Khosro Najari,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Dumping syndrome is a common complication after bariatric surgery and can adversely affect patients’ quality of life, particularly in those with diabetes. Although gastric bypass has traditionally been associated with a higher risk of dumping syndrome, evidence comparing its frequency with sleeve gastrectomy remains inconclusive. This study aimed to compare the frequency of dumping syndrome following these two procedures in patients with morbid obesity.
Methods: This prospective cohort study was conducted from April 2021 to July 2022 at Sina Hospital in Tehran. A total of 90 patients with morbid obesity who met the indications for bariatric surgery were not randomly assigned to two treatment groups: gastric bypass (n = 45) and sleeve gastrectomy (n = 45). Baseline assessments included medical history, physical examination, review of medical records, and necessary specialist consultations (including endocrinology and cardiology). All patients’ data were recorded in the Sina Bariatric Surgery Registry Database. Following surgery, patients received standard postoperative care and were evaluated for symptoms of dumping syndrome at one and three months postoperatively using the validated Sigstad questionnaire. Statistical analyses were performed using SPSS software.
Results: The results showed no statistically significant differences between the two groups in terms of age group, gender, excess weight, preoperative BMI, final BMI, and history of diabetes prior to surgery (P-value > 0.05). The final weight was significantly higher in the sleeve gastrectomy group (P-value = 0.033). There were no significant differences in the frequency of early and late dumping syndrome related to the consumption of sweets and other foods between the two groups at the first and third postoperative months (P-value > 0.05). Early dumping syndrome following the consumption of sweets and bread was significantly more frequent among diabetic patients (P-value = 0.037 and P-value = 0.045, respectively).
Conclusion: The prevalence of dumping syndrome was similar in both sleeve and bypass groups. Weight loss over time was significant (P < 0.001) and did not differ between groups (P = 0.211). The syndrome was significantly more common in diabetic patients, highlighting the importance of careful postoperative care and dietary guidance.
Methods: This prospective cohort study was conducted from April 2021 to July 2022 at Sina Hospital in Tehran. A total of 90 patients with morbid obesity who met the indications for bariatric surgery were not randomly assigned to two treatment groups: gastric bypass (n = 45) and sleeve gastrectomy (n = 45). Baseline assessments included medical history, physical examination, review of medical records, and necessary specialist consultations (including endocrinology and cardiology). All patients’ data were recorded in the Sina Bariatric Surgery Registry Database. Following surgery, patients received standard postoperative care and were evaluated for symptoms of dumping syndrome at one and three months postoperatively using the validated Sigstad questionnaire. Statistical analyses were performed using SPSS software.
Results: The results showed no statistically significant differences between the two groups in terms of age group, gender, excess weight, preoperative BMI, final BMI, and history of diabetes prior to surgery (P-value > 0.05). The final weight was significantly higher in the sleeve gastrectomy group (P-value = 0.033). There were no significant differences in the frequency of early and late dumping syndrome related to the consumption of sweets and other foods between the two groups at the first and third postoperative months (P-value > 0.05). Early dumping syndrome following the consumption of sweets and bread was significantly more frequent among diabetic patients (P-value = 0.037 and P-value = 0.045, respectively).
Conclusion: The prevalence of dumping syndrome was similar in both sleeve and bypass groups. Weight loss over time was significant (P < 0.001) and did not differ between groups (P = 0.211). The syndrome was significantly more common in diabetic patients, highlighting the importance of careful postoperative care and dietary guidance.
Maryam Safari, Abbas Ghaisouri, Shokofeh Mohammadi,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Shortness of breath is a common disorder and means difficulty in breathing and shortness and shallow breathing that the patient feels unpleasant, difficulty and shallow breathing. The main purpose of this study was to analyze patients undergoing pulmonary angiography with a prognosis of pulmonary embolism in the emergency department.
Methods: This descriptive-analytical study was performed in the adult emergency department of Shahid Mostafa Hospital in Ilam in March2018-March2020 after receiving permission from the ethics committee. This study evaluated patients over 18 years of age who underwent CTPA with a pre-diagnosis of PE.
Results: The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In our study based on CT results, 30.2% of patients suffered from PE. The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In the present study, 65.5% of patients presented with shortness of breath, of which CT results showed 28.9% (PE), 38.2% (Non PE) and 98% (Normal). Other complaints of patients with shortness of breath were reported with CP (7.8%), lower edema (6%), respiratory distress (8.6%), CP and fever (5.2%) and hemotypy (1.7%).
Conclusion: Based on the above study, we conclude that the criterion for selecting patients for CT angiography to rule out PTE is the most important criterion for clinical examination and the Welsh Criteria score. As we can see, the results showed that patients with a Wales score above 8-12 had 80% PTE and patients with a Wales score of 3-6 had 23.5% PTE and the rest had a negative answer, so the Wells criteria were good criteria which unfortunately Due to some conditions, the diagnosis of a general practitioner or carelessness in examinations are not taken into account and causes a large percentage of patients with complaints of shortness of breath to undergo CT angiography while not having the necessary criteria based on Wells scores and clinical examination. CT angiography is either normal or another condition that does not require CT angiography and radiation.
Methods: This descriptive-analytical study was performed in the adult emergency department of Shahid Mostafa Hospital in Ilam in March2018-March2020 after receiving permission from the ethics committee. This study evaluated patients over 18 years of age who underwent CTPA with a pre-diagnosis of PE.
Results: The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In our study based on CT results, 30.2% of patients suffered from PE. The highest frequency was reported in CT findings of 31.9% normal, 27.6% PE. In the present study, 65.5% of patients presented with shortness of breath, of which CT results showed 28.9% (PE), 38.2% (Non PE) and 98% (Normal). Other complaints of patients with shortness of breath were reported with CP (7.8%), lower edema (6%), respiratory distress (8.6%), CP and fever (5.2%) and hemotypy (1.7%).
Conclusion: Based on the above study, we conclude that the criterion for selecting patients for CT angiography to rule out PTE is the most important criterion for clinical examination and the Welsh Criteria score. As we can see, the results showed that patients with a Wales score above 8-12 had 80% PTE and patients with a Wales score of 3-6 had 23.5% PTE and the rest had a negative answer, so the Wells criteria were good criteria which unfortunately Due to some conditions, the diagnosis of a general practitioner or carelessness in examinations are not taken into account and causes a large percentage of patients with complaints of shortness of breath to undergo CT angiography while not having the necessary criteria based on Wells scores and clinical examination. CT angiography is either normal or another condition that does not require CT angiography and radiation.
Mobina Zamanifard, Hamid Reza Norouzi, Fazilat Jokar Darzi , Malihe Safari,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Helicobacter pylori (H. pylori) is a human gastrointestinal pathogen that infects more than half of the world's population and leads to chronic gastritis and its role in the development of gastric ulcers, gastric cancer and gastric lymphomas is considered. However, eradication of this bacterium with triple therapy fails in more than 30% of cases. Therefore, efforts to find new treatment methods are increasing. As a result, this study was conducted to evaluate the effectiveness and tolerability of several drug regimens compared to the standard regimen.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
The comparison of blood loss in cesarean section undergoing
general anesthesia and spinal anesthesia
Mohammad Sadegh Sanie Jahromi , Reza Ashrafzadeh, Ahmad Rastgarian, Navid Kalani , Mohammad Hasan Damshenas,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: In general anesthesia, anesthetic agents are administered by inhalation or intravenously, leading to loss of consciousness, immobility, analgesia, and amnesia. In spinal anesthesia, injection of a local anesthetic into the intrathecal space causes sensory and motor block. The aim of this study was to compare the volume of bleeding during cesarean section under general anesthesia and spinal anesthesia.
Methods: This study is a cross-sectional prospective study. The gauzes used were weighed before the operation and bloody gauzes were weighed after the operation. The difference between the weight of bloody and dry gauzes was recorded as the volume of bleeding. This volume was then added to the volume of blood in the suction chamber and the final bleeding volume was estimated.
Results: 70 patients who were candidates for cesarean section were included in the study. The mean age of the patients included in the study was 24.82±4.98 and their mean weight was 77.11±8.97. The mean hemoglobin in the spinal anesthesia group was 91.12±39. Volume of bleeding during cesarean section by spinal anesthesia was significantly less than general anesthesia (P=0.001). Also, the visual estimation of bleeding in spinal anesthesia was significantly lower than general anesthesia (P<0.001). In this study, there was no significant difference between heart rate, systolic and diastolic pressure before and during surgery, and the first- and fifth-minute Apgar scores between the two groups of general and spinal anesthesia.
Conclusion: We found in this study that the volume of bleeding during cesarean section under spinal anesthesia is less than general anesthesia. It is suggested that in future studies, other methods of estimating bleeding such as postoperative hemoglobin reduction, dilution method, atomic absorption spectroscopy and photometry be used. Also, a comparison should be made between the three groups of general, spinal and epidural anesthesia, and the volume of bleeding in each should be checked and the best anesthesia method should be selected for cesarean section.
Methods: This study is a cross-sectional prospective study. The gauzes used were weighed before the operation and bloody gauzes were weighed after the operation. The difference between the weight of bloody and dry gauzes was recorded as the volume of bleeding. This volume was then added to the volume of blood in the suction chamber and the final bleeding volume was estimated.
Results: 70 patients who were candidates for cesarean section were included in the study. The mean age of the patients included in the study was 24.82±4.98 and their mean weight was 77.11±8.97. The mean hemoglobin in the spinal anesthesia group was 91.12±39. Volume of bleeding during cesarean section by spinal anesthesia was significantly less than general anesthesia (P=0.001). Also, the visual estimation of bleeding in spinal anesthesia was significantly lower than general anesthesia (P<0.001). In this study, there was no significant difference between heart rate, systolic and diastolic pressure before and during surgery, and the first- and fifth-minute Apgar scores between the two groups of general and spinal anesthesia.
Conclusion: We found in this study that the volume of bleeding during cesarean section under spinal anesthesia is less than general anesthesia. It is suggested that in future studies, other methods of estimating bleeding such as postoperative hemoglobin reduction, dilution method, atomic absorption spectroscopy and photometry be used. Also, a comparison should be made between the three groups of general, spinal and epidural anesthesia, and the volume of bleeding in each should be checked and the best anesthesia method should be selected for cesarean section.
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
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.
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. |
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.
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