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Comparison of the frequency of dumping syndrome following gastric bypass and sleeve gastrectomy in patients with morbid obesity
Yaser Sharafi, Mohammad Talebpour, Khosro Najari,
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.

Analysis of parameters of patients undergoing pulmonary angiography with the possibility of pulmonary embolism in the emergency department
Maryam Safari, Abbas Ghaisouri, Shokofeh Mohammadi,
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.

Comparison of the success effect of three different treatment regimens on Helicobacter pylori eradication: randomized clinical trail
Mobina Zamanifard, Hamid Reza Norouzi, Fazilat Jokar Darzi , Malihe Safari,
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.

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)
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.

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)
Abstract

Comparison of the frequency and pattern of clinical manifestations of patients with phenylketonuria in the two provinces of Sistan and Baluchestan and West Azerbaijan
Elham Shafighi Shahri , Akram Ehsasatvatan, Sara Rigy Nejad ,
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.

The prevalence and clinical course of cisplatin-induced acute kidney injury patients undergoing cisplatin-based chemotherapy
Mohammad Mehdi Khatib Shahidi, Ali Sadoogh Abbasian , Maliheh Safari ,
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.
 

Prevalence of fatty liver disease in patients with high-risk coronary plaque on CT angiography
Moghgan Samet Zadeh , Sahar Nikouzad Shahraki , Mohammad Ghasem Hanafi ,
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.

Addressing concurrent hypoglycemia and thrombocytopenia in a neonate: a case report
Amir Naddaf, Vafa Ghorban Sabbagh , Ghazaleh Rasti, Raheleh Moradi, Mobina Taghva Nakhjiri ,
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.

 

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