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Ali Mohammad Mosadeghrad,,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Reza Saeidi , Mahboobe Gholami ,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Maternal substance abuse during pregnancy is a significant global public health concern, affecting approximately 10% of pregnant women worldwide and leading to serious adverse outcomes for both mother and fetus. Given Iran’s geographical location and its role as a transit route for narcotics, the prevalence of substance abuse, particularly opium and its derivatives, is notably higher than in many other countries. This systematic review and meta-analysis aimed to determine the prevalence of substance abuse and the most commonly used substances (including opium, heroin, crystal methamphetamine, methadone, amphetamines, and cigarettes) among pregnant Iranian women from 2000 to 2024.
Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, SID, and Iranmedex for articles published between January 2000 and January 2024. Studies investigating the prevalence of substance abuse in pregnant Iranian women were included. Case studies, reviews, letters to the editor, and studies without quantitative data were excluded. Two researchers independently extracted data. Extracted information included: author name, year of publication, province/city, sample size, mean age of participants, type of substance used, and incidence or prevalence rate. Data were analyzed using a random-effects model, and heterogeneity was assessed using the I2 index.
Results: Out of 127 identified articles, 22 were included in the meta-analysis. The overall estimated prevalence of substance abuse among pregnant Iranian women was 3.3% (CI 95%: 2.4-4.5), with high heterogeneity (I2=83%). The most prevalent substances were opium (1.7%), cigarettes (1.3%), methadone (0.5%), heroin (0.3%), crystal methamphetamine (0.2%), amphetamines/methamphetamines (0.1%), cannabis (0.4%), and alcohol (0.2%). Polydrug use was reported at 0.7%. A rising trend in substance abuse prevalence was observed, increasing from 2.1% in 2000-2009 to 3.8% in 2015-2024. A temporal trend analysis of the incidence of substance abuse showed that the incidence of substance abuse in Iranian pregnant women increased from 2.1% in 2000-2009 to 3.8% in 2015-2024. Sensitivity and publication bias analyses showed that the exclusion of low-quality studies did not significantly affect the results. The funnel plot indicated a low probability of publication bias.
Conclusion: Substance abuse among pregnant Iranian women remains a serious challenge, necessitating broader preventive and therapeutic interventions.
Keywords: neonatal withdrawal syndrome, opium, pregnancy, substance abuse.
Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, SID, and Iranmedex for articles published between January 2000 and January 2024. Studies investigating the prevalence of substance abuse in pregnant Iranian women were included. Case studies, reviews, letters to the editor, and studies without quantitative data were excluded. Two researchers independently extracted data. Extracted information included: author name, year of publication, province/city, sample size, mean age of participants, type of substance used, and incidence or prevalence rate. Data were analyzed using a random-effects model, and heterogeneity was assessed using the I2 index.
Results: Out of 127 identified articles, 22 were included in the meta-analysis. The overall estimated prevalence of substance abuse among pregnant Iranian women was 3.3% (CI 95%: 2.4-4.5), with high heterogeneity (I2=83%). The most prevalent substances were opium (1.7%), cigarettes (1.3%), methadone (0.5%), heroin (0.3%), crystal methamphetamine (0.2%), amphetamines/methamphetamines (0.1%), cannabis (0.4%), and alcohol (0.2%). Polydrug use was reported at 0.7%. A rising trend in substance abuse prevalence was observed, increasing from 2.1% in 2000-2009 to 3.8% in 2015-2024. A temporal trend analysis of the incidence of substance abuse showed that the incidence of substance abuse in Iranian pregnant women increased from 2.1% in 2000-2009 to 3.8% in 2015-2024. Sensitivity and publication bias analyses showed that the exclusion of low-quality studies did not significantly affect the results. The funnel plot indicated a low probability of publication bias.
Conclusion: Substance abuse among pregnant Iranian women remains a serious challenge, necessitating broader preventive and therapeutic interventions.
Keywords: neonatal withdrawal syndrome, opium, pregnancy, substance abuse.
Majid Vatankhah Tarbebar , Saeid Kashani, Milad Mohammadi , Zohreh Nik Eghbali, Mehrdad Malekshoar,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Laparoscopic cholecystectomy is the gold standard for treating gallbladder diseases; however, it is associated with physiological challenges from pneumoperitoneum and specific patient positioning. Positive end-expiratory pressure (PEEP) may mitigate these effects, but the optimal level remains uncertain. This study compared the impact of three PEEP levels on respiratory performance and hemodynamic stability during laparoscopic cholecystectomy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
Maryam Hajhashemi , Hedieh Bonakdarchian, Tahereh Khalili Borujeni , Minoo Movahedi , Roya Sahebi, Fedyeh Haghollahi,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Pelvic organ prolapse (POP) is a condition resulting from weakness or damage to the muscles, ligaments, and other supporting structures of the vagina, and it exposes affected women to reduced quality of life and sexual function. The present study examined the symptoms, sexual function, and quality of life of women one year after repair of pelvic organ prolapse.
Methods: This study was a prospective cohort before-after study that was conducted on 200 married women with pelvic prolapse grade 1-4 (POP-Q) in the age group of 47-75 years who underwent reconstructive surgery (anterior and posterior colporrhaphy) in Shahid Beheshti and Al-Zahra hospitals in Isfahan between October 2022 and March 2024. The data collection tools were three questionnaires: Female Sexual Function Index (FSFI), Pelvic Discomfort (PFDI-20) and Quality of Life (SF-36) which were completed before surgery and one year after surgery. Stata software version 17 was used to analyze the data. To compare the scores before and after, paired t-test or Wilcoxon statistical tests were used, to compare the severity of patients' clinical symptoms based on the levels before and after surgery, the symmetry/Bowker test was used, and to compare the status of the sexual function index (impairment/no impairment) before and after surgery, the McNemar test was used and the significance level was considered to be P<0.05.
Results: The mean age of the study participants was 59.5±12.6 years. The majority of the women (157 individuals; 78.5%) were housewives. The mean number of pregnancies was 4.3±2.1, and the mean number of live births was 3.75±1.89. All women included in the study were postmenopausal. The severity of clinical symptoms, sexual dysfunction index status, and median quality of life score were significant between before and after the intervention. The severity of clinical symptoms, the status of the sexual dysfunction index, and the median quality of life score showed significant differences before and after the intervention.
Conclusion: Pelvic prolapse surgery can significantly improve the quality of life and sexual function of patients one year after surgery, in addition to correcting the anatomical structure.
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.
Kosar Hajati, Behnaz Deihim ,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Leishmaniasis is one of the most significant parasitic diseases and is susceptible to secondary bacterial infections, which can result in increased inflammation, delayed tissue repair, and increased drug resistance. Given the importance of this phenomenon, the present study was designed to identify bacterial agents and determine their antibiotic resistance patterns in lesions of patients with cutaneous leishmaniasis.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
Fatemeh Eftekharian, Arnoosh Ghodsian, Reza Sahraei,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Dermatomyositis is a rare inflammatory muscle disease with systemic manifestations, in which muscle weakness, dysphagia, and pulmonary and cardiac involvement are common problems. The aim of this report is to examine the challenges and management of general anesthesia in a patient with dermatomyositis with the rare complication of buried bumper syndrome after PEG placement and gallbladder surgery.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
Case Presentation: A 53-year-old male patient was referred to the operating room of Seyed al-Shohada Hospital in Jahrom for gallbladder stone surgery due to abdominal pain in April-May 2024. The patient had presented to the hospital approximately one month prior with complaints of myalgia and progressive lower limb weakness. He subsequently developed severe dysphagia. Based on clinical and paraclinical evaluations, a diagnosis of dermatomyositis was ultimately made and confirmed. Due to the swallowing difficulty, a Percutaneous endoscopic gastrostomy (PEG) tube was placed for him. His treatment regimen included high-dose corticosteroid pulse therapy and Intravenous immunoglobulin (IVIG). One month later, the patient was readmitted with acute abdominal pain. Imaging studies revealed multiple gallstones, leading to a referral to a general surgeon for operative management. Additionally, a complication related to the PEG tube, known as Buried Bumper Syndrome, was considered as a potential cause of the abdominal pain. Given the patient's history of dermatomyositis and swallowing disorder, a comprehensive re-evaluation was performed in the operating room. Cricoid pressure (Sellick maneuver) was applied to prevent aspiration. The surgery was successfully completed, and the patient remained hemodynamically stable throughout the procedure.
Conclusion: General anesthesia in patients with dermatomyositis requires careful preoperative evaluation, continuous muscle and hemodynamic monitoring, selection of appropriate doses of muscle relaxants, and use of stress doses of steroids. In addition, attention to specific complications such as buried bumper syndrome after PEG and proper airway management and prevention of aspiration are of particular importance. The present report emphasizes that multifaceted and planned management can lead to successful outcomes in these patients.
Epidural initiation time based on fetal head position criteria in painless labor: a letter to editor
Banafsheh Mashak, Reza Taghvaei, Reza Payami , Mohammad Hossein Shakeri Goki , Fatemeh Javaheri, Roya Bolhassani,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Ayoub Tavakolian, Shapour Badiee, Mahdi Mohammadi, Elahe Pourahmadi, Samaneh Sabouri, Navid Kalani , Mahdi Foroughian ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
| Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers. Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay. Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care. Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care. |
Elham Shafighi Shahri , Akram Ehsasatvatan, Sara Rigy Nejad ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Phenylketonuria (PKU) is a genetic metabolic disorder that, if left untreated, leads to irreversible cognitive, behavioral, and neurological damage. Sistan and Baluchestan and West Azerbaijan provinces are among the regions that have reported high rates of the disease due to specific ethnic characteristics. This study aims to compare the frequency and pattern of clinical symptoms in the two provinces of Sistan and Baluchestan and West Azerbaijan. Methods: This cross-sectional descriptive-analytical study was conducted on 60 patients with PKU who had been referred to Imam Ali Hospital (Zahedan) and Urmia Hospital during the past ten years. Data were collected from medical records and structured interviews. Results: The mean age of the patients was 5.67 ± 6.98 years. The mean height, weight, and head circumference were 30.28 ± 113.08 cm, 13.22 ± 25.13 kg, and 1.83 ± 43.36 cm, respectively. The mean serum phenylalanine level at the time of diagnosis was 13.58 ± 14.65 mg/dL. Of the 60 patients, 31 (51.7%) were male and 29 (48.3%) were female. The difference between the two sexes in the occurrence of clinical symptoms was not statistically significant (p<0.05). Psychiatric disorders were reported in 20 (33.3%) of the patients. The prevalence of these disorders was significantly higher with increasing age (p = 0.041). Conclusion: This study indicates the existence of significant regional differences in the clinical manifestations of phenylketonuria; such that patients from Sistan and Baluchestan province experienced a higher rate of psychiatric and neurological symptoms than patients from West Azerbaijan. The severity of symptoms increased with increasing age and duration of illness, emphasizing the importance of early diagnosis and continuous therapeutic follow-up. It was also noteworthy that some patients still had severe clinical symptoms despite having lower phenylalanine levels at diagnosis. Overall, the findings of this study emphasize the need for early diagnosis, equitable access to health services, and sustained metabolic control to improve outcomes for PKU patients in the country. |
Mohammad Mehdi Khatib Shahidi, Ali Sadoogh Abbasian , Maliheh Safari ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Cisplatin is one of the most effective chemotherapy agents; however, its nephrotoxicity remains the primary dose-limiting factor. This study aimed to determine the prevalence and clinical course of acute kidney injury (AKI) in patients receiving high-dose cisplatin therapy.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results: Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion: High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results: Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion: High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.
Sara Memarian, Narges Mostajabi, Behdad Gharib, Parastoo Rostami , Mohammad Taghi Majnoon , Farzaneh Abbasi, Reihaneh Mohsenipour,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Type 1 diabetes mellitus, with its increasing prevalence in the pediatric population, has a significant impact on the mental health, quality of life, and lifestyle of patients.. The onset of the disease in childhood and its association with the child during school and adolescence, and during the growth and development process, has numerous effects on the growth process and mental experiences of patients.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Moghgan Samet Zadeh , Sahar Nikouzad Shahraki , Mohammad Ghasem Hanafi ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
|
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases worldwide and is closely associated with metabolic syndrome and insulin resistance. Growing evidence suggests a link between NAFLD and cardiovascular diseases, independent of traditional risk factors. Coronary computed tomography angiography (CCTA) is a reliable noninvasive method for evaluating coronary artery disease (CAD) and identifying high-risk coronary plaque characteristics. However, data regarding the association between NAFLD and high-risk coronary plaques remain limited, particularly in Iran. This study aimed to evaluate the prevalence of NAFLD in patients with high-risk coronary plaques detected by CCTA. Methods: In this cross-sectional study, 200 patients who underwent CCTA for the evaluation of coronary plaques in outpatient clinics or the emergency department of Golestan Hospital in ahvaz ,1403 ,were enrolled. Demographic data, including age, sex, weight, and body mass index (BMI), along with clinical characteristics and cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking status, and medical history were collected. Patients with a history of alcohol consumption or known liver disease were excluded. NAFLD was assessed based on imaging findings. Statistical analyses were performed to compare variables between patients with and without NAFLD. Results: The mean age of patients with NAFLD was 57.89 ± 9.72 years, compared with 55.77 ± 8.97 years in patients without NAFLD, with no statistically significant difference. The prevalence of NAFLD was slightly higher in women than men; however, this difference was not significant. Patients with NAFLD had a significantly higher mean weight than those without NAFLD (85.21 ± 12.12 kg vs. 79.62 ± 11.85 kg; p = 0.001). Additionally, the prevalence of NAFLD increased significantly with higher BMI categories, particularly in obese individuals. Conclusion: Age and gender were not significantly associated with NAFLD prevalence in patients with high-risk coronary plaques. In contrast, increased body weight and higher BMI, especially obesity, were independently associated with a higher risk of NAFLD in this population. |
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: The duration of hospitalization of patients is considered an important indicator in health resource management and patient evaluation. This study investigated the frequency and causes of readmission in cardiovascular patients
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Hadi Khorsand Zak, Seyed Hasan Seyed Sharifi , Yaser Abbasi , Rasul Nikdel,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Intestinal lymphangiomatosis is a rare benign disorder of the gastrointestinal tract characterized by abnormal proliferation and dilatation of lymphatic channels within the intestinal wall and mesentery. It accounts for less than 1% of gastrointestinal tumors and predominantly affects the small intestine, particularly in pediatric patients. Clinical manifestations vary widely depending on the size, location, and extent of the lesions, ranging from asymptomatic presentations to acute complications. Due to its rarity and nonspecific features, early diagnosis is often difficult. Imaging modalities, especially ultrasonography, computed tomography, and magnetic resonance imaging, are crucial for initial evaluation and preoperative planning.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
Case Presentation: We report an infant who presented with failure to thrive, progressive abdominal distension, and acute symptoms of gastrointestinal obstruction. The patient was admitted to Imam Reza Hospital, Bojnurd, in February 2024. A detailed clinical assessment and laboratory evaluation were performed, followed by abdominal ultrasonography, which revealed a multiloculated cystic mass originating from the small bowel, highly suggestive of a lymphatic malformation. Due to complete small bowel obstruction and worsening clinical status, urgent exploratory laparotomy was undertaken. Intraoperative findings demonstrated a cystic lesion involving a segment of the small intestine, causing total luminal obstruction. Segmental resection of the affected bowel with primary anastomosis was performed, and the resected specimen was submitted for histopathological analysis. The postoperative course was uneventful, with gradual resolution of abdominal distension and successful reintroduction of enteral feeding. Histopathological examination confirmed intestinal lymphangioma, showing dilated lymphatic channels lined by endothelial cells within the intestinal wall, with no evidence of malignancy. During follow-up, the patient demonstrated satisfactory weight gain and normalization of gastrointestinal function, without recurrence or postoperative complications.
Conclusion: Although rare, intestinal lymphangiomatosis should be considered in infants presenting with failure to thrive and signs of bowel obstruction. Timely imaging, particularly ultrasonography, is essential for early diagnosis. Surgical resection remains the definitive treatment in symptomatic cases and is associated with favorable outcomes. Increased clinical awareness can help prevent delayed diagnosis and minimize associated morbidity.
Navid Kalani, Mehrdad Sayadinia, Amir Hossein Pourdavood , Maryam Ziaei, Tayyebeh Zare , Bibi Mona Razavi , Mansour Deylami ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: With the rapid advancement of minimally invasive surgical techniques, laparoscopic cholecystectomy has become one of the most frequently performed procedures worldwide. Despite its benefits, such as reduced postoperative complications and faster recovery, effective pain management remains a critical challenge. Postoperative pain can significantly impact patient recovery, hospital stay duration, and overall satisfaction. Given the limitations and side effects of opioid-based analgesics, there is growing interest in non-opioid alternatives for pain control following laparoscopic cholecystectomy. This narrative review evaluates the efficacy of various non-opioid analgesics in managing postoperative pain in patients undergoing this procedure.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Mohammad Saadatnia , Faezeh Sharifi, Fariborz Khoroush,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Subarachnoid hemorrhage (SAH) is a life-threatening emergency condition often accompanied by severe, sudden-onset headache. The main causes are head trauma and aneurysm rupture. Pain management in these patients remains challenging, typically requiring opioids which carry significant adverse effects. As anti-neuropathic agents, gabapentin and pregabalin may serve as suitable alternatives to opioids. This systematic review aimed to evaluate the efficacy and safety of gabapentin and pregabalin in managing SAH-associated headaches.
Methods: Following PRISMA guidelines, we conducted comprehensive searches in PubMed, SCOPUS, Web of Science, and EMBASE through May 2025. Key search terms included "Gabapentin," "Pregabalin," "Subarachnoid Hemorrhage," and "Headache." After initial screening, we selected English or Persian-language articles investigating these medications' effects on SAH-related headache. After removal of duplicates and screening, four eligible studies (including randomized controlled trials and cohort studies) were included for final analysis. Data on study type, sample size, type of interventions, headache management-related outcomes, as well as safety and tolerability profiles were extracted.
Results: Pregabalin demonstrated significant efficacy, showing a statistically significant reduction in pain intensity compared to placebo before anesthesia induction (P≤0.004) and up to 24 hours post-operatively (P=0.007). Additionally, patients receiving pregabalin required significantly fewer rescue analgesics (P≤0.005). In contrast, gabapentin did not produce a statistically significant reduction in pain intensity or morphine equivalent requirements compared to placebo, although a non-significant trend toward decreased pain was observed. Safety profiles were favorable for both medications; no serious adverse events leading to drug discontinuation were reported.
Conclusion: Pregabalin appears to be an effective, safe, and well-tolerated option for managing SAH-related headache, significantly reducing both pain intensity and opioid requirements. Current evidence for gabapentin remains limited and inconclusive, warranting further large-scale, randomized controlled trials to confirm its potential role in this setting.
Methods: Following PRISMA guidelines, we conducted comprehensive searches in PubMed, SCOPUS, Web of Science, and EMBASE through May 2025. Key search terms included "Gabapentin," "Pregabalin," "Subarachnoid Hemorrhage," and "Headache." After initial screening, we selected English or Persian-language articles investigating these medications' effects on SAH-related headache. After removal of duplicates and screening, four eligible studies (including randomized controlled trials and cohort studies) were included for final analysis. Data on study type, sample size, type of interventions, headache management-related outcomes, as well as safety and tolerability profiles were extracted.
Results: Pregabalin demonstrated significant efficacy, showing a statistically significant reduction in pain intensity compared to placebo before anesthesia induction (P≤0.004) and up to 24 hours post-operatively (P=0.007). Additionally, patients receiving pregabalin required significantly fewer rescue analgesics (P≤0.005). In contrast, gabapentin did not produce a statistically significant reduction in pain intensity or morphine equivalent requirements compared to placebo, although a non-significant trend toward decreased pain was observed. Safety profiles were favorable for both medications; no serious adverse events leading to drug discontinuation were reported.
Conclusion: Pregabalin appears to be an effective, safe, and well-tolerated option for managing SAH-related headache, significantly reducing both pain intensity and opioid requirements. Current evidence for gabapentin remains limited and inconclusive, warranting further large-scale, randomized controlled trials to confirm its potential role in this setting.
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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