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Maedeh Afshar, Mahboubeh Haddad , Aliakbar Heydari, Majid Khadem Rezaiyan ,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Brucellosis is the most frequently encountered zoonosis and one of the most important health challenges, especially in developing countries. This disease can be accompanied by bacteremia and may result in severe complications. A definitive diagnosis may be made by culture of the organism from blood, body fluids or tissues, although serum agglutination test is often recognized as the reference test. While bacteremic brucellosis is not uncommon, research on this topic remains limited. The present study was conducted to determine the epidemiological, clinical, and para-clinical characteristics of patients hospitalized with bacteremic brucellosis.
Methods: This retrospective cross-sectional study evaluated the epidemiological, clinical, and para-clinical characteristics, and clinical outcomes of patients hospitalized with bacteremic brucellosis from March 2011 to February 2021 at Imam Reza and Ghaem hospitals in Mashhad, Iran. A list of adult patients with confirmed brucellosis was assembled from microbiology laboratory records. The inclusion criterion was a positive blood culture for Brucella, regardless of the Brucella serology results. According to the laboratory report, the BACTEC culture medium was used to identify the organism, and the reported results did not specify the Brucella species. Demographic data, clinical presentations, paraclinical findings (including Wright, 2ME Wright, and Coombs Wright), and clinical outcomes were extracted from archived medical records.
Results: The mean age was 38.8±18 years, and 17 patients (53.1%) were male. Cardiac diseases were the most common underlying disease, and 15.7% of patients were immunocompromised. Fever and mono-arthritis were the most common symptoms and signs, respectively. Serologic investigations were negative in 12 patients (37.5%). 84.4% of patients had anemia. There was no mortality among patients.
Conclusion: A significant property of patients with positive blood culture for Brucella may not be identified with serologic assays, so if there is strong clinical suspicion of brucellosis, blood culture should also be considered. According to this study, bacteremic brucellosis is not accompanied by mortality, and the patients respond well to common antibiotic regimens.
Conclusion: A significant property of patients with positive blood culture for Brucella may not be identified with serologic assays, so if there is strong clinical suspicion of brucellosis, blood culture should also be considered. According to this study, bacteremic brucellosis is not accompanied by mortality, and the patients respond well to common antibiotic regimens.
Bahar Rostamizadeh, Alireza Jalali-Zand , Kamran Qhaedi, Rozita Nasiri,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Insects and arthropods, along with their products, have been used as medicinal sources since ancient times, that is called entomotherapy. Cancer is one of the major problems in medical science, for which a drug has not yet been discovered to control it quickly and accurately. Arthropods have been medicinal sources since ancient times and they especially Insects have a high potential for insect therapy because of the biodiversity. This research investigates the effect of insect body extracts and arthropods in inhibiting the growth of cancer cells or tumours, specifically on the breast cancer cell line, MCF7002E
Methods: The basic and applied study was conducted in Isfahan from 2018 to 2023. In this research, six species of insects, namely Gryllotalpa sp., Polyrhachis sp., Dolichovespula sp., Apis mellifera, Periplaneta americana, Drosophila melanogaster, and one species of Chilopoda, Scolopendra sp., were used. The samples were washed with distilled water and 70% alcohol, then frozen and powdered and prepared in 1% DMSO at eight concentrations of 62.5, 125, 250, 500, 1000, 2000, 4000, 8000 μg/ml and were evaluated for the control of two lines of breast cancer cells MCF-7 by the MTT test was performed to check the effect of doses. The affected doses of insects and centipedes were performed in 6 replicates and three times to MCF-7 cells. IC50 and LD50 were calculated by Prism version six software to check the effect of concentrations determine the effective dose and choose the best extract to control the growth of MCF-7 breast cancer cells.
Methods: The basic and applied study was conducted in Isfahan from 2018 to 2023. In this research, six species of insects, namely Gryllotalpa sp., Polyrhachis sp., Dolichovespula sp., Apis mellifera, Periplaneta americana, Drosophila melanogaster, and one species of Chilopoda, Scolopendra sp., were used. The samples were washed with distilled water and 70% alcohol, then frozen and powdered and prepared in 1% DMSO at eight concentrations of 62.5, 125, 250, 500, 1000, 2000, 4000, 8000 μg/ml and were evaluated for the control of two lines of breast cancer cells MCF-7 by the MTT test was performed to check the effect of doses. The affected doses of insects and centipedes were performed in 6 replicates and three times to MCF-7 cells. IC50 and LD50 were calculated by Prism version six software to check the effect of concentrations determine the effective dose and choose the best extract to control the growth of MCF-7 breast cancer cells.
Results: Scolopendra sp., Drosophila melanogaster, Periplaneta americana, Polyrhachis sp., Apis mellifera, and Gryllotalpa sp. are the most effective species, respectively, in inducing apoptosis and cell death in MCF-7 cancer cell line. Dolichovespula sp. had the least effect. Scolopendra sp. at a concentration of 500 μg/litre induced cell death in more than 50% of MCF-7 cancer cells.
Conclusion: The results of the application of seven different genera of arthropods and insects showed that these genera have excellent therapeutic potential, particularly in the treatment of MCF-7 cancer cells.
Conclusion: The results of the application of seven different genera of arthropods and insects showed that these genera have excellent therapeutic potential, particularly in the treatment of MCF-7 cancer cells.
Fatemeh Rasouli Amiri , Khadijeh Ezoji, Seyed Reza Hosseini, Ali Bijani , Kayvan Latifi ,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: People with chronic pain have a shorter life expectancy than the general population, in part as a result of excess mortality from cardiovascular disease (CVD). The purpose of this study was to investigate the relationship between chronic pain and risk factors of cardiovascular diseases.
Methods: In this study, 400 elderly diabetic patients in phase one of the Amirkola Elderly Cohort Study (AHAP), which was conducted between April 2011 to March 2016, were divided into two groups of 200 people, with chronic pain and without chronic pain. Then, the risk factors for cardiovascular diseases that are available in this plan such as physical activity level, body mass index, blood sugar levels, blood lipid profile status, Hypertension and smoking were examined.
Methods: In this study, 400 elderly diabetic patients in phase one of the Amirkola Elderly Cohort Study (AHAP), which was conducted between April 2011 to March 2016, were divided into two groups of 200 people, with chronic pain and without chronic pain. Then, the risk factors for cardiovascular diseases that are available in this plan such as physical activity level, body mass index, blood sugar levels, blood lipid profile status, Hypertension and smoking were examined.
Results: In the study of baseline variables in the elderly with and without pain with diabetes, it was found that women reported more pain with 54.4% than men with 45.6% that there is a significant difference between the two sexes (P=0.0001). Education level was also associated with having pain so that 67.8% of the elderly with having pain were illiterate and this relationship was significant (P=0.006). 82.5% of the elderly with higher physical activity had less pain than the elderly with less physical activity. This indicates the effect of physical activity in reducing pain and the observed relationship was significant (P=0.001). Triglyceride levels and history of underlying disease were lower in painless elderly (P=0.009 and P=0.002). Physical activity in the elderly without pain was higher than the elderly who had pain and this significant difference was reported (P=0.002).
Conclusion: The results of this study indicate a high prevalence of chronic pain in the elderly in Amirkola. In the elderly without chronic pain, there were lower triglyceride levels, more physical activity and fewer underlying diseases. Attention to chronic pain features among elderly to identify vulnerable groups and providing better care can increase the quality of life in this group.
Conclusion: The results of this study indicate a high prevalence of chronic pain in the elderly in Amirkola. In the elderly without chronic pain, there were lower triglyceride levels, more physical activity and fewer underlying diseases. Attention to chronic pain features among elderly to identify vulnerable groups and providing better care can increase the quality of life in this group.
Reza Sahraei, Fatemeh Eftekharian, Navid Kalani , Hajar Taghizadeh,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Pulmonary embolism (PE) occurs when a blood clot blocks a pulmonary artery or its branches. Complications after a hysterectomy can include bleeding, infection, thrombosis, damage to surrounding structures and bowel or bladder problems. This study reports a case of acute pulmonary embolism after hysterectomy surgery.
Case Presenetation: A 52-year-old woman who was a candidate for Total Abdominal Hysterectomy (TAH)+Bilateral Salpingo-Oophorectomy (BSO) due to vaginal bleeding for 3 weeks. During the surgery, the patient's hemodynamics were normal. The surgery lasted about one and a half hours. The patient's bleeding and urine output were normal. At the end of the surgery, the patient was released from muscle relaxation with neostigmine and atropine. The patient woke up and had stable hemodynamics during recovery and was transferred to the women's ward. The next day, the patient started walking in the ward when he suddenly had syncope. The cardiopulmonary resuscitation team immediately arrived at the patient's bedside. Due to the patient's poor breathing, the patient was quickly intubated and resuscitation with cardiac massage and appropriate medications was initiated. A cardiologist and radiologist were consulted urgently and they arrived at the patient's bedside. During cardiopulmonary resuscitation, echocardiography showed a clot in the proximal right and left pulmonary arteries, and an appropriate dose of Reteplase was administered with a diagnosis of extensive pulmonary embolism. Unfortunately, despite the medical team's efforts, the patient died.
Conclusion: Based on the results of the present study, patients who undergo hysterectomy with a history of previous bleeding are at risk of acute pulmonary embolism; therefore, these patients should be closely monitored after surgery and receive appropriate medications after surgery to prevent pulmonary embolism as ordered by the Physians.
Case Presenetation: A 52-year-old woman who was a candidate for Total Abdominal Hysterectomy (TAH)+Bilateral Salpingo-Oophorectomy (BSO) due to vaginal bleeding for 3 weeks. During the surgery, the patient's hemodynamics were normal. The surgery lasted about one and a half hours. The patient's bleeding and urine output were normal. At the end of the surgery, the patient was released from muscle relaxation with neostigmine and atropine. The patient woke up and had stable hemodynamics during recovery and was transferred to the women's ward. The next day, the patient started walking in the ward when he suddenly had syncope. The cardiopulmonary resuscitation team immediately arrived at the patient's bedside. Due to the patient's poor breathing, the patient was quickly intubated and resuscitation with cardiac massage and appropriate medications was initiated. A cardiologist and radiologist were consulted urgently and they arrived at the patient's bedside. During cardiopulmonary resuscitation, echocardiography showed a clot in the proximal right and left pulmonary arteries, and an appropriate dose of Reteplase was administered with a diagnosis of extensive pulmonary embolism. Unfortunately, despite the medical team's efforts, the patient died.
Conclusion: Based on the results of the present study, patients who undergo hysterectomy with a history of previous bleeding are at risk of acute pulmonary embolism; therefore, these patients should be closely monitored after surgery and receive appropriate medications after surgery to prevent pulmonary embolism as ordered by the Physians.
Seyed Mohammad Reza Hadavi , Maryam Zahedi, Navid Kalani, Naeimeh Ossadat Asmarian , Reza Sahraei ,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Shoulder labral repair surgery is associated with significant postoperative pain and restricted mobility. Inadequate pain management may lead to delayed rehabilitation, increased risk of chronic pain development, and higher opioid consumption. This study aimed to compare postoperative pain intensity during the first two weeks following shoulder labral repair between patients receiving interscalene block alone versus those receiving interscalene block combined with intravenous morphine.
Methods: In this randomized, double-blind, parallel-group clinical trial, 120 patients undergoing open rotator cuff repair at Chamran Hospital, Shiraz (June-December 2024) were allocated using balanced block randomization. Group 1 received preoperative interscalene block with 30 mL of 0.5% ropivacaine, while Group 2 received the same block plus intravenous morphine (1% mg/kg). Data analysis was performed using descriptive statistics such as mean and percentage and appropriate statistical tests such as Repeated measurement and Anova using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). The significance level was considered to be (P<0.05).
Results: Demographic characteristics (age, sex, weight, ASA class) showed no significant intergroup differences (p>0.05). Pain scores were significantly lower at all time points in the combination therapy group compared to the block-only group (p<0.05).
Conclusion: The results of the present study showed that the combination of interscalene block with morphine was significantly more effective in reducing pain after rotator cuff surgery than interscalene block alone. This finding suggests that the use of morphine as an additional analgesic can enhance the analgesic effects of interscalene block and provide better pain relief. The combination of these two methods may cause a positive interaction in pain relief and reduce the need for other medications, which consequently prevents the side effects caused by additional analgesic drugs, and patients who receive the combination of these two treatment methods experience greater comfort and better functional improvement. However, it is recommended that further studies focusing on the precise dosage and timing of drug combinations be conducted to obtain more precise results regarding the optimization of pain management after rotator cuff surgery. Also, examining the long-term effects of this treatment method could help to better understand its advantages and disadvantages.
Methods: In this randomized, double-blind, parallel-group clinical trial, 120 patients undergoing open rotator cuff repair at Chamran Hospital, Shiraz (June-December 2024) were allocated using balanced block randomization. Group 1 received preoperative interscalene block with 30 mL of 0.5% ropivacaine, while Group 2 received the same block plus intravenous morphine (1% mg/kg). Data analysis was performed using descriptive statistics such as mean and percentage and appropriate statistical tests such as Repeated measurement and Anova using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). The significance level was considered to be (P<0.05).
Results: Demographic characteristics (age, sex, weight, ASA class) showed no significant intergroup differences (p>0.05). Pain scores were significantly lower at all time points in the combination therapy group compared to the block-only group (p<0.05).
Conclusion: The results of the present study showed that the combination of interscalene block with morphine was significantly more effective in reducing pain after rotator cuff surgery than interscalene block alone. This finding suggests that the use of morphine as an additional analgesic can enhance the analgesic effects of interscalene block and provide better pain relief. The combination of these two methods may cause a positive interaction in pain relief and reduce the need for other medications, which consequently prevents the side effects caused by additional analgesic drugs, and patients who receive the combination of these two treatment methods experience greater comfort and better functional improvement. However, it is recommended that further studies focusing on the precise dosage and timing of drug combinations be conducted to obtain more precise results regarding the optimization of pain management after rotator cuff surgery. Also, examining the long-term effects of this treatment method could help to better understand its advantages and disadvantages.
Meisam Rezaei, Mehdi Asgari , Amir Ashrafi, Elham Farhadi ,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Gallstones are a common gastrointestinal complication following bariatric surgery, potentially resulting in cholecystitis, cholangitis, and pancreatitis. These complications arise due to biliary homeostasis alterations and rapid postoperative weight loss. Ursodeoxycholic acid (UDCA) has been shown to reduce biliary cholesterol saturation, thereby preventing gallstone formation. This study aimed to evaluate the effectiveness of Ursobil (UDCA) in preventing gallstones in patients undergoing bariatric surgery.
Methods: This case-control study was conducted study was conducted at Golestan Hospital in Ahvaz, Iran, from October 2022 to March 2023. Ethical approval was obtained from the institutional review board. Patients aged 18 to 65 years with a BMI between 35 and 65 kg/m² were eligible. Exclusion criteria included a history of gallstones, previous bariatric or cholecystectomy surgery, inflammatory bowel disease, recent UDCA use, or bleeding disorders. Participants were divided into two groups: the case group received 600 mg of UDCA daily for six months postoperatively, while the control group received no UDCA. Abdominal ultrasonography was performed before surgery and six months afterward. Outcome measures included gallstone formation, weight loss, need for cholecystectomy, and health-related quality of life, assessed using the WHOQOL-BREF questionnaire.
Results: The two groups were comparable in terms of age, gender distribution, and baseline BMI. The mean weight loss was similar between groups after six months. Gallstone formation occurred in 1.7% (n=1) of the UDCA group compared to 15% (n=9) of the control group (P=0.012). None of the patients in the intervention group required cholecystectomy, whereas 11.7% (n=7) in the control group underwent the procedure (P=0.011). Quality of life scores were higher in the UDCA group, though not statistically significant.
Conclusion: Oral administration of UDCA effectively and significantly reduces the risk of gallstone formation and the need for cholecystectomy in post-bariatric surgery patients. Routine use of UDCA during rapid weight loss phases may improve clinical outcomes and reduce gallstone-related complications. Preventive use of UDCA may effectively and significantly reduce gallstone-related morbidity in patients undergoing rapid weight loss.
Methods: This case-control study was conducted study was conducted at Golestan Hospital in Ahvaz, Iran, from October 2022 to March 2023. Ethical approval was obtained from the institutional review board. Patients aged 18 to 65 years with a BMI between 35 and 65 kg/m² were eligible. Exclusion criteria included a history of gallstones, previous bariatric or cholecystectomy surgery, inflammatory bowel disease, recent UDCA use, or bleeding disorders. Participants were divided into two groups: the case group received 600 mg of UDCA daily for six months postoperatively, while the control group received no UDCA. Abdominal ultrasonography was performed before surgery and six months afterward. Outcome measures included gallstone formation, weight loss, need for cholecystectomy, and health-related quality of life, assessed using the WHOQOL-BREF questionnaire.
Results: The two groups were comparable in terms of age, gender distribution, and baseline BMI. The mean weight loss was similar between groups after six months. Gallstone formation occurred in 1.7% (n=1) of the UDCA group compared to 15% (n=9) of the control group (P=0.012). None of the patients in the intervention group required cholecystectomy, whereas 11.7% (n=7) in the control group underwent the procedure (P=0.011). Quality of life scores were higher in the UDCA group, though not statistically significant.
Conclusion: Oral administration of UDCA effectively and significantly reduces the risk of gallstone formation and the need for cholecystectomy in post-bariatric surgery patients. Routine use of UDCA during rapid weight loss phases may improve clinical outcomes and reduce gallstone-related complications. Preventive use of UDCA may effectively and significantly reduce gallstone-related morbidity in patients undergoing rapid weight loss.
Nazila Farnosh, Abdolreza Roueintan, Seyd Ebrahim Hejazian, Khadijeh Ezoji , Fatemeh Abdullah Gorji , Sadrollah Motamed,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Introduction & Objective: Reductive mammoplasty, which is performed for medical or cosmetic reasons, can be carried out with different techniques. In this study, we compare the results obtained from vertical mammoplasty surgery with reverse T method and purse method in patients.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Mohammad Haji Aghajani , Mohammad Parsa Mahjoob , Reza Miri , Roxana Sadeghi , Fatemeh Omidi , Maryam Roozitalab,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Changes in the heart during pregnancy, especially changes in the left side of the heart, have been evaluated in various studies. However, alterations in the right ventricle have not been well studied. Thus, the present study aimed to investigate the changes in echocardiographic indices of the right ventricle in the second trimester of pregnancy.
Methods: In this cross-sectional study, 30 pregnant women, as case group, in their second trimester who were referred to the perinatology clinic of Imam Hossein Hospital, Tehran, were examined by trans-thoracic echocardiography From April 4, 2023, to April 10, 2024. The results of the control group were compared with 30 age-matched non-pregnant and healthy women, as the control group. Exclusion criteria included multiple gestation, maternal age > 40, underlying cardiovascular disease, and significant obstetric or fetal complications. Hemodynamics and demographic data including age, height, weight, and body mass index were recorded and compared. Also, the anatomical and functional indices of the right ventricle were evaluated and compared.
Results: 60 participants were enrolled in this study. The two investigated groups were similar in terms of age, but the weight, height, and BMI were significantly different in the two groups; Such that weight and body mass index were significantly higher in pregnant women and height in non-pregnant women (p<0.05). Comparison of echocardiographic indices showed that tricuspid regurgitation gradient (TRG) and fractional area change (FAC) were significantly different in the two groups (in pregnant women, TRG index was higher and FAC index was lower (p<0.05)). Right atrium area, RV length, base of RV, mid of RV, and Tricuspid annular plane systolic excursion showed no significant differences between case and control group.
Conclusion: FAC and TRG indices were significantly different between pregnant women and the control group. Paying attention to the changes in the normal values of these variables in pregnant women can be useful in improving the diagnosis of disorders and preventing the occurrence of cardiac events during pregnancy.
Methods: In this cross-sectional study, 30 pregnant women, as case group, in their second trimester who were referred to the perinatology clinic of Imam Hossein Hospital, Tehran, were examined by trans-thoracic echocardiography From April 4, 2023, to April 10, 2024. The results of the control group were compared with 30 age-matched non-pregnant and healthy women, as the control group. Exclusion criteria included multiple gestation, maternal age > 40, underlying cardiovascular disease, and significant obstetric or fetal complications. Hemodynamics and demographic data including age, height, weight, and body mass index were recorded and compared. Also, the anatomical and functional indices of the right ventricle were evaluated and compared.
Results: 60 participants were enrolled in this study. The two investigated groups were similar in terms of age, but the weight, height, and BMI were significantly different in the two groups; Such that weight and body mass index were significantly higher in pregnant women and height in non-pregnant women (p<0.05). Comparison of echocardiographic indices showed that tricuspid regurgitation gradient (TRG) and fractional area change (FAC) were significantly different in the two groups (in pregnant women, TRG index was higher and FAC index was lower (p<0.05)). Right atrium area, RV length, base of RV, mid of RV, and Tricuspid annular plane systolic excursion showed no significant differences between case and control group.
Conclusion: FAC and TRG indices were significantly different between pregnant women and the control group. Paying attention to the changes in the normal values of these variables in pregnant women can be useful in improving the diagnosis of disorders and preventing the occurrence of cardiac events during pregnancy.
Reza Ghalehtaki, Mahdieh Razmkhah, Ali Kazemian, Mostafa Farzin, Samaneh Salarvand, Kasra Kolahdouzan, Ehsan Saraee,
Volume 82, Issue 10 (January 2025)
Volume 82, Issue 10 (January 2025)
Abstract
Background: Gliomas are the most common primary brain tumors in adults, with low-grade gliomas making up 15% of cases. These slow-growing tumors often occur in young adults. Radiotherapy is one of the treatment options. New radiotherapy techniques like IMRT may reduce complications by sparing normal tissue. The study aims to determine which tumors benefit most from IMRT based on tumor location and size.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.
Mojtaba Ghaedi, Mojtaba Sohrabpour , Gholamreza Motazedian, Navid Kalani , Reza Sahraei , Mohammad Sadegh Sanie Jahromi,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: Hemodynamic instability is a significant perioperative complication that can threaten surgical outcome through various mechanisms: exacerbating intraoperative bleeding, compromising visibility of the surgical field, and elevating immediate and delayed postoperative complication risks. In septorhinoplasty, a procedure with challenging hemodynamic control due to the nasal anatomy's complexity of vessels, these effects are particularly relevant. This study examines the modulation of important hemodynamic parameters (SBP, DBP, MAP, HR, and SpO₂) by intravenous dexmedetomidine while ensuring cardiovascular stability and dose-dependent effects and optimal timing of administration at different phases of surgery. The findings aim to offer evidence-based recommendations for hemodynamic control in rhinoplasty surgery, which can reduce rates of complications and improve recovery profiles.
Methods: A randomized, double-blind clinical trial was conducted involving 50 eligible patients (aged 18-45 years) scheduled for septorhinoplasty at Ostad Motahari Hospital, Jahrom, during May-September 2023. Participants were randomly allocated to either a dexmedetomidine or control group. Collected data encompassed demographic characteristics (age, gender, BMI=Body mass index) and hemodynamic parameters (systolic/diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation). The data were analyzed using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean, standard deviation, percentage, count, and frequency) and inferential statistical tests (Mann-Whitney U test and independent t-test) were applied. A significance level of P < 0.05 was considered for all statistical analyses.
Results: The dexmedetomidine group demonstrated statistically significant variations in hemodynamic parameters (SBP, DBP, MAP, HR) from pre-induction through post-recovery phases (p<0.001). Significant between-group differences in blood pressure metrics were observed at all measured intervals following induction (1, 5, 15, 30, 60 minutes) and during recovery periods (p<0.05), with the dexmedetomidine group consistently showing lower values. Comparison between the intervention and control groups revealed no statistically significant differences in heart rate and oxygen saturation (O₂ sat) levels (except during recovery time).
Conclusion: The results of this study indicate that dexmedetomidine administration had a significant effect on reducing systolic blood pressure, diastolic blood pressure, and MAP compared to the control group, with this reduction being evident at all measured time points from post-induction to post-recovery. These findings suggest that dexmedetomidine can be effectively used as a blood pressure-lowering agent during surgery without significantly affecting heart rate or the patient's blood oxygen levels.
Methods: A randomized, double-blind clinical trial was conducted involving 50 eligible patients (aged 18-45 years) scheduled for septorhinoplasty at Ostad Motahari Hospital, Jahrom, during May-September 2023. Participants were randomly allocated to either a dexmedetomidine or control group. Collected data encompassed demographic characteristics (age, gender, BMI=Body mass index) and hemodynamic parameters (systolic/diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation). The data were analyzed using SPSS software, version 21 (SPSS Inc., Chicago, IL, USA). Descriptive statistics (mean, standard deviation, percentage, count, and frequency) and inferential statistical tests (Mann-Whitney U test and independent t-test) were applied. A significance level of P < 0.05 was considered for all statistical analyses.
Results: The dexmedetomidine group demonstrated statistically significant variations in hemodynamic parameters (SBP, DBP, MAP, HR) from pre-induction through post-recovery phases (p<0.001). Significant between-group differences in blood pressure metrics were observed at all measured intervals following induction (1, 5, 15, 30, 60 minutes) and during recovery periods (p<0.05), with the dexmedetomidine group consistently showing lower values. Comparison between the intervention and control groups revealed no statistically significant differences in heart rate and oxygen saturation (O₂ sat) levels (except during recovery time).
Conclusion: The results of this study indicate that dexmedetomidine administration had a significant effect on reducing systolic blood pressure, diastolic blood pressure, and MAP compared to the control group, with this reduction being evident at all measured time points from post-induction to post-recovery. These findings suggest that dexmedetomidine can be effectively used as a blood pressure-lowering agent during surgery without significantly affecting heart rate or the patient's blood oxygen levels.
Mahmoud Khodabandeh, Mohammadreza Abdolsalehi , Mojtaba Gorji,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: Congenital tuberculosis is a rare but serious disease in neonates and infants that often presents with nonspecific respiratory symptoms. Pulmonary involvement in tuberculosis can have similar manifestations to bacterial pneumonia with common microorganisms. In case of failure to respond to treatment in pneumonia, tuberculosis infection should be considered. The aim of this study was to present a two-month-old infant suspected of bacterial pneumonia, who was ultimately diagnosed with tuberculosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress. Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress. Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.
Reza Baghbanian, Shirin Azizidoost , Kamran Mahmoodi , Mahbobeh Rashidi , Golshan Mirmomeni, Sina Ganji Nataj ,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Background: Coagulopathy is one of the most common causes of mortality in the intensive care unit. This study was designed and implemented to investigate the relationship between acidosis and coagulation disorders in patients undergoing laparotomy in the intensive care unit.
Methods: This retrospective study reviewed the files of 121 patients undergoing laparotomy in the intensive care unit of Imam Khomeini Hospital of Ahvaz during 2024. Demographic and clinical records and blood test results were extracted to measure parameters related to acidosis and coagulation tests. Then, the rates of coagulopathy, thrombocytopenia, acidosis, and patient outcome were calculated. The data obtained were analyzed using SPSS version 27 software.
Results: Most patients studied were male (72 (59.5%)) with a mean age of 54.18±21.1 years and a mean length of stay of 6.78±5.87 days. Hypertension (34 (28.1%)) was the most important comorbidity and peritonitis (54 (44.6%)) was the most important cause of hospitalization. The incidence rates of coagulopathy, thrombocytopenia, and acidosis were reported to be 29 (24%), 27 (22.3%) and 115 (95%), respectively. A total of 44 (36.5%) patients died during the study period. Although the rates of coagulopathy and thrombocytopenia were higher in patients with acidosis, these differences were not significant (P<0.05). The mortality rates among those without thrombocytopenia, mild, moderate, and severe thrombocytopenia were reported as 27 (28.7%), 4 (33.3%), 9 (81.1%), and 4 (100%), respectively, showing a significant difference (P=0.001). The mean pH in deceased patients was significantly lower than in others (0.13±7.19 vs. 0.88±7.25; P=0.005). The mortality rate in patients with coagulopathy was also significantly higher than in others (20 (69%) vs.24 (26.4%); P=0.000).
Conclusion: The incidence of acidosis and coagulation disorders in patients undergoing laparotomy and admitted to the intensive care unit is significant and is linked to poorer outcomes for these patients. However, acidosis was not found to be an independent risk factor for coagulation disorders in this population. Further research is necessary to confirm or refute these findings.
Methods: This retrospective study reviewed the files of 121 patients undergoing laparotomy in the intensive care unit of Imam Khomeini Hospital of Ahvaz during 2024. Demographic and clinical records and blood test results were extracted to measure parameters related to acidosis and coagulation tests. Then, the rates of coagulopathy, thrombocytopenia, acidosis, and patient outcome were calculated. The data obtained were analyzed using SPSS version 27 software.
Results: Most patients studied were male (72 (59.5%)) with a mean age of 54.18±21.1 years and a mean length of stay of 6.78±5.87 days. Hypertension (34 (28.1%)) was the most important comorbidity and peritonitis (54 (44.6%)) was the most important cause of hospitalization. The incidence rates of coagulopathy, thrombocytopenia, and acidosis were reported to be 29 (24%), 27 (22.3%) and 115 (95%), respectively. A total of 44 (36.5%) patients died during the study period. Although the rates of coagulopathy and thrombocytopenia were higher in patients with acidosis, these differences were not significant (P<0.05). The mortality rates among those without thrombocytopenia, mild, moderate, and severe thrombocytopenia were reported as 27 (28.7%), 4 (33.3%), 9 (81.1%), and 4 (100%), respectively, showing a significant difference (P=0.001). The mean pH in deceased patients was significantly lower than in others (0.13±7.19 vs. 0.88±7.25; P=0.005). The mortality rate in patients with coagulopathy was also significantly higher than in others (20 (69%) vs.24 (26.4%); P=0.000).
Conclusion: The incidence of acidosis and coagulation disorders in patients undergoing laparotomy and admitted to the intensive care unit is significant and is linked to poorer outcomes for these patients. However, acidosis was not found to be an independent risk factor for coagulation disorders in this population. Further research is necessary to confirm or refute these findings.
Reza Tavakolizadeh , Abbas Alibakhshi, Sevil Abdolmohamadian ,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Background: Primary hyperparathyroidism is a rare but significant endocrine disorder in pediatric patients; although uncommon, parathyroid adenomas are the most frequently identified cause of primary hyperparathyroidism in this population. Diagnosis and treatment of primary hyperparathyroidism in children, especially in cases caused by parathyroid adenoma, demand careful assessment and require a coordinated and multidisciplinary approach involving endocrinologists, pediatric surgeons, radiologists, and other specialists. Early diagnosis is often delayed due to the rarity of the disease and the nonspecific nature of presenting symptoms.
Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up.
Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications.
Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up.
Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications.
Banafsheh Mashak, Reza Payami, Fatemeh Javaheri, Alireza Babajani, Mohammad Hossein Shakeri,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Sahar Karimpour Reyhan , Mahsa Abbaszadeh, Alireza Esteghamati ,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
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Hyperthyroidism is one of the most important endocrine disorders, characterized by increased activity of the thyroid gland and excessive production of thyroid hormones. These hormones play a key role in regulating the body’s metabolism; therefore, their excess leads to a wide range of clinical manifestations. The most common symptoms include anxiety, restlessness, weight loss despite normal or even increased appetite, palpitations, excessive sweating, fine tremors of the hands, sleep disturbances, and heat intolerance. Some patients may also experience mood changes such as irritability and nervousness. On physical examination, rapid tendon reflexes, tachycardia, moist and thin skin, and in many cases the presence of goiter (thyroid enlargement) may be observed. The condition is more common in women than men and is most frequently seen between the ages of 20 and 50 years. Once hyperthyroidism is confirmed, the underlying cause of thyrotoxicosis must be determined. The most common cause is Graves’ disease, an autoimmune disorder that leads to diffuse thyroid enlargement and overproduction of hormones. Toxic multinodular goiter and solitary toxic adenoma are other important causes. For definitive diagnosis, blood tests measuring TSH, T3, and T4 are essential. In hyperthyroidism, TSH is typically suppressed while T3 and T4 are elevated. In addition to laboratory testing, thyroid ultrasound can help evaluate the structure of the gland, and a thyroid radioactive iodine uptake scan can further differentiate between different causes and determine disease activity. Several treatment options are available for managing hyperthyroidism. Antithyroid drugs such as methimazole or propylthiouracil inhibit the synthesis of thyroid hormones. Beta-blockers are often prescribed to control cardiovascular symptoms and reduce palpitations. Radioactive iodine therapy is a common and effective method that destroys the overactive thyroid tissue. In rare cases, or when other treatments fail, thyroidectomy (surgical removal of part or all of the thyroid gland) may be required. Overall, hyperthyroidism is a manageable condition, but it requires accurate diagnosis, careful selection of therapy, and close follow-up with a specialist. Patient cooperation and adherence to treatment play a crucial role in controlling symptoms and preventing long-term complications. This review will focus on describing the symptoms, causes, diagnostic methods, and treatment options.
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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.
Reza Sahraei, Anahita Haghjoo , Hasan Zabetian, Mansour Deylami, Rahil Haghjoo, Fatemeh Khadempir, Navid Kalani ,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Spinal anesthesia is a common method for elective cesarean sections; however, complications such as shivering and nausea may affect postoperative recovery quality. Bupivacaine is a standard drug used in this procedure, but its combination with opioids like sufentanil may have beneficial effects in reducing these complications. This study aimed to compare the incidence of shivering and nausea in women undergoing elective cesarean section who received either bupivacaine alone or a bupivacaine-sufentanil combination.
Methods: The present study was a double-blind randomized clinical trial conducted over a 6-month period from April 2021 to October 2021 on 30 patients undergoing elective cesarean section with spinal anesthesia at Motahari Hospital in Jahrom city. Patients were randomly assigned using a random number table into two groups: bupivacaine alone and bupivacaine-sufentanil combination. The frequency of nausea, vomiting, and shivering was recorded at different time points: before spinal anesthesia, after spinal anesthesia, 3 minutes before delivery, immediately after delivery, at 15, 30, and 45 minutes, upon recovery room admission, and upon discharge from recovery. The data analysis was performed using descriptive statistics indicators (frequency, percentage, mean, and standard deviation) and inferential statistical tests (t-test, Mann-Whitney, chi-square and Friedman) using SPSS software version 21. A significance level of p < 0.05 was considered.
Results: In the bupivacaine-sufentanil group, the highest frequency of shivering occurred at 30 minutes post-spinal anesthesia (20%) and upon recovery room admission (26.7%). In the bupivacaine-alone group, the highest frequency was observed upon recovery room admission (33.3%) and at discharge from recovery (26.7%). The highest nausea frequency was 33.3% in the bupivacaine-sufentanil group and 40% in the bupivacaine group at 3 minutes before delivery. However, no statistically significant difference was found between the two groups at different time points.
Conclusion: The present study showed that adding low-dose sufentanil to bupivacaine in spinal anesthesia protocols, while potentially having minor clinical effects on certain complications, did not lead to a significant difference in the incidence of shivering and nausea. Therefore, for more precise clinical decision-making regarding drug combinations in regional anesthesia, further studies with larger sample sizes and different drug dosages are recommended.
Methods: The present study was a double-blind randomized clinical trial conducted over a 6-month period from April 2021 to October 2021 on 30 patients undergoing elective cesarean section with spinal anesthesia at Motahari Hospital in Jahrom city. Patients were randomly assigned using a random number table into two groups: bupivacaine alone and bupivacaine-sufentanil combination. The frequency of nausea, vomiting, and shivering was recorded at different time points: before spinal anesthesia, after spinal anesthesia, 3 minutes before delivery, immediately after delivery, at 15, 30, and 45 minutes, upon recovery room admission, and upon discharge from recovery. The data analysis was performed using descriptive statistics indicators (frequency, percentage, mean, and standard deviation) and inferential statistical tests (t-test, Mann-Whitney, chi-square and Friedman) using SPSS software version 21. A significance level of p < 0.05 was considered.
Results: In the bupivacaine-sufentanil group, the highest frequency of shivering occurred at 30 minutes post-spinal anesthesia (20%) and upon recovery room admission (26.7%). In the bupivacaine-alone group, the highest frequency was observed upon recovery room admission (33.3%) and at discharge from recovery (26.7%). The highest nausea frequency was 33.3% in the bupivacaine-sufentanil group and 40% in the bupivacaine group at 3 minutes before delivery. However, no statistically significant difference was found between the two groups at different time points.
Conclusion: The present study showed that adding low-dose sufentanil to bupivacaine in spinal anesthesia protocols, while potentially having minor clinical effects on certain complications, did not lead to a significant difference in the incidence of shivering and nausea. Therefore, for more precise clinical decision-making regarding drug combinations in regional anesthesia, further studies with larger sample sizes and different drug dosages are recommended.
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.
Niloofar Shashaani, Vadood Javadi Parvaneh, Reza Shiari , Khosro Rahmani,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Immunoglobulin A (IgA) vasculitis or Henoch–Schönlein Purpura (HSP) is a systemic vasculitis of small vessels associated with IgA deposition. It is the most common Vasculitis in childhood and presents with a wide spectrum of clinical manifestations, most commonly palpable purpura, renal involvement, and arthritis. However, its manifestations are not limited to these organs and may also involve other systems of the body. The coexistence of Henoch–Schönlein purpura with other autoimmune and autoinflammatory diseases has been reported. In particular, its association with Familial Mediterranean Fever (FMF), Inflammatory Bowel Disease (IBD), and Behcet Disease (BD) has been observed in different studies. Patients with Familial Mediterranean Fever who develop Henoch–Schönlein purpura usually exhibit more severe and prolonged inflammatory symptoms. Therefore, reporting the co-occurrence of these diseases can provide a better understanding of the spectrum of clinical manifestations and diagnostic-therapeutic challenges.
Case Presentation: This case describes a 7-year-old girl with initial manifestations of Henoch–Schönlein purpura, who, due to severe gastrointestinal symptoms, underwent further evaluations. In the performed investigations, the coexistence of Familial Mediterranean Fever and Inflammatory Bowel Disease was diagnosed, and incomplete Behcet Disease was also considered. The patient was placed under appropriate medical treatment. Finally, the patient was controlled with appropriate medical treatment.
Conclusion: This report shows that in children with Henoch–Schönlein purpura, especially in severe and recurrent cases, the possibility of associated autoimmune and autoinflammatory diseases such as Familial Mediterranean Fever, Inflammatory Bowel Disease, and Behcet Disease should be considered. These associated diseases can play a key role in the course of appropriate treatment.
Case Presentation: This case describes a 7-year-old girl with initial manifestations of Henoch–Schönlein purpura, who, due to severe gastrointestinal symptoms, underwent further evaluations. In the performed investigations, the coexistence of Familial Mediterranean Fever and Inflammatory Bowel Disease was diagnosed, and incomplete Behcet Disease was also considered. The patient was placed under appropriate medical treatment. Finally, the patient was controlled with appropriate medical treatment.
Conclusion: This report shows that in children with Henoch–Schönlein purpura, especially in severe and recurrent cases, the possibility of associated autoimmune and autoinflammatory diseases such as Familial Mediterranean Fever, Inflammatory Bowel Disease, and Behcet Disease should be considered. These associated diseases can play a key role in the course of appropriate treatment.
Pourya Adibi , Somayeh Mehrpour, Reza Sahraei , Samira Zanbagh, Majid Vatankhah, Mehrdad Malekshoar, Mansour Deylami, Bibi Mona Razavi, Tayyebeh Zarei ,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Today, cesarean section is one of the most common surgeries performed in different countries. Shivering after surgery is one of the common complications of spinal anesthesia in cesarean surgery. Many drugs have been investigated to prevent or reduce shivering, but the ideal drug has not yet been finally approved. The purpose of this study is to investigate the effect of dexmedetomidine in preventing shivering after cesarean section surgery under spinal anesthesia in the form of a systematic review.
Methods: In this systematic review, the Persian keywords "dexmedetomidine", "spinal anesthesia", "caesarean" and dexmedetomidine" and the English keywords dexmedetomidine", "Caesarean section", "Spinal Anesthesia" "Dexmedetomidine and "C-Section" in databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinical Trials.gov and Scopus, SID, Magiran, Medlib and Google Scholar search engine, without time limit Done. Data extraction was performed independently by two authors. Study name, year of study, country, study groups, and incidence of shivering were extracted from the studies. Our primary outcome was the severity of shivering in patients. All disagreements in data extraction were resolved through discussion between the reviewers or, if not possible, by a third reviewer. Data were entered into an Excel file.
Results: In this systematic review, 19 studies were examined. The total number of patients included in the study was 2001 patients. The study range was from 2016 to 2022. The age group of most patients was between 18-45. The drugs studied in combination with dexmedetomidine in the studies included: pethidine, dexamethasone, nalbuphine, ondansetron, and morphine. The most studied drugs were pethidine and dexamethasone in three studies. In 13 studies, dexmedetomidine was more effective in controlling shivering than the other groups studied. Also, in five studies, dexmedetomidine, along with three drugs: pethidine, dexamethasone, and ondansetron, had similar effects in controlling shivering in patients. In one study, dexmedetomidine produced less anti-tremor effects than nalbuphine.
Conclusion: In the review of the studies, the results indicated that dexmedomedin is effective in preventing post-operative shivering in patients undergoing caesarean section. Therefore, it seems that the use of dexmedetomidine to prevent shivering after surgery is useful in these patients.
Methods: In this systematic review, the Persian keywords "dexmedetomidine", "spinal anesthesia", "caesarean" and dexmedetomidine" and the English keywords dexmedetomidine", "Caesarean section", "Spinal Anesthesia" "Dexmedetomidine and "C-Section" in databases PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Clinical Trials.gov and Scopus, SID, Magiran, Medlib and Google Scholar search engine, without time limit Done. Data extraction was performed independently by two authors. Study name, year of study, country, study groups, and incidence of shivering were extracted from the studies. Our primary outcome was the severity of shivering in patients. All disagreements in data extraction were resolved through discussion between the reviewers or, if not possible, by a third reviewer. Data were entered into an Excel file.
Results: In this systematic review, 19 studies were examined. The total number of patients included in the study was 2001 patients. The study range was from 2016 to 2022. The age group of most patients was between 18-45. The drugs studied in combination with dexmedetomidine in the studies included: pethidine, dexamethasone, nalbuphine, ondansetron, and morphine. The most studied drugs were pethidine and dexamethasone in three studies. In 13 studies, dexmedetomidine was more effective in controlling shivering than the other groups studied. Also, in five studies, dexmedetomidine, along with three drugs: pethidine, dexamethasone, and ondansetron, had similar effects in controlling shivering in patients. In one study, dexmedetomidine produced less anti-tremor effects than nalbuphine.
Conclusion: In the review of the studies, the results indicated that dexmedomedin is effective in preventing post-operative shivering in patients undergoing caesarean section. Therefore, it seems that the use of dexmedetomidine to prevent shivering after surgery is useful in these patients.
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