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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.
Mahasti Emami Hamzehkolaee , Amirhesam Alirezaei, Marjan Moudi, Sepide Veysi , Masoumeh Asgharpour,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Hydrochlorothiazide (HCTZ) is widely used for hypertension, but electrolyte disorders-especially hyponatremia remain major safety concerns. Limited regional data on its prevalence, timing, and determinants may undermine patient safety. This retrospective study evaluated risk factors for HCTZ-associated hyponatremia in hospitalized adults with hypertension and identified predictors of its severity.
Methods: A retrospective analysis was conducted on 217 patients hospitalized at Ayatollah Rouhani Hospital in Babol (2019-2021). Eligible participants were aged ≥18 years and had received HCTZ for at least seven consecutive days. Patients with baseline hyponatremia, concurrent use of drugs independently causing hyponatremia, or incomplete laboratory data were excluded. Demographic, clinical, medication, and biochemical variables were abstracted from medical records. Hyponatremia was defined as serum sodium <135 mmol/L and categorized as mild (130-134), moderate (125-129), or severe (<125). Predictors of occurrence were estimated with multivariable logistic regression; onset timing was assessed using a Cox proportional hazards model; and severity determinants were examined through multinomial logistic regression. Statistical significance was set at P<0.05.
Results: Hyponatremia occurred in 32.7% (71.217) of patients, most frequently within the early weeks of HCTZ treatment. Among affected individuals, 49.3% had mild, 31.0% moderate, and 19.7% severe hyponatremia. Adjusted analyses showed that older age, concurrent nonsteroidal anti-inflammatory drug (NSAID) use, shorter HCTZ duration, and lower serum potassium and uric acid independently increased hyponatremia risk, while HCTZ dose and sex were nonsignificant. In the Cox model, older age and lower potassium and uric acid predicted earlier onset. Patients with hyponatremia more often presented with weakness, headache, altered consciousness, and seizures. Baseline glucose, creatinine, and most comorbidities were not independently associated with risk or timing.
Conclusion: HCTZ-related hyponatremia was common and typically emerged soon after initiation. Advanced age, NSAID co-administration, brief exposure, and reduced potassium and uric acid were practical, readily measurable markers associated with both occurrence and earlier onset. Routine early and repeated electrolyte monitoring particularly in older adults and patients receiving NSAIDs- together with patient education on warning symptoms is recommended. These findings highlight key predictors for targeted surveillance and prevention in similar clinical contexts.
Methods: A retrospective analysis was conducted on 217 patients hospitalized at Ayatollah Rouhani Hospital in Babol (2019-2021). Eligible participants were aged ≥18 years and had received HCTZ for at least seven consecutive days. Patients with baseline hyponatremia, concurrent use of drugs independently causing hyponatremia, or incomplete laboratory data were excluded. Demographic, clinical, medication, and biochemical variables were abstracted from medical records. Hyponatremia was defined as serum sodium <135 mmol/L and categorized as mild (130-134), moderate (125-129), or severe (<125). Predictors of occurrence were estimated with multivariable logistic regression; onset timing was assessed using a Cox proportional hazards model; and severity determinants were examined through multinomial logistic regression. Statistical significance was set at P<0.05.
Results: Hyponatremia occurred in 32.7% (71.217) of patients, most frequently within the early weeks of HCTZ treatment. Among affected individuals, 49.3% had mild, 31.0% moderate, and 19.7% severe hyponatremia. Adjusted analyses showed that older age, concurrent nonsteroidal anti-inflammatory drug (NSAID) use, shorter HCTZ duration, and lower serum potassium and uric acid independently increased hyponatremia risk, while HCTZ dose and sex were nonsignificant. In the Cox model, older age and lower potassium and uric acid predicted earlier onset. Patients with hyponatremia more often presented with weakness, headache, altered consciousness, and seizures. Baseline glucose, creatinine, and most comorbidities were not independently associated with risk or timing.
Conclusion: HCTZ-related hyponatremia was common and typically emerged soon after initiation. Advanced age, NSAID co-administration, brief exposure, and reduced potassium and uric acid were practical, readily measurable markers associated with both occurrence and earlier onset. Routine early and repeated electrolyte monitoring particularly in older adults and patients receiving NSAIDs- together with patient education on warning symptoms is recommended. These findings highlight key predictors for targeted surveillance and prevention in similar clinical contexts.
Hossein Akhavan, Fatemeh Rezaei,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: An Electrocardiogram is a non-invasive method for receiving heart signals. Despite advances in imaging methods, the electrocardiogram still plays an important role remains a vital tool in the diagnosis of heart diseases. Analysis of electrocardiogram signals plays an important role in the early detection of heart diseases such as arrhythmias and heart attacks. Today, with the advancement of science and technology, computer methods have received more and more attention from doctors. In this study, machine learning methods were used to classify normal and abnormal heartbeats.
Methods: The data under study were extracted from a dataset called Heartbeat published on the Kaggle website. This dataset includes samples of audio ECG signals that are divided into healthy and unhealthy categories. First, the data were preprocessed and normalized to prepare them for input into the model. Then, temporal and frequency features were extracted from the signals. Next, a hybrid model consisting of one-dimensional convolutional layers was designed and trained. Also, by using the early stopping method, overfitting was prevented and the stability of the model was improved.
Results: In this study, it was shown that by using deep learning, especially using CNN and 1D Conv, an accuracy of 0.99% and a loss of 0.0350 for test data in detecting normal and abnormal heartbeats can be achieved. This model has the ability to analyze complex structures and temporal dynamics of ECG signals and is able to detect patterns related to cardiac disorders.
Conclusion: Today, the electrocardiogram has received more attention than ever before. Appropriate selection of the model, data standardization, and a qualitative range of data are among the factors of high accuracy in this study. This study can be an effective step in the development of intelligent systems for diagnosing cardiac disorders and can be used in medical applications, especially in the field of continuous patient monitoring.
Saeed Kafrashi, Hamidreza Norouzi, Malihe Safari,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: In this study, Botox method is compared with sleeve gastrectomy as one of the endoscopic methods in the treatment of obesity for patients who are not effective in lifestyle and drug modification methods and do not have the interest or necessary conditions for bariatric surgery.
Methods: This Cross-sectional study was conducted in eligible patients who were outpatients at the gastroenterology clinics of Amir al-Momenin Hospital, Arak, in June 2014 for one year in the gastroenterology clinic after obtaining informed consent, demographic information, and anthropometric measurements. After 12 weeks, patients in both groups were visited again. In patients in group A (Botox group), endoscopy was performed by an experienced gastroenterologist under sedation after a 10-hour fast, and in patients in group B (sleeve gastrectomy) under general anesthesia, a partial and longitudinal gastrectomy was performed. The BAROS questionnaire was used to assess the quality of life of patients.
Results: The mean age of the subjects in the endoscopic botulinum neurotoxin group was 30.88±11.89 years and the sleeve gastrectomy group was 29.88±11.06 years. In this study, 12 subjects (24.0%) were male and 38 subjects (76%) were female. There was a significant difference in the mean body mass index and weight at four measurements in the two study groups (endoscopic botulinum neurotoxin and sleeve gastrectomy). There was no statistically significant difference in the mean blood pressure, laboratory results, and mean quality of life in the study groups.
Conclusion: Endoscopic botulinum injection in the stomach is an effective and safe method for short-term weight loss, but its long-term effect on weight and the occurrence of complications or metabolic effects requires long-term follow-up.
Methods: This Cross-sectional study was conducted in eligible patients who were outpatients at the gastroenterology clinics of Amir al-Momenin Hospital, Arak, in June 2014 for one year in the gastroenterology clinic after obtaining informed consent, demographic information, and anthropometric measurements. After 12 weeks, patients in both groups were visited again. In patients in group A (Botox group), endoscopy was performed by an experienced gastroenterologist under sedation after a 10-hour fast, and in patients in group B (sleeve gastrectomy) under general anesthesia, a partial and longitudinal gastrectomy was performed. The BAROS questionnaire was used to assess the quality of life of patients.
Results: The mean age of the subjects in the endoscopic botulinum neurotoxin group was 30.88±11.89 years and the sleeve gastrectomy group was 29.88±11.06 years. In this study, 12 subjects (24.0%) were male and 38 subjects (76%) were female. There was a significant difference in the mean body mass index and weight at four measurements in the two study groups (endoscopic botulinum neurotoxin and sleeve gastrectomy). There was no statistically significant difference in the mean blood pressure, laboratory results, and mean quality of life in the study groups.
Conclusion: Endoscopic botulinum injection in the stomach is an effective and safe method for short-term weight loss, but its long-term effect on weight and the occurrence of complications or metabolic effects requires long-term follow-up.
Masoome Pourmokhtari , Shahram Shafa, Nasim Nabizadeh, Reza Sahraei, Hasan Zabetian, Mansour Deylami, Navid Kalani,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Spinal anesthesia is an effective method for providing analgesia in surgery and a safe alternative to general analgesia; But despite its benefits, in many cases it is not free of side effects, including unwanted cardiovascular events such as hypotension and bradycardia. Ondansetron effectively reduces the incidence of nausea, vomiting, and bradycardia associated with spinal anesthesia Thus, the present study aimed to assess intravenous ondansetron's efficacy in preventing post-spinal hypotension among patients scheduled for lower extremity orthopedic surgery at Peymanieh Hospital in Jahrom, Iran.
Methods: This randomized double-blind clinical trial included 60 patients undergoing lower limb orthopedic surgery at Peymanieh Hospital, Jahrom, Iran, from March 2021 to February 2022. Patients were randomly allocated into two groups: the intervention group (receiving 8 mg intravenous ondansetron) and the control group (receiving distilled water). Systolic and diastolic blood pressure (SBP, DBP) and heart rate (HR) were measured before pre-spinal anesthesia, after spinal anesthesia and then every two minutes for the first ten minutes and at 15, 30, 45, 60 and 90 minutes after surgery. After spinal anesthesia, the patient was asked about pruritus every 10 minutes. Nausea and vomiting during surgery in case of incidence, recording and nausea after spinal anesthesia, the patient was asked every 10 minutes.
Results: The chi-square test indicated no significant differences between the study groups regarding age and sex distribution(P>0.05). Time before anesthesia, immediately after anesthesia, 10 minutes, 15 minutes, 30 minutes, 45 minutes, 60 minutes, 75 minutes, and 90 minutes after anesthesia, significant difference between ondansetron and placebo groups from There was no mean SBP and DBP and HR (P <0.05). No significant difference between ondansetron and placebo groups in the incidence of pruritus and nausea and vomiting at different times (p <0.05).
Conclusion: Dose of 8 mg of ondansetron in lower limb orthopedic surgery has no significant effect on hemodynamic symptoms as well as the prevention of postoperative nausea, vomiting and pruritus in these patients. Therefore, to achieve more results regarding the transient effect of this drug, it can be compared with other drugs in the class of HT3-5 receptor antagonists.
Nooshin Shirzad, Fateme Ziamanesh, Seyedahmad Seyedalinaghi , Alireza Esteghamati , Mahboobeh Hemmatabadi ,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Patients with type 2 diabetes mellitus (T2DM) are diagnosed with a wide range of renal damage, usually presenting with albuminuria and decreased estimated Glomerular Filtration Rate (eGFR). Some patients have only albuminuria and normal eGFR, while others have normoalbuminuria even in advanced stages of chronic kidney disease. This study investigated and followed the course of diabetic nephropathy in patients with T2DM.
Methods: 1107 patients with T2DM were enrolled in the study. This historical cohort was conducted between the years 2017 and 2022. Patients with confirmed type 2 DM, referred to the diabetes clinic of Vali-Asr Hospital, affiliated with the Tehran University of Medical Science. Complete medical history, blood pressure, and laboratory data were obtained in the first and follow-up visits. Follow-up was every 3 to 6 months for 30 months. Every year, 24-hour urinary albumin was measured, and eGFR was estimated based on the Cockcroft-Gault formula.
Results: Male sex, age, disease duration, weight, systolic blood pressure, 2 hours postprandial (2hpp) glucose, serum triglyceride, and uric acid significantly correlated with albuminuria. At the initiation of the study, the highest eGFR values occurred in microalbuminuric patients, followed by a sharp decrease. No significant correlation was found between eGFR and albuminuria in most patients, and more than half of them with eGFR of less than 60 ml/min/m2 still had normal albuminuria
Conclusion: This study showed that patients with microalbuminuria and normoalbuminuria had the highest eGFR values followed by macroalbuminuria, but patients with normoalbuminuria and microalbuminuria had an initial increase and then a decrease, and the macroalbuminuria group showed the sustained and greatest decrease during the follow-up period. Serial surveillance of both albuminuria and GFR is crucial in T2DM.
Methods: 1107 patients with T2DM were enrolled in the study. This historical cohort was conducted between the years 2017 and 2022. Patients with confirmed type 2 DM, referred to the diabetes clinic of Vali-Asr Hospital, affiliated with the Tehran University of Medical Science. Complete medical history, blood pressure, and laboratory data were obtained in the first and follow-up visits. Follow-up was every 3 to 6 months for 30 months. Every year, 24-hour urinary albumin was measured, and eGFR was estimated based on the Cockcroft-Gault formula.
Results: Male sex, age, disease duration, weight, systolic blood pressure, 2 hours postprandial (2hpp) glucose, serum triglyceride, and uric acid significantly correlated with albuminuria. At the initiation of the study, the highest eGFR values occurred in microalbuminuric patients, followed by a sharp decrease. No significant correlation was found between eGFR and albuminuria in most patients, and more than half of them with eGFR of less than 60 ml/min/m2 still had normal albuminuria
Conclusion: This study showed that patients with microalbuminuria and normoalbuminuria had the highest eGFR values followed by macroalbuminuria, but patients with normoalbuminuria and microalbuminuria had an initial increase and then a decrease, and the macroalbuminuria group showed the sustained and greatest decrease during the follow-up period. Serial surveillance of both albuminuria and GFR is crucial in T2DM.
Hamidreza Abdolsamadi , Pardies Mahmoudvand, Zahra Pourgholi Takrami , Elahe Alipour,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Although osteosarcoma in the head and neck region is relatively rare accounting for 2.1% of all malignant oral and maxillofacial tumors it is nevertheless regarded as the most common primary malignant bone tumor in children and young adults. In the craniofacial skeleton its overall occurrence remains uncommon, and that rarity contributes to diagnostic difficulty and occasional delay. The neoplasm is recognized simultaneously for its infrequency and its malignant character, and these features together can obscure recognition when early symptoms are muted or resemble more benign oral conditions. Because presentations may be subtle, careful clinical attention to patient-reported sensations and visible mucosal or submucosal changes is advisable. Early complaints may initially involve tingling paresthesia or awareness of a focal oral mass. Vigilance matters in everyday oral and maxillofacial practice.
Case Presentation: The patient was a 38-year-old married man from Asadabad County, Hamedan Province, who presented to the Department of Oral and Maxillofacial Diseases at the School of Dentistry, Hamedan, during February March 2025. He reported a tingling, electric-shock like sensation together with a lesion on the floor of the mouth. The persistence of the sensation and the presence of a visible lesion prompted evaluation in a specialized academic clinic. The demographic context, the anatomic location in the floor of the mouth, and the clear time frame are central features of the presentation. The chief complaint centered on the peculiar sensation and the discernible lesion, which together motivated clinical assessment in an oral and maxillofacial setting.
Conclusion: This report highlights the importance of considering mandibular osteosarcoma in the differential diagnosis of peripheral tumoral lesions. Reporting such cases can improve understanding of unusual clinical presentations and assist in more accurate clinical decision-making. The central message is unchanged: clinicians should include mandibular osteosarcoma among diagnostic possibilities when encountering peripheral lesions so that evaluation proceeds thoughtfully.
Reza Saeidi , Mahboobe Gholami,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Neonatal circumcision is one of the most common surgical procedures worldwide, performed for cultural, religious, and health-related reasons. The two primary methods for neonatal circumcision are the classic surgical method (using sutures or clamps such as Gomco or Mogen) and the plastic ring method (e.g., Plastibell). This systematic review and meta-analysis aimed to compare the benefits and complications of these two methods in neonates.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases for articles published between 2000 and 2024. Inclusion and exclusion criteria: Included studies included randomized controlled trials (RCTs), cohort studies, and cross-sectional studies that compared the benefits and harms of classical surgery and plastic ring in infants (<28 days). Studies without a comparison group, studies conducted in older children or adults, and articles that did not provide sufficient data were excluded. Keywords included "neonatal circumcision", "plastic ring", "Plastibell", "classical surgery", "Gomco clamp", "Mogen clamp", "benefits", "complications" and their English equivalents.
Studies comparing the benefits and complications of the classic surgical method and the plastic ring method in neonates were included. Data were meta-analyzed using a random-effects model, and risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results: From a total of 12 included studies (involving 5,342 neonates), the plastic ring method was associated with a significant reduction in bleeding (RR: 0.45; 95% CI: 0.32-0.64) and healing time (mean difference: -2.3 days; 95% CI: -3.1 to -1.5) compared to the classic surgical method. However, the risk of skin adhesion was higher with the plastic ring method (RR: 1.32; 95% CI: 1.05-1.66). Serious complications, such as urethral injury, were rare in both methods (less than 0.2%).
Conclusion: The plastic ring method is a suitable option for neonatal circumcision due to its ease of use, reduced bleeding, and faster healing time. However, careful post-procedural care is essential to minimize the risk of skin adhesion. The choice of method should consider the operator’s expertise and parental preferences.
Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Google Scholar databases for articles published between 2000 and 2024. Inclusion and exclusion criteria: Included studies included randomized controlled trials (RCTs), cohort studies, and cross-sectional studies that compared the benefits and harms of classical surgery and plastic ring in infants (<28 days). Studies without a comparison group, studies conducted in older children or adults, and articles that did not provide sufficient data were excluded. Keywords included "neonatal circumcision", "plastic ring", "Plastibell", "classical surgery", "Gomco clamp", "Mogen clamp", "benefits", "complications" and their English equivalents.
Studies comparing the benefits and complications of the classic surgical method and the plastic ring method in neonates were included. Data were meta-analyzed using a random-effects model, and risk ratios (RR) with 95% confidence intervals (CI) were calculated.
Results: From a total of 12 included studies (involving 5,342 neonates), the plastic ring method was associated with a significant reduction in bleeding (RR: 0.45; 95% CI: 0.32-0.64) and healing time (mean difference: -2.3 days; 95% CI: -3.1 to -1.5) compared to the classic surgical method. However, the risk of skin adhesion was higher with the plastic ring method (RR: 1.32; 95% CI: 1.05-1.66). Serious complications, such as urethral injury, were rare in both methods (less than 0.2%).
Conclusion: The plastic ring method is a suitable option for neonatal circumcision due to its ease of use, reduced bleeding, and faster healing time. However, careful post-procedural care is essential to minimize the risk of skin adhesion. The choice of method should consider the operator’s expertise and parental preferences.
Elham Shirvani Naghani , Leila Moradi, Alireza Jahanshahi, Homeira Rashidi, Alireza Sedaghat,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Thyroid disorders are common among young women, and hypothyroidism ranges clinically from subclinical to overt disease, potentially causing various maternal and fetal complications. Determining the appropriate levothyroxine (LT4) dose during pregnancy is crucial for maintaining maternal euthyroidism and optimising pregnancy outcomes. This study aimed to evaluate the dose requirements of LT4 in pregnant women with and without a prior history of hypothyroidism, and to investigate the association with Thyroid peroxidase antibody (TPO) levels.
Methods: This hospital- and clinic-based study was conducted from September 2022 to March 2023 among 146 pregnant women attending a private clinic or Golestan Hospital in Ahvaz, Iran. A total of 146 pregnant women diagnosed with subclinical hypothyroidism (SCH, n=62) or overt hypothyroidism (OH, n=84) were randomly selected. Participants were divided into groups based on their history of hypothyroidism and received LT4 treatment. LT4 requirements were determined according to trimester-specific TSH ranges: >10 mIU/L or 2.5-10 mIU/L in the first trimester, and 3-10 mIU/L in the second and third trimesters. Data analysis was performed using SPSS version 22, employing descriptive statistics (mean±SD, frequency, and percentage) and analytical tests, including the independent t-test and Mann-Whitney U test.
Results: Pregnant women with overt hypothyroidism showed a statistically significant difference in mean LT4 dose between those with and without a prior history of hypothyroidism (P<0.05). In contrast, no significant difference was observed in LT4 requirements among women with subclinical hypothyroidism. TPO Ab positivity was associated with higher LT4 requirements, particularly in women with overt disease. Dose adjustments were most frequent during the first trimester, with incremental increases observed in subsequent trimesters. These findings support individualized monitoring, iodine testing, adherence checks, and coordinated antenatal endocrinology care to improve maternal and neonatal outcomes.
Conclusion: Following the diagnosis of hypothyroidism in early pregnancy, LT4 dosing should be tailored according to disease severity, prior history of hypothyroidism, TPO Ab status, and study location to ensure optimal maternal and fetal outcomes.
Methods: This hospital- and clinic-based study was conducted from September 2022 to March 2023 among 146 pregnant women attending a private clinic or Golestan Hospital in Ahvaz, Iran. A total of 146 pregnant women diagnosed with subclinical hypothyroidism (SCH, n=62) or overt hypothyroidism (OH, n=84) were randomly selected. Participants were divided into groups based on their history of hypothyroidism and received LT4 treatment. LT4 requirements were determined according to trimester-specific TSH ranges: >10 mIU/L or 2.5-10 mIU/L in the first trimester, and 3-10 mIU/L in the second and third trimesters. Data analysis was performed using SPSS version 22, employing descriptive statistics (mean±SD, frequency, and percentage) and analytical tests, including the independent t-test and Mann-Whitney U test.
Results: Pregnant women with overt hypothyroidism showed a statistically significant difference in mean LT4 dose between those with and without a prior history of hypothyroidism (P<0.05). In contrast, no significant difference was observed in LT4 requirements among women with subclinical hypothyroidism. TPO Ab positivity was associated with higher LT4 requirements, particularly in women with overt disease. Dose adjustments were most frequent during the first trimester, with incremental increases observed in subsequent trimesters. These findings support individualized monitoring, iodine testing, adherence checks, and coordinated antenatal endocrinology care to improve maternal and neonatal outcomes.
Conclusion: Following the diagnosis of hypothyroidism in early pregnancy, LT4 dosing should be tailored according to disease severity, prior history of hypothyroidism, TPO Ab status, and study location to ensure optimal maternal and fetal outcomes.
Mandana Pouladzadeh, Fatemeh Khazaei, Saeid Bitaraf, Hossein Karimpourian, Mahsa Mombeyni, Mohammad-Reza Mahmoudian-Sani ,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Breast cancer is the most prevalent malignancy among women and remains a leading cause of cancer-related mortality worldwide. Early detection can markedly improve patient survival, yet existing screening methods often lack sufficient accuracy and sensitivity. lncRNA KCNQ1OT1 has been implicated in the initiation and progression of tumors in several cancers, including breast cancer. This study aimed to evaluate the diagnostic potential of serum lncRNA KCNQ1OT1 expression as a biomarker for early detection of breast cancer.
Methods: This case-control study was conducted at Ahvaz Jundishapur University of Medical Sciences, Shafa Hospital, Ahvaz, Iran, between September 2024 and March 2025. Serum samples were obtained from 30 patients with histologically confirmed breast cancer and 30 healthy women serving as controls. Total RNA was extracted from 500 µL of serum, and cDNA was synthesized using oligo (dT) primers. Real-Time PCR was performed in triplicate, with GAPDH as the internal control. Relative gene expression was calculated using the 2^-ΔΔCt method, and data were analyzed using the Mann-Whitney U test and ROC analysis.
Results: The patient and control groups were homogeneous for most demographic parameters, but showed significant differences in age (P=0.023) and ethnicity (P=0.004). Most patients were in stage I of the disease. The median expression of serum KCNQ1OT1 was significantly lower in patients (0.024, IQR 0.013-0.033) than in controls (0.039, IQR 0.027-0.051), indicating marked downregulation in the patient group (P=0.0003). The ROC analysis yielded an AUC of 0.82 (95% CI: 0.67-0.96, SE=0.07, P=0.0005). At an optimal cutoff value of >0.031, the sensitivity was 70%, the specificity was 95%, and the positive likelihood ratio (LR⁺) ≈ was approximately 14, demonstrating strong discriminative ability.
Conclusion: Serum KCNQ1OT1 exhibits promising diagnostic performance for identifying early-stage breast cancer and may serve as a reliable noninvasive biomarker. Larger multicenter studies incorporating molecular subtyping and tissue correlation are required to validate its clinical applicability and strengthen diagnostic accuracy.
Ali-Akbar Shafiei , Saeed Rahmani , Abbas Riazi, Alireza Akbarzadeh Baghan ,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: This study investigates the use of color filters, which represent a scientific and standardized approach to assist individuals with visual impairment. Although there is no fixed protocol for prescribing color filters, these filters, which are often prescribed by ocular care providers in a trial-and-error manner today, help improve visual performance, control glare, and enhance motor skills in affected individuals. Given the absence of formal guidelines and standardized protocols in this area, this study tested common diseases leading to visual impairment against various color filters.
Methods: The study population consisted of patients visiting the Optometry Clinic of Labbafi Nejad Hospital. Participants were voluntarily referred from retinal and corneal departments to this clinic. This quasi-experimental study evaluated acuity at distance and near and contrast sensitivity function with and without color filters, and compared the results. After analysis, filter(s) suitable for each participant were identified and applied clinically, with one-month monitoring and re-evaluation.
Results: A total of 99 participants (54 male, 45 female) with a mean age of 32.19±15.41 years were included. The results showed that after using color filters, distance visual acuity (BCVA) improved significantly in most diseases (P<0.001). However, in albinism and diabetic retinopathy patients, there was no significant improvement in distance vision. At near distance, there was generally a significant improvement in near vision in most diseases after applying the filters (P=0.001). Exceptions included albinism and glaucoma, where no significant difference was observed (P=0.073). For contrast sensitivity (CSF), most patients showed improvement and increased contrast sensitivity (P<0.001), but this increase was not significant in albinism and glaucoma (P=0.483).
Conclusion: The study suggests that the use of certain color filters in visually impaired patients leads to significant improvements in both distance and near acuity and contrast sensitivity function, potentially enhancing quality of life. Based on the quantitative results, selecting the appropriate filter should be disease-specific and done with greater precision. However, the diversity and severity of diseases, the degree of vision loss, and genetic differences among individuals require greater attention to practical experiences and statements from this patient group. Additionally, patients with more than one ocular condition often changed the type and color of the filter.
Methods: The study population consisted of patients visiting the Optometry Clinic of Labbafi Nejad Hospital. Participants were voluntarily referred from retinal and corneal departments to this clinic. This quasi-experimental study evaluated acuity at distance and near and contrast sensitivity function with and without color filters, and compared the results. After analysis, filter(s) suitable for each participant were identified and applied clinically, with one-month monitoring and re-evaluation.
Results: A total of 99 participants (54 male, 45 female) with a mean age of 32.19±15.41 years were included. The results showed that after using color filters, distance visual acuity (BCVA) improved significantly in most diseases (P<0.001). However, in albinism and diabetic retinopathy patients, there was no significant improvement in distance vision. At near distance, there was generally a significant improvement in near vision in most diseases after applying the filters (P=0.001). Exceptions included albinism and glaucoma, where no significant difference was observed (P=0.073). For contrast sensitivity (CSF), most patients showed improvement and increased contrast sensitivity (P<0.001), but this increase was not significant in albinism and glaucoma (P=0.483).
Conclusion: The study suggests that the use of certain color filters in visually impaired patients leads to significant improvements in both distance and near acuity and contrast sensitivity function, potentially enhancing quality of life. Based on the quantitative results, selecting the appropriate filter should be disease-specific and done with greater precision. However, the diversity and severity of diseases, the degree of vision loss, and genetic differences among individuals require greater attention to practical experiences and statements from this patient group. Additionally, patients with more than one ocular condition often changed the type and color of the filter.
Navid Kalani , Arnoosh Ghodsian , Abdolali Sepidkar, Mehrdad Sayadinia, Reza Sahraei ,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Although abdominoplasty is cosmetically effective in patients with obesity or a history of significant weight loss, it can lead to serious complications. This case report highlights the role of elevated intra-abdominal pressure and delayed diagnosis of Abdominal compartment syndrome (ACS) in the development of multiorgan failure and patient mortality.
Case Presentation: A 49-year-old female patient with a history of appendectomy and hysterectomy in the past years was admitted to the hospital for cosmetic abdominoplasty. She had a history of hypothyroidism and was taking levothyroxine regularly. Occasional tobacco use was also mentioned in the patient's history. During the operation, in addition to abdominoplasty, liposuction and flank surgery were also performed. The patient was initially placed in the supine position and then in the prone position for the last two hours. During recovery, the patient complained of shortness of breath and developed tachycardia. Despite persistently elevated BUN and creatinine, and progressive acidosis, a surgical consultation was performed with suspicion of Abdominal compartment syndrome (ACS), but this diagnosis was rejected by the surgeon. Also, despite clinical suspicion of Abdominal compartment syndrome (ACS) by the anesthesia team, in the early stages, the surgeon responsible for the patient did not have sufficient clinical suspicion of this complication and accordingly, intra-abdominal pressure measurement via bladder catheter was not performed. Since monitoring intra-abdominal pressure via bladder catheter requires a specific technique and coordination between anesthesia, surgery, and critical care teams, and since the possibility of ACS had been ruled out by the surgeon at that time, this procedure was not performed. Ultimately, the patient was transferred to the dialysis unit, but during hemodialysis, he suffered respiratory arrest and, after tracheal intubation, subsequently suffered cardiac arrest. Unfortunately, despite cardiopulmonary resuscitation efforts, the patient died.
Conclusion: Although rare, abdominal compartment syndrome should be considered a critical differential diagnosis in high-risk patients following prolonged surgeries such as abdominoplasty with extensive plication. Monitoring intra-abdominal pressure and early intervention upon symptom onset may prevent fatal outcomes.
Case Presentation: A 49-year-old female patient with a history of appendectomy and hysterectomy in the past years was admitted to the hospital for cosmetic abdominoplasty. She had a history of hypothyroidism and was taking levothyroxine regularly. Occasional tobacco use was also mentioned in the patient's history. During the operation, in addition to abdominoplasty, liposuction and flank surgery were also performed. The patient was initially placed in the supine position and then in the prone position for the last two hours. During recovery, the patient complained of shortness of breath and developed tachycardia. Despite persistently elevated BUN and creatinine, and progressive acidosis, a surgical consultation was performed with suspicion of Abdominal compartment syndrome (ACS), but this diagnosis was rejected by the surgeon. Also, despite clinical suspicion of Abdominal compartment syndrome (ACS) by the anesthesia team, in the early stages, the surgeon responsible for the patient did not have sufficient clinical suspicion of this complication and accordingly, intra-abdominal pressure measurement via bladder catheter was not performed. Since monitoring intra-abdominal pressure via bladder catheter requires a specific technique and coordination between anesthesia, surgery, and critical care teams, and since the possibility of ACS had been ruled out by the surgeon at that time, this procedure was not performed. Ultimately, the patient was transferred to the dialysis unit, but during hemodialysis, he suffered respiratory arrest and, after tracheal intubation, subsequently suffered cardiac arrest. Unfortunately, despite cardiopulmonary resuscitation efforts, the patient died.
Conclusion: Although rare, abdominal compartment syndrome should be considered a critical differential diagnosis in high-risk patients following prolonged surgeries such as abdominoplasty with extensive plication. Monitoring intra-abdominal pressure and early intervention upon symptom onset may prevent fatal outcomes.
Mobina Zamanifard, Hamid Reza Norouzi, Fazilat Jokar Darzi , Malihe Safari,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Helicobacter pylori (H. pylori) is a human gastrointestinal pathogen that infects more than half of the world's population and leads to chronic gastritis and its role in the development of gastric ulcers, gastric cancer and gastric lymphomas is considered. However, eradication of this bacterium with triple therapy fails in more than 30% of cases. Therefore, efforts to find new treatment methods are increasing. As a result, this study was conducted to evaluate the effectiveness and tolerability of several drug regimens compared to the standard regimen.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
Methods: This study is a randomized clinical trial in which patients with Helicobacter pylori infection were randomly selected in the endoscopy department of Amiralmomenin Hospital and the Gastroenterology Clinic of Professor Ghavamzadeh Clinic, Arak from October 2024 to March 2025 and were divided into three groups, including a control group and two intervention groups, with three different drug regimens. Four weeks after treatment, the rate of bacterial eradication in all three evaluation groups was assessed using fecal antigen testing and the treatment results were compared using appropriate statistical analyses.
Results: The frequency of negative test results in intervention group 2 was higher than in control and intervention group 1. (P<0.001) and the rate of Helicobacter pylori eradication was in intervention group 2 (94%), in control group (54%), and in intervention group 1 (20%). The chance of H.P eradication in intervention group 1 decreased by 84% compared to the control group and increased by 10.77 times in intervention group 2 compared to the control group. Also, a significant proportion of H.P eradication success was observed in people without diabetes (p-value = 0.022, Phi = -0.188, n = 150) and the rate of drug side effects was higher in intervention group 2 compared to the other two groups.
Conclusion: This study showed that compared to the standard regimen, a 2-week regimen of amoxicillin, omeprazole, and clarithromycin plus bismuth is a good, potent, and more cost-effective regimen for eradicating Helicobacter pylori.
Samaneh Arab, Mohammad-Reza Mahmoudian-Sani , Najmeh Fattahi , Zakiye Ekhlasi, Samira Asgharzade,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Retinal photoreceptor degeneration is a major cause of blindness. Stem cell therapies offer promise, and the miR-183/96/182 cluster, particularly miR-182 and miR-183, plays a crucial role in photoreceptor development and survival. Targeting these miRNAs may enhance human bone marrow–derived mesenchymal stem cells) hBMSCs (differentiation into photoreceptor-like cells, improving their therapeutic potential.
Methods: This in vitro study was conducted from April 2019 to March 2021 at the Clinical Biochemistry Research Center, Shahrekord University of Medical Sciences. hBMSCs were cultured in DMEM with fetal bovine serum and transfected with miR-182 and miR-183 mimics using Lipofectamine, with a scramble miRNA control. Transfection efficiency and miRNA overexpression were evaluated at 24 and 48 hours using real-time PCR. miRNA expression was normalised to Snord, while mRNA levels were normalised to GAPDH using the 2−ΔΔCt method. Photoreceptor-like differentiation was assessed by measuring the expression of retina-specific transcription factors and markers (OTX2, CRX, NRL, SLC1A1, PKCα, Recoverin, and RHO). Statistical analyses included the Shapiro–Wilk test for normality and the Mann-Whitney U test for group comparisons. Data were reported as Mean ± SEM, with 95% confidence intervals, and significance set at α = 0.05.
Results: Transfection of miR-182 and miR-183 significantly increased miRNA levels at 24–48 hours (P < 0.001) compared to the scramble control. This led to a marked upregulation of retinal-related genes, including CRX, OTX2, PKCα, Recoverin, NRL, and RHO, indicating activation of the photoreceptor gene network. Time-resolved analysis revealed stronger effects at 24–48 hours, supporting a transient window for pro-differentiation. RHO and CRX exhibited the most significant increases, while OTX2 and PKCα showed parallel rises, suggesting coordinated activation of early and intermediate photoreceptor programs. Scramble controls did not show comparable changes.
Conclusion: Transient overexpression of miR-182 and miR-183 in hBMSCs activates a photoreceptor-like gene expression program, promoting differentiation toward photoreceptor-like cells. This finding supports the potential use of miR-182/183 in stem cell-based therapies for retinal degeneration. Further studies should confirm protein expression, functional outcomes, and in vivo efficacy.
Alireza Eskandarifar, Zahra Taherkhani, Soleiman Mohammadzadeh , Rama Naghshizadian, Khaled Rahmani,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Primary nocturnal enuresis (PNE) is a common and distressing childhood disorder characterized by involuntary urination during sleep after the age when bladder control is normally achieved. It affects not only the child’s quality of life but also family dynamics and social relationships. Previous studies have suggested a possible link between PNE and psychological or behavioral problems, yet findings have been inconsistent across populations. The present study aimed to investigate and compare the prevalence and patterns of psychiatric disorders among children with primary nocturnal enuresis and healthy controls in Sanandaj, Iran.
Methods: This case-control study was conducted in Sanandaj from October 2024 to April 2025. The study population included children referred to the Medical, Educational, and Therapeutic Center of Kurdistan University of Medical Sciences. A total of 228 participants were enrolled, comprising 108 children diagnosed with primary nocturnal enuresis and 120 age- and sex-matched healthy controls selected through convenient sampling. Psychiatric assessments were performed using the parent version of the Child Symptom Inventory-4 (CSI-4) questionnaire, which evaluates a wide range of childhood behavioral and emotional disorders based on DSM-IV criteria. Statistical analysis was performed using Stata version 18, and comparisons between groups were made using the chi-square and Fisher’s exact tests. A p-value < 0.05 was considered statistically significant.
Results: Children with primary nocturnal enuresis had significantly higher frequencies of attention deficit disorder (ADD), hyperactivity disorder (HD), attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), generalized anxiety disorder (GAD), and tic disorder compared with the control group (p < 0.05). In contrast, the prevalence of phobia and obsessive-compulsive disorder (OCD) was slightly higher in the control group. No statistically significant difference was found regarding post-traumatic stress disorder (PTSD) between the two groups.
Conclusion: The findings suggest that primary nocturnal enuresis may serve as an indicator of increased vulnerability to certain psychiatric disorders in childhood. Early recognition and psychological evaluation of children with enuresis are recommended to improve long-term outcomes and mental well-being.
Methods: This case-control study was conducted in Sanandaj from October 2024 to April 2025. The study population included children referred to the Medical, Educational, and Therapeutic Center of Kurdistan University of Medical Sciences. A total of 228 participants were enrolled, comprising 108 children diagnosed with primary nocturnal enuresis and 120 age- and sex-matched healthy controls selected through convenient sampling. Psychiatric assessments were performed using the parent version of the Child Symptom Inventory-4 (CSI-4) questionnaire, which evaluates a wide range of childhood behavioral and emotional disorders based on DSM-IV criteria. Statistical analysis was performed using Stata version 18, and comparisons between groups were made using the chi-square and Fisher’s exact tests. A p-value < 0.05 was considered statistically significant.
Results: Children with primary nocturnal enuresis had significantly higher frequencies of attention deficit disorder (ADD), hyperactivity disorder (HD), attention deficit-hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), generalized anxiety disorder (GAD), and tic disorder compared with the control group (p < 0.05). In contrast, the prevalence of phobia and obsessive-compulsive disorder (OCD) was slightly higher in the control group. No statistically significant difference was found regarding post-traumatic stress disorder (PTSD) between the two groups.
Conclusion: The findings suggest that primary nocturnal enuresis may serve as an indicator of increased vulnerability to certain psychiatric disorders in childhood. Early recognition and psychological evaluation of children with enuresis are recommended to improve long-term outcomes and mental well-being.
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.
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.
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
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