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Mohammad Shojaie, Afshin Avazpour, Navid Kalani ,
Volume 82, Issue 12 (3-2025)
Volume 82, Issue 12 (3-2025)
Abstract
Background: Coronary artery disease (CAD) is among the most common life-threatening cardiovascular diseases, in which blood supply to the heart muscles is reduced or completely blocked. Coronary artery disease has various treatment options, one of which is PCI (Percutaneous Coronary Intervention) or stent placement via angioplasty. Dabigatran etexilate is the only orally available direct thrombin inhibitor, which is actually a prodrug that is rapidly converted to its active form and absorbed through the gastrointestinal tract. The purpose of this study is to compare mortality in patients with Atrial Fibrillation (AF) with a history of Percutaneous coronary intervention (PCI) treated with a low dose (110 mg). In contrast, it was treated with a high dose (150 mg).
Methods: The present study was a systematic review and meta-analysis on 4 online databases PubMed, Scopus, Web of Science and EMBASE to find articles that the rate of long-term complications related to bleeding or Thrombotic events were performed in AF patients who underwent PCI and were treated with dabigatran. STATA software was used for data analysis.
Results: Nine RCTs or prospective studies with 5694 participants were included. The studies showed that when comparing dabigatran (110 and 150 mg) with warfarin (with/without dual antiplatelet), dabigatran 110 mg was associated with a significant reduction in major bleeding (OR=0.46, 95% CI: 0.24-0.86, P=0.01), while the 150 mg dose was not statistically different (OR=0.12, 95% CI: 0.01-1.32, P=0.08). Also, comparing dabigatran 150 with 110 mg showed a higher risk of bleeding at the higher dose (OR=0.77, 95% CI: 0.64-0.92, P<0.001). On the other hand, dabigatran 110 mg was associated with a significant increase in mortality (OR=1.33, P=0.01) and myocardial infarction (OR=1.61, P=0.01) compared with combination therapy of warfarin and antiplatelet, but the 150 mg dose did not show a statistical difference. Heterogeneity was high in some analyses (I2 up to 99.49%), but funnel plots and Egger's test rejected publication bias.
Conclusion: There seems to be strong evidence that bleeding complications in dabigatran are less than old antiplatelet and anticoagulation drugs, but in terms of efficacy in reducing mortality, although we did not obtain strong evidence for analysis, older drugs are more effective in preventing death from any cause.
Methods: The present study was a systematic review and meta-analysis on 4 online databases PubMed, Scopus, Web of Science and EMBASE to find articles that the rate of long-term complications related to bleeding or Thrombotic events were performed in AF patients who underwent PCI and were treated with dabigatran. STATA software was used for data analysis.
Results: Nine RCTs or prospective studies with 5694 participants were included. The studies showed that when comparing dabigatran (110 and 150 mg) with warfarin (with/without dual antiplatelet), dabigatran 110 mg was associated with a significant reduction in major bleeding (OR=0.46, 95% CI: 0.24-0.86, P=0.01), while the 150 mg dose was not statistically different (OR=0.12, 95% CI: 0.01-1.32, P=0.08). Also, comparing dabigatran 150 with 110 mg showed a higher risk of bleeding at the higher dose (OR=0.77, 95% CI: 0.64-0.92, P<0.001). On the other hand, dabigatran 110 mg was associated with a significant increase in mortality (OR=1.33, P=0.01) and myocardial infarction (OR=1.61, P=0.01) compared with combination therapy of warfarin and antiplatelet, but the 150 mg dose did not show a statistical difference. Heterogeneity was high in some analyses (I2 up to 99.49%), but funnel plots and Egger's test rejected publication bias.
Conclusion: There seems to be strong evidence that bleeding complications in dabigatran are less than old antiplatelet and anticoagulation drugs, but in terms of efficacy in reducing mortality, although we did not obtain strong evidence for analysis, older drugs are more effective in preventing death from any cause.
Fatemeh Habibollahi, Ghazaleh Eslamian, Kiana Hasibi , Sepehr Khoshbaf Khiabanian , Bentolhosna Dehghan Nayeri , Aref Adeli Mosabbeb ,
Volume 82, Issue 12 (3-2025)
Volume 82, Issue 12 (3-2025)
Abstract
Background: Infertility is defined as the failure to achieve pregnancy after one year or more of regular unprotected sexual intercourse. Assisted reproductive technologies (ART) represent a key therapeutic approach for infertile couples. Bisphenol-A (BPA), a compound found in plastic polymer products, has been associated with increased infertility risk. This systematic review addresses whether BPA affects ART outcomes.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.
Shahram Shafa, Mehrdad Sayadinia, Bibi Mona Razavi, Tayyebeh Zarei , Maryam Ziyaei , Mansour Deylami,
Volume 83, Issue 2 (5-2025)
Volume 83, Issue 2 (5-2025)
Abstract
Background: Controlling patients' anxiety before surgery reduces the possibility of postoperative problems and increases the possibility of patient participation and cooperation in the postoperative care and treatment plan.
Methods: This study uses a review approach to investigate non-pharmacological methods of anxiety management in patients undergoing orthopedic surgery. The systematic search involves several key steps. Literature search: A thorough search was conducted in PubMed, Sciences Direct, Scopus, Magiran, Sid, and Google Scholar databases. The search was refined using keywords such as “aromatherapy,” “music therapy,” “massage,” “educational intervention,” “educational film,” and “sound of the Quran” and their English equivalents to identify relevant studies published in the past ten years. Inclusion criteria included studies on orthopedic surgery, Persian and English articles, and original articles. Exclusion criteria included studies outside the specified time frame or studies that deviated from the defined focus. In this review, we conclude by summarizing key aspects of the review process, emphasizing the rigorous approach applied in study selection, data extraction, and synthesis.
Results: The results of the present study showed that the non-pharmacological methods used to control or reduce anxiety in orthopedic surgery include methods; Music therapy, the sound of the Quran, relaxation techniques, back massage, educational intervention, educational video, awareness and training before surgery and aromatherapy (chamomile, lemon, rose, valerian, cardamom, cinnamon, calendula, lavender, lemon sour).
Conclusion: The results of numerous and reputable research findings clearly show that the use of non-pharmacological methods plays an effective role in reducing the level of anxiety of patients before, during and after orthopedic surgery. These methods, which are generally low-cost, low-complication, and applicable in various clinical settings, include techniques such as preoperative education, music therapy, breathing and relaxation techniques, mindfulness-based interventions, psychological support, and the creation of a calm and reassuring environment. Since anxiety is a known factor in weakening the immune system, increasing postoperative pain, prolonging the recovery period, and reducing overall patient satisfaction, its management is of great importance. Therefore, by integrating and utilizing such non-invasive methods into nursing care protocols and holistic patient care programs, the detrimental and undesirable effects of anxiety after orthopedic surgery can be significantly reduced and faster recovery, a better patient experience, and more favorable clinical outcomes can be achieved.
Nooshin Shirzad, Fateme Ziamanesh, Seyedahmad Seyedalinaghi , Alireza Esteghamati , Mahboobeh Hemmatabadi ,
Volume 83, Issue 3 (6-2025)
Volume 83, Issue 3 (6-2025)
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 (6-2025)
Volume 83, Issue 3 (6-2025)
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.
Samaneh Arab, Mohammad-Reza Mahmoudian-Sani , Najmeh Fattahi , Zakiye Ekhlasi, Samira Asgharzade,
Volume 83, Issue 5 (8-2025)
Volume 83, Issue 5 (8-2025)
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.
Kosar Hajati, Behnaz Deihim ,
Volume 83, Issue 6 (9-2025)
Volume 83, Issue 6 (9-2025)
Abstract
Background: Leishmaniasis is one of the most significant parasitic diseases and is susceptible to secondary bacterial infections, which can result in increased inflammation, delayed tissue repair, and increased drug resistance. Given the importance of this phenomenon, the present study was designed to identify bacterial agents and determine their antibiotic resistance patterns in lesions of patients with cutaneous leishmaniasis.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
Methods: The present cross-sectional study was conducted in Dezful, Iran, from May 2022 to December 2022 among 173 patients with suspected cutaneous leishmaniasis. In addition to sampling skin lesions for the diagnosis of leishmaniasis, wound exudates were collected using sterile swabs and cultured on blood agar and MacConkey agar plates. Bacteria were identified by Gram staining and biochemical tests. Antibiotic susceptibility patterns were determined by disk diffusion, according to the CLSI 2024 guidelines. SPSS version 20 software was used for data analysis. In Staphylococcus aureus isolates, methicillin resistance was determined using a cefoxitin disk (30 μg), and vancomycin resistance was determined by broth microdilution. In vancomycin-resistant Enterococcus isolates, a vancomycin disk (30 μg) was used. In Enterobacteriaceae, the extended-spectrum beta-lactamase (ESBL) phenotype was performed using ceftazidime (30 μg) and the ceftazidime/clavulanic acid combination disk (30/10 μg).
Results: Cutaneous leishmaniasis was detected in 65.3% of cases, of which 46 cases (26.6%) had secondary bacterial infection. Staphylococcus aureus (67.4%) and Klebsiella pneumoniae (13%) were the most common isolates. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 13 cases, accounting for 41.9% of the isolates. The frequency of Multidrug-resistant (MDR) Staphylococcus aureus among leishmaniasis patients was 38.7%, but all isolates were susceptible to vancomycin and teicoplanin. Two ESBL-producing Escherichia coli were isolated from leishmaniasis foot ulcers. Leg and back wounds were more frequently involved in bacterial infection (P<0.05).
Conclusion: Inappropriate environmental conditions and lack of treatment facilities play an important role in the occurrence and exacerbation of infectious leishmaniasis lesions. An integrated treatment approach and medical staff training can improve disease control and wound healing.
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