Search published articles
Showing 293 results for Rat
Neda Faraji, Mahbobeh Alizadeh, Asghar Ghorbani, Hadiseh Hosami Roodsari , Samane Akbarpour , Mohammad Arefi,
Volume 82, Issue 11 (2-2025)
Volume 82, Issue 11 (2-2025)
Abstract
Background: This study aimed to evaluate serum amylase levels in hospitalized COVID-19 patients and investigate its association with disease prognosis. Elevated serum amylase levels have been reported in some COVID-19 patients, particularly in severe cases. This increase may indicate pancreatic involvement (pancreatitis) due to viral infection. This cross-sectional study aimed to evaluate the role of serum amylase levels as a prognostic marker in COVID-19 patients.
Methods: This descriptive cross-sectional study was conducted on 150 hospitalized patients with confirmed COVID-19 at Baharloo Hospital, Tehran, over a one-year period (July 2021–July 2022). The results showed that 20% of patients (30 out of 150) had elevated serum amylase levels. Patients with high amylase levels had significantly longer hospital stays (mean 14 days vs. 8 days) and higher mortality rates (15% vs. 5%). Additionally, these patients were more likely to require intensive care (25% vs. 10%). Statistical analysis revealed that elevated serum amylase levels were independently associated with poorer clinical outcomes.
Results: These results have important clinical implications for patient management. Routine measurement of serum amylase at admission could help identify high-risk patients who may benefit from closer monitoring and early intervention. Further research is needed to determine whether specific treatments for pancreatic involvement could improve outcomes in these patients.
Conclusion: These findings suggest that measuring serum amylase levels at admission can serve as a simple and accessible marker for identifying high-risk patients. Elevated amylase in COVID-19 patients is an important biological indicator of multi-organ involvement (pancreas and kidney) and severe inflammation, which is associated with worse prognosis and higher mortality. Monitoring this marker may aid clinical decision-making and improve patient outcomes
Methods: This descriptive cross-sectional study was conducted on 150 hospitalized patients with confirmed COVID-19 at Baharloo Hospital, Tehran, over a one-year period (July 2021–July 2022). The results showed that 20% of patients (30 out of 150) had elevated serum amylase levels. Patients with high amylase levels had significantly longer hospital stays (mean 14 days vs. 8 days) and higher mortality rates (15% vs. 5%). Additionally, these patients were more likely to require intensive care (25% vs. 10%). Statistical analysis revealed that elevated serum amylase levels were independently associated with poorer clinical outcomes.
Results: These results have important clinical implications for patient management. Routine measurement of serum amylase at admission could help identify high-risk patients who may benefit from closer monitoring and early intervention. Further research is needed to determine whether specific treatments for pancreatic involvement could improve outcomes in these patients.
Conclusion: These findings suggest that measuring serum amylase levels at admission can serve as a simple and accessible marker for identifying high-risk patients. Elevated amylase in COVID-19 patients is an important biological indicator of multi-organ involvement (pancreas and kidney) and severe inflammation, which is associated with worse prognosis and higher mortality. Monitoring this marker may aid clinical decision-making and improve patient outcomes
Mahmoud Khodabandeh, Mohammadreza Abdolsalehi , Mojtaba Gorji,
Volume 82, Issue 11 (2-2025)
Volume 82, Issue 11 (2-2025)
Abstract
Background: Congenital tuberculosis is a rare but serious disease in neonates and infants that often presents with nonspecific respiratory symptoms. Pulmonary involvement in tuberculosis can have similar manifestations to bacterial pneumonia with common microorganisms. In case of failure to respond to treatment in pneumonia, tuberculosis infection should be considered. The aim of this study was to present a two-month-old infant suspected of bacterial pneumonia, who was ultimately diagnosed with tuberculosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress. Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.
Case Presentation: This case report describes a two-month-old infant diagnosed with tuberculosis who presented to the emergency department with severe respiratory distress. Despite repeated hospitalizations and initial antibiotic therapy, the patient's symptoms did not improve and he was eventually referred to the Children's Medical Center. Chest radiography showed diffuse reticular opacities, alveolar opacities in the lower lobe of the right lung, and parahilar opacities in the left lung. Initial laboratory tests included elevated CRP and ESR levels, elevated white blood cell count, thrombocytosis, and abnormal arterial blood gases. Despite three negative gastric aspirate samples for tuberculosis, bronchoscopy was performed and a Bronchoalveolar Lavage (BAL) sample was sent for Polymerase Chain Reaction (PCR) testing for Mycobacterium tuberculosis, which was positive, confirming the diagnosis of tuberculosis. Careful evaluation of the parents revealed that although they had no respiratory symptoms, the mother had imaging evidence of tuberculosis, and her AFB test was positive. The patient showed significant clinical improvement after starting anti-tuberculosis therapy. A six-month follow-up confirmed complete recovery.
Conclusion: In infants with recurrent pneumonia and failure to respond to initial treatments, tuberculosis should be considered as a possible diagnosis.
Reza Tavakolizadeh , Abbas Alibakhshi, Sevil Abdolmohamadian ,
Volume 82, Issue 12 (3-2025)
Volume 82, Issue 12 (3-2025)
Abstract
Background: Primary hyperparathyroidism is a rare but significant endocrine disorder in pediatric patients; although uncommon, parathyroid adenomas are the most frequently identified cause of primary hyperparathyroidism in this population. Diagnosis and treatment of primary hyperparathyroidism in children, especially in cases caused by parathyroid adenoma, demand careful assessment and require a coordinated and multidisciplinary approach involving endocrinologists, pediatric surgeons, radiologists, and other specialists. Early diagnosis is often delayed due to the rarity of the disease and the nonspecific nature of presenting symptoms.
Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up.
Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications.
Case Presentation: This case report describes the complex clinical management of a 9-year-old boy who presented with gradual onset of bone pain and visible deformities of the upper and lower extremities, which prompted further evaluation and later led to a diagnosis of hyperparathyroidism secondary to a parathyroid adenoma. The diagnosis was confirmed by elevated parathyroid hormone levels, hypercalcemia, and imaging studies revealing a parathyroid adenoma. Despite a comprehensive preoperative planning and surgical intervention, adenoma resection was not successful during the first two surgeries, leading to persistent hyperparathyroidism and subsequent surgical complications such as postoperative thyroid tissue damage and resultant iatrogenic hypothyroidism. Ultimately, the third surgical attempt successfully removed the adenoma, leading to a marked resolution of hyperparathyroidism and gradual return to normal calcium and parathyroid hormone levels. The patient’s bone pain and deformities showed improvement during follow-up.
Conclusion: This case highlights the numerous challenges in managing hyperparathyroidism in pediatric patients. In particular, it illustrates the potential complications that can arise when the disease is resistant to initial treatment efforts. This report underscores the importance of having a multidisciplinary approach, carefully planned and executed surgical intervention and vigilant postoperative care in pediatric patients with hyperparathyroidism. Early recognition, accurate localization of the adenoma, and coordination among specialists are essential for favorable outcomes in complex pediatric cases such as this. Continued follow-up is essential to monitor for recurrence and to manage any long-term complications.
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.
Majid Vatankhah, Saeed Kashani, Mohsen Sarafikhah, Bibi Mona Razavi, Mehrdad Sayadinia, Mehrdad Malekshoar,
Volume 83, Issue 2 (5-2025)
Volume 83, Issue 2 (5-2025)
Abstract
Background: Aspiration pneumonia is a significant and potentially preventable cause of morbidity and mortality in critically ill ICU patients. Prophylactic pharmacological interventions, particularly antiemetics like metoclopramide (a prokinetic agent) and ondansetron (a 5-HT3 receptor antagonist), are commonly employed to reduce gastric aspiration and subsequent pneumonia. Despite their widespread use, comparative efficacy data remains limited. This randomized controlled trial was specifically designed to rigorously compare the effectiveness of these two distinct antiemetic strategies in preventing aspiration pneumonia among high-risk, mechanically ventilated patients, aiming to provide evidence-based guidance for clinical practice.
Methods: This double-blind randomized clinical trial involved 116 individuals admitted to the ICU at Shahid Mohammadi Hospital, Bandar Abbas from March 2024 to March 2025. Subjects were randomly assigned to metoclopramide or ondansetron groups. Enrollment criteria consisted of patients between 17 and 70 years old in the ICU requiring intubation and mechanical ventilation. Monitoring continued for 72 hours, with evaluation utilizing the Clinical Pulmonary Infection Score (CPIS), chest X-ray (CXR) results, and physical assessments. Data were analyzed with SPSS version 21 employing descriptive statistics (mean, standard deviation, percentage, frequency) and inferential tests with significance set at P<0.05.
Results: Chi-square analysis indicated no statistically significant gender difference between groups (P=0.947). Mean age was 30.6±10.5 years for metoclopramide recipients and 32.9±6.12 years for ondansetron recipients. Further analysis revealed no significant differences in age or BMI between cohorts. No significant difference emerged between metoclopramide and ondansetron groups regarding aspiration pneumonia occurrence, with similar incidence rates in both arms. Multiple logistic regression demonstrated that statistically, no variables influenced aspiration pneumonia development.
Conclusion: The results of this randomized trial clearly demonstrate no statistically significant difference in efficacy between metoclopramide and ondansetron for preventing aspiration pneumonia in intubated ICU patients. Both agents showed comparable effectiveness in our study population, suggesting that either drug represents a clinically acceptable prophylactic option. This finding provides clinicians with valuable therapeutic flexibility based on individual patient characteristics, drug availability, and cost considerations. However, further multicenter studies with larger sample sizes are recommended to confirm these findings across diverse patient populations and settings.
Sepideh Mahdavi, Mohammad Hassan Emamian , Zahra Kordi, Mansooreh Fateh, Mostafa Enayatrad,
Volume 83, Issue 2 (5-2025)
Volume 83, Issue 2 (5-2025)
Abstract
Background: Stomach cancer is the fifth most common cancer worldwide. This study aimed to investigate the trend in the incidence of stomach cancer in Shahroud and Meyami districts over a thirteen-year period.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
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.
Artadokht Khoshooei, Seyedeh Fatemeh Hosseini Nejad , Armin Kia , Nadia Zergani ,
Volume 83, Issue 4 (7-2025)
Volume 83, Issue 4 (7-2025)
Abstract
Background: Nowadays, there is an increased emphasis on using safer and more modern anesthetic drugs. The addition of adjuvants not only enhances the anesthetic effect of the medication but also reduces the required dosage, thereby improving the safety margin. Effective postoperative pain control is a critical component in enhancing recovery and improving outcomes for orthopedic patients. Proper pain management not only facilitates early mobilization but also reduces complications and increases patient satisfaction. This study aimed to evaluate the impact of dexmedetomidine and ketamine as adjuvant drugs in supraclavicular nerve block for reducing postoperative pain following forearm orthopedic surgery.
Methods: This randomized, triple-blind clinical trial was meticulously conducted between April 2024 and March 2025 at Razi Hospital, a major teaching facility affiliated with Jundishapur University of Medical Sciences in Ahvaz, Iran. A total of 102 eligible patients were carefully enrolled and randomly assigned to three distinct groups: dexmedetomidine, ketamine, and control. Each patient received a standardized supraclavicular block using 2% lidocaine combined with the designated adjuvant drug to enhance analgesic efficacy. Vital signs, including heart rate, oxygen saturation, and Mean arterial pressure (MAP), were closely monitored every 15 minutes during surgery. Postoperative pain intensity was assessed using the Visual analog scale (VAS) at 1, 2, 6, 12, and 24 hours after surgery.
Results: Patients in the dexmedetomidine group showed significantly lower heart rate, MAP, and pain intensity compared to both ketamine and control groups at all measured time points (P<0.001). Ketamine also demonstrated better pain control and hemodynamic stability than the control group, although it was less effective than dexmedetomidine. Most differences in mean values between groups were statistically significant, confirming the superior performance of dexmedetomidine.
Conclusion: Dexmedetomidine, when used as an adjuvant in supraclavicular block for forearm orthopedic surgery, resulted in superior pain relief and greater hemodynamic stability compared to ketamine and standard care. These findings support its clinical use as an effective adjunct in regional anesthesia protocols.
Javad Hashemi, Hoseinali Soltani , Ali Esmaeili , Fatemeh Roshanravan Yazdi , Seyed Hassan Seyed Sharifi ,
Volume 83, Issue 4 (7-2025)
Volume 83, Issue 4 (7-2025)
Abstract
Background: Postoperative pain is a significant concern after cholecystectomy. Given the role of vitamin D in pain management, this study investigated the correlation between preoperative vitamin D levels and postoperative pain severity in patients undergoing laparoscopic cholecystectomy, with the aim of improving pain management and enhancing postoperative care.
Methods: This prospective observational study (January 2024- February 2025) was conducted on 87 patients undergoing laparoscopic cholecystectomy at Imam Ali Hospital of Bojnurd. Inclusion criteria were age 18-45, non-urgent laparoscopic cholecystectomy, and good physical status. Exclusion criteria were chronic pain, regular analgesic use, known psychiatric or neurological disease or treatment, substance abuse, emergency cholecystectomy, or conversion to open surgery. Participants fasted for 12 hours preoperatively. All received 1 g (IV) ceftriaxone one hour before and 12 hours after surgery. Anesthesia was induced with propofol and fentanyl and maintained with isoflurane, nitrous oxide, or oxygen. Anesthesia and surgical technique were standardized, with any deviations recorded. We collected demographic data and extracted perioperative details from records and interviews. Pre-induction venous blood samples were collected, processed, and stored at -20°C. Serum vitamin D concentrations were quantified via ELISA method, and participants were subsequently stratified into two groups based on these measurements. Postoperative pain was assessed on a Visual Analog Scale (0-10) at 6, 12, 18, and 24 hours. Analgesic regimens followed standard protocol under physician supervision and were unaffected by the study.
Results: Lower serum vitamin D levels were associated with higher postoperative pain scores (P<0.01), with this relationship being significant at 6, 12, and 18 hours postoperatively (P<0.01, P<0.01, and P<0.05, respectively). Insufficient vitamin D levels and female gender were also independent risk factors for acute pain after laparoscopic cholecystectomy (P<0.01).
Conclusion: Based on the results of the present study, preoperative vitamin D deficiency is associated with increased postoperative acute pain scores in patients undergoing laparoscopic cholecystectomy, especially in women. These findings may be useful for postoperative pain management in patients with vitamin D deficiency.
Majid Vatankhah Tarbebar , Saeid Kashani, Milad Mohammadi , Zohreh Nik Eghbali, Mehrdad Malekshoar,
Volume 83, Issue 6 (9-2025)
Volume 83, Issue 6 (9-2025)
Abstract
Background: Laparoscopic cholecystectomy is the gold standard for treating gallbladder diseases; however, it is associated with physiological challenges from pneumoperitoneum and specific patient positioning. Positive end-expiratory pressure (PEEP) may mitigate these effects, but the optimal level remains uncertain. This study compared the impact of three PEEP levels on respiratory performance and hemodynamic stability during laparoscopic cholecystectomy.
Methods: This randomized double-blind clinical trial was conducted at Shahid Mohammadi Hospital, Bandar Abbas, Iran, from August 2023 to February 2024. A total of 75 adult patients aged 18-70 years with ASA class I-II scheduled for elective laparoscopic cholecystectomy were assigned to three groups (n=25 each): PEEP 0 cmH₂O (control), PEEP 5 cmH₂O, and PEEP 7 cmH₂O. Standardized general anesthesia and mechanical ventilation with tidal volumes of 6-8 mL/kg were applied. Hemodynamic variables (mean arterial pressure, heart rate) and respiratory parameters (SpO₂, EtCO₂) were recorded before intubation, during intubation, and at 15, 30, and 60 minutes post-intubation, as well as in the recovery room. Arterial blood gas analysis was performed 30 minutes after intubation. Data were analyzed using ANOVA and chi-square tests with a significance level of 0.05.
Results: The mean age of patients was 41.89±11.39 years, and baseline demographic variables showed no significant differences among groups. Oxygen saturation remained above 94% across all time points without intergroup differences. EtCO₂ values differed significantly at 30 minutes (P=0.04) and 60 minutes (P=0.01), with the highest levels observed in the PEEP 7 group and the lowest in the PEEP 5 group. Although mean arterial pressure and heart rate did not show statistically significant variation among groups, the PEEP 7 group demonstrated the smallest postoperative decline in blood pressure.
Conclusion: A PEEP level of 5 cmH₂O offers the most favorable balance between maintaining oxygenation, supporting effective ventilation, and preserving hemodynamic stability during laparoscopic cholecystectomy. This level can be recommended as a safe and optimal ventilation strategy.
Hossein Majedi , Ebrahim Espahbodi, Seyedeh Fatemeh Hosseini Nejad, Mahshid Vaziri, Fatemeh Javaherforoushzadeh , Mahbubeh Rashidi, Rouzbeh Amiri Motlagh ,
Volume 83, Issue 7 (10-2025)
Volume 83, Issue 7 (10-2025)
Abstract
Background: Postoperative pain remains a major concern following abdominal surgeries, including laparoscopic cholecystectomy. Inadequate pain control may lead to increased opioid consumption, delayed recovery, prolonged hospitalization, and reduced patient satisfaction. Therefore, the use of anesthetic adjuvants with effective analgesic properties and minimal side effects has gained increasing attention. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, and dexmedetomidine, a highly selective α2-adrenergic agonist, are commonly used agents with distinct mechanisms of action. The present study aimed to compare the effects of intraoperative ketamine and dexmedetomidine on postoperative pain following laparoscopic cholecystectomy.
Methods: This randomized, double-blind, controlled clinical trial was conducted on 252 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into three equal groups: ketamine, dexmedetomidine, and control. The ketamine group received an intravenous infusion of ketamine at a dose of 0.5 mg/kg/h, the dexmedetomidine group received 0.6 µg/kg/min of dexmedetomidine, and the control group received normal saline. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Hemodynamic parameters, including heart rate and mean arterial pressure, were continuously monitored throughout the perioperative period. Data were analyzed using appropriate statistical tests, including ANOVA and nonparametric analyses.
Results: The results demonstrated that postoperative pain scores were significantly lower in the ketamine group compared to both the dexmedetomidine and control groups at all evaluated time points within the first 24 hours after surgery (P < 0.001). Although dexmedetomidine also provided effective analgesia compared with the control group, ketamine showed superior pain reduction. No statistically significant differences were observed among the three groups regarding hemodynamic parameters, indicating comparable cardiovascular stability.
.Conclusion: Intraoperative administration of ketamine was more effective than dexmedetomidine in reducing postoperative pain following laparoscopic cholecystectomy, without compromising hemodynamic stability. Nevertheless, both agents proved to be safe and effective options for postoperative pain management. Ketamine may be considered a preferable.
Methods: This randomized, double-blind, controlled clinical trial was conducted on 252 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into three equal groups: ketamine, dexmedetomidine, and control. The ketamine group received an intravenous infusion of ketamine at a dose of 0.5 mg/kg/h, the dexmedetomidine group received 0.6 µg/kg/min of dexmedetomidine, and the control group received normal saline. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Hemodynamic parameters, including heart rate and mean arterial pressure, were continuously monitored throughout the perioperative period. Data were analyzed using appropriate statistical tests, including ANOVA and nonparametric analyses.
Results: The results demonstrated that postoperative pain scores were significantly lower in the ketamine group compared to both the dexmedetomidine and control groups at all evaluated time points within the first 24 hours after surgery (P < 0.001). Although dexmedetomidine also provided effective analgesia compared with the control group, ketamine showed superior pain reduction. No statistically significant differences were observed among the three groups regarding hemodynamic parameters, indicating comparable cardiovascular stability.
.Conclusion: Intraoperative administration of ketamine was more effective than dexmedetomidine in reducing postoperative pain following laparoscopic cholecystectomy, without compromising hemodynamic stability. Nevertheless, both agents proved to be safe and effective options for postoperative pain management. Ketamine may be considered a preferable.
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
Volume 83, Issue 7 (10-2025)
Volume 83, Issue 7 (10-2025)
Abstract
Background: The duration of hospitalization of patients is considered an important indicator in health resource management and patient evaluation. This study investigated the frequency and causes of readmission in cardiovascular patients
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Navid Kalani, Mehrdad Sayadinia, Amir Hossein Pourdavood , Maryam Ziaei, Tayyebeh Zare , Bibi Mona Razavi , Mansour Deylami ,
Volume 83, Issue 8 (11-2025)
Volume 83, Issue 8 (11-2025)
Abstract
Background: With the rapid advancement of minimally invasive surgical techniques, laparoscopic cholecystectomy has become one of the most frequently performed procedures worldwide. Despite its benefits, such as reduced postoperative complications and faster recovery, effective pain management remains a critical challenge. Postoperative pain can significantly impact patient recovery, hospital stay duration, and overall satisfaction. Given the limitations and side effects of opioid-based analgesics, there is growing interest in non-opioid alternatives for pain control following laparoscopic cholecystectomy. This narrative review evaluates the efficacy of various non-opioid analgesics in managing postoperative pain in patients undergoing this procedure.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Methods: A comprehensive literature search was conducted across multiple electronic databases, including Scopus, PubMed, Science Direct, SID, Magiran, and Google Scholar, using both Persian and English keywords. English equivalents were "Pain" and "Laparoscopic Cholecystectomy." Studies discussing pharmacological interventions for postoperative pain management in laparoscopic cholecystectomy were included.
Results: The review identified a wide range of non-opioid analgesics used for pain control in laparoscopic cholecystectomy patients. These included: Systemic medications (intravenous/oral) were magnesium sulfate, ketamine, ketorolac, paracetamol, ibuprofen, pregabalin, gabapentin, acetazolamide, N-acetylcysteine, dexamethasone, clonidine, celecoxib, and diclofenac. Local anesthetics & adjuvants were used intraperitoneally like bupivacaine, lidocaine, and hydrocortisone. Administration routes varied, with most drugs given intravenously, intraperitoneally, or preemptively (e.g., celecoxib and clonidine before surgery). Some studies highlighted the benefits of multimodal analgesia, combining different drug classes to enhance pain relief while minimizing side effects.
Conclusion: Despite the availability of numerous non-opioid analgesics, no single drug has been universally endorsed as the gold standard for postoperative pain management in laparoscopic cholecystectomy. Current evidence suggests that the choice of analgesic should be individualized, considering patient factors (e.g., comorbidities, pain tolerance) and the anesthesiologist’s expertise. Multimodal approaches, combining different drug classes, may offer superior pain control with fewer adverse effects compared to monotherapy. Further high-quality randomized trials are needed to establish standardized protocols and optimize pain management strategies for these patients.
Related Websites
Site Keywords
Cardiology, Anatomy, Biology, Epidemiology, Immunology, Neuroscience, Physical therapy, Physiology, Dermatology, Endocrinology and metabolicSite Statistics
- Registered users: 8207 users
- Online users: 1 users
- Guest users: 469 users
- All visits: 37663433 visits
- Visits in 24 Hours: 32166 visits
- Total articles: 12024 articles
- Published articles: 5086 articles
© 2026 , Tehran University of Medical Sciences, CC BY-NC 4.0
Designed & Developed by : Yektaweb