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Roshan Nikbakht, Samira Panahandeh, Farideh Moramezi, Maryam Farzaneh ,
Volume 82, Issue 3 (June 2024)
Volume 82, Issue 3 (June 2024)
Abstract
Background: Infertility is defined as the inability to achieve conception after one year of unprotected intercourse. This study aimed to explore the factors associated with infertility in men referred to the infertility center at Imam Khomeini Hospital in Ahvaz.
Methods: This descriptive study utilized a cross-sectional questionnaire during March 2016 to September 2019, involving 800 infertile couples with complete records. We extracted demographic data, including age, occupation, duration of infertility, smoking habits, surgical history, semen analysis, and sperm condition and quality from the files of these men referred to the IVF department. The collected details were systematically entered into an information form. Quantitative results are presented as mean±standard deviation, with differences of p<0.05 between groups deemed statistically significant.
Methods: This descriptive study utilized a cross-sectional questionnaire during March 2016 to September 2019, involving 800 infertile couples with complete records. We extracted demographic data, including age, occupation, duration of infertility, smoking habits, surgical history, semen analysis, and sperm condition and quality from the files of these men referred to the IVF department. The collected details were systematically entered into an information form. Quantitative results are presented as mean±standard deviation, with differences of p<0.05 between groups deemed statistically significant.
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Results: In this study, the average age of the men referred for evaluation was 33.5 years. The analysis of semen quality revealed a mean semen volume of 2.34 mL, which falls within the acceptable range for normal ejaculate volume, typically defined as being greater than 1.4 mL. The average sperm count recorded was 16,365,000 per mL. Additionally, our study demonstrated that only 5.8% of the sperm exhibited normal morphology. Sperm motility, another key factor in male fertility, averaged at 9.24%, significantly lower than the normal standard. Regarding employment status, a significant majority of participants were employed (89%), while 11% were unemployed. The surgical history among the referred men primarily included varicocelectomy (n=108), hemorrhoid surgery (n=29), urinary tract procedures (n=28), testicular hernia repairs (n=23), and appendectomies (n=18). Additionally, 24% of the subjects reported drug use, with a notable distinction made between smoking and other forms of drug use.
Conclusion: The findings from this study underscore significant concerns regarding male fertility among the referred men, particularly in terms of sperm count, motility, and morphology. These metrics suggest that many individuals may face challenges in achieving conception without medical intervention. Understanding these factors is crucial for developing effective treatment plans and improving reproductive outcomes for men facing infertility issues. |
Mahshad Mohtadi, Mohammad Javad Pasand , Ghazaleh Eslamian,
Volume 82, Issue 3 (June 2024)
Volume 82, Issue 3 (June 2024)
Abstract
Background: Athletes are seeking ways to enhance sports performance and protect themselves from the long-term effects of exercise. One potentially effective solution is the administration of colostrum supplements. Evidence suggests that it can support immune system function by maintaining the integrity of the intestinal barrier. The aim of this study is to evaluate the impact of colostrum supplementation on athletes' immune system performance.
Methods: This systematic review searched English and Farsi databases including Medline, Scopus, Embase, ScienceDirect, Scientific Information Database, Islamic World Science Citation, Cochrane, and Google Scholar website without a time limit until November 2023. Eighteen randomized clinical trials, following the Cochrane protocol, were analyzed to assess the effects of colostrum supplementation on athletes' immune systems. The studies measured various factors, such as the amount of cytokines, concentration of serum immunoglobulins, salivary immunoglobulin, white blood cell count, neutrophil oxidative reactions, and the rate of respiratory system-related diseases in athletes during the consumption of colostrum supplements or its derivatives. The potential risks of bias in the studies were evaluated using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.
Methods: This systematic review searched English and Farsi databases including Medline, Scopus, Embase, ScienceDirect, Scientific Information Database, Islamic World Science Citation, Cochrane, and Google Scholar website without a time limit until November 2023. Eighteen randomized clinical trials, following the Cochrane protocol, were analyzed to assess the effects of colostrum supplementation on athletes' immune systems. The studies measured various factors, such as the amount of cytokines, concentration of serum immunoglobulins, salivary immunoglobulin, white blood cell count, neutrophil oxidative reactions, and the rate of respiratory system-related diseases in athletes during the consumption of colostrum supplements or its derivatives. The potential risks of bias in the studies were evaluated using the Cochrane Risk of Bias 2.0 tool for randomized controlled trials.
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Results: The findings of these studies indicate that daily consumption of 3.2 grams of colostrum for 24 weeks can decrease the production of inflammatory cytokines caused by exercise and increase anti-inflammatory cytokines. Additionally, a daily intake of 20 grams of colostrum supplement can protect against the reduction of neutrophil function and immune responses resulting from long-term exercise. The group receiving colostrum experienced fewer upper respiratory tract diseases compared to the placebo group in studies that investigated this indicator. No significant effects on leukocyte count were observed with any dosage of supplementation, and the results of studies on other immune indicators were inconsistent.
Conclusion: Bovine colostrum can improve athletes' immune system performance by regulating immune parameters and mitigating the negative effects of intense exercise. However, the contradictory results of existing studies call for further research that examines different doses of colostrum in various sports. |
Romina Ghazi Mirsaid , Shirin Farahyar, Shahram Mahmoudi ,
Volume 82, Issue 3 (June 2024)
Volume 82, Issue 3 (June 2024)
Abstract
Khadije Sohrabi, Abbas Ali Gaeini , Elham Shirzad , Shahram Khorshidi , Shahriar Nafissi, Hamid Reza Fateh,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Spinal Muscular Atrophy (SMA) is a neurodegenerative disorder caused by a mutation in the survival motor neuron 1 (SMN1) gene. It is classified into five types (from type 0 to 4) based on the age of onset of symptoms and maximum motor function. This autosomal recessive mutation results in progressive weakness and atrophy of the proximal muscles. Due to the high cost of treatment, the critical timing of intervention, and the varied responses of patients, many individuals do not sufficiently benefit from current therapeutic methods. This study evaluates the impact of resistance training on the quality of life and fatigue in patients with SMA type III, considering the potential benefits of such training.
Methods: The present study was developmental and semi-experimental. Fourteen ambulatory patients with SMA type III were randomly assigned to exercise and control groups. The exercise group engaged in lower limb resistance training at an intensity of 6 to 8 on an adult resistance exercise scale for 10 weeks (25 sessions). During this period, the control group maintained their usual daily activities. Patients in the exercise group did not engage in any exercise activity other than the protocol of the present study. Patients' quality of life was measured with the Short Form 36 (SF-36) questionnaire, and fatigue severity was measured with the Fatigue Severity Scale (FSS), both evaluated pre- and post-intervention. The assessments and exercises were conducted in the occupational therapy department of Shariati Hospital, Tehran, from July 2023 to September 2023.
| Results: Analysis of the results showed significant improvements (P<0.05) in the exercise group compared to the control group in the subscales of physical functioning and fatigue within the quality of life assessment. Additionally, notable differences were found between the groups on the fatigue intensity scale. However, No significant difference was observed in the patients' Body Mass Index (BMI) measurements. Conclusion: Progressive resistance training of the lower limbs enhances the quality of life and reduces fatigue in patients with SMA type III. |
Navid Qaraei, Mohammad Ali Jafari, Maedeh Jafari , Fatemeh Karami Robati , Saeedeh Parvaresh,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Nephrolithiasis is one of the oldest known systemic diseases of kidney and urinary tract in children. This study aimed to compare the serum level of vitamin D in children with nephrolithiasis and healthy children.
Methods: The present descriptive-cross-sectional study was conducted from October 2017 to September 2019. 74 children with kidney stones and 63 healthy children referring to Afzalipour Hospital in Kerman were selected by simple sampling method. Healthy children who were considered as the control group were matched with the case group in terms of age and gender. All patients underwent kidney and urinary tract ultrasound. The diagnosis of kidney stones was based on the radiologist's opinion. Demographic characteristics of patients (age and sex) were recorded. Patients' blood tests were checked for vitamin D and calcium. Descriptive and analytical methods and SPSS software version 21 were used to analyze the data.
Methods: The present descriptive-cross-sectional study was conducted from October 2017 to September 2019. 74 children with kidney stones and 63 healthy children referring to Afzalipour Hospital in Kerman were selected by simple sampling method. Healthy children who were considered as the control group were matched with the case group in terms of age and gender. All patients underwent kidney and urinary tract ultrasound. The diagnosis of kidney stones was based on the radiologist's opinion. Demographic characteristics of patients (age and sex) were recorded. Patients' blood tests were checked for vitamin D and calcium. Descriptive and analytical methods and SPSS software version 21 were used to analyze the data.
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Results: The average age of children with kidney stones and healthy children was 5.41±1.8 and 10.06±0.41 years old, respectively (P=0.971). The most number of patients were boys (58.1%). 29.7% of patients and 15.9% of healthy children had a family history of kidney stones (P=0.056). 71.6% of patients had unilateral kidney stones and 28% had bilateral kidney stones. The mean serum level of vitamin D was higher in healthy children (P=0.021). The average calcium was higher in children with kidney stones (P=0.001). The average calcium was higher in children with kidney stones who had a family history of kidney stones (P=0.018). Average calcium was higher in children with bilateral kidney stones (11.4±1.1) (P=0.033). The mean calcium was higher in children with kidney stones with vitamin D deficiency (P=0.001) and sufficient vitamin D levels (P=0.037).
Conclusion: The average level of vitamin D serum in healthy children was significantly higher than that of children with kidney stones, and the average level of calcium in children with kidney stones was significantly higher than that of healthy children. Larger studies with more patients are needed to investigate these relationships. |
Fatemeh Shakki Katouli , Jayran Zebardast, Zahra Tavoli, Leila Bayani, Fahimeh Zeinalkhani, Reza Mardani , Fahimeh Azizinik,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: The prevalence of cesarean section (CS) has recently increased dramatically. Cesarean scar defect (CSD) is one of the most common complications of CS. This study aims to investigate and compare the depth and volume of the CSD in symptomatic patients with and without uterine adenomyosis.
Methods: This retrospective case-control study was done from November 2020 to November 2022 at our referral women's hospital. The patients who underwent sonohysterography with a previous history of one or two CS for at least one year ago and chief complaints of abnormal uterine bleeding were included in our study. The patients with myometrial or endometrial pathology were excluded from the study. The symptomatic patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were obtained from the patient’s documents and archived images. In sonohysterography, CSD features, including the length, depth, width, volume, RMT (Remained Myometrial Thickness), AMT (Adjacent Myometrial Thickness), and RMT/AMT were measured. To analyze the variables, t-tests, and chi-square were used.
Methods: This retrospective case-control study was done from November 2020 to November 2022 at our referral women's hospital. The patients who underwent sonohysterography with a previous history of one or two CS for at least one year ago and chief complaints of abnormal uterine bleeding were included in our study. The patients with myometrial or endometrial pathology were excluded from the study. The symptomatic patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were obtained from the patient’s documents and archived images. In sonohysterography, CSD features, including the length, depth, width, volume, RMT (Remained Myometrial Thickness), AMT (Adjacent Myometrial Thickness), and RMT/AMT were measured. To analyze the variables, t-tests, and chi-square were used.
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Results: Among 310 symptomatic women with a history of previous cesarean section underwent sonohysterography, 160 patients met the inclusion criteria (case group with adenomyosis: 82 patients and control group without adenomyosis: 78 patients). The chief complaints were post-menstrual bleeding (43.8%), prolonged bleeding (34.3%), and intermenstrual bleeding (21.9%). In the case group, 25.6% had CSD with RMT<2mm, but in the control group (without adenomyosis), only 6.4% had RMT<2mm. CSD depth and volume were significantly larger in patients with underlying adenomyosis (P-value of 0.002 and 0.038, respectively). Also, the mean RMT and RMT/AMT ratio were significantly lower in the case group (P-values of 0.004 and 0.00, respectively).
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Conclusion: Our study demonstrated a strong association between the presence of adenomyosis and larger CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.
Majid Salmanian Mashhadi , Anoushe Haghighi, Nahid Kianmehr, Marjan Mokhtare, Sara Zarasvandnia, Parna Hosseini Meigoni , Seyede Maryam Mirghorbani ,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Liver fibrosis is a major concern associated with long-term side effects among patients with rheumatoid arthritis (RA) treated with methotrexate. The aim of the present study was to compare the fibrosis-4 (FIB-4) index and the results of liver fibrosis severity derived from FibroScan device in rheumatoid arthritis patients who were treated with methotrexate.
Methods: The present cross-sectional study was conducted in 70 RA patients referred to rheumatology clinic of Hazrat Rasool Akram Hospital, Tehran, from July 2022 to July 2023. First, FIB-4 was calculated and the data from transient elastography, which was performed using a FibroScan device to diagnose liver fibrosis for each patient, will be compared with the results of the FIB-4 of each patient. Furthermore, the correlation between FIB-4 index and FibroScan grade with demographic characteristic, methotrexate dose and disease duration was also evaluated.
| Results: The average age of patients was 59.59±11.75 and most of them (74.3%) were women. Most patients (75.71%) with a normal to mild FIB-4 index stage had a normal to mild elastography stage. of patients had normal to mild liver fibrosis. FibroScan grade were not related to the age, gender, body mass index, methotrexate dose and duration of the disease (P>0.05). The average FIB-4 was 1.25±0.6, which was not significantly related to gender, body mass index, disease duration and methotrexate dose but directly related to the age of patients (P<0.001, (CL95%, 0.51-0.53)).The correlation between FIB-4 and FibroScan grade of the patients showed a positive association, which was not statistically significant (P=0.594, r=0.06, CL95%, -0.24-0.4). The FIB-4 in normal to mild grade was 85% rejecting the moderate to severe grade in FibroScan but none of them were statistically significant (P=0.146). Conclusion: Overall, the FIB-4 was incapable of predicting the FibroScan result. On the contrary, this case was also inconclusive and the results of FibroScan did not justify FIB-4 results of the patients. The FIB-4 cannot replace in RA patients. It is recommended to conduct future studies with a larger sample size in RA patients. |
Navid Kalani , Hasan Zabetian, Shahram Shafa, Erfaneh Alirezai, Fatemeh Eftekharian, Reza Sahraei ,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Recently, epinephrine is used to increase the depth and duration of local anesthetic pain, and it is widely used topically to reduce local anesthetic release and reduce bleeding caused by surgery.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.
Methods: This study was a randomized, double-blind clinical trial on 30 patients aged 18 to 85 years undergoing lower limb orthopedic surgery referred to Peymaniyeh Hospital in Jahrom from September to December 2022. Patients were randomly assigned to two groups, A (epinephrine+fentanyl+bupivacaine) and B (bupivacaine+fentanyl). Systolic blood pressure, diastolic pressure, mean arterial pressure, arterial blood oxygen saturation percentage, and pulse rate were measured and recorded before drug administration, before spinal anesthesia, after anesthesia, and then every half hour until the end of surgery (15, 45, 30, 60, 75, 90, 120) and during recovery. Data analysis was performed using SPSS version 21 software and descriptive (mean, standard deviation) and inferential statistics (t-test, chi-square, Mann-Whitney, Friedman) at a significance level of P<0.05.
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Results: Thirty patients aged 18 to 85 years (in two groups of 15) with anesthesia class I and II undergoing lower limb orthopedic surgery were evaluated. The study groups are matched in terms of age and gender variables. There was no significant difference in mean systolic, diastolic, mean arterial blood pressure, and heart rate before and after anesthesia, 15, 45, 30, 60, 75, 90, and 120 minutes after drug injection, and at entry and exit from recovery between the Epinephrine+Fentanyl+Bupivacaine and Fentanyl+Bupivacaine groups. There was a significant difference in mean O2SAT before anesthesia, 15, 30, and 75 minutes after drug injection between the epinephrine+fentanyl+bupivacaine and fentanyl+ bupivacaine groups (P<0.05).
Conclusion: The use of the combination of epinephrine+fentanyl+intrathecal bupivacaine compared to the combination of fentanyl+bupivacaine did not have a significant difference in the studied variables of patients' vital signs. |
Hamid Reza Mehryar, Mohammad Reza Hosseini Azar , Afshin Ebrahimi , Omid Garkaz,
Volume 82, Issue 4 (July 2024)
Volume 82, Issue 4 (July 2024)
Abstract
Background: Although the respiratory system is the main element involved in the disease of COVID-19, nevertheless, there are reports of the involvement of other organs and their lesser symptoms. This study was conducted with the aim of investigating the frequency of gastrointestinal symptoms in patients with COVID-19.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.
Methods: This cross-sectional descriptive study was conducted on all patients diagnosed with COVID-19 hospitalized in Imam Khomeini Hospital from April to September 2021 by census method. The data was collected using a checklist that included demographic information. After the data was collected, it was entered into SPSS software, version 18 (IBM SPSS, Armonk, NY, USA) and analyzed with the help of descriptive statistics.
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Results: In this study, the results showed that out of 2580 hospitalized patients, 54% were women and 46% were men. And the average age of the patients was 58.67±17.68. The highest frequency of people was in the age range of 40-59 years (925 people). 64% of patients had at least one gastrointestinal symptom, Each of the symptoms had a different prevalence, Anorexia 40% with a preference for men (57%) and the highest frequency in the age range of 40-59 years (430 people), gastrointestinal bleeding 10% with a preference for men (80%), And the highest frequency in the age range of 60-79 years (112 people), abdominal pain 8% with preference for women (65%) with preference for frequency in the age range of 40-59 years (65 people), vomiting 3% with preference for women (51%) with abundance in the age range of 80-99 years (58 people), diarrhea 1.5% with preference in men (51%) with abundance in the age range of 60-79 years (18 people) and constipation in 0.2% with preference Women (67%), all of whom were over 60 years old.
Conclusion: The findings of this study showed that the COVID-19 disease can not only involve the respiratory system but also the digestive system in the course or beginning of the disease. |
Fatemeh Hayati, Fariba Talebi, Maryam Khombi Shooshtari , Seyed Bahman Qaderian, Leila Moradi , Asieh Aref,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: Diabetic kidney disease is a common complication of diabetes and the most common cause of end-stage kidney disease worldwide. Empagliflozin is associated with slower progression of kidney disease and a lower incidence of kidney complications. So, the aim of the study is to compare renal outcomes in type 2 diabetic patients with and without empagliflozin.
Methods: This research is a cross-sectional study based on the information contained in the files of patients referred to Imam Khomeini and Golestan hospitals in Ahvaz in 1400-1401. Inclusion criteria included age over 18 years, type 2 diabetes, HGA1c less than or equal to 9, GFR between 30 and 60 ml/min/1.73 m2, use of empagliflozin for more than or equal to three months, and urinary albumin to creatinine ratio greater than 30 mg/dL. Exclusion criteria included patients not attending the clinic for follow-up during the study, proteinuria due to glomerulonephritis, type 1 diabetes, vaginitis, UTI, and liver failure based on history.
Based on this, 136 people with type 2 diabetes were included in the study and were randomly divided into two drug and control groups, one group of patients who took empagliflozin for three months and the other group of patients who did not receive this treatment. Patient data, including serum creatinine, HBA1C, albuminuria, weight, blood pressure, side effects, were extracted and then the patients' data were collected three and six months after receiving empagliflozin. Data analysis was done with descriptive and analytical statistics.
Methods: This research is a cross-sectional study based on the information contained in the files of patients referred to Imam Khomeini and Golestan hospitals in Ahvaz in 1400-1401. Inclusion criteria included age over 18 years, type 2 diabetes, HGA1c less than or equal to 9, GFR between 30 and 60 ml/min/1.73 m2, use of empagliflozin for more than or equal to three months, and urinary albumin to creatinine ratio greater than 30 mg/dL. Exclusion criteria included patients not attending the clinic for follow-up during the study, proteinuria due to glomerulonephritis, type 1 diabetes, vaginitis, UTI, and liver failure based on history.
Based on this, 136 people with type 2 diabetes were included in the study and were randomly divided into two drug and control groups, one group of patients who took empagliflozin for three months and the other group of patients who did not receive this treatment. Patient data, including serum creatinine, HBA1C, albuminuria, weight, blood pressure, side effects, were extracted and then the patients' data were collected three and six months after receiving empagliflozin. Data analysis was done with descriptive and analytical statistics.
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Results: In this study, 56 (41.2%) were male and 80 (58.8%) were female. Changes in eGFR (P=0.044) and (P=0.003), HbA1C (P=0.014), albuminuria (P=0.001) during 3 months and 6 months, and changes in systolic blood pressure (0.020) during 3 months between the empagliflozin group were significantly different compared to the control group. However, there was no significant difference between the two groups in terms of weight changes during 3 months and 6 months (P=0.97) and changes in systolic blood pressure during 6 months (P=0.13).
Conclusion: Using empagliflozin can improve kidney function and reduce albuminuria. |
Aso Yazdani, Hamed Tavan, Kourosh Sayehmiri,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: One of the main causes of death in the world is cardiovascular disease. While there is no denying that lipids play a risk factor in cardiovascular disease, statins are effective medications for treating this condition. We used network meta-analysis to compare the impact of three drugs atorvastatin, simvastatin, and rosuvastatin on lipids.
Methods: Type of study of this research was a systematic review and network meta-analysis. Databases such as Scopus, PubMed, ISI, Science Direct, Google Scholar, SID, MagIran, web of Science, and Cochrane Library were searched. Keywords atorvastatin, simvastatin, and rosuvastatin were used in the search strategy. We did both standard meta-analyses and network meta-analyses. Consistency was checked by comparing direct and indirect effect sizes. The time period for searching articles was from 2000 to June 2024. All relevant articles published in English or Persian were reviewed. Paired wised comparisons were made using the intervalplot command in STATA. The surface under the cumulative ranking (SUCRA) was used to rank the efficacy of treatments. The Q test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using STATA Ver. 17.
Results: From the 61 articles that were included in the network meta-analysis (atorvastatin 43 studies, rosuvastatin 22 studies, simvastatin 21 studies, and placebo 15 studies). The total sample size was 62178 patients. The results showed that the effect of, atorvastatin, rosuvastatin, and simvastatin with placebo on fat lipids was significant (P<0.001). Still, there was not a substantial difference between the effects of the three drugs. The best treatment for reducing LDL was atorvastatin (standard mean difference (SMD) =-5.18, 95% confidence interval (CI);-7.42,-2.95, P<.001). SMD LDL for rosuvastatin and simvastatin were -4.35(95% CI; -6.81,-1.89), and -3.44(95% CI;-5.89,-.98) respectively. The surface under the cumulative ranking (SUCRA) showed that the probability that Rosuvastatin was the best drug for reducing triglycerides was 82.4% and the likelihood that atorvastatin was the best drug for reducing cholesterol was 80.3%.
Conclusion: Atorvastatin, rosuvastatin, and simvastatin have a better effectiveness than placebo in reducing fat lipids. Atorvastatin was the best treatment to reduce LDL, and TC and increase HDL. Rosuvastatin was the best drug to reduce TG. Atorvastatin, rosuvastatin, and simvastatin were the effective treatments to reduce fat lipids respectively.
Methods: Type of study of this research was a systematic review and network meta-analysis. Databases such as Scopus, PubMed, ISI, Science Direct, Google Scholar, SID, MagIran, web of Science, and Cochrane Library were searched. Keywords atorvastatin, simvastatin, and rosuvastatin were used in the search strategy. We did both standard meta-analyses and network meta-analyses. Consistency was checked by comparing direct and indirect effect sizes. The time period for searching articles was from 2000 to June 2024. All relevant articles published in English or Persian were reviewed. Paired wised comparisons were made using the intervalplot command in STATA. The surface under the cumulative ranking (SUCRA) was used to rank the efficacy of treatments. The Q test and I2 index were used to assess the heterogeneity of the studies. Data were analyzed using STATA Ver. 17.
Results: From the 61 articles that were included in the network meta-analysis (atorvastatin 43 studies, rosuvastatin 22 studies, simvastatin 21 studies, and placebo 15 studies). The total sample size was 62178 patients. The results showed that the effect of, atorvastatin, rosuvastatin, and simvastatin with placebo on fat lipids was significant (P<0.001). Still, there was not a substantial difference between the effects of the three drugs. The best treatment for reducing LDL was atorvastatin (standard mean difference (SMD) =-5.18, 95% confidence interval (CI);-7.42,-2.95, P<.001). SMD LDL for rosuvastatin and simvastatin were -4.35(95% CI; -6.81,-1.89), and -3.44(95% CI;-5.89,-.98) respectively. The surface under the cumulative ranking (SUCRA) showed that the probability that Rosuvastatin was the best drug for reducing triglycerides was 82.4% and the likelihood that atorvastatin was the best drug for reducing cholesterol was 80.3%.
Conclusion: Atorvastatin, rosuvastatin, and simvastatin have a better effectiveness than placebo in reducing fat lipids. Atorvastatin was the best treatment to reduce LDL, and TC and increase HDL. Rosuvastatin was the best drug to reduce TG. Atorvastatin, rosuvastatin, and simvastatin were the effective treatments to reduce fat lipids respectively.
Yunus Soleymani, Farahnaz Aghahoseini, Peyman Sheikhzadeh,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: Nuclear medicine imaging has shown high accuracy in evaluating the metabolism of colon cancer lesions. The aim of this study was to investigate the ability of radiomics features extracted from nuclear medicine images as non-invasive biomarkers of lesion metabolism in patients with colon cancer by examining the correlation of these features with SUV (standardized uptake value) max values.
Methods: The current study was a cross-sectional study that was conducted from July 2022 to July 2023 in the nuclear medicine department of Tehran University of Medical Sciences. In this study, PET/CT (positron emission tomography/computed tomography) images of 60 patients with primary colon cancer were used. Colon cancer lesions were manually delineated on PET images by an experienced physician and saved as VOIs (volumes of interest). Thirty-two textural radiomics features were extracted from each VOI, including feature groups of gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), neighborhood grey-level difference matrix (NGLDM), and gray-level zone length matrix (GLZLM). Then, the correlation of these features with SUVmax values was investigated using the Spearman correlation coefficient statistical test. Also, the value of p<0.05 was considered as the significance level of the test.
Methods: The current study was a cross-sectional study that was conducted from July 2022 to July 2023 in the nuclear medicine department of Tehran University of Medical Sciences. In this study, PET/CT (positron emission tomography/computed tomography) images of 60 patients with primary colon cancer were used. Colon cancer lesions were manually delineated on PET images by an experienced physician and saved as VOIs (volumes of interest). Thirty-two textural radiomics features were extracted from each VOI, including feature groups of gray-level co-occurrence matrix (GLCM), gray-level run-length matrix (GLRLM), neighborhood grey-level difference matrix (NGLDM), and gray-level zone length matrix (GLZLM). Then, the correlation of these features with SUVmax values was investigated using the Spearman correlation coefficient statistical test. Also, the value of p<0.05 was considered as the significance level of the test.
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Results: A comprehensive analysis revealed that more than 96% of the examined radiomics features specifically, 31 out of 32 exhibited a statistically significant correlation with lesion metabolism values, as indicated by p-values less than 0.05. Among these features, GLZLM_HGZE stood out with a high correlation coefficient of 0.9881, alongside a significance level of less than 0.0001. Similarly, GLZLM_SZHGE also demonstrated a strong correlation, with a coefficient of 0.9723 and a significance level below 0.0001, indicating a robust relationship with SUVmax values. In contrast, GLZLM_LZHGE was the only feature that failed to show a significant correlation with lesion metabolism values (p>0.05).
Conclusion: The radiomics method has the potential to be used as a completely non-invasive method to evaluate the metabolism of colon cancer lesions and facilitate the monitoring and treatment of patients with colon cancer. |
Solmaz Ohadian Moghadam , , Mohsen Ayati, Erfan Amini , Faeze Salahshour, Mohsen Shiraghaei ,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: Sarcopenia is the degenerative loss of skeletal muscle mass, which is known as a poor postoperative outcome in various cancer types. Radical cystectomy (RC) is often associated with high mortality rates, and sarcopenia is hypothesized to aid in risk stratification. Hence, this study assessed the role of Sarcopenia as an indicator of postoperative outcomes and survival rates in patients undergoing RC for bladder cancer.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
Methods: This cross-sectional research was carried out between January 2022 and January 2023 on 30 patients with bladder cancer who were candidates for RC and referred to the urology clinic of Imam Khomeini Hospital in Tehran. One week before surgery, the cross-sectional area of the psoas muscle was measured using MRI to estimate muscle volume, and the sarcopenia index was calculated. Muscle area evaluation was performed by calculating the cross-sectional area of the left and right psoas muscles on MRI. The psoas muscle area was calculated by excluding blood vessels, bony structures, and intermuscular fat regions based on fat signals. The calculated psoas muscle area was then normalized to the patient's height in square meters. To improve the quality of reporting on surgical complications, the patients were re-examined and the duration of patients' hospital stays was measured.
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Results: The mean sarcopenic index for the patients was 1264.6 ± 591.5 mm²/m². Seven patients (24.1%) were smokers, while 22 patients (75.9%) were non-smokers. During the 10-month follow-up period, 25 patients (83.3%) remained alive, and 5 patients (16.7%) passed away. The mean value of sarcopenic index in patients with localized cancer was higher than those with advanced cancer, but this difference was not statistically significant. Data analysis revealed a significant association between higher mortality rates and the presence of locally advanced bladder tumors (P = 0.046). Additionally, a reduced sarcopenic index in this study was significantly correlated with lymphovascular invasion. In this study, no correlation was found between perioperative complications and sarcopenic index.
Conclusion: To conclude, a significant association was observed between a reduction in the sarcopenic index and lymphovascular invasion; however, no connection was identified between mortality rates and postoperative complications following RC. |
Shahla Ahmadi Halili , Zahra Soltani, Saeed Hesam, Maryam Khombi Shooshtari ,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
Background: Diabetic nephropathy is one of the most important complications of diabetes worldwide. In diabetic patients, although renal biopsies performed with less frequency, it is important because these patients may have glomerular disorders other than diabetic nephropathy. Therefore, in this study, we investigated the results of renal biopsies performed on diabetic patients referred to diabetic clinics in Imam Khomeini and Golestan hospitals in Ahvaz, southwest Iran.
Methods: In this descriptive-cross-sectional study, information related to biopsy samples from 67 patients recognize with diabetes who underwent renal biopsy from August 2103 to September 2018, collected and recorded retrospectively. The presence of diabetic nephropathy and other renal diseases was confirmed by pathological evaluation of all renal biopsy specimens. Then, the data were analyzed by using SPSS 20 software.
Methods: In this descriptive-cross-sectional study, information related to biopsy samples from 67 patients recognize with diabetes who underwent renal biopsy from August 2103 to September 2018, collected and recorded retrospectively. The presence of diabetic nephropathy and other renal diseases was confirmed by pathological evaluation of all renal biopsy specimens. Then, the data were analyzed by using SPSS 20 software.
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Results: The results of this study presented that diabetic nephropathy (67.2%), diabetic nephropathy along with acute tubulointerstitial nephritis (7.5%), acute tubulointerstitial nephritis (6%) and membrane glomerulonephritis (6%) were the most frequent diagnosis in diabetic patients with renal disorder. Furthermore, in the described cases, class IV (47.9%), III (35.4%) and II (12.5%) and I (4.2%) were the most common classes of nephropathy, respectively. Interestingly, there was no significant association between age, sex, proteinuria and hematuria with the frequency of nephropathy in the patient who underwent renal biopsy. Also, in this study, the frequency of class I and II nephropathy was 100% in patients older than 50 years, while 64.7% of class III was in patients under 50 years of age, which was also statistically significant (P=0.018). On the other hand, in the studied patients, there were not significant different between the frequency of diabetic nephropathy class and proteinuria, azotemia, and hematuria (P>0.05).
Conclusion: According to the obtained results, to reduce the risk of complications and costs, it seems crucial to be more wary in pick out diabetic patients for renal biopsy and to enhance the threshold of renal biopsy in diabetic patients as much as possible. |
Reihane Chegini , Seyed Hasan Seyed Sharifi , Rasul Nikdel ,
Volume 82, Issue 5 (August 2024)
Volume 82, Issue 5 (August 2024)
Abstract
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Background: Benign tumors of the gastrointestinal tract with a muscular origin are typically found in the esophagus, stomach, or small intestine, and rarely in the large intestine. Approximately 3% of all gastrointestinal leiomyomas occur in the large intestine, primarily in the descending colon and sigmoid colon. These lesions are usually asymptomatic and are often discovered during endoscopic procedures. Case Presentation: A 38-year-old female patient admitted to the emergency department of Imam Ali Hospital in Bojnurd city in January 2024, reporting vague and nonspecific lower abdominal pain, abdominal distension, nausea, vomiting, low appetite and signs of partial gastrointestinal obstruction over the past week that don’t have any history of weight loss, gastrointestinal bleeding, constipation or family history of cancer. Her symptoms had not responded to Over-the-counter (OTC) medicines and outpatient treatment. Given the nonspecific manifestations, a CT scan of the abdomen and pelvis with iv contrast was requested for further evaluation of inta abdominal disease. The CT findings indicated a 5.5 cm lesion at the beginning of the large intestine, which exerted pressure on the distal part of small intestine, leading to evidence of partial obstruction of the distal part of small intestin. The patient was diagnosed with small bowel obstruction due to an ascending colon tumor and was scheduled for surgical intervention. She underwent resection of right colon, 10-15 cm of terminal ileum along with drainage of the regional lymph nodes. The excised tissue sample was sent for histopathological examination, which suggested a benign colon tumor likely to be a leiomyoma. To facilitate a more accurate diagnosis, immunohistochemical analysis was recommended, which confirmed the diagnosis of leiomyoma. Conclusion: Colonic leiomyomas can present with various symptoms depending on their size and location. Due to the difficulty in differentiating leiomyomas from malignant colonic tumors, particularly when they are larger, surgical intervention is often recommended. This case highlights the importance of early diagnosis and appropriate management strategies for these tumors to prevent potential complications. |
Farzane Hayati, Esma’il Akade, Negar Dinarvand, Gholam Abbas Kaydani , Shahram Jalilian,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Epstein-Barr virus (EBV), human herpesvirus 8 (HHV-8), hepatitis B virus (HBV), human papilloma virus (HPV), Merkel cell polyomavirus (MCPyV), human lymphotropic virus type 1 (HTLV-1) and Hepatitis C virus (HCV) are among the most important viruses that cause cancer in humans. These viruses are collectively known as oncoviruses due to their potential to induce malignant transformations in host cells. Oncoviruses exert their cancer-causing effects by utilizing various viral oncoproteins and non-coding RNAs, which can drive host cells toward malignancy through multiple pathways. One critical strategy these viruses employ involves altering the host cell's regulatory mechanisms, particularly by influencing DNA methylation processes.
DNA methylation is a crucial modification that occurs on the promoter regions of genes, effectively reducing their expression levels. Under normal cellular conditions, a delicate balance of methylation and demethylation is maintained by a specific set of enzymes. Key players in this process include DNA methyltransferases (DNMTs) and TET methylcytosine dioxygenases (TETs), which are pivotal in regulating gene expression through methylation. These enzymes are prime targets for oncoviruses because, by altering their activity, viruses can hijack the host cell's regulatory machinery. Viral oncoproteins, though diverse in structure and function, often converge on disrupting the expression of these enzymes. By doing so, they induce widespread changes in DNA methylation patterns, effectively reprogramming the gene expression landscape of the host cell. This reprogramming is not random; rather, it is a calculated mechanism through which oncoviruses can manipulate the cell cycle, promoting uncontrolled cellular proliferation and progression towards cancer. By suppressing or activating specific genes, these viruses can push cells past normal checkpoints, eventually leading to tumor formation. Despite the critical role of DNA methylation in cancer development, the precise mechanisms by which oncoviruses modulate these methylation processes are not fully understood. Researchers have made significant progress in exploring the connection between viral infections and cancer, but many of the detailed pathways through which oncoviruses control methylation remain to be elucidated. As a result, this area remains a fertile ground for further research, offering potential avenues for therapeutic intervention in virus-induced cancers.
DNA methylation is a crucial modification that occurs on the promoter regions of genes, effectively reducing their expression levels. Under normal cellular conditions, a delicate balance of methylation and demethylation is maintained by a specific set of enzymes. Key players in this process include DNA methyltransferases (DNMTs) and TET methylcytosine dioxygenases (TETs), which are pivotal in regulating gene expression through methylation. These enzymes are prime targets for oncoviruses because, by altering their activity, viruses can hijack the host cell's regulatory machinery. Viral oncoproteins, though diverse in structure and function, often converge on disrupting the expression of these enzymes. By doing so, they induce widespread changes in DNA methylation patterns, effectively reprogramming the gene expression landscape of the host cell. This reprogramming is not random; rather, it is a calculated mechanism through which oncoviruses can manipulate the cell cycle, promoting uncontrolled cellular proliferation and progression towards cancer. By suppressing or activating specific genes, these viruses can push cells past normal checkpoints, eventually leading to tumor formation. Despite the critical role of DNA methylation in cancer development, the precise mechanisms by which oncoviruses modulate these methylation processes are not fully understood. Researchers have made significant progress in exploring the connection between viral infections and cancer, but many of the detailed pathways through which oncoviruses control methylation remain to be elucidated. As a result, this area remains a fertile ground for further research, offering potential avenues for therapeutic intervention in virus-induced cancers.
Saeed Rahmani, Aliakbar Shafiee, Abbas Riazi , Alireza Akbarzadeh Baghban , Alireza Jafari , Maryam Dashti,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Background: Problems related to blue light exposure are among the various issues experienced by individuals who have undergone Photorefractive Keratectomy (PRK).Given the growing concerns regarding blue light’s effects on visual health, this study aimed to thoroughly investigate the impacts of blue blocker filters on the improvement of vision in patients post-refractive surgery of the PRK type. The primary objective was to evaluate the overall effectiveness of these filters in enhancing visual quality and in reducing complications associated with the surgery, which can significantly affect a patient’s quality of life.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
Methods: In a quasi-experimental study conducted from September 1, 2024, to the end of October 2024, individuals who had undergone PRK surgery were examined at the optometry clinic of Dr. Labbafi Nejad Hospital in Tehran. Participants were subjected to assessments both with and without the application of blue blocker filters. Key parameters, including visual acuity and contrast sensitivity among attendees, were meticulously measured under both conditions. The results were then systematically compared and analyzed to draw meaningful conclusions about the impact of blue blocker filters in this context.
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Results: A total of thirty-four participants, comprising 73.5% females and 26.5% males, with an average age of 32.6 years, were incorporated into the study. Post-surgery, the average refraction measured in the right and left eyes was documented as -0.42±0.16 D and -0.30±0.16 D, respectively. Notably, visual acuity in both eyes significantly improved with the use of the blue light blocking filter (P<0.005) Moreover, contrast sensitivity at varying spatial frequencies of 1.5, 6, and 18 cycles per degree (c/d) also exhibited significant enhancement (P<0.005).
Conclusion: The incorporation of blue blocker filters for individuals with a history of PRK surgery has led to noteworthy improvements in visual acuity and enhanced contrast sensitivity. These findings underscore the critical importance of integrating blue light protection in the post-operative care of patients, as it significantly elevates the overall visual experience and may contribute to better long-term outcomes following refractive surgery. |
Ehsan Roshan Nasab , Farzaneh Hematian, Ahmad Shamsizadeh Hayatdavodi, Mohammadreza Mirkarimi , Mohsen Ali Samir , Mandana Izadpanah,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Background: Vancomycin resistance in intensive care units has significant complications and additional costs. Given the need for rational use of this antibiotic to prevent the occurrence of antibiotic resistance, the present study was designed to evaluate how to prescribe the antibiotic vancomycin consumption pattern in a pediatric subspecialty hospital.
Methods: This cross-sectional descriptive-analytical study was conducted over a 3-month period (February, May, and June) in 2021 at the Pediatric Hospital of Jundishapur University of Medical Sciences, Ahvaz. All patients hospitalized in the intensive care unit and infectious disease ward with vancomycin prescription were included in the study. Patients who were hospitalized for less than three days or had no desire to enter the study were excluded from the study. Vancomycin prescription by clinical pharmacist was reviewed based on the latest version of Lexicomp from Wolters Kluwer and the National Health Service (NHS) guidelines.
Methods: This cross-sectional descriptive-analytical study was conducted over a 3-month period (February, May, and June) in 2021 at the Pediatric Hospital of Jundishapur University of Medical Sciences, Ahvaz. All patients hospitalized in the intensive care unit and infectious disease ward with vancomycin prescription were included in the study. Patients who were hospitalized for less than three days or had no desire to enter the study were excluded from the study. Vancomycin prescription by clinical pharmacist was reviewed based on the latest version of Lexicomp from Wolters Kluwer and the National Health Service (NHS) guidelines.
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Results: Of the 91 hospitalized patients, 70.3% (64 cases) were prescribed vancomycin without performing an antibiogram culture based on experience and 29.7% (27 cases) were based on an antibiogram culture. In 96.7% (88 cases) , the duration of intravenous vancomycin infusion did not comply with the protocol. Red Man Syndrome was observed in 8.8% (8 cases). In 91.2 % (83 cases), no adverse effects were reported. In 65.9% (60 cases), the drug dose was determined based on the correct renal function Glomerular filtration rate (GFR) and in 34.1%, the drug dose was determined regardless of the renal function of the patients. Vancomycin doses were lower and higher than the guidelines in 6 and 25 patients, respectively. Out of all patients, eighty four cases recovered and seven cases died.
Conclusion: In almost half of the patients, Vancomycin were prescribed based on experience and without performing an antibiogram test. Use of guidelines, Serum level monitoring programs and continuous medical education for doctors can be effective in rational use of antibiotics. |
Pourya Mashategan, Mohammad Reza Ghane , Ali Bahramifar, Mahdi Raei ,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Background: Intubation is normally conducted in an emergency or prior to surgery. A cuffed tracheal tube is fitted, whose inflated cuff exerts pressure on the tracheal wall. Such pressure should, therefore, be monitored every day by use of pressure gauge devices. The general guideline in this regard is that the pressure of the cuff must lie between 20 and 30 cm of water. The exaggerated pressure may cause tissue ischemia, wound, and necrosis of the tracheal wall; if it is too low, this could result in air leakage and oropharyngeal secretions, increasing the risk of insufficient ventilation and aspiration pneumonia. This study aimed at comparing the cuff pressure of an endotracheal tube inflated with alkaline lidocaine versus air for any post-extubation complications and cuff pressure changes.
Methods: This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.
Results: The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.
Conclusion: Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.
Methods: This prospective cohort study was conducted on patients who were admitted to the intensive care unit of Baqiyatullah Al-Azam Hospital in Tehran between May 2023 and February 2024, underwent intubation in this unit and met the inclusion criteria for the study. This prospective study included 62 patients, and tracheal tube cuff pressure was recorded at 30 minutes, 60 minutes, 120 minutes, 6 hours, and 24 hours after intubation with a pressure gauge. Patients were randomly divided into two groups-an 'air group', whose cuff was inflated to the pressure of 20 cmH2O by air, and a 'lidocaine group,' whose cuff was filled with 2% lidocaine to the same pressure. In this study, the post-extubation complications, such as sore throat, hoarseness, and cough, were assessed immediately and 24 hours after extubation. Similarly, the tracheal tube displacement during the intubation process was monitored in both groups.
Results: The results showed that the pressure of an endotracheal tube cuff inflated with lidocaine was drastically lower than the one inflated with air, with a p-value of 0.001. On the other hand, the sore throat, cough, and hoarseness after extubation and 24 hours later were significantly fewer in the lidocaine group compared with the air group at a p-value of 0.001.
Conclusion: Cuffs inflated with alkalinized lidocaine clearly avoided high cuff pressure at induction and reduced postextubation sore throat. Hence, alkalinized lidocine-filled endotracheal tube cuffs are comparatively safer and more beneficial than conventional air-filled cuffs.
Majid Jahanshahi , Morteza Taheri , Seyyed Abdollahadi Daneshi , Mostafa Haji Rezaei ,
Volume 82, Issue 6 (September 2024)
Volume 82, Issue 6 (September 2024)
Abstract
Background: Decompressive craniectomy (DC) is a therapeutic approach for patients with raised intracranial pressure and cerebral edema. Although DC is not a complicated procedure, it is associated with significant complications and morbidities that significantly affect clinical outcomes. This study investigates the frequency of cerebrospinal fluid (CSF) circulation disorders after DC and evaluates related factors.
Methods: This cross-sectional analytical study was conducted on 79 patients who underwent DC at Shohadaye Haftome Tir Hospital, one of the main trauma centers in Tehran. The patients' files and the Picture Archiving and Communication System (PACS) were reviewed to collect demographic, clinical, and radiologic data. After identifying patients with post-operative (after DC) CSF circulation disorders, the relevant factors were determined using multivariate logistic regression.
Methods: This cross-sectional analytical study was conducted on 79 patients who underwent DC at Shohadaye Haftome Tir Hospital, one of the main trauma centers in Tehran. The patients' files and the Picture Archiving and Communication System (PACS) were reviewed to collect demographic, clinical, and radiologic data. After identifying patients with post-operative (after DC) CSF circulation disorders, the relevant factors were determined using multivariate logistic regression.
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Results: Overall, seventy-nine patients were studied. The mean age of patients was 40.56±12.64 years and 82.3% were male. Forty-seven patients (59.5%) underwent DC due to traumatic causes and thirty-two patients (40.5%) due to vascular pathologies. In total, 36.7% (nineteen) of patients were affected by some degree of subdural hygromas of which 13 patients (44.8%) progressed to clinical and radiologic hydrocephalus. 19% (fifteen patients) developed hydrocephalus within the first six months after surgery. Considering the clinical variables, the GCS of patients was the only one that showed a significant relationship with CSF circulation disorders. Regarding radiological variables, the presence of intraventricular hemorrhage (IVH) was the only relevant factor. In addition, from the surgical perspective, performing duraplasty (autograft or allograft) and reoperation demonstrated significant relationships with CSF circulation disorders. The results of multivariate logistic regression showed that having intraventricular hemorrhage (OR, 6.15-6.9414: CI95%, P=0.003) and reoperation (75.91: OR, 3.88-3.6, 1485/43: CI95%, P=0.004) were two independent factors associated with hydrocephalus in DC patients.
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Conclusion: In patients who have undergone decompressive craniectomy, intraventricular hemorrhage (IVH) and reoperation can be independent risk factors for CSF circulation disorders. Although the incidence and presence of IVH cannot be controlled, careful and meticulous surgical technique and skill can significantly improve the outcome of decompressive craniectomy by reducing the need for reoperation
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