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Fateh Rahimi , Sanaz Khashei,
Volume 82, Issue 7 (October 2024)
Volume 82, Issue 7 (October 2024)
Abstract
Background: Biofilm producing uropathogenic Escherichia coli (UPEC) strains are of major concern in clinical settings which display increased resistance to conventional antimicrobial therapy. Nitric oxide (NO) has shown to exhibit anti-biofilm effects in a variety of bacterial species. In this study we aimed to evaluate the effectiveness of NO on the formation and eradication of biofilm of UPEC strains isolated from patients with urinary infection (UI) in Tehran.
Methods: During May 2022 to April 2023, a total of 3814 suspected isolates of UPEC were collected from a pathobiology laboratory in Tehran and confirmed as E. coli strains using specific primers for elongation factor Tu (tufA) gene. All strains were screened for the ability to form biofilm by the microtiter plate (MTP) and Congo red agar (CRA) assays, and also the presence of biofilm genes were detected among biofilm producing strains. Moreover, the effect of NO on biofilm formation and its dispersal was evaluated by the high (30 mM) and low (125 nM) concentrations of sodium nitroprusside (SNP) as NO donor.
Methods: During May 2022 to April 2023, a total of 3814 suspected isolates of UPEC were collected from a pathobiology laboratory in Tehran and confirmed as E. coli strains using specific primers for elongation factor Tu (tufA) gene. All strains were screened for the ability to form biofilm by the microtiter plate (MTP) and Congo red agar (CRA) assays, and also the presence of biofilm genes were detected among biofilm producing strains. Moreover, the effect of NO on biofilm formation and its dispersal was evaluated by the high (30 mM) and low (125 nM) concentrations of sodium nitroprusside (SNP) as NO donor.
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Results: All collected isolates were confirmed by the polymerase chain reaction (PCR) using specific primers, in which 1309 strains (34%) were able to form colonies with red, dry and rough (rdar, curli and cellulose positive) (n=682, 52%), brown, dry and rough (bdar, curli positive and cellulose negative) (n=353, 27%) and pink, dry and rough (pdar, cellulose positive and curli negative) (n=274, 21%) morphotypes on CRA and selected as biofilm positive strains. Furthermore, 228 (17%), 402 (31%) and 679 (52%) strains were able to form a weak, moderate, and strong biofilm, respectively, and csgA, csgD, yedQ, and bcsA genes were found among 87, 98, 100 and 79% of biofilm-positive strains, respectively. The 30 mM concentration of SNP significantly decreased the biofilm formation (17-40%) and increased biofilm dispersal (20-45%) among UPEC strains.
Conclusion: These findings confirmed the applicability of nitric oxide as an anti-biofilm agent for UPEC strains. These findings contribute to the development of novel strategies for fighting biofilm-associated infections. |
Mozaffar Jan Faza, Mohammad Rahman Rahimi ,
Volume 82, Issue 7 (October 2024)
Volume 82, Issue 7 (October 2024)
Abstract
Background: The aim of our study was to evaluate the effect of 8 weeks of aerobic exercise with vitamin D supplementation on indulin-1 and nitric oxide in patients with hypertension aged 30 to 50 years.
Methods: This study was conducted as a semi-experimental pre-test and post-test design, and was conducted from June 1401 at Seyyed Shohada Hospital in Urmia. 40 eligible men and women were randomly divided into four groups (supplement group, placebo + exercise group, a supplement + exercise group, and a control group). The training program of the experimental groups included eight weeks of aerobic exercise running on a treadmill (3 sessions/8 weeks). Blood sampling to evaluate biochemical variables was performed 48 hours before and after the intervention in a fasting state with a volume of 10 cc.
| Results: The results of the study show that after 8 weeks of aerobic exercise, vitamin D, BMI, NO, ET-1 and weight were significantly affected (P < 0.05) and systolic blood pressure in the supplement, supplement + exercise and exercise + placebo groups changed compared to the control group(P < 0.05). Conclusion: Based on the results of the present study, the results showed that taking eight weeks of vitamin D supplements along with aerobic activity reduced blood pressure indices in the subjects. Also, taking vitamin D supplements along with physical activity reduced BMI and increased NO, reduced ET-1 and body weight in the subjects in the study. |
Ebrahim Piri, Amirali Jafarnezhadgero, Anders Stålman,
Volume 82, Issue 7 (October 2024)
Volume 82, Issue 7 (October 2024)
Abstract
Nazila Farnosh, Abdolreza Roueintan, Seyd Ebrahim Hejazian, Khadijeh Ezoji , Fatemeh Abdullah Gorji , Sadrollah Motamed,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Introduction & Objective: Reductive mammoplasty, which is performed for medical or cosmetic reasons, can be carried out with different techniques. In this study, we compare the results obtained from vertical mammoplasty surgery with reverse T method and purse method in patients.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Methods: In this retrospective cross-sectional study, we examined sample consisted of 58 patients referred to the 15- KORDAD educational center in Tehran for reductive mammoplasty surgery. In all patients, the scar length was 12 cm and the resected was 300 g. Patients were followed up in the first week, 1 and 3 months after surgery, and conducted photographism was assessed based on Vancouver and patient and observer scar assessment scal (POSAS) criterion .The duration of wound restoration and the presence of redness and discharge (secretion) complications or long-term itching were assessed.
Results: The obtained results showed that age, body mass index and resection weight did not have statistically significant difference between the reverse T incision groups and the purse method. However, the duration of surgery (minute) in reverse T group was longer than the purse method, which was statistically significant. Postoperative scars rate using POSAS criterion were not significantly different between the two groups in terms of redness, discharge and itching complications. Postoperative scar rate using Vancouver criterion were not significantly different in terms of hyper and hypopigmentation, vascularity and high and medium scale satisfaction, but in terms of Pliability and wound height were higher in the purse group and were significantly different. Complications of seroma, nipple areola necrosis and anesthesia in nipple areola and infection and hematoma were not significantly different in both groups.
Conclusion: Reverse T-mammoplasty had a longer operation time, but satisfaction was higher in this method, but only in a good scale. The Pliability and height of the wound were higher in the purse group.
Farhad Tavakkoli, Ebrahim Espahbodi,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Navid Kalani, Masoud Ghanei, Hossein Hakimelahi,
Volume 82, Issue 10 (January 2025)
Volume 82, Issue 10 (January 2025)
Abstract
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Background: Varicocele, defined as an abnormal enlargement and tortuosity of the veins in the pampiniform plexus, is the most common cause of correctable male infertility that might increase chance of fertility even in presence of further male factor infertility causes. While it is well known to be reason of fertility in male and is easy to treat, here we present a case with 20 years of infertility due to missed opportunity of varicocelectomy.
Case Presentation: A 39-year-old male patient with a family history of infertility for about 20 years was referred for azoospermia and stated that after two testicular biopsies and failure to obtain sperm in one of the equipped infertility treatment centers, he was recommended to receive a donated embryo, but he wanted to have his biological child genetically. In the history taken, he had a history of mild left varicocele and no other clinical problems, and mild bilateral varicocele was evident on examination. Karyotype and Y chromosome examination were normal, and hormonal tests and gonadotropin and testosterone levels were within normal limits. Semen volume was 1 ml in two tests one month apart, and semen was alkaline. The patient underwent microscopic bilateral varicocelectomy with an inguinal incision. The patient underwent fluoroscopy, vasography, which showed distal dilatation of both Vas deferens. Diluted methylene blue solution was also injected into the vas deferens and Folley was fixed. But the urine color did not turn blue, so the patient's position was changed to lithotomy and the patient underwent resection of the ejaculatory duct via the urethra, that is the Verumontanum was resected with a cautery-cutting cautery. Three months later, the patient presented with a completely normal semen analysis. The patient was advised to try to conceive at least four months after the operation. Two months later, pregnancy occurred again, and after 9 months, a healthy male fetus was born by cesarean section. Conclusion: This study demonstrates that varicocele treatment can significantly improve fertility parameters and enhance the chances of successful conception in affected patients. The most important suggestion of this case report is to highlight the importance of timely diagnosis and treatment of varicocele as a correctable cause of male infertility. Unfortunately, our patient suffered from infertility for 20 years due to not undergoing varicocelectomy. Even obstruction treatment may not necessarily be needed in this case, as a sole varicocelectomy might make sperm extraction possible for further in vitro procedures. |
Fatemeh Kiaee, Kiyana Bahani, Heshmat Shahi,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: Helicobacter pylori (H. pylori) infection is the most common infection worldwide and results in chronic gastritis, and rarely gastric carcinoma. Chronic inflammation, which is a major engine of disease development. Is dominantly controlled by adaptive and humoral immunity. This study reveals the intricate IL-21 and IL-23 relationship in H.pylori associated diseases as well as inflammatory GI disorders, as the crtically govern the differentiation and activity of T helper 17 (TH17) cells in the gastric mucosa. Understanding these cytokines pathways is essential for comprehending the immune pathogenesis of H. pylori infection and its outcome.
Methods: A literature search was conducted in the PubMed database using the MESH keywords "Helicobacter pylori" "Interleukin 21," "Interleukin 23," and "gastric cancer" to identify relevant English-language studies. Articles that were reviews, case reports, or letters to the editor were excluded.
Results: IL-23 significantly exacerbates both intestinal and gastric inflammatory responses by stimulating T cells particularly Th17 cell subsets, through the mediation of STAT3 signaling pathways and reducing IL-10 production, while T cells lacking the IL-23 receptor promote Treg expansion and intestinal homeostasis. IL-21 is implicated in chronic inflammation of the gastric and intestinal mucosa, with elevated levels observed in ulcerative colitis patients, contributing to the recruitment of inflammatory cells, increased inflammation, and angiogenesis. This particular cytokine plays an essential role in the recruitment of inflammatory cells, the increase of tissue inflammation, and the promotion of pathological angiogenesis. Moreover, IL-21 exerts influence over B cell differentiation and the production of antibodies, establishing a connection to humoral immune responses within chronic inflammations.
Conclusion: CD4+ T helper 17 (Th17) cells exhibit both antimicrobial and pathogenic immune functions in the gastrointestinal environment. These processes are interconnected, as cytokines such as IL-21 and IL-23 are essential for Th17 cell maintenance and support humoral immune responses. A comprehensive understanding of the dynamic immunological interactions in H. pylori-related and inflammatory gastrointestinal diseases may facilitate the development of novel immunology-based therapeutic interventions.
Farahnaz Bidari Zerehpoosh , Mahdieh Saffari, Shahram Sabeti , Kaveh Ebrahimzadeh, Mahbobeh Taheri,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: This study aimed to investigate the markers ACTH, KI67, CAM5.2, GH, PRL, FSH, LH, TSH in pathological samples of patients with pituitary neuroendocrine tumors by IHC staining.
Methods: In this retrospective study, all patients with PitNETs who had undergone surgery at Loghman Hospital from 2020 to 2022 were included in the study. The slides were prepared by IHC staining and with the markers ACTH, KI67, CAM5.2, GH, PRL, FSH, LH, TSH were evaluated. IHC staining for SF1-PIT1-TPit transcription factors was performed for 16 patients with negative initial markers.
Results: 424 patients participated in this study. The mean and standard deviation of the age of the patients studied were 43.7 and 13.7 years, respectively. LH and FSH markers had the highest and TSH marker had the lowest proportion of positive cases. The possibility of LH and FSH markers being positive in men was significantly higher than in women, and conversely, the possibility of GH and ACTH markers being positive in women was significantly higher than in men. The possibility of LH and FSH markers being positive in patients over 40 years of age was significantly higher than in patients 40 years of age and younger, and conversely, the possibility of GH and PRL markers being positive in patients 40 years of age and younger was significantly higher than in patients over 40 years of age. Most cases (66.3%) were treated during the follow-up period.
Conclusion: The findings indicate that accurate pathological identification of tumors plays an important role in the selection of treatment methods, especially drug and surgical treatment, and can lead to improved patient management.
Ramyar Rahimi Darehbagh , Sara Moradian , Afshin Hajihasanzadeh, Masood Moradi, Farhang Safar Nejhad ,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: Acute pancreatitis is a common and challenging disease that can develop local and systemic complications. It is divided into biliary and non-biliary pancreatitis, based on ultrasonographic findings. This study aimed to evaluate the clinical and paraclinical findings of patients with acute pancreatitis and related factor.
Methods: This cross-sectional study included all patients hospitalized with a diagnosis of acute pancreatitis in Besat and Towhid hospitals of Sanandaj from March 2016 to March 2018. All patients admitted with a confirmed diagnosis of acute pancreatitis during the mentioned period were enrolled. Inclusion criteria were a definitive diagnosis of acute pancreatitis based on clinical features (characteristic abdominal pain), laboratory findings (serum amylase or lipase elevated more than three times the normal level), and/or imaging evidence. Patients with chronic underlying conditions such as diabetes, chronic renal or hepatic failure, advanced cardiac disease, or neoplasms were excluded to reduce confounding effects.
Results: Of the 150 patients, 89 were female (59.33%), and 61 were male (40.67%). The mean age of the patients was 53.11 years old. 62% of patients had biliary pancreatitis, and 38% had non-biliary. The prevalence of alcoholic pancreatitis in the population was 5.33%. The age of people with biliary pancreatitis was more than non-biliary. According to Ranson's criteria, 6% of patients had severe acute pancreatitis, all of whom were over 60.
Conclusion: Acute pancreatitis was more prevalent among women, particularly in the fifth decade of life, with gallstones being the leading cause. Patients with biliary pancreatitis were significantly older, and advanced age was associated with increased disease severity. Moreover, blood glucose, AST, and LDH were significantly higher in severe cases. These findings highlight the importance of early diagnosis, accurate severity assessment, and special attention to elderly patients and those with biliary pancreatitis to reduce complications and improve clinical outcomes.
Methods: This cross-sectional study included all patients hospitalized with a diagnosis of acute pancreatitis in Besat and Towhid hospitals of Sanandaj from March 2016 to March 2018. All patients admitted with a confirmed diagnosis of acute pancreatitis during the mentioned period were enrolled. Inclusion criteria were a definitive diagnosis of acute pancreatitis based on clinical features (characteristic abdominal pain), laboratory findings (serum amylase or lipase elevated more than three times the normal level), and/or imaging evidence. Patients with chronic underlying conditions such as diabetes, chronic renal or hepatic failure, advanced cardiac disease, or neoplasms were excluded to reduce confounding effects.
Results: Of the 150 patients, 89 were female (59.33%), and 61 were male (40.67%). The mean age of the patients was 53.11 years old. 62% of patients had biliary pancreatitis, and 38% had non-biliary. The prevalence of alcoholic pancreatitis in the population was 5.33%. The age of people with biliary pancreatitis was more than non-biliary. According to Ranson's criteria, 6% of patients had severe acute pancreatitis, all of whom were over 60.
Conclusion: Acute pancreatitis was more prevalent among women, particularly in the fifth decade of life, with gallstones being the leading cause. Patients with biliary pancreatitis were significantly older, and advanced age was associated with increased disease severity. Moreover, blood glucose, AST, and LDH were significantly higher in severe cases. These findings highlight the importance of early diagnosis, accurate severity assessment, and special attention to elderly patients and those with biliary pancreatitis to reduce complications and improve clinical outcomes.
Fatemeh Habibollahi, Ghazaleh Eslamian, Kiana Hasibi , Sepehr Khoshbaf Khiabanian , Bentolhosna Dehghan Nayeri , Aref Adeli Mosabbeb ,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Background: Infertility is defined as the failure to achieve pregnancy after one year or more of regular unprotected sexual intercourse. Assisted reproductive technologies (ART) represent a key therapeutic approach for infertile couples. Bisphenol-A (BPA), a compound found in plastic polymer products, has been associated with increased infertility risk. This systematic review addresses whether BPA affects ART outcomes.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.
Methods: A comprehensive and systematic literature search was conducted across PubMed, Google Scholar, Web of Science, and Scopus up to December 2024 without any language or time restrictions. The search strategy combined relevant keywords and medical subject headings such as “bisphenol A,” “infertility,” “assisted reproductive technology,” “in vitro fertilization,” and “embryo implantation.” All human studies assessing the relationship between BPA exposure and ART outcomes were considered. After removing duplicates and screening titles and abstracts, 23 studies that met the inclusion criteria were reviewed in detail. The selected studies included cross-sectional and prospective cohort designs, and data on sample size, BPA measurement methods, and reproductive endpoints were extracted for qualitative synthesis.
Results: The reviewed studies consistently indicate that exposure to BPA is associated with adverse reproductive outcomes, particularly in women undergoing IVF treatment. Evidence suggests that higher BPA levels correlate with fewer retrieved oocytes, reduced oocyte maturation rates, and impaired ovarian response to hormonal stimulation. Several studies also observed reduced estradiol concentrations and lower fertilization and cleavage rates, leading to decreased implantation success and clinical pregnancy rates. In addition, diminished ovarian reserve markers, such as anti-Müllerian hormone and antral follicle count, have been negatively influenced by BPA exposure. Male factors were also affected, with reports of decreased sperm motility, abnormal morphology, and increased DNA fragmentation, which could compromise embryo quality and early development. Variability in study methodologies, small sample sizes, and differences in BPA detection techniques, however, make direct comparison challenging.
Conclusion: Current evidence supports an inverse association between BPA exposure and fertility outcomes, but further prospective studies with larger sample sizes and more precise measurement methods are needed.
Ramyar Rahimi Darehbagh , Ebrahim Khajeh, Daem Roshani , Farhang Safarnejhad,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Background: Surgical site infections (SSIs) represent one of the most common and significant complications following surgical interventions. These infections not only prolong hospital stay and recovery but also impose a considerable economic burden on healthcare systems and patients. Reducing the risk of SSIs is therefore a major focus of perioperative care, and several strategies have been proposed to minimize their occurrence. One of the most widely practiced preventive measures is preoperative skin antisepsis, aimed at lowering the microbial load at the surgical site. Among available antiseptics, chlorhexidine has been shown to have broad-spectrum antimicrobial activity and sustained effectiveness. This study was designed to evaluate the effect of preoperative chlorhexidine showers on the incidence of SSIs in patients undergoing elective inguinal hernia surgery.
Methods: A randomized clinical trial was carried out in 2019 at Kowsar Hospital, Sanandaj. A total of 300 patients scheduled for elective inguinal hernia repair were enrolled and randomly assigned into three groups of 100 participants each. The intervention group was instructed to take a shower with 4% chlorhexidine solution on the night before surgery. Control group 1 took a routine bath using regular detergents, while control group 2 did not bathe prior to the operation. All patients were monitored for the occurrence of superficial SSIs for up to 30 days postoperatively.
Results: Among the 300 patients included in the study, 12 cases (4%) of superficial SSIs were documented. The distribution of infections varied significantly across the groups: one case in the chlorhexidine group, three cases in the regular detergent group, and eight cases in the group that did not shower. Statistical analysis confirmed that the difference in infection rates among the groups was significant (P=0.034).
Conclusion: The findings of this clinical trial demonstrate that preoperative showers with 4% chlorhexidine solution are effective in reducing the incidence of SSIs in patients undergoing elective inguinal hernia surgery. Implementing this simple, low-cost intervention may therefore be a valuable strategy in routine surgical practice to enhance patient outcomes and reduce postoperative complications.
Reza Sahraei, Anahita Haghjoo , Hasan Zabetian, Mansour Deylami, Rahil Haghjoo, Fatemeh Khadempir, Navid Kalani ,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Spinal anesthesia is a common method for elective cesarean sections; however, complications such as shivering and nausea may affect postoperative recovery quality. Bupivacaine is a standard drug used in this procedure, but its combination with opioids like sufentanil may have beneficial effects in reducing these complications. This study aimed to compare the incidence of shivering and nausea in women undergoing elective cesarean section who received either bupivacaine alone or a bupivacaine-sufentanil combination.
Methods: The present study was a double-blind randomized clinical trial conducted over a 6-month period from April 2021 to October 2021 on 30 patients undergoing elective cesarean section with spinal anesthesia at Motahari Hospital in Jahrom city. Patients were randomly assigned using a random number table into two groups: bupivacaine alone and bupivacaine-sufentanil combination. The frequency of nausea, vomiting, and shivering was recorded at different time points: before spinal anesthesia, after spinal anesthesia, 3 minutes before delivery, immediately after delivery, at 15, 30, and 45 minutes, upon recovery room admission, and upon discharge from recovery. The data analysis was performed using descriptive statistics indicators (frequency, percentage, mean, and standard deviation) and inferential statistical tests (t-test, Mann-Whitney, chi-square and Friedman) using SPSS software version 21. A significance level of p < 0.05 was considered.
Results: In the bupivacaine-sufentanil group, the highest frequency of shivering occurred at 30 minutes post-spinal anesthesia (20%) and upon recovery room admission (26.7%). In the bupivacaine-alone group, the highest frequency was observed upon recovery room admission (33.3%) and at discharge from recovery (26.7%). The highest nausea frequency was 33.3% in the bupivacaine-sufentanil group and 40% in the bupivacaine group at 3 minutes before delivery. However, no statistically significant difference was found between the two groups at different time points.
Conclusion: The present study showed that adding low-dose sufentanil to bupivacaine in spinal anesthesia protocols, while potentially having minor clinical effects on certain complications, did not lead to a significant difference in the incidence of shivering and nausea. Therefore, for more precise clinical decision-making regarding drug combinations in regional anesthesia, further studies with larger sample sizes and different drug dosages are recommended.
Methods: The present study was a double-blind randomized clinical trial conducted over a 6-month period from April 2021 to October 2021 on 30 patients undergoing elective cesarean section with spinal anesthesia at Motahari Hospital in Jahrom city. Patients were randomly assigned using a random number table into two groups: bupivacaine alone and bupivacaine-sufentanil combination. The frequency of nausea, vomiting, and shivering was recorded at different time points: before spinal anesthesia, after spinal anesthesia, 3 minutes before delivery, immediately after delivery, at 15, 30, and 45 minutes, upon recovery room admission, and upon discharge from recovery. The data analysis was performed using descriptive statistics indicators (frequency, percentage, mean, and standard deviation) and inferential statistical tests (t-test, Mann-Whitney, chi-square and Friedman) using SPSS software version 21. A significance level of p < 0.05 was considered.
Results: In the bupivacaine-sufentanil group, the highest frequency of shivering occurred at 30 minutes post-spinal anesthesia (20%) and upon recovery room admission (26.7%). In the bupivacaine-alone group, the highest frequency was observed upon recovery room admission (33.3%) and at discharge from recovery (26.7%). The highest nausea frequency was 33.3% in the bupivacaine-sufentanil group and 40% in the bupivacaine group at 3 minutes before delivery. However, no statistically significant difference was found between the two groups at different time points.
Conclusion: The present study showed that adding low-dose sufentanil to bupivacaine in spinal anesthesia protocols, while potentially having minor clinical effects on certain complications, did not lead to a significant difference in the incidence of shivering and nausea. Therefore, for more precise clinical decision-making regarding drug combinations in regional anesthesia, further studies with larger sample sizes and different drug dosages are recommended.
Mastaneh Moghtaderi, Hossein Amirzargar, Behnaz Bazargani , Arash Abbasi, Daryoush Fahimi, Fahime Asgarian,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Posterior urethral valve (PUV) is recognized as one of the most frequent causes of obstructive uropathy in the pediatric population, particularly in male infants. This congenital anomaly leads to variable degrees of urinary outflow obstruction, which may result in progressive renal damage and deterioration of kidney function over time. Despite advances in diagnostic modalities and surgical interventions, infants and children affected by PUV continue to demonstrate suboptimal long term renal outcomes, with a considerable proportion developing chronic kidney disease (CKD). Understanding early predictors of adverse renal prognosis is essential to guide timely interventions and optimize follow up strategies. The present study aimed to assess the long term renal outcomes, over a minimum of five years, of patients with PUV treated at the Children’s Medical Center, and to investigate the role of preoperative serum creatinine levels as a predictor of future CKD in this patient group.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results: Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.
Methods: A cross sectional and retrospective study design was employed. The medical records of patients diagnosed with PUV between March 2011 and March 2016 who had at least five years of documented follow up were reviewed at the Children’s Medical Center in 2021. Data extracted included demographic characteristics, laboratory tests—particularly pre and post operative serum creatinine—ultrasound imaging results, surgical details, and follow up findings throughout the study period.
Results: Eighty one patients met the inclusion criteria, with a mean age at diagnosis of 105 days. At the five year follow up, the overall prevalence of CKD among these patients was estimated at approximately 9.9%. During the follow up period, one patient died due to kidney disease, one underwent kidney transplantation, and three required maintenance dialysis. Statistical analysis demonstrated that a preoperative creatinine level exceeding 1.15 mg/dL was strongly associated with the future development of CKD, showing 100% sensitivity and 75% specificity in predicting adverse long term renal outcomes.
Conclusion: This study underscores the persistent risk of CKD in children with PUV, even after surgical intervention. Regular and comprehensive monitoring of renal function remains vital in this high risk group. Preoperative serum creatinine may serve as a reliable, accessible, and clinically useful prognostic marker to identify patients who may benefit from closer follow up and proactive management strategies.
Anahita Zoghi , Mahbobe Taheri, Shima Alizadeh ,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
Background: Migraine is a complex neurological disease that has affected hundreds of people of different ages and races. Migraine causes changes in the white matter and may cause cognitive changes in affected patients, but studies in this field are still limited and sometimes have contradictory results. The purpose of this study is investigate and compare cognitive function in patients with migraine.
Methods: In this case-control study, which was conducted with the aim of investigating and comparing cognitive function in migraine patients with the control group, cognitive function in migraine patients (with and without aura) referred to the Luqman Hospital clinic in the year 2023 were evaluated and compared with the healthy control group. Patient information was recorded in SPSSv.25 and analyzed.
Results: A gender difference was observed between the two groups, and women were significantly more in the migraine group (P-value: 0.003). This issue was also seen regarding age, and people with migraine were significantly older than normal people (33.91 ± 10.86 vs. 30.43 ± 7.89, P-value: 0.013). The visual score had a significant difference between the two groups (P-value: 0.001). In general, it was seen that the cognitive status score had a statistically significant difference between the two groups and it was lower in the migraine group (P-value<0.001).
Conclusion: It is concluded that migraine patients have some degree of cognitive impairment and this is not associated with migraine. Based on our findings, there is a significant difference in gender and level of education between normal individuals and migraineurs, and migraineurs are usually women and have lower education than normal individuals, which could be due to impaired quality of life due to migraine and cognitive impairment. The current study did not examine chronic migraine, but it was found that there was no difference in cognitive impairment between migraine with and without aura. Whether chronic migraine differs from other migraines in the incidence of cognitive impairment needs to be investigated in future studies.
Methods: In this case-control study, which was conducted with the aim of investigating and comparing cognitive function in migraine patients with the control group, cognitive function in migraine patients (with and without aura) referred to the Luqman Hospital clinic in the year 2023 were evaluated and compared with the healthy control group. Patient information was recorded in SPSSv.25 and analyzed.
Results: A gender difference was observed between the two groups, and women were significantly more in the migraine group (P-value: 0.003). This issue was also seen regarding age, and people with migraine were significantly older than normal people (33.91 ± 10.86 vs. 30.43 ± 7.89, P-value: 0.013). The visual score had a significant difference between the two groups (P-value: 0.001). In general, it was seen that the cognitive status score had a statistically significant difference between the two groups and it was lower in the migraine group (P-value<0.001).
Conclusion: It is concluded that migraine patients have some degree of cognitive impairment and this is not associated with migraine. Based on our findings, there is a significant difference in gender and level of education between normal individuals and migraineurs, and migraineurs are usually women and have lower education than normal individuals, which could be due to impaired quality of life due to migraine and cognitive impairment. The current study did not examine chronic migraine, but it was found that there was no difference in cognitive impairment between migraine with and without aura. Whether chronic migraine differs from other migraines in the incidence of cognitive impairment needs to be investigated in future studies.
Ali Ayatollahi, Maryam Dashti,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Refractive errors are among the most common and preventable causes of visual impairment in children. Early detection and proper correction are essential to prevent long-term visual complications such as amblyopia and reduced academic performance. The present study aimed to determine the prevalence and distribution patterns of different types of refractive errors among elementary school boys in Hamedan Province, located in western Iran, where limited data are available on this age group.
Methods: This cross-sectional study was conducted between October 2022 and December 2023 on 1053 male students aged 6-12 years, selected through a multistage cluster sampling method covering both urban and rural areas. Examinations included Uncorrected visual acuity (UCVA), Best-corrected visual acuity (BCVA), cycloplegic refraction, cover test, and ophthalmoscopy, all performed by a trained optometrist following a standardized protocol. Based on cycloplegic spherical equivalent refraction, myopia was defined as -0.50 diopter or worse, hyperopia as +2.00 diopter or more, and astigmatism as a cylinder of -0.50 diopter or more. The data were statistically analyzed to explore the association between age and the type of refractive error.
Results: Data from 1027 students were included in the final analysis. The mean age of participants was 9.52±1.63 years. UCVA of 20/40 or worse was found in 16.5% of students, and BCVA of 20/40 or worse in 1.2%. The prevalence rates of myopia, hyperopia, and astigmatism were 6.5%, 5.6%, and 18.9%, respectively. With-the-rule astigmatism was the most frequent type observed. The prevalence of myopia tended to increase with age, while hyperopia showed a decreasing trend.
Conclusion: The findings revealed a relatively high prevalence of refractive errors, particularly astigmatism, among school-aged boys in western Iran. These results emphasize the importance of implementing periodic, school-based vision screening programs and ensuring better access to refractive care services. Promoting awareness among parents, teachers, and health authorities regarding the need for early eye examinations could play a crucial role in preventing avoidable visual impairment and improving children’s visual health and academic success.
Methods: This cross-sectional study was conducted between October 2022 and December 2023 on 1053 male students aged 6-12 years, selected through a multistage cluster sampling method covering both urban and rural areas. Examinations included Uncorrected visual acuity (UCVA), Best-corrected visual acuity (BCVA), cycloplegic refraction, cover test, and ophthalmoscopy, all performed by a trained optometrist following a standardized protocol. Based on cycloplegic spherical equivalent refraction, myopia was defined as -0.50 diopter or worse, hyperopia as +2.00 diopter or more, and astigmatism as a cylinder of -0.50 diopter or more. The data were statistically analyzed to explore the association between age and the type of refractive error.
Results: Data from 1027 students were included in the final analysis. The mean age of participants was 9.52±1.63 years. UCVA of 20/40 or worse was found in 16.5% of students, and BCVA of 20/40 or worse in 1.2%. The prevalence rates of myopia, hyperopia, and astigmatism were 6.5%, 5.6%, and 18.9%, respectively. With-the-rule astigmatism was the most frequent type observed. The prevalence of myopia tended to increase with age, while hyperopia showed a decreasing trend.
Conclusion: The findings revealed a relatively high prevalence of refractive errors, particularly astigmatism, among school-aged boys in western Iran. These results emphasize the importance of implementing periodic, school-based vision screening programs and ensuring better access to refractive care services. Promoting awareness among parents, teachers, and health authorities regarding the need for early eye examinations could play a crucial role in preventing avoidable visual impairment and improving children’s visual health and academic success.
Elham Shirvani Naghani , Leila Moradi, Alireza Jahanshahi, Homeira Rashidi, Alireza Sedaghat,
Volume 83, Issue 4 (July 2025)
Volume 83, Issue 4 (July 2025)
Abstract
Background: Thyroid disorders are common among young women, and hypothyroidism ranges clinically from subclinical to overt disease, potentially causing various maternal and fetal complications. Determining the appropriate levothyroxine (LT4) dose during pregnancy is crucial for maintaining maternal euthyroidism and optimising pregnancy outcomes. This study aimed to evaluate the dose requirements of LT4 in pregnant women with and without a prior history of hypothyroidism, and to investigate the association with Thyroid peroxidase antibody (TPO) levels.
Methods: This hospital- and clinic-based study was conducted from September 2022 to March 2023 among 146 pregnant women attending a private clinic or Golestan Hospital in Ahvaz, Iran. A total of 146 pregnant women diagnosed with subclinical hypothyroidism (SCH, n=62) or overt hypothyroidism (OH, n=84) were randomly selected. Participants were divided into groups based on their history of hypothyroidism and received LT4 treatment. LT4 requirements were determined according to trimester-specific TSH ranges: >10 mIU/L or 2.5-10 mIU/L in the first trimester, and 3-10 mIU/L in the second and third trimesters. Data analysis was performed using SPSS version 22, employing descriptive statistics (mean±SD, frequency, and percentage) and analytical tests, including the independent t-test and Mann-Whitney U test.
Results: Pregnant women with overt hypothyroidism showed a statistically significant difference in mean LT4 dose between those with and without a prior history of hypothyroidism (P<0.05). In contrast, no significant difference was observed in LT4 requirements among women with subclinical hypothyroidism. TPO Ab positivity was associated with higher LT4 requirements, particularly in women with overt disease. Dose adjustments were most frequent during the first trimester, with incremental increases observed in subsequent trimesters. These findings support individualized monitoring, iodine testing, adherence checks, and coordinated antenatal endocrinology care to improve maternal and neonatal outcomes.
Conclusion: Following the diagnosis of hypothyroidism in early pregnancy, LT4 dosing should be tailored according to disease severity, prior history of hypothyroidism, TPO Ab status, and study location to ensure optimal maternal and fetal outcomes.
Methods: This hospital- and clinic-based study was conducted from September 2022 to March 2023 among 146 pregnant women attending a private clinic or Golestan Hospital in Ahvaz, Iran. A total of 146 pregnant women diagnosed with subclinical hypothyroidism (SCH, n=62) or overt hypothyroidism (OH, n=84) were randomly selected. Participants were divided into groups based on their history of hypothyroidism and received LT4 treatment. LT4 requirements were determined according to trimester-specific TSH ranges: >10 mIU/L or 2.5-10 mIU/L in the first trimester, and 3-10 mIU/L in the second and third trimesters. Data analysis was performed using SPSS version 22, employing descriptive statistics (mean±SD, frequency, and percentage) and analytical tests, including the independent t-test and Mann-Whitney U test.
Results: Pregnant women with overt hypothyroidism showed a statistically significant difference in mean LT4 dose between those with and without a prior history of hypothyroidism (P<0.05). In contrast, no significant difference was observed in LT4 requirements among women with subclinical hypothyroidism. TPO Ab positivity was associated with higher LT4 requirements, particularly in women with overt disease. Dose adjustments were most frequent during the first trimester, with incremental increases observed in subsequent trimesters. These findings support individualized monitoring, iodine testing, adherence checks, and coordinated antenatal endocrinology care to improve maternal and neonatal outcomes.
Conclusion: Following the diagnosis of hypothyroidism in early pregnancy, LT4 dosing should be tailored according to disease severity, prior history of hypothyroidism, TPO Ab status, and study location to ensure optimal maternal and fetal outcomes.
Fatemeh Mollarahimi-Maleki , Pershang Nazemi, Maryam Yousefi,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: One of the most common cancers in women is cervical cancer, which is the most preventable cancer leading to death among women worldwide. Among the causes related to cervical cancer, the human papillomavirus (HPV) is the main factor responsible for causing cervical intraepithelial neoplasia (CIN) and cervical cancer. The aim of this study was to investigate the prevalence of high-risk HPVs (HPV16 and HPV18) and to determine the immediate absolute risk of CIN2+ in individuals with a positive HPV test.
Methods: This cross-sectional study included women who tested positive for HPV and visited the Gynecologic Oncology Clinic at Tehran University of Medical Sciences from October 2022 to March 2025. Individuals with a positive high-risk HPV result were referred for colposcopy and biopsy. The immediate absolute risk of CIN2+ in HPV-positive patients with HPV16, HPV18, or concurrent HPV16/18 genotypes (Multi. HPV+) was evaluated across different cytologic grades, ranging from NILM (Negative for Intraepithelial Lesion or Malignancy) to SCC (Squamous Cell Carcinoma).
Results: A total of 727 patients participated in the study. The mean age and standard deviation of the participants were 35.99 and 8.48 years, respectively. Among all referrals, the number of women who were positive only for HPV 16 was 170 (23%), and 24 (3.3%) were positive only for HPV 18. The highest number of positive cases for HPV16 and HPV18 were in the age range of 30 to 39 years (45%). In the Multi. HPV+ group, the highest number was observed in individuals under 29 years old (50%). The calculated immediate absolute risk of CIN2+ in HPV16+ individuals was 14% for NILM and 8.6% for ASCUS, while in HPV18+ individuals, it was 8.3% for NILM.
Conclusion: Cytologic triage combined with HPV genotyping testing can be utilized firstly as an approach to identify cellular abnormalities in HPV-infected individuals and subsequently as an appropriate method to reduce referrals for colposcopy.
Methods: This cross-sectional study included women who tested positive for HPV and visited the Gynecologic Oncology Clinic at Tehran University of Medical Sciences from October 2022 to March 2025. Individuals with a positive high-risk HPV result were referred for colposcopy and biopsy. The immediate absolute risk of CIN2+ in HPV-positive patients with HPV16, HPV18, or concurrent HPV16/18 genotypes (Multi. HPV+) was evaluated across different cytologic grades, ranging from NILM (Negative for Intraepithelial Lesion or Malignancy) to SCC (Squamous Cell Carcinoma).
Results: A total of 727 patients participated in the study. The mean age and standard deviation of the participants were 35.99 and 8.48 years, respectively. Among all referrals, the number of women who were positive only for HPV 16 was 170 (23%), and 24 (3.3%) were positive only for HPV 18. The highest number of positive cases for HPV16 and HPV18 were in the age range of 30 to 39 years (45%). In the Multi. HPV+ group, the highest number was observed in individuals under 29 years old (50%). The calculated immediate absolute risk of CIN2+ in HPV16+ individuals was 14% for NILM and 8.6% for ASCUS, while in HPV18+ individuals, it was 8.3% for NILM.
Conclusion: Cytologic triage combined with HPV genotyping testing can be utilized firstly as an approach to identify cellular abnormalities in HPV-infected individuals and subsequently as an appropriate method to reduce referrals for colposcopy.
Samaneh Arab, Mohammad-Reza Mahmoudian-Sani , Najmeh Fattahi , Zakiye Ekhlasi, Samira Asgharzade,
Volume 83, Issue 5 (August 2025)
Volume 83, Issue 5 (August 2025)
Abstract
Background: Retinal photoreceptor degeneration is a major cause of blindness. Stem cell therapies offer promise, and the miR-183/96/182 cluster, particularly miR-182 and miR-183, plays a crucial role in photoreceptor development and survival. Targeting these miRNAs may enhance human bone marrow–derived mesenchymal stem cells) hBMSCs (differentiation into photoreceptor-like cells, improving their therapeutic potential.
Methods: This in vitro study was conducted from April 2019 to March 2021 at the Clinical Biochemistry Research Center, Shahrekord University of Medical Sciences. hBMSCs were cultured in DMEM with fetal bovine serum and transfected with miR-182 and miR-183 mimics using Lipofectamine, with a scramble miRNA control. Transfection efficiency and miRNA overexpression were evaluated at 24 and 48 hours using real-time PCR. miRNA expression was normalised to Snord, while mRNA levels were normalised to GAPDH using the 2−ΔΔCt method. Photoreceptor-like differentiation was assessed by measuring the expression of retina-specific transcription factors and markers (OTX2, CRX, NRL, SLC1A1, PKCα, Recoverin, and RHO). Statistical analyses included the Shapiro–Wilk test for normality and the Mann-Whitney U test for group comparisons. Data were reported as Mean ± SEM, with 95% confidence intervals, and significance set at α = 0.05.
Results: Transfection of miR-182 and miR-183 significantly increased miRNA levels at 24–48 hours (P < 0.001) compared to the scramble control. This led to a marked upregulation of retinal-related genes, including CRX, OTX2, PKCα, Recoverin, NRL, and RHO, indicating activation of the photoreceptor gene network. Time-resolved analysis revealed stronger effects at 24–48 hours, supporting a transient window for pro-differentiation. RHO and CRX exhibited the most significant increases, while OTX2 and PKCα showed parallel rises, suggesting coordinated activation of early and intermediate photoreceptor programs. Scramble controls did not show comparable changes.
Conclusion: Transient overexpression of miR-182 and miR-183 in hBMSCs activates a photoreceptor-like gene expression program, promoting differentiation toward photoreceptor-like cells. This finding supports the potential use of miR-182/183 in stem cell-based therapies for retinal degeneration. Further studies should confirm protein expression, functional outcomes, and in vivo efficacy.
Heshmat Shahi , Fatemeh Kiaee ,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Helicobacter pylori is one of the most common chronic bacterial infections worldwide, with acquisition often occurring in childhood. While its role in the pathology of gastroduodenal diseases in adults is well-established, its impact on the pediatric population presents a unique set of clinical and pathophysiological challenges. This comprehensive review examines the complex and bidirectional relationship between Helicobacter pylori infection and host iron metabolism in pediatric and infant populations. For this review, the PubMed database was utilized for studies published from April 1979 through December 2024. Studies based on English language were included using the MESH terms "Helicobacter pylori," "iron," and "ferritin." According to the inclusion criteria, studies related to H. pylori infection and iron condition in patients under 18 years old were selected. Articles such as review articles, case reports, letters to the editor, and animal or in vitro studies were excluded. The main aim of this study was to illuminate the critical role of iron as an essential micronutrient and factor for both the host and the pathogen, examining the multifaceted mechanisms involved in H. pylori-induced iron homeostasis disruption in children.
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The findings indicate a multifaceted relationship: virulent Helicobacter pylori strains are significantly and inversely associated with true body iron stores, leading to Iron deficiency anemia (IDA). However, chronic inflammatory states can paradoxically elevate ferritin levels, masking underlying iron deficiency. Complex interaction between bacterial infection, host inflammatory responses, and iron deficiency is an important factor influencing both the severity of the damage caused by this bacterial infection and its chronicity in the pediatric population. Identification and comprehensive understanding of these complex mechanisms is of great importance for the effective management of iron deficiency anemia in children with H. pylori infection. Considering, increase in the incidence of H. pylori infection in childhood, it is essential that H. pylori infection be evaluation in children with unknown reasons IDA. Finally, screening methods for H. pylori infection in children is recommended, as this could improve long-term health outcomes.
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Maryam Hajhashemi , Hedieh Bonakdarchian, Tahereh Khalili Borujeni , Minoo Movahedi , Roya Sahebi, Fedyeh Haghollahi,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: Pelvic organ prolapse (POP) is a condition resulting from weakness or damage to the muscles, ligaments, and other supporting structures of the vagina, and it exposes affected women to reduced quality of life and sexual function. The present study examined the symptoms, sexual function, and quality of life of women one year after repair of pelvic organ prolapse.
Methods: This study was a prospective cohort before-after study that was conducted on 200 married women with pelvic prolapse grade 1-4 (POP-Q) in the age group of 47-75 years who underwent reconstructive surgery (anterior and posterior colporrhaphy) in Shahid Beheshti and Al-Zahra hospitals in Isfahan between October 2022 and March 2024. The data collection tools were three questionnaires: Female Sexual Function Index (FSFI), Pelvic Discomfort (PFDI-20) and Quality of Life (SF-36) which were completed before surgery and one year after surgery. Stata software version 17 was used to analyze the data. To compare the scores before and after, paired t-test or Wilcoxon statistical tests were used, to compare the severity of patients' clinical symptoms based on the levels before and after surgery, the symmetry/Bowker test was used, and to compare the status of the sexual function index (impairment/no impairment) before and after surgery, the McNemar test was used and the significance level was considered to be P<0.05.
Results: The mean age of the study participants was 59.5±12.6 years. The majority of the women (157 individuals; 78.5%) were housewives. The mean number of pregnancies was 4.3±2.1, and the mean number of live births was 3.75±1.89. All women included in the study were postmenopausal. The severity of clinical symptoms, sexual dysfunction index status, and median quality of life score were significant between before and after the intervention. The severity of clinical symptoms, the status of the sexual dysfunction index, and the median quality of life score showed significant differences before and after the intervention.
Conclusion: Pelvic prolapse surgery can significantly improve the quality of life and sexual function of patients one year after surgery, in addition to correcting the anatomical structure.
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