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Evaluation of urothelial carcinoma variants and its
relationship with invasion of muscularis propria
Atoosa Gharib, Sahar Yazdanparast, Peyman Mohammadi Torbati ,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: It is necessary to determine the morphological type of invasive urothelial carcinoma and their invasive behavior to surrounding tissues. What we will discuss in the present study will be the examination of the types of urothelial carcinoma variants and its relationship with the invasion of the muscularis propria.
Methods: In this descriptive study, the study population included: all patients with ureteral carcinoma and other bladder malignancies with a history of hospitalization in Labafinezhad and Modares hospitals from April 2019 to March 2023. To collect data, after approval by the university ethics committee, files of patients with ureteral carcinoma and other bladder malignancies were extracted from the pathology department archives of Labafinezhad and Modares hospitals. Background information, clinical characteristics, laboratory and pathological data of the patients were collected and recorded by reviewing their archive files. Divergent differentiation and morphology of various variants of carcinomas included in the study were evaluated and the percentage of each was determined. Also, cases with muscularis propria invasion were identified and the frequencies of each type of invasion in different variants were determined.
Methods: In this descriptive study, the study population included: all patients with ureteral carcinoma and other bladder malignancies with a history of hospitalization in Labafinezhad and Modares hospitals from April 2019 to March 2023. To collect data, after approval by the university ethics committee, files of patients with ureteral carcinoma and other bladder malignancies were extracted from the pathology department archives of Labafinezhad and Modares hospitals. Background information, clinical characteristics, laboratory and pathological data of the patients were collected and recorded by reviewing their archive files. Divergent differentiation and morphology of various variants of carcinomas included in the study were evaluated and the percentage of each was determined. Also, cases with muscularis propria invasion were identified and the frequencies of each type of invasion in different variants were determined.
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Results: A total of 1243 patients participated in this study. The mean and standard deviation of the age of the patients were 65.2 and 11.2 years, respectively. 152 people (12.3%) were women and 1091 people (87.7%) were men. Patients with PT1 stage constitute more than 50% of cases. PT4 stage patients account for only 2.7% of cases. The highest frequency is in low grade papillary urothelial carcinoma.
Conclusion: The present study showed that about 27% of patients had Muscularis Propria invasion. In the high grade invasive urothelial carcinoma variant compared to other variants, muscularis propria invasion has been observed in a higher proportion of patients, and in the low grade papillary urothelial carcinoma variant, the lowest proportion of muscularis propria invasion has been seen. |
Iraj Nazari, Seyed Masood Mousavi, Ali Asghar Dastyar , Shaghayegh Sherafatmand , Ali Saeidi,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Vascular trauma is a life-threatening emergency and the third leading cause of death worldwide. Due to the frequency and importance of distal lower extremity artery injury in lower extremity trauma, the present study aimed to investigate the outcomes of vascular surgical interventions in patients with non-penetrating arterial trauma of the distal lower extremity (sub-trifurcation).
Methods: In this retrospective study, trauma patients with suspected non-penetrating injuries of the lower extremity arteries (sub-trifurcation) who referred to the Vascular Surgery Center of Golestan Hospital, Ahvaz, between September 2021 to September 2023 were evaluated. Data included demographic information, duration of surgery, length of hospitalization, and side effects of surgery.
| Results: Of the total of 86 patients, 76 patients (88.4%) were treated with open surgery. 83.7% of patients (72) were male and in the age range of 30-35 years. The most common surgical method used was bi-artery repair (92.3%). The most complications were in the bi-artery bypass repair method, but only the results of nerve involvement and limb preservation in the Ligation repair or bypass two artery intervention showed a statistically significant difference in the first week after surgery (P=0.05). Among patients, only two cases of mortality were observed one week after surgery, which was in the bi-artery repair group. (5.1%). The bi-artery repair intervention method was the best and least complicated surgical method among patients with vascular injury under blunt trauma. Conclusion: According to the results of this study, the bi-artery repair intervention method had the lowest rate of other complications and was the best and least complicated surgical method among patients with vascular injury under blunt trauma. |
Shokoofeh Kazemzadeh, Maryam Khanehzad, Sina Mojaverrostami, Soheila Madadi, Tahereh Alizamir,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Estimating the stature and identifying unknown bodies is an important challenge for forensic specialists and anthropologists, especially when dismembered and mutilated body parts are found. The purpose of this study was to predict the stature by measuring lower limb parameters and to determine the relationship between stature and thigh length, leg length, foot length and lower limb length in Iranian medical students.
Methods: This study was conducted in the Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran in 2019 (May-August). The study population consisted of 200 Iranian medical students (100 males and 100 females, aged 17-36 years). Four lower extremity parameters (thigh length, leg length, foot length, and lower limb length) and stature were measured on the left side according to standard measurement methods. All measurements were performed according to ethical standards provided by the Ethics Committee for Human Experimentations. The measurements were done using standard anthropometric instruments. Linear regression analysis was used to investigate the relationship between the stature and the lengths of the four lower extremity parameters. Then, stature prediction was done based on regression equations. The data were analyzed using SPSS version 25. Independent-samples t-test was used to compare the mean values of the anthropometric measurements between males and females. The relationships between quantitative data were evaluated using the Pearson’s correlation coefficient and linear regression was applied to determine the relationship between stature and lower extremity parameters.
Results: The results of this study indicated a strong correlation between stature and lower limb length (r=0.892, P=0.000), foot length (r=0.852, P=0.000) and thigh length (r=0.805, P=0.000) and a moderate correlation between stature and leg length (r=0.505, P=0.000).
Conclusion: The results of this study suggest that lower limb dimensions and regression equations are appropriate for stature estimation in forensic medicine. However in the future, further research should be conducted to analyze the applicability of these equations for stature estimation in other Iranian populations.
Methods: This study was conducted in the Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran in 2019 (May-August). The study population consisted of 200 Iranian medical students (100 males and 100 females, aged 17-36 years). Four lower extremity parameters (thigh length, leg length, foot length, and lower limb length) and stature were measured on the left side according to standard measurement methods. All measurements were performed according to ethical standards provided by the Ethics Committee for Human Experimentations. The measurements were done using standard anthropometric instruments. Linear regression analysis was used to investigate the relationship between the stature and the lengths of the four lower extremity parameters. Then, stature prediction was done based on regression equations. The data were analyzed using SPSS version 25. Independent-samples t-test was used to compare the mean values of the anthropometric measurements between males and females. The relationships between quantitative data were evaluated using the Pearson’s correlation coefficient and linear regression was applied to determine the relationship between stature and lower extremity parameters.
Results: The results of this study indicated a strong correlation between stature and lower limb length (r=0.892, P=0.000), foot length (r=0.852, P=0.000) and thigh length (r=0.805, P=0.000) and a moderate correlation between stature and leg length (r=0.505, P=0.000).
Conclusion: The results of this study suggest that lower limb dimensions and regression equations are appropriate for stature estimation in forensic medicine. However in the future, further research should be conducted to analyze the applicability of these equations for stature estimation in other Iranian populations.
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Bahar Rostamizadeh, Alireza Jalali-Zand , Kamran Qhaedi, Rozita Nasiri,
Volume 82, Issue 8 (November 2024)
Volume 82, Issue 8 (November 2024)
Abstract
Background: Insects and arthropods, along with their products, have been used as medicinal sources since ancient times, that is called entomotherapy. Cancer is one of the major problems in medical science, for which a drug has not yet been discovered to control it quickly and accurately. Arthropods have been medicinal sources since ancient times and they especially Insects have a high potential for insect therapy because of the biodiversity. This research investigates the effect of insect body extracts and arthropods in inhibiting the growth of cancer cells or tumours, specifically on the breast cancer cell line, MCF7002E
Methods: The basic and applied study was conducted in Isfahan from 2018 to 2023. In this research, six species of insects, namely Gryllotalpa sp., Polyrhachis sp., Dolichovespula sp., Apis mellifera, Periplaneta americana, Drosophila melanogaster, and one species of Chilopoda, Scolopendra sp., were used. The samples were washed with distilled water and 70% alcohol, then frozen and powdered and prepared in 1% DMSO at eight concentrations of 62.5, 125, 250, 500, 1000, 2000, 4000, 8000 μg/ml and were evaluated for the control of two lines of breast cancer cells MCF-7 by the MTT test was performed to check the effect of doses. The affected doses of insects and centipedes were performed in 6 replicates and three times to MCF-7 cells. IC50 and LD50 were calculated by Prism version six software to check the effect of concentrations determine the effective dose and choose the best extract to control the growth of MCF-7 breast cancer cells.
Methods: The basic and applied study was conducted in Isfahan from 2018 to 2023. In this research, six species of insects, namely Gryllotalpa sp., Polyrhachis sp., Dolichovespula sp., Apis mellifera, Periplaneta americana, Drosophila melanogaster, and one species of Chilopoda, Scolopendra sp., were used. The samples were washed with distilled water and 70% alcohol, then frozen and powdered and prepared in 1% DMSO at eight concentrations of 62.5, 125, 250, 500, 1000, 2000, 4000, 8000 μg/ml and were evaluated for the control of two lines of breast cancer cells MCF-7 by the MTT test was performed to check the effect of doses. The affected doses of insects and centipedes were performed in 6 replicates and three times to MCF-7 cells. IC50 and LD50 were calculated by Prism version six software to check the effect of concentrations determine the effective dose and choose the best extract to control the growth of MCF-7 breast cancer cells.
Results: Scolopendra sp., Drosophila melanogaster, Periplaneta americana, Polyrhachis sp., Apis mellifera, and Gryllotalpa sp. are the most effective species, respectively, in inducing apoptosis and cell death in MCF-7 cancer cell line. Dolichovespula sp. had the least effect. Scolopendra sp. at a concentration of 500 μg/litre induced cell death in more than 50% of MCF-7 cancer cells.
Conclusion: The results of the application of seven different genera of arthropods and insects showed that these genera have excellent therapeutic potential, particularly in the treatment of MCF-7 cancer cells.
Conclusion: The results of the application of seven different genera of arthropods and insects showed that these genera have excellent therapeutic potential, particularly in the treatment of MCF-7 cancer cells.
Farkhondeh Jamshidi, Maryam Mirsalar, Mehdi Torabizadeh, Mehrnoosh Zakerkish , Maryam Rostami, Maryam Moradi ,
Volume 82, Issue 9 (December 2024)
Volume 82, Issue 9 (December 2024)
Abstract
Background: Vitamin D deficiency is associated with various complications, including preterm birth, low birth weight, and neonatal infections. This study aimed to measure the level of vitamin D in the umbilical cord blood of full-term and premature babies and consider the prevalence of vitamin D deficiency in pregnant women.
Methods: In this case-control study, maternal vitamin D levels and umbilical cord blood vitamin D levels were estimated in March 2023 at Imam Khomeini Hospital in Ahvaz. The information obtained from questionnaires and laboratory measurements was statistically analyzed. Two groups of term or preterm infants delivered vaginally were enrolled in this study. As part of routine delivery room protocols, 2 mL of umbilical cord blood was collected from each neonate in a non-heparinized tube. The results were determined, and the prevalence of vitamin D deficiency was determined. The samples were categorized into three groups based on vitamin D serum levels: less than 20 ng/ml (severe deficiency), 20-29 ng/ml (moderate deficiency), and higher than 30 ng/ml (normal group).
Results: In this study, 39 term infants (55.7%) and 31 preterm infants (44.3%) participated. The mean umbilical cord blood vitamin D levels were 44.15 ± 24.33 ng/mL in term infants and 30.98 ± 17.05 ng/mL in preterm infants. Similarly, maternal vitamin D levels averaged 17.09 ± 7.87 ng/mL for term pregnancies and 18.76 ± 6.6 ng/mL for preterm pregnancies. Preterm babies had higher odds of underlying diseases (OR: 2.31, 95% CI: 0.51-10.53). Multivitamin consumption was more prevalent among mothers of premature babies (71%). No significant differences in vitamin D levels were found between term and preterm babies or their mothers (P > 0.05).
Conclusion: This study highlights the importance of multivitamin consumption among pregnant women, particularly those at risk of preterm delivery. The increased likelihood of underlying conditions and delayed recovery of vitamin D levels in preterm infants underscores the need for targeted interventions. Moreover, healthcare providers should emphasize vitamin D supplementation and monitoring.
Methods: In this case-control study, maternal vitamin D levels and umbilical cord blood vitamin D levels were estimated in March 2023 at Imam Khomeini Hospital in Ahvaz. The information obtained from questionnaires and laboratory measurements was statistically analyzed. Two groups of term or preterm infants delivered vaginally were enrolled in this study. As part of routine delivery room protocols, 2 mL of umbilical cord blood was collected from each neonate in a non-heparinized tube. The results were determined, and the prevalence of vitamin D deficiency was determined. The samples were categorized into three groups based on vitamin D serum levels: less than 20 ng/ml (severe deficiency), 20-29 ng/ml (moderate deficiency), and higher than 30 ng/ml (normal group).
Results: In this study, 39 term infants (55.7%) and 31 preterm infants (44.3%) participated. The mean umbilical cord blood vitamin D levels were 44.15 ± 24.33 ng/mL in term infants and 30.98 ± 17.05 ng/mL in preterm infants. Similarly, maternal vitamin D levels averaged 17.09 ± 7.87 ng/mL for term pregnancies and 18.76 ± 6.6 ng/mL for preterm pregnancies. Preterm babies had higher odds of underlying diseases (OR: 2.31, 95% CI: 0.51-10.53). Multivitamin consumption was more prevalent among mothers of premature babies (71%). No significant differences in vitamin D levels were found between term and preterm babies or their mothers (P > 0.05).
Conclusion: This study highlights the importance of multivitamin consumption among pregnant women, particularly those at risk of preterm delivery. The increased likelihood of underlying conditions and delayed recovery of vitamin D levels in preterm infants underscores the need for targeted interventions. Moreover, healthcare providers should emphasize vitamin D supplementation and monitoring.
Reza Ghalehtaki, Mahdieh Razmkhah, Ali Kazemian, Mostafa Farzin, Samaneh Salarvand, Kasra Kolahdouzan, Ehsan Saraee,
Volume 82, Issue 10 (January 2025)
Volume 82, Issue 10 (January 2025)
Abstract
Background: Gliomas are the most common primary brain tumors in adults, with low-grade gliomas making up 15% of cases. These slow-growing tumors often occur in young adults. Radiotherapy is one of the treatment options. New radiotherapy techniques like IMRT may reduce complications by sparing normal tissue. The study aims to determine which tumors benefit most from IMRT based on tumor location and size.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.
Soraya Ahmadian Mask , Abbas Haghparast,
Volume 82, Issue 10 (January 2025)
Volume 82, Issue 10 (January 2025)
Abstract
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Background: Recent advances in modern radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) and Stereotactic Radiosurgery (SRS) have significantly increased the need for accurate and reliable dosimetry in radiation therapy. Accurate dose delivery is particularly critical in small electron fields, which are increasingly used in targeted treatments. However, these fields pose unique challenges due to factors such as electron disequilibrium, increased lateral scatter, and steep dose gradients. These physical characteristics can introduce significant uncertainties in dose distribution, thereby reducing the effectiveness and safety of the treatment if not properly accounted for. Traditional dosimeters often struggle to maintain accuracy under such conditions. The aim of this study was to evaluate the performance of MAGIC polymer gel as a three-dimensional (3D) dosimeter in small electron fields and to compare its dosimetric characteristics with standard dosimeters including diode, semiflex, and pinpoint.
Methods: This experimental and applied study was conducted at the Radiotherapy Department of Imam Reza Hospital, Kermanshah, Iran, over a one-year period from December 2022 to December 2023. Five electron field sizes (2×2, 2.5×2.5, 3×3, 4×4, and 5×5 cm²) were generated using an Elekta linear accelerator at two electron beam energies of 6 and 9 MeV. MAGIC polymer gel phantoms were irradiated accordingly and scanned with a 1.5 Tesla MRI system to obtain three-dimensional dose distributions. These were compared to measurements obtained from diode, semiflex, and pinpoint dosimeters. Results: The depth dose curves of MAGIC gel exhibited greater agreement with diode measurements compared to those from semiflex and pinpoint detectors. As field size decreased and beam energy increased, discrepancies in absorbed dose readings between different dosimeters became more apparent. These results underscore the importance of selecting appropriate dosimetric tools for accurate dose evaluation in small-field electron beams. Conclusion: MAGIC polymer gel demonstrated strong potential as a reliable 3D dosimeter for small electron field dosimetry, showing the highest compatibility with the diode dosimeter. |
Elham Rajaei , Forough Nokhostin, Maedeh Ekhtelat, Nasrin Masihpour, Maryam Dastoorpour,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: Autoimmune inflammatory diseases, which are often associated with severe and chronic complications, affect approximately 7.6-9.4% of world's population. The present study was conducted with the aim of investigating the frequency of ocular side effects of anti-TNF-α drugs in patients with rheumatic diseases.
Methods: In this analytical epidemiological study, 122 patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis who were treated with TNF-α inhibitory drugs (including Infliximab, Adalimumab and Etanercept) referred to Golestan Hospital of Ahvaz, Iran, in 2019-2022 were examined. Ocular complications including anterior uveitis, macular edema, anterior ischemic optic neuropathy, diplopia with paired neurological involvement, anterior uveitis with diplopia and keratitis sicca were evaluated by an ophthalmologist after six months of treatment with TNF-α inhibitory drugs. Infliximab was used on day zero, week two and four, and then every 6 to 8 weeks with a dose of 3 to 5 per kilogram of body weight. Adalimumab dosage was 40 mg every other week and Etanercept was taken at a dose of 50 mg weekly.
Results: From 122 patients, 59 (48.36%) and 36 (29.51%) had rheumatoid arthritis and ankylosing spondylitis, respectively. Among 7.38% of reported ocular complications, anterior uveitis was the most common complication (3.28%). Type of anti-TNF-α drug had no significant correlation with the occurrence of ocular complications and eye complications were mainly observed in patients who used etanercept, but there was no significant difference compared to the other two drugs (P=0.1). The mean duration of disease in patients with and without eye complications was 5.47±4.13 and 3.22±2.58 years, respectively (P=0.03). No significant relationship was observed between the duration of anti-TNF-α drugs use and eye complications (P=0.66).
Conclusion: Given the higher incidence of ocular complications in patients taking etanercept, as well as the significant association between the duration of the disease and the occurrence of ocular complications, monitoring long-term treatment and follow-up of rheumatic patients taking anti-TNF-α drugs is of great importance.
Farkhondeh Ajdari, Abolfazl Gheshlaghi , Aida Shakiba, Shirin Haghighat, Marzieh Jamalidoust, Jamal Sarvari ,
Volume 82, Issue 11 (February 2025)
Volume 82, Issue 11 (February 2025)
Abstract
Background: The exact cause chronic lymphocytic leukemia (CLL) is still unknown. Cytomegalovirus (CMV) may play a role in the development of CLL, Therefore, the aim of this study is to investigate the frequency of CMV in patients with CLL and its relationship with blood and genetic factors.
Methods: This cross-sectional study was conducted between April 2020 and October 2022 on 40 CLL patients that referred to Dr. Daneshbod Pathobiology Laboratory (Shiraz, Iran). After taking blood and separating the buffy coat, viral DNA was extracted using a commercial DNA extraction kit and the CMV burden was measured using Real-time PCR assay. Moreover, a blood cell count test was performed. The amount of lactate dehydrogenase of the serum was measured using the kit. Also, common chromosomal disorders and CD38 marker related data were extracted from the file patients. SPSS software and Student's t-test were used to result analysis.
Results: The mean age of the patients was 62.25 ± 10.49 years. Of the 40 patients, 28 were men (70%). The average number of white blood cells was 46.06±1.49* 109, which was significantly higher in women than in men (p=0.031). Real-time PCR results showed that two patients (5%) have detectable amounts of CMV virus genome. The level of lactate dehydrogenase, CD38 marker, and the number of malignant cells in male and female patients did not differ significantly (p=0.362). Moreover, chromosomal abnormalities include deletions in 11q (ATM) and 17P (TP53), were observed in 3 (7.5%) and 4 (10%) patients, respectively.
Conclusion: Our finding indicated the CMV might not involve in the pathogenesis of CLL disease. More studies are recommended for clarify this finding.
Methods: This cross-sectional study was conducted between April 2020 and October 2022 on 40 CLL patients that referred to Dr. Daneshbod Pathobiology Laboratory (Shiraz, Iran). After taking blood and separating the buffy coat, viral DNA was extracted using a commercial DNA extraction kit and the CMV burden was measured using Real-time PCR assay. Moreover, a blood cell count test was performed. The amount of lactate dehydrogenase of the serum was measured using the kit. Also, common chromosomal disorders and CD38 marker related data were extracted from the file patients. SPSS software and Student's t-test were used to result analysis.
Results: The mean age of the patients was 62.25 ± 10.49 years. Of the 40 patients, 28 were men (70%). The average number of white blood cells was 46.06±1.49* 109, which was significantly higher in women than in men (p=0.031). Real-time PCR results showed that two patients (5%) have detectable amounts of CMV virus genome. The level of lactate dehydrogenase, CD38 marker, and the number of malignant cells in male and female patients did not differ significantly (p=0.362). Moreover, chromosomal abnormalities include deletions in 11q (ATM) and 17P (TP53), were observed in 3 (7.5%) and 4 (10%) patients, respectively.
Conclusion: Our finding indicated the CMV might not involve in the pathogenesis of CLL disease. More studies are recommended for clarify this finding.
Reza Baghbanian, Shirin Azizidoost , Kamran Mahmoodi , Mahbobeh Rashidi , Golshan Mirmomeni, Sina Ganji Nataj ,
Volume 82, Issue 12 (March 2025)
Volume 82, Issue 12 (March 2025)
Abstract
Background: Coagulopathy is one of the most common causes of mortality in the intensive care unit. This study was designed and implemented to investigate the relationship between acidosis and coagulation disorders in patients undergoing laparotomy in the intensive care unit.
Methods: This retrospective study reviewed the files of 121 patients undergoing laparotomy in the intensive care unit of Imam Khomeini Hospital of Ahvaz during 2024. Demographic and clinical records and blood test results were extracted to measure parameters related to acidosis and coagulation tests. Then, the rates of coagulopathy, thrombocytopenia, acidosis, and patient outcome were calculated. The data obtained were analyzed using SPSS version 27 software.
Results: Most patients studied were male (72 (59.5%)) with a mean age of 54.18±21.1 years and a mean length of stay of 6.78±5.87 days. Hypertension (34 (28.1%)) was the most important comorbidity and peritonitis (54 (44.6%)) was the most important cause of hospitalization. The incidence rates of coagulopathy, thrombocytopenia, and acidosis were reported to be 29 (24%), 27 (22.3%) and 115 (95%), respectively. A total of 44 (36.5%) patients died during the study period. Although the rates of coagulopathy and thrombocytopenia were higher in patients with acidosis, these differences were not significant (P<0.05). The mortality rates among those without thrombocytopenia, mild, moderate, and severe thrombocytopenia were reported as 27 (28.7%), 4 (33.3%), 9 (81.1%), and 4 (100%), respectively, showing a significant difference (P=0.001). The mean pH in deceased patients was significantly lower than in others (0.13±7.19 vs. 0.88±7.25; P=0.005). The mortality rate in patients with coagulopathy was also significantly higher than in others (20 (69%) vs.24 (26.4%); P=0.000).
Conclusion: The incidence of acidosis and coagulation disorders in patients undergoing laparotomy and admitted to the intensive care unit is significant and is linked to poorer outcomes for these patients. However, acidosis was not found to be an independent risk factor for coagulation disorders in this population. Further research is necessary to confirm or refute these findings.
Methods: This retrospective study reviewed the files of 121 patients undergoing laparotomy in the intensive care unit of Imam Khomeini Hospital of Ahvaz during 2024. Demographic and clinical records and blood test results were extracted to measure parameters related to acidosis and coagulation tests. Then, the rates of coagulopathy, thrombocytopenia, acidosis, and patient outcome were calculated. The data obtained were analyzed using SPSS version 27 software.
Results: Most patients studied were male (72 (59.5%)) with a mean age of 54.18±21.1 years and a mean length of stay of 6.78±5.87 days. Hypertension (34 (28.1%)) was the most important comorbidity and peritonitis (54 (44.6%)) was the most important cause of hospitalization. The incidence rates of coagulopathy, thrombocytopenia, and acidosis were reported to be 29 (24%), 27 (22.3%) and 115 (95%), respectively. A total of 44 (36.5%) patients died during the study period. Although the rates of coagulopathy and thrombocytopenia were higher in patients with acidosis, these differences were not significant (P<0.05). The mortality rates among those without thrombocytopenia, mild, moderate, and severe thrombocytopenia were reported as 27 (28.7%), 4 (33.3%), 9 (81.1%), and 4 (100%), respectively, showing a significant difference (P=0.001). The mean pH in deceased patients was significantly lower than in others (0.13±7.19 vs. 0.88±7.25; P=0.005). The mortality rate in patients with coagulopathy was also significantly higher than in others (20 (69%) vs.24 (26.4%); P=0.000).
Conclusion: The incidence of acidosis and coagulation disorders in patients undergoing laparotomy and admitted to the intensive care unit is significant and is linked to poorer outcomes for these patients. However, acidosis was not found to be an independent risk factor for coagulation disorders in this population. Further research is necessary to confirm or refute these findings.
Sahar Karimpour Reyhan , Mahsa Abbaszadeh, Alireza Esteghamati ,
Volume 83, Issue 1 (April 2025)
Volume 83, Issue 1 (April 2025)
Abstract
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Hyperthyroidism is one of the most important endocrine disorders, characterized by increased activity of the thyroid gland and excessive production of thyroid hormones. These hormones play a key role in regulating the body’s metabolism; therefore, their excess leads to a wide range of clinical manifestations. The most common symptoms include anxiety, restlessness, weight loss despite normal or even increased appetite, palpitations, excessive sweating, fine tremors of the hands, sleep disturbances, and heat intolerance. Some patients may also experience mood changes such as irritability and nervousness. On physical examination, rapid tendon reflexes, tachycardia, moist and thin skin, and in many cases the presence of goiter (thyroid enlargement) may be observed. The condition is more common in women than men and is most frequently seen between the ages of 20 and 50 years. Once hyperthyroidism is confirmed, the underlying cause of thyrotoxicosis must be determined. The most common cause is Graves’ disease, an autoimmune disorder that leads to diffuse thyroid enlargement and overproduction of hormones. Toxic multinodular goiter and solitary toxic adenoma are other important causes. For definitive diagnosis, blood tests measuring TSH, T3, and T4 are essential. In hyperthyroidism, TSH is typically suppressed while T3 and T4 are elevated. In addition to laboratory testing, thyroid ultrasound can help evaluate the structure of the gland, and a thyroid radioactive iodine uptake scan can further differentiate between different causes and determine disease activity. Several treatment options are available for managing hyperthyroidism. Antithyroid drugs such as methimazole or propylthiouracil inhibit the synthesis of thyroid hormones. Beta-blockers are often prescribed to control cardiovascular symptoms and reduce palpitations. Radioactive iodine therapy is a common and effective method that destroys the overactive thyroid tissue. In rare cases, or when other treatments fail, thyroidectomy (surgical removal of part or all of the thyroid gland) may be required. Overall, hyperthyroidism is a manageable condition, but it requires accurate diagnosis, careful selection of therapy, and close follow-up with a specialist. Patient cooperation and adherence to treatment play a crucial role in controlling symptoms and preventing long-term complications. This review will focus on describing the symptoms, causes, diagnostic methods, and treatment options.
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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.
Mahasti Emami Hamzehkolaee , Amirhesam Alirezaei, Marjan Moudi, Sepide Veysi , Masoumeh Asgharpour,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Hydrochlorothiazide (HCTZ) is widely used for hypertension, but electrolyte disorders-especially hyponatremia remain major safety concerns. Limited regional data on its prevalence, timing, and determinants may undermine patient safety. This retrospective study evaluated risk factors for HCTZ-associated hyponatremia in hospitalized adults with hypertension and identified predictors of its severity.
Methods: A retrospective analysis was conducted on 217 patients hospitalized at Ayatollah Rouhani Hospital in Babol (2019-2021). Eligible participants were aged ≥18 years and had received HCTZ for at least seven consecutive days. Patients with baseline hyponatremia, concurrent use of drugs independently causing hyponatremia, or incomplete laboratory data were excluded. Demographic, clinical, medication, and biochemical variables were abstracted from medical records. Hyponatremia was defined as serum sodium <135 mmol/L and categorized as mild (130-134), moderate (125-129), or severe (<125). Predictors of occurrence were estimated with multivariable logistic regression; onset timing was assessed using a Cox proportional hazards model; and severity determinants were examined through multinomial logistic regression. Statistical significance was set at P<0.05.
Results: Hyponatremia occurred in 32.7% (71.217) of patients, most frequently within the early weeks of HCTZ treatment. Among affected individuals, 49.3% had mild, 31.0% moderate, and 19.7% severe hyponatremia. Adjusted analyses showed that older age, concurrent nonsteroidal anti-inflammatory drug (NSAID) use, shorter HCTZ duration, and lower serum potassium and uric acid independently increased hyponatremia risk, while HCTZ dose and sex were nonsignificant. In the Cox model, older age and lower potassium and uric acid predicted earlier onset. Patients with hyponatremia more often presented with weakness, headache, altered consciousness, and seizures. Baseline glucose, creatinine, and most comorbidities were not independently associated with risk or timing.
Conclusion: HCTZ-related hyponatremia was common and typically emerged soon after initiation. Advanced age, NSAID co-administration, brief exposure, and reduced potassium and uric acid were practical, readily measurable markers associated with both occurrence and earlier onset. Routine early and repeated electrolyte monitoring particularly in older adults and patients receiving NSAIDs- together with patient education on warning symptoms is recommended. These findings highlight key predictors for targeted surveillance and prevention in similar clinical contexts.
Methods: A retrospective analysis was conducted on 217 patients hospitalized at Ayatollah Rouhani Hospital in Babol (2019-2021). Eligible participants were aged ≥18 years and had received HCTZ for at least seven consecutive days. Patients with baseline hyponatremia, concurrent use of drugs independently causing hyponatremia, or incomplete laboratory data were excluded. Demographic, clinical, medication, and biochemical variables were abstracted from medical records. Hyponatremia was defined as serum sodium <135 mmol/L and categorized as mild (130-134), moderate (125-129), or severe (<125). Predictors of occurrence were estimated with multivariable logistic regression; onset timing was assessed using a Cox proportional hazards model; and severity determinants were examined through multinomial logistic regression. Statistical significance was set at P<0.05.
Results: Hyponatremia occurred in 32.7% (71.217) of patients, most frequently within the early weeks of HCTZ treatment. Among affected individuals, 49.3% had mild, 31.0% moderate, and 19.7% severe hyponatremia. Adjusted analyses showed that older age, concurrent nonsteroidal anti-inflammatory drug (NSAID) use, shorter HCTZ duration, and lower serum potassium and uric acid independently increased hyponatremia risk, while HCTZ dose and sex were nonsignificant. In the Cox model, older age and lower potassium and uric acid predicted earlier onset. Patients with hyponatremia more often presented with weakness, headache, altered consciousness, and seizures. Baseline glucose, creatinine, and most comorbidities were not independently associated with risk or timing.
Conclusion: HCTZ-related hyponatremia was common and typically emerged soon after initiation. Advanced age, NSAID co-administration, brief exposure, and reduced potassium and uric acid were practical, readily measurable markers associated with both occurrence and earlier onset. Routine early and repeated electrolyte monitoring particularly in older adults and patients receiving NSAIDs- together with patient education on warning symptoms is recommended. These findings highlight key predictors for targeted surveillance and prevention in similar clinical contexts.
Sepideh Mahdavi, Mohammad Hassan Emamian , Zahra Kordi, Mansooreh Fateh, Mostafa Enayatrad,
Volume 83, Issue 2 (May 2025)
Volume 83, Issue 2 (May 2025)
Abstract
Background: Stomach cancer is the fifth most common cancer worldwide. This study aimed to investigate the trend in the incidence of stomach cancer in Shahroud and Meyami districts over a thirteen-year period.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
Methods: This study is a cross-sectional study that examines the incidence of stomach cancer using data from the population-based cancer registry system in Shahroud and Meyami Districts in Semnan province over a thirteen-year period from the beginning of April 2010 to the end of March 2022. Age-standardized incidence rates were calculated using both the new and old-World Health Organization standard populations. Trend in cancer incidence were analyzed using Joinpoint regression.
Results: Between 2010 and 2022, a total of 474 new cases of stomach cancer were reported. The mean age at diagnosis was 69.3±12.8 years, with 70.3±12.7 years in men and 67.8±12.8 years in women. The age-standardized incidence rate based on the new WHO population was 15.1 per 100,000 people for the entire period, and 20.9 and 9.5 per 100,000 for men and women, respectively. The annual percentage change indicated a (APC: -4.60 % (95% CI: -0.08 to -9.36)) decrease per year, which was statistically significant (P=0.047), particularly in men (APC= -4.42%, (95% CI: -8.39 to -0.63, P=0.024)), whereas the decline in women was not statistically significant (APC= -4.28%, (95% CI: -10.45 to 1.79, P=0.150)). The incidence of stomach cancer increases with age, with the highest number of cases observed in the 75-79 years age group. The incidence trend in the age group 70-74 years (AAPC: -8.98% (95% CI: -2.75, -14.72 was significantly (P=0.005) decreasing.
Conclusion: The findings of this study showed that the age-standardized incidence rate of stomach cancer had a decreasing trend and that incidence increased with advancing age. Moreover, the incidence rate in men was approximately twice that in women. In men, the incidence trend showed a significant decline, whereas in women no significant change was observed.
Nooshin Shirzad, Fateme Ziamanesh, Seyedahmad Seyedalinaghi , Alireza Esteghamati , Mahboobeh Hemmatabadi ,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Patients with type 2 diabetes mellitus (T2DM) are diagnosed with a wide range of renal damage, usually presenting with albuminuria and decreased estimated Glomerular Filtration Rate (eGFR). Some patients have only albuminuria and normal eGFR, while others have normoalbuminuria even in advanced stages of chronic kidney disease. This study investigated and followed the course of diabetic nephropathy in patients with T2DM.
Methods: 1107 patients with T2DM were enrolled in the study. This historical cohort was conducted between the years 2017 and 2022. Patients with confirmed type 2 DM, referred to the diabetes clinic of Vali-Asr Hospital, affiliated with the Tehran University of Medical Science. Complete medical history, blood pressure, and laboratory data were obtained in the first and follow-up visits. Follow-up was every 3 to 6 months for 30 months. Every year, 24-hour urinary albumin was measured, and eGFR was estimated based on the Cockcroft-Gault formula.
Results: Male sex, age, disease duration, weight, systolic blood pressure, 2 hours postprandial (2hpp) glucose, serum triglyceride, and uric acid significantly correlated with albuminuria. At the initiation of the study, the highest eGFR values occurred in microalbuminuric patients, followed by a sharp decrease. No significant correlation was found between eGFR and albuminuria in most patients, and more than half of them with eGFR of less than 60 ml/min/m2 still had normal albuminuria
Conclusion: This study showed that patients with microalbuminuria and normoalbuminuria had the highest eGFR values followed by macroalbuminuria, but patients with normoalbuminuria and microalbuminuria had an initial increase and then a decrease, and the macroalbuminuria group showed the sustained and greatest decrease during the follow-up period. Serial surveillance of both albuminuria and GFR is crucial in T2DM.
Methods: 1107 patients with T2DM were enrolled in the study. This historical cohort was conducted between the years 2017 and 2022. Patients with confirmed type 2 DM, referred to the diabetes clinic of Vali-Asr Hospital, affiliated with the Tehran University of Medical Science. Complete medical history, blood pressure, and laboratory data were obtained in the first and follow-up visits. Follow-up was every 3 to 6 months for 30 months. Every year, 24-hour urinary albumin was measured, and eGFR was estimated based on the Cockcroft-Gault formula.
Results: Male sex, age, disease duration, weight, systolic blood pressure, 2 hours postprandial (2hpp) glucose, serum triglyceride, and uric acid significantly correlated with albuminuria. At the initiation of the study, the highest eGFR values occurred in microalbuminuric patients, followed by a sharp decrease. No significant correlation was found between eGFR and albuminuria in most patients, and more than half of them with eGFR of less than 60 ml/min/m2 still had normal albuminuria
Conclusion: This study showed that patients with microalbuminuria and normoalbuminuria had the highest eGFR values followed by macroalbuminuria, but patients with normoalbuminuria and microalbuminuria had an initial increase and then a decrease, and the macroalbuminuria group showed the sustained and greatest decrease during the follow-up period. Serial surveillance of both albuminuria and GFR is crucial in T2DM.
Elham Rajaei, Tina Vosoughi, Forough Nokhostin, Hojatollah Yousefimanesh, Mahnaz Parvazi,
Volume 83, Issue 3 (June 2025)
Volume 83, Issue 3 (June 2025)
Abstract
Background: Osteonecrosis of the jaw has recently been reported in patients receiving denosumab for cancer treatment. Accordingly, the present study aimed to determine the frequency of osteonecrosis of the jaw in cancer patients receiving denosumab.
Methods: In the present descriptive-analytical study, 62 cancer patients receiving denosumab who referred to the oncology clinic of Golestan and Shafa Hospitals in Ahvaz in 1403 were studied. The prevalence of osteonecrosis of the jaw among the studied patients was investigated and its relationship with predisposing factors, including gender, type of cancer, comorbidity, and dental caries status, was recorded and analyzed in a checklist.
Results: The prevalence of osteonecrosis of the jaw was 1.6%. There was no significant association between the incidence of osteonecrosis of the jaw and gender and comorbidities (P<0.05), but females showed a 38% higher probability of developing osteonecrosis of the jaw (95% confidence interval; 1.62-1.18, r=1.386). Breast cancer was the most common type of cancer among the study participants (61.3%), but no significant association was found between the incidence of osteonecrosis of the jaw and the incidence of the cancers studied (P-value=0.986). No significant association was found between the incidence of osteonecrosis of the jaw and dental caries (P-value=0.741). The odds of developing osteonecrosis of the jaw in patients with or without dental caries risk were reported to be 1.1 (95% confidence interval; 1.205-1.021, r=1.109).
Conclusion: Despite the lack of a significant association between the incidence of osteonecrosis of the jaw and various factors such as gender, type of cancer, comorbidities, and dental caries, there was evidence of a relative increase in the risk of osteonecrosis of the jaw in women with cancer treated with denosumab, which highlights the need for further investigation.
Methods: In the present descriptive-analytical study, 62 cancer patients receiving denosumab who referred to the oncology clinic of Golestan and Shafa Hospitals in Ahvaz in 1403 were studied. The prevalence of osteonecrosis of the jaw among the studied patients was investigated and its relationship with predisposing factors, including gender, type of cancer, comorbidity, and dental caries status, was recorded and analyzed in a checklist.
Results: The prevalence of osteonecrosis of the jaw was 1.6%. There was no significant association between the incidence of osteonecrosis of the jaw and gender and comorbidities (P<0.05), but females showed a 38% higher probability of developing osteonecrosis of the jaw (95% confidence interval; 1.62-1.18, r=1.386). Breast cancer was the most common type of cancer among the study participants (61.3%), but no significant association was found between the incidence of osteonecrosis of the jaw and the incidence of the cancers studied (P-value=0.986). No significant association was found between the incidence of osteonecrosis of the jaw and dental caries (P-value=0.741). The odds of developing osteonecrosis of the jaw in patients with or without dental caries risk were reported to be 1.1 (95% confidence interval; 1.205-1.021, r=1.109).
Conclusion: Despite the lack of a significant association between the incidence of osteonecrosis of the jaw and various factors such as gender, type of cancer, comorbidities, and dental caries, there was evidence of a relative increase in the risk of osteonecrosis of the jaw in women with cancer treated with denosumab, which highlights the need for further investigation.
The comparison of blood loss in cesarean section undergoing
general anesthesia and spinal anesthesia
Mohammad Sadegh Sanie Jahromi , Reza Ashrafzadeh, Ahmad Rastgarian, Navid Kalani , Mohammad Hasan Damshenas,
Volume 83, Issue 6 (September 2025)
Volume 83, Issue 6 (September 2025)
Abstract
Background: In general anesthesia, anesthetic agents are administered by inhalation or intravenously, leading to loss of consciousness, immobility, analgesia, and amnesia. In spinal anesthesia, injection of a local anesthetic into the intrathecal space causes sensory and motor block. The aim of this study was to compare the volume of bleeding during cesarean section under general anesthesia and spinal anesthesia.
Methods: This study is a cross-sectional prospective study. The gauzes used were weighed before the operation and bloody gauzes were weighed after the operation. The difference between the weight of bloody and dry gauzes was recorded as the volume of bleeding. This volume was then added to the volume of blood in the suction chamber and the final bleeding volume was estimated.
Results: 70 patients who were candidates for cesarean section were included in the study. The mean age of the patients included in the study was 24.82±4.98 and their mean weight was 77.11±8.97. The mean hemoglobin in the spinal anesthesia group was 91.12±39. Volume of bleeding during cesarean section by spinal anesthesia was significantly less than general anesthesia (P=0.001). Also, the visual estimation of bleeding in spinal anesthesia was significantly lower than general anesthesia (P<0.001). In this study, there was no significant difference between heart rate, systolic and diastolic pressure before and during surgery, and the first- and fifth-minute Apgar scores between the two groups of general and spinal anesthesia.
Conclusion: We found in this study that the volume of bleeding during cesarean section under spinal anesthesia is less than general anesthesia. It is suggested that in future studies, other methods of estimating bleeding such as postoperative hemoglobin reduction, dilution method, atomic absorption spectroscopy and photometry be used. Also, a comparison should be made between the three groups of general, spinal and epidural anesthesia, and the volume of bleeding in each should be checked and the best anesthesia method should be selected for cesarean section.
Methods: This study is a cross-sectional prospective study. The gauzes used were weighed before the operation and bloody gauzes were weighed after the operation. The difference between the weight of bloody and dry gauzes was recorded as the volume of bleeding. This volume was then added to the volume of blood in the suction chamber and the final bleeding volume was estimated.
Results: 70 patients who were candidates for cesarean section were included in the study. The mean age of the patients included in the study was 24.82±4.98 and their mean weight was 77.11±8.97. The mean hemoglobin in the spinal anesthesia group was 91.12±39. Volume of bleeding during cesarean section by spinal anesthesia was significantly less than general anesthesia (P=0.001). Also, the visual estimation of bleeding in spinal anesthesia was significantly lower than general anesthesia (P<0.001). In this study, there was no significant difference between heart rate, systolic and diastolic pressure before and during surgery, and the first- and fifth-minute Apgar scores between the two groups of general and spinal anesthesia.
Conclusion: We found in this study that the volume of bleeding during cesarean section under spinal anesthesia is less than general anesthesia. It is suggested that in future studies, other methods of estimating bleeding such as postoperative hemoglobin reduction, dilution method, atomic absorption spectroscopy and photometry be used. Also, a comparison should be made between the three groups of general, spinal and epidural anesthesia, and the volume of bleeding in each should be checked and the best anesthesia method should be selected for cesarean section.
Sara Memarian, Narges Mostajabi, Behdad Gharib, Parastoo Rostami , Mohammad Taghi Majnoon , Farzaneh Abbasi, Reihaneh Mohsenipour,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: Type 1 diabetes mellitus, with its increasing prevalence in the pediatric population, has a significant impact on the mental health, quality of life, and lifestyle of patients.. The onset of the disease in childhood and its association with the child during school and adolescence, and during the growth and development process, has numerous effects on the growth process and mental experiences of patients.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Methods: This cross-sectional study was conducted in Children, s Medical Center from march 2022 to February 2023 on 183 patients with type 1 diabetes aged 9 to 18 years. The duration of the disease ranged from 1 year to 15 years. 44% of the populations were girls and 56% were boys. 77% were under 13 years of age and the rest were over 13 years of age. Information was completed by parents in the Achenbach electronic questionnaire (112 questions). Then, based on the standard defined for the questionnaire, the scores were classified into clinical, borderline, and normal categories.
Results: No significant differences were observed between the two sexes in terms of the incidence of various disorders. However, significant differences in the incidence of externalizing problems have been reported at different ages and different disease durations. Analysis of the mean T-scores of the studied patients showed that there were significant differences between patients older than 13 years younger than 13 years in terms of externalizing problems, anxiety/depressive disorders, attention deficit/hyperactivity disorders, law-breaking behavior, internalizing problems, and general problems. a significant relationship was observed between the study population and the duration of the illness in terms of aggressive problems, law-breaking problems, and externalizing disorders.
Average scores in externalizing disorders, affective/depressive disorders, law-breaking behavior, internalizing problems, and general problems were significantly related to different ages.
Conclusion: The results of this study show that as patients aging and more than 5 years since the onset of diabetes, the risk of developing psychiatric disorders increases. As a result, routine psychiatric screening is recommended for these children.
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
Volume 83, Issue 7 (October 2025)
Volume 83, Issue 7 (October 2025)
Abstract
Background: The duration of hospitalization of patients is considered an important indicator in health resource management and patient evaluation. This study investigated the frequency and causes of readmission in cardiovascular patients
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Methods: This was a retrospective study of 105 patients with cardiovascular diseases referred to Imam Khomeini Hospital in Ahvaz who were readmitted from April 2024 until August 2024 within 30 days after discharge due to recurrence of symptoms. Demographic (including age and gender) and clinical information (including duration of hospitalization, regular medication use, regular physician visits, disease diagnosis and dietary adherence) of the patients was extracted from electronic records using a researcher-made checklist.
Results: From 105 patients, 43 (41%) were admitted in the first trimester and 62 (59%) in the second trimester. The mean age of patients in the first trimester was higher than in the second trimester with a statistically significant association with readmission (P=0.038). Most patients were male and their number was higher in the second trimester than in the first trimester and a statistically significant association was observed between the gender of patients with readmission in the first trimester compared to the second trimester (P=0.015). 72 patients with acute coronary syndrome (68.6%) and 33 patients with heart failure (31.4%) were readmitted. The mean length of stay in the first trimester was 1.6 ± 1.15 days and 2.9 ± 2.7 days in the second trimester. A significant association was observed between the duration of hospitalization and readmission (P=0.003). However, no association was observed between regular medication use and regular physician visits in readmitted patients. However, a significant association was observed between dietary adherence in readmitted patients (P=0.045).
Conclusion: Readmission of cardiovascular patients follows a seasonal pattern and is associated with factors such as age, sex, length of stay, and dietary adherence. Routine disease management measures are not sufficient to counteract these effects, and targeted educational programs are necessary at the threshold of high-risk periods.
Amir Naddaf, Vafa Ghorban Sabbagh , Ghazaleh Rasti, Raheleh Moradi, Mobina Taghva Nakhjiri ,
Volume 83, Issue 8 (November 2025)
Volume 83, Issue 8 (November 2025)
Abstract
Background: Neonatal hypoglycemia is a common metabolic disturbance during the first days of life, particularly in infants with risk factors such as prematurity, perinatal stress, intrauterine growth restriction, or maternal diabetes. Early onset thrombocytopenia within the first 72 hours is often attributed to placental insufficiency and reduced platelet production, whereas persistent hypoglycemia beyond this period may indicate sepsis, necrotizing enterocolitis, or hyperinsulinemic states. Given that perinatal stress and asphyxia can predispose to both hypoglycemia and thrombocytopenia, simultaneous presentation of these conditions may complicate diagnosis and management. This case report describes a neonate with persistent hypoglycemia and thrombocytopenia unresponsive to standard therapies, ultimately attributed to transient hyperinsulinism.
Case Presentation: This case was managed and documented at Valiasr Hospital, Tehran University of Medical Sciences, in April 2023. A late preterm female infant born at 36+2 weeks via emergency cesarean section for intrauterine growth restriction and fetal distress presented with hypotonia and hypoglycemia (38 mg/dL) at 15 hours of life. Despite intravenous dextrose infusion up to 13 mg/kg/min, recurrent hypoglycemia persisted. Concurrently, severe thrombocytopenia (26,000/µL) was noted, unresponsive to platelet transfusion and intravenous immunoglobulin. Maternal platelet count was normal, excluding autoimmune etiologies. On day six, a glucagon stimulation test demonstrated a rise in glucose from 44 to 78 mg/dL, confirming hyperinsulinemic hypoglycemia. Laboratory evaluation revealed elevated insulin levels with absent ketones. Glucagon infusion was initiated, followed by diazoxide therapy (15 mg/kg/day) beginning on day ten. After two doses, glucose levels stabilized above 50 mg/dL, allowing gradual reduction of intravenous fluids. Remarkably, platelet counts normalized within five days of diazoxide initiation. Diazoxide was tapered and discontinued by day 27, and the infant was discharged on day 31 with stable glucose levels and normal platelet counts.
Conclusion: This case highlights the coexistence of transient hyperinsulinemic hypoglycemia and thrombocytopenia in a neonate, both of which responded to diazoxide therapy. The temporal relationship suggests a potential modulatory effect of insulin or diazoxide on platelet dynamics. Further clinical and mechanistic studies are needed to clarify this association.
Case Presentation: This case was managed and documented at Valiasr Hospital, Tehran University of Medical Sciences, in April 2023. A late preterm female infant born at 36+2 weeks via emergency cesarean section for intrauterine growth restriction and fetal distress presented with hypotonia and hypoglycemia (38 mg/dL) at 15 hours of life. Despite intravenous dextrose infusion up to 13 mg/kg/min, recurrent hypoglycemia persisted. Concurrently, severe thrombocytopenia (26,000/µL) was noted, unresponsive to platelet transfusion and intravenous immunoglobulin. Maternal platelet count was normal, excluding autoimmune etiologies. On day six, a glucagon stimulation test demonstrated a rise in glucose from 44 to 78 mg/dL, confirming hyperinsulinemic hypoglycemia. Laboratory evaluation revealed elevated insulin levels with absent ketones. Glucagon infusion was initiated, followed by diazoxide therapy (15 mg/kg/day) beginning on day ten. After two doses, glucose levels stabilized above 50 mg/dL, allowing gradual reduction of intravenous fluids. Remarkably, platelet counts normalized within five days of diazoxide initiation. Diazoxide was tapered and discontinued by day 27, and the infant was discharged on day 31 with stable glucose levels and normal platelet counts.
Conclusion: This case highlights the coexistence of transient hyperinsulinemic hypoglycemia and thrombocytopenia in a neonate, both of which responded to diazoxide therapy. The temporal relationship suggests a potential modulatory effect of insulin or diazoxide on platelet dynamics. Further clinical and mechanistic studies are needed to clarify this association.
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