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Epidural initiation time based on fetal head position criteria in painless labor: a letter to editor
Banafsheh Mashak, Reza Taghvaei, Reza Payami , Mohammad Hossein Shakeri Goki , Fatemeh Javaheri, Roya Bolhassani,
Volume 83, Issue 6 (September 2025)
Abstract

A comparative study on HOSPICE centers for patients with advanced non-curable advanced disease with a life expectancy of less than six months in the world
Ayoub Tavakolian, Shapour Badiee, Mahdi Mohammadi, Elahe Pourahmadi, Samaneh Sabouri, Navid Kalani , Mahdi Foroughian ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: The present study is a systematic and comparative review of the studies conducted in the field of hospice centers for patients with acute incurable diseases with a life expectancy of less than six months in the world with the aim of examining the need in Iran and the experiences of other countries, identifying candidates to receive these services, type of services provided, costs and resources in these centers.
Methods: The present study was conducted as a systematic review by searching the databases: Scopus, PubMed, Elsevier, and Google Scholar search engine between 2010 and 2023. To search these databases, keywords such as hospice care centers, centers providing health services for patients with life expectancy less than six months, allocation of resources, allocation were used. After selecting the articles, the following topics were extracted from each article and compared: costs, sources of funding, candidates for receiving services, families' views, quality of near-death care, quality of life, quality of death, services provided, therapeutic interventions performed, place of death, length of stay.
Results: 6 articles referred to the discussion of cost, and in all articles except one case, the use of hospice was associated with reducing the cost of patients. In one study, the source of funding was philanthropic contributions and in another study, the national budget. In all the reviewed articles, the use of hospice was associated with an increase in the quality of care, quality of end of life and quality of death, and a decrease in therapeutic interventions. The care provided by hospice was also introduced in the form of symptom assessment and management, pain relief, psychosocial support and respite care.
Conclusion: Based on the findings of the present study, hospices can play an effective role in reducing treatment costs and, on the other hand, improve the quality of care, life and death in eligible people. In addition, hospices improved the end-of-life quality from the perspective of the deceased's family by reducing invasive interventions and providing physical and spiritual care.
 

The beneficial effects of Lactobacillus brevis in inflammatory bowel disease, clinical effects and therapeutic prospects: a review article
Ardeshir Ebrahiminejad Shahroudi, Abbas Akhavan Sepahi , Anna Meyfour, Abbas Yadegar, Sedigheh Mehrabian,
Volume 83, Issue 7 (October 2025)
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing gastrointestinal disorder characterized by persistent inflammation of the intestinal mucosa, disruption of epithelial barrier function, and dysregulation of the immune system. Its pathogenesis involves complex interactions among genetic predisposition, environmental factors, gut microbiota, and host immune responses. Dysregulated cytokine signaling plays a central role, with elevated levels of pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-6, IL-12, and interferon-gamma (IFN-γ), contributing to tissue damage, epithelial barrier dysfunction, and clinical manifestations such as diarrhea, bleeding, and weight loss. Conversely, anti-inflammatory cytokines, including interleukin-10 (IL-10), IL-35, and IL-37, counteract these inflammatory responses, inhibit excessive immune activation, and maintain mucosal homeostasis. Probiotics, particularly Lactobacillus strains, have emerged as promising adjunctive therapies for IBD due to their capacity to restore microbial balance, modulate immune responses, and enhance gut barrier integrity. Among them, Lactobacillus brevis has demonstrated significant immunoregulatory and anti-inflammatory effects. Various strains, including AL0035, SBC8803, Bmb6, HY7401, and KU15152, reduce pro-inflammatory cytokines, upregulate tight junction proteins such as ZO-1, regulate Th1/Th2/Th17 responses, and inhibit NF-κB and MAPK signaling pathways. L. brevis-derived metabolites, notably long-chain polyphosphates, attenuate fibrosis, reduce TGF-β1 and collagen expression, and protect epithelial cells from oxidative stress. Heat-killed L. brevis strains also retain immunomodulatory activity, allowing therapeutic use even when live bacteria cannot effectively colonize the gut. Preclinical studies demonstrate that oral administration of L. brevis improves disease activity indices in experimental colitis models, reduces mucosal immune cell infiltration, restores epithelial integrity, and prevents ulceration, bleeding, and goblet cell depletion. Clinical evidence, although limited, suggests that L. brevis supplementation can enhance gut microbiota diversity, increase beneficial bacterial populations, and modulate serum cytokines, further supporting intestinal homeostasis. Furthermore, L. brevis influences metabolite profiles, such as serotonin and polyamines, which are linked to gut motility, epithelial repair, and immune regulation, highlighting its multifaceted role in gut health. In this review article, for the first time, we discussed the beneficial effects of L. brevis in inflammatory bowel disease, highlighting its clinical effects and therapeutic prospects.
 

Comparison of the analgesic efficacy of pethidine and ketorolac in renal colic patients.
Aref Teymurinejad, Hossein Seidkhani , Zahra Mohebinejad, Amirreza Eidypou , Hamed Azadi ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: Kidney stones are the third most common urinary tract disorder after prostate disease and infection. Painful attacks are the most common clinical manifestation, which is known as renal colic. The aim of the present study is to determine the effect of pethidine, pethidine and ketorolac, and ketorolac in patients with primary renal colic.
Methods: Renal colic patients at Imam Khomeini Hospital in Ilam from April 2023 and March 2023. were divided into three groups of 36 people. The first group received pethidine 25 mg, the second group received ketorolac 30 mg, and the third group received a combination of 2 drugs. A questionnaire included demographic information of the patients, heart rate, systolic and diastolic blood pressure, respiratory rate, oxygen saturation, side effects, pain intensity, length of hospitalization, and type of treatment received.
Results: After receiving the drug, the average heart rate increased in all three groups. But in group A, this increase was less than two groups, B and C, and this difference was not statistically significant (P=0.34). The average systolic blood pressure before receiving the drug was significantly higher in the three studied groups (P=0.006), which decreased after receiving the drug, but this decrease in systolic blood pressure in the three groups was not statistically significant (P=0.98). The average pain intensity before receiving the drug was 8.56 ± 1.2 in group A, 9.17 ± 0.878 in group B, and 8.86 ± 0.961 in group C. There was no significant difference between the three groups in terms of initial pain intensity (P=0.45). While the average pain intensity after receiving the medicine was significantly reduced and there was a significant difference (P<0.000).
Conclusion: Overall, the obtained results showed that ketorolac and pethidine have a faster effect and power compared to pethidine and ketorolac alone in controlling the pain of patients with renal colic, and the need for life-saving treatment is also less in this drug, and according to numerous studies, its side effects are also less.
 
Comparative study effect of Dexmedetomidine and Ketamine on post operative analgesia after laparoscopic cholecystectomy
Hossein Majedi , Ebrahim Espahbodi, Seyedeh Fatemeh Hosseini Nejad, Mahshid Vaziri, Fatemeh Javaherforoushzadeh , Mahbubeh Rashidi, Rouzbeh Amiri Motlagh ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: Postoperative pain remains a major concern following abdominal surgeries, including laparoscopic cholecystectomy. Inadequate pain control may lead to increased opioid consumption, delayed recovery, prolonged hospitalization, and reduced patient satisfaction. Therefore, the use of anesthetic adjuvants with effective analgesic properties and minimal side effects has gained increasing attention. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, and dexmedetomidine, a highly selective α2-adrenergic agonist, are commonly used agents with distinct mechanisms of action. The present study aimed to compare the effects of intraoperative ketamine and dexmedetomidine on postoperative pain following laparoscopic cholecystectomy.
Methods: This randomized, double-blind, controlled clinical trial was conducted on 252 patients undergoing elective laparoscopic cholecystectomy. Patients were randomly assigned into three equal groups: ketamine, dexmedetomidine, and control. The ketamine group received an intravenous infusion of ketamine at a dose of 0.5 mg/kg/h, the dexmedetomidine group received 0.6 µg/kg/min of dexmedetomidine, and the control group received normal saline. Pain intensity was assessed using the Visual Analogue Scale (VAS) at 1, 6, 12, and 24 hours postoperatively. Hemodynamic parameters, including heart rate and mean arterial pressure, were continuously monitored throughout the perioperative period. Data were analyzed using appropriate statistical tests, including ANOVA and nonparametric analyses.
Results: The results demonstrated that postoperative pain scores were significantly lower in the ketamine group compared to both the dexmedetomidine and control groups at all evaluated time points within the first 24 hours after surgery (P < 0.001). Although dexmedetomidine also provided effective analgesia compared with the control group, ketamine showed superior pain reduction. No statistically significant differences were observed among the three groups regarding hemodynamic parameters, indicating comparable cardiovascular stability.
.Conclusion: Intraoperative administration of ketamine was more effective than dexmedetomidine in reducing postoperative pain following laparoscopic cholecystectomy, without compromising hemodynamic stability. Nevertheless, both agents proved to be safe and effective options for postoperative pain management. Ketamine may be considered a preferable.
 

Comparison of the frequency and pattern of clinical manifestations of patients with phenylketonuria in the two provinces of Sistan and Baluchestan and West Azerbaijan
Elham Shafighi Shahri , Akram Ehsasatvatan, Sara Rigy Nejad ,
Volume 83, Issue 7 (October 2025)
Abstract




Background: Phenylketonuria (PKU) is a genetic metabolic disorder that, if left untreated, leads to irreversible cognitive, behavioral, and neurological damage. Sistan and Baluchestan and West Azerbaijan provinces are among the regions that have reported high rates of the disease due to specific ethnic characteristics. This study aims to compare the frequency and pattern of clinical symptoms in the two provinces of Sistan and Baluchestan and West Azerbaijan.
Methods: This cross-sectional descriptive-analytical study was conducted on 60 patients with PKU who had been referred to Imam Ali Hospital (Zahedan) and Urmia Hospital during the past ten years. Data were collected from medical records and structured interviews.
Results: The mean age of the patients was 5.67 ± 6.98 years. The mean height, weight, and head circumference were 30.28 ± 113.08 cm, 13.22 ± 25.13 kg, and 1.83 ± 43.36 cm, respectively. The mean serum phenylalanine level at the time of diagnosis was 13.58 ± 14.65 mg/dL. Of the 60 patients, 31 (51.7%) were male and 29 (48.3%) were female. The difference between the two sexes in the occurrence of clinical symptoms was not statistically significant (p<0.05). Psychiatric disorders were reported in 20 (33.3%) of the patients. The prevalence of these disorders was significantly higher with increasing age (p = 0.041).
Conclusion: This study indicates the existence of significant regional differences in the clinical manifestations of phenylketonuria; such that patients from Sistan and Baluchestan province experienced a higher rate of psychiatric and neurological symptoms than patients from West Azerbaijan. The severity of symptoms increased with increasing age and duration of illness, emphasizing the importance of early diagnosis and continuous therapeutic follow-up. It was also noteworthy that some patients still had severe clinical symptoms despite having lower phenylalanine levels at diagnosis. Overall, the findings of this study emphasize the need for early diagnosis, equitable access to health services, and sustained metabolic control to improve outcomes for PKU patients in the country.

The prevalence and clinical course of cisplatin-induced acute kidney injury patients undergoing cisplatin-based chemotherapy
Mohammad Mehdi Khatib Shahidi, Ali Sadoogh Abbasian , Maliheh Safari ,
Volume 83, Issue 7 (October 2025)
Abstract
Background: Cisplatin is one of the most effective chemotherapy agents; however, its nephrotoxicity remains the primary dose-limiting factor. This study aimed to determine the prevalence and clinical course of acute kidney injury (AKI) in patients receiving high-dose cisplatin therapy.
Methods: This cross-sectional descriptive study was conducted at Ayatollah Khansari Hospital in Arak, based on clinical records of hospitalized patients from March 2021 to June 2022. Patients who received at least four cycles of cisplatin-based chemotherapy at a dose of 260 mg/m² were included. Data were extracted from the Hospital Information System (HIS) and physical records. Ninety eligible cases were selected via random sampling. Data were summarized using descriptive statistics.
Results:  Regarding gender distribution, 54.4% were female (n=49) and 45.6% were male (n=41). The relative frequency of cisplatin-induced AKI was 21.11%. Overall, 26.32% of patients developed chronic kidney disease (CKD), 10.53% reached end-stage renal disease (ESRD), and only 11.42% recovered. An 18 to 24-month follow-up revealed a mortality rate of 21.05%, while 15.79% required treatment modification, and 5.26% needed kidney transplantation. No treatment discontinuation was observed. Logistic regression analysis identified female gender, age 61-70, age >70, poor hydration status, five or more chemotherapy cycles, and diabetes mellitus as significant risk factors for AKI.
Conclusion:  High-dose cisplatin is associated with a high risk of permanent renal damage. Given the low recovery rate and the potential for progression to chronic renal failure, careful monitoring of risk factors and rigorous hydration management are vital for these patients.
 

Prevalence of fatty liver disease in patients with high-risk coronary plaque on CT angiography
Moghgan Samet Zadeh , Sahar Nikouzad Shahraki , Mohammad Ghasem Hanafi ,
Volume 83, Issue 7 (October 2025)
Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most prevalent chronic liver diseases worldwide and is closely associated with metabolic syndrome and insulin resistance. Growing evidence suggests a link between NAFLD and cardiovascular diseases, independent of traditional risk factors. Coronary computed tomography angiography (CCTA) is a reliable noninvasive method for evaluating coronary artery disease (CAD) and identifying high-risk coronary plaque characteristics. However, data regarding the association between NAFLD and high-risk coronary plaques remain limited, particularly in Iran. This study aimed to evaluate the prevalence of NAFLD in patients with high-risk coronary plaques detected by CCTA.
Methods: In this cross-sectional study, 200 patients who underwent CCTA for the evaluation of coronary plaques in outpatient clinics or the emergency department of Golestan Hospital in ahvaz ,1403 ,were enrolled. Demographic data, including age, sex, weight, and body mass index (BMI), along with clinical characteristics and cardiovascular risk factors such as hypertension, diabetes mellitus, dyslipidemia, smoking status, and medical history were collected. Patients with a history of alcohol consumption or known liver disease were excluded. NAFLD was assessed based on imaging findings. Statistical analyses were performed to compare variables between patients with and without NAFLD.
Results: The mean age of patients with NAFLD was 57.89 ± 9.72 years, compared with 55.77 ± 8.97 years in patients without NAFLD, with no statistically significant difference. The prevalence of NAFLD was slightly higher in women than men; however, this difference was not significant. Patients with NAFLD had a significantly higher mean weight than those without NAFLD (85.21 ± 12.12 kg vs. 79.62 ± 11.85 kg; p = 0.001). Additionally, the prevalence of NAFLD increased significantly with higher BMI categories, particularly in obese individuals.
Conclusion: Age and gender were not significantly associated with NAFLD prevalence in patients with high-risk coronary plaques. In contrast, increased body weight and higher BMI, especially obesity, were independently associated with a higher risk of NAFLD in this population.

Investigation the frequency and causes of readmission in patients with cardiovascular diseases
Somayeh Abbaspour , Hassan Karimi, Maryam Farzaneh , Zahra Karimi , Shirin Azizidoost ,
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.
 

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