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Novel Insights into Pontocerebellar Hypoplasia Type 3: Discovery of a New Disease-causing PCLO Variant and Development of a CRISPR-generated Cell Model
Background: Pathogenic variations in the PCLO gene cause Pontocerebellar Hypoplasia type 3 (PCH3), an extremely rare autosomal recessive disease characterized by seizure, intellectual disability, developmental delay, and microcephaly. PCLO encodes the Piccolo protein, which plays a critical role in synaptic function and neurological disorders. To date, only one pathogenic PCLO variant associated with PCH3 has been reported in the literature. While research on PCH3 is ongoing, the rarity of the condition has limited the number of studies. Materials and Methods: A novel homozygous variant in PCLO (NM_033026: c.458T>C, p. Met153Thr) was identified through wholeexome sequencing and confirmed by Sanger sequencing. Functional studies were conducted to assess the pathogenicity of this variant using next-generation sequencing (NGS), in silico analysis, CRISPR-edited cells, and real-time PCR. Results: The proband presented with seizure, microcephaly, mild ataxia, and behavioral issues. Notably, in addition to previously reported symptoms, the patient also exhibited toe-walking, loss of tendon reflexes, and unilateral paralysis. The PCLO knockout cell model and molecular analysis confirmed the loss of function of the Piccolo protein in the homozygous variant. Our findings also demonstrated that Piccolo deficiency may affect the expression of other genes, including CtBp1 and BSN. Conclusion: We identified a novel PCLO variant responsible for PCH3 in a second known family worldwide. Additionally, a CRISPR-based cell model for PCH3 was developed, providing a valuable foundation for further research into the molecular mechanisms underlying Piccolo function and disease pathogenesis.
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Investigating the Relationship between Demographic, Radiological and Clinical Factors and In-Hospital Mortality of Non-Traumatic Subarachnoid Hemorrhage Before and After COVID-19 Pandemic
Background: Subarachnoid hemorrhage (SAH) is a life-threatening neurological condition that accounts for approximately 5% of all strokes. This study aimed to evaluate the demographic, clinical, and radiological factors associated with in-hospital mortality in patients with non-traumatic SAH and to assess potential differences before and after the COVID-19 pandemic. Materials and Methods: This retrospective analytical study was conducted on 177 patients with non-traumatic SAH admitted to Imam Hossein Hospital, Tehran, from November 2021 to December 2022. Diagnosis was confirmed by a neurologist using clinical presentation, imaging, and cerebrospinal fluid analysis. Patients were grouped based on discharge status (deceased vs. survived), and also classified into early- and late- pandemic subgroups based on their admission date. Comparative analyses and binary logistic regression were performed to identify predictors of in-hospital mortality. Results: Among 177 patients (mean age: 54.75 years), 36 (20.3%) died during hospitalization. Blood pressure, blood sugar, and level of consciousness at admission were significantly associated with mortality (P < 0.05), as were disease severity (Hunt and Hess grade) and angiography status (P < 0.001). No significant associations were found for age, sex, hospitalization duration, creatinine, platelets, hypertension, diabetes, or aneurysm characteristics (P > 0.05). Logistic regression identified lower Glasgow Coma Scale (GCS) scores (P < 0.001) and higher systolic blood pressure (P = 0.004) as independent predictors of mortality. Mortality was higher in the late-pandemic group (23.9% vs. 16.0%), though not statistically significant (P = 0.18). Conclusion: Lower GCS scores and elevated systolic blood pressure at admission were independent predictors of in-hospital mortality in patients with non-traumatic SAH. The COVID-19 pandemic period was associated with reduced use of angiography and a trend toward increased mortality, underscoring the importance of maintaining access to timely care during public health crises. [GMJ.2025;14:e3866] DOI:10.31661/gmj.v14i.3866
Effects of Preanhepatic Glucose-Insulin Infusion on Metabolic and Hemodynamic Outcomes in Liver Transplantation: A Randomized Clinical Trial
Background: Liver transplantation is a complex procedure requiring meticulous perioperative management to optimize outcomes. The administration of glucose-insulin solutions during the preanhepatic phase may influence hemodynamic and metabolic stability. This study aimed to evaluate the effects of dextrose-insulin infusion on hemodynamic, metabolic, and clinical outcomes in liver transplant recipients. Materials and Methods: A randomized, double-blinded clinical trial was conducted on 88 patients (1:1 allocation) undergoing liver transplantation at Taleghani Hospital, Iran. The intervention group received dextrose 50% (1g/kg) and insulin (1u/kg), while the control group received normal saline. Hemodynamic parameters (cardiac output, vascular resistance), metabolic markers (glucose, potassium, lactate), and clinical outcomes (hospital stay, complications) were assessed across preanhepatic, anhepatic, and reperfusion phases. Statistical analysis was performed using SPSS v27.0. Results: The intervention group demonstrated significantly higher cardiac output (6.95±1.66 vs. 5.56±2.02 L/min, P<0.001) and lower inotropic requirements (65.9% vs. 88.6%, P=0.018) during the anhepatic phase. Postoperatively, the intervention group had reduced ALT (P=0.038), AST (P=0.019), bilirubin (P=0.021), BNP (P=0.002), and lactate (P<0.001). No differences were observed in hospital stay, ICU duration, or complication rates. Conclusion: Dextrose-insulin administration during liver transplantation improves intraoperative hemodynamics and reduces postoperative metabolic stress without increasing adverse events.
Assessment of the Relationship Between ABO Blood Group and Familial Cancer Occurrence in Kirkuk City
Background: The potential connection between blood types and cancer risk has become a puzzling yet intriguing area of research in recent years; while its association is widely assessed with cancer occurrence, it is not well assessed in case of hereditary cancers. This study aimed to assess the relation between ABO blood groups and the occurrence of familial cancers. Materials and Methods: This cross-sectional study was carried out in Kirkuk city from the period 15th October 2023 to 15th April 2024 on 398 patients diagnosed with cancer. The study included three groups: patients with a family history of cancer in first-degree relatives (n=90), no family history (n=288), and second-degree relatives (n=20). Data was collected from both medical records and patient interviews, focusing on demographic details, lifestyle habits, medical history. In-depth interviews provided further details on lifestyle patterns, including smoking habits, alcohol use, eating habits, medical conditions, medication use, viral infections, and exposure to chemicals or radiation. Results: Significant differences were noted in age distribution, with the 38-47 and 48-57 age groups being more common in the first-degree and no family history groups, respectively. Sex distribution showed a higher proportion of females in the first-degree and second-degree groups (P=0.017). There were higher proportions of high socioeconomic status in the second-degree group and married individuals in the first-degree and second-degree groups compared to non-familial cancers. Breast cancer was more prevalent in the first-degree and second-degree groups. Adjusting for demographic, socioeconomic, Body-Mass-Index, cancer type, and health related habits, O- blood group was significantly associated with a higher likelihood of familial cancer history in first-degree relatives (OR: 14.083, P=0.024) compared to non-familial ones. Other blood groups did not show significant associations. Conclusion: There might be an association between familial cancer O- blood group that needs to be re-evaluated in further studies.
Determinants of Serum Iron Profile in Non-Anemic Pregnant Women at Delivery: A Cross-Sectional Study at Baharloo Hospital (2022-2023)
Background: Iron deficiency during pregnancy poses a significant risk to maternal and fetal health, especially among anemic women whose physiological demand for iron increases drastically. This study aimed to evaluate the serum iron profile of non-anemic pregnant women at the time of delivery and to identify associated demographic and clinical factors. Materials and Methods: Conducted at Baharloo Hospital between 2022 and 2023, this cross-sectional study involved pregnant women who met the primary inclusion criteria of being non-anemic in the first and second trimesters and were admitted for scheduled labor. Serum ferritin, serum iron, and total iron-binding capacity (TIBC) were quantified, alongside comprehensive analysis of hemoglobin (HB) levels and red blood cell (RBC) indices. Data on demographic characteristics, and prenatal supplement usage were collected through medical records and analyzed using SPSS software. Results: This study of 120 pregnant women (mean age 28.85 ± 6.34 years, gestational age 39.21 ± 0.8 weeks) found that most participants regularly consumed iron (93.33%) and multivitamin supplements (81.67%), with average serum iron levels of 98.73 ± 20.7 µg/dL at 3rd trimester. Key correlations included negative associations between gestational age and maternal age (r=-0.26) and between ferritin and gestational age (r=-0.18), while hemoglobin and hematocrit levels were strongly positively correlated. Logistic regression identified lower second-trimester hemoglobin as protective against delivery-time anemia (OR=0.29), and lower second-trimester MCV significantly predicted iron-deficiency anemia (IDA) (OR=0.70), when adjusting for age, gestational age, BMI, supplements or iron usage, multiparity, and educational level. Conclusion: As iron and multivitamin supplementation did not significantly reduce anemia risk and it was basically related to second-trimester MCV and hemoglobin, higher thresholds of these markers should be assigned as the goal of anemia prevention programs for Iranian women.
Evaluating C-peptide Levels in Children with Type 1 Diabetes and Its Association with Anthropometric and Clinical Variables
Background: C-peptide, a byproduct of insulin production, plays significant physiological roles, including stabilizing blood glucose levels and protecting tissues. Its potential therapeutic role in Type 1 diabetes mellitus (T1DM) management remains underexplored, particularly in preserving β-cell function and improving glycemic control. Materials and Methods: This cross-sectional study included 69 pediatric patients with T1DM at Bo Ali Diabetes Clinic, Shiraz, Iran, from December 2022 to April 2023. Patients with a disease duration less than 2 years or metabolic comorbidities were excluded. Anthropometric measurements, HbA1c, and serum C-peptide levels were collected after three months of dietary counseling and insulin adjustment. Data were analyzed using Spearman’s correlation and linear regression. Results: The study population consisted of 69 children (mean age: 11.92 ± 3.65 years; mean disease duration: 63.13 ± 33.16 months). Serum C-peptide levels (mean: 87.02 ± 73.89 pmol/L) were inversely correlated with disease duration (ρ=-0.433, P<0.001) and HbA1c (ρ=-0.404, P=0.001). Regression analysis confirmed that both HbA1c and disease duration were significant predictors of C-peptide levels (P<0.05). However, no significant associations were observed between C-peptide and age, weight, height, or BMI. Conclusion: Reduced C-peptide levels are correlated with poorer glycemic control (greater HbA1c) and longer disease duration in children with T1DM. These findings highlight the clinical relevance of C-peptide supplementation as a potential therapeutic strategy to preserve β-cell function and improve long-term outcomes in T1DM management. Longitudinal studies are warranted to further evaluate its efficacy.
The Effect of Trigger-to-Retrieval Time Interval on Assisted Reproductive Technology Outcomes in Patients with Poor Ovarian Response
Background: The timing of oocyte retrieval after the oocyte maturation trigger is a critical factor influencing the clinical outcomes of assisted reproductive technologies (ART). This study examined how different time intervals of 34 and 36 hours between trigger administration and oocyte pickup (OPU) influence on ART outcomes in patients with poor ovarian response (POR). Materials and Methods: This prospective randomized controlled study enrolled 217 women undergoing intracytoplasmic sperm injection (ICSI) cycles between April 2024 and March 2025. All participants received a GnRH antagonist protocol, followed by a dual trigger for final oocyte maturation. The cycles were stratified into two groups based on the time interval between trigger administration and OPU at 34 and 36 hours. Comparative analyses were conducted to evaluate the outcomes between the two groups. Results: Throughout the trial, no significant statistical differences were observed between the intervention and control groups concerning baseline clinical and demographic characteristics, except for the antral follicle count (AFC) at baseline. The findings revealed that the 34-hour OPU group exhibited a significantly higher number of retrieved oocytes, oocyte maturity rate, fertilization rate, and number of high-quality embryos compared to the 36-hour group (P<0.05). Furthermore, pregnancy outcomes were most favorable in the 34-hour group (P<0.05). After adjusting for AFC, all observed differences remained statistically significant, with the exception of the fertilization rate. Conclusions: Our findings suggest that in POR patients, a 34-hour OPU interval with dual triggering significantly improves fertilization rates, embryo quality, biochemical and chemical pregnancy rates compared to 36 hours. This timing adjustment may enhance oocyte maturation and optimize ART success rates.
Dissecting Uricase Immunogenicity: Unveiling the Role of Quaternary Epitopes through In Silico Analysis
Background: Protein-based therapeutics offer remarkable precision and effectiveness, yet their immunogenic potential remains a significant challenge. Uricase, an enzyme used to treat hyperuricemia, is no exception, often eliciting immune responses due to its non-human origins and repeated administration requirements. Understanding the immunogenic mechanisms at play is crucial for enhancing therapeutic efficacy. Materials and Methods: This in silico study investigates the immunogenic landscape of uricase, focusing on the identification of linear, conformational, and the underexplored quaternary epitopes. Using a comprehensive approach, we analyzed multiple uricase variants through structural alignments, epitope prediction algorithms, and network-based residue interaction models. Predictive tools, including BepiPred, DiscoTope, and SEMA, were employed to identify epitope regions, with a novel focus on quaternary epitopes formed by inter-chain interactions. Results: Our analysis reveals conserved structural motifs across uricase variants, with linear and conformational epitopes localized in similar regions. The groundbreaking identification of quaternary epitopes—epitopes formed through interactions between protein chains—provides a novel insight into uricase immunogenicity. These epitopes, located in structurally prominent regions, likely play a critical role in the immune response to uricase. Conclusions: This study marks a significant advance in understanding uricase immunogenicity, introducing quaternary epitopes as pivotal factors in immune recognition. The findings open new avenues for designing uricase variants with reduced immunogenicity, offering potential improvements in therapeutic strategies for hyperuricemia management.
Vaginal Progesterone Effects on Ultrasound Indices, Fetal Outcomes, and Preeclampsia in High-risk Pregnancy
Background: According to the high prevalence and importance of preeclampsia and its relationship with uterine artery resistance, the purpose of this study was to determine the effect of vaginal progesterone administration on ultrasound indices, fetal outcomes, and high-risk women pregnancy in terms of the incidence of preeclampsia. Materials and Methods: In this randomized, double-blind clinical trial, the number of 60 pregnant women between 11 to 14 weeks with risk factors for preeclampsia were examined according to the inclusion criteria and based on random assignation method in two groups of 30 patients (intervention group: 80 mg aspirin tablets + 400 mg vaginal progesterone suppositories and control group: 80 mg aspirin tablets) based on maternal and fetal outcomes and uterine artery color Doppler ultrasound (pulsatility index (PI) and vascular resistance index (RI). Results: The prevalence of preterm birth in the intervention group was lower significantly difference (P≤0.05). In the intervention group, uterine artery PI after the study had a greater decrease than before the study on the right side (0.33±0.42 vs. 0.05±0.28, P≤0.05) and on the left side (0.38±0.49 vs. 0.09±0.2, P≤0.05), compared to the control group. In the intervention group, uterine artery RI after the study had a greater decrease than before the study on the right side (0.20±0.31 vs. 0.02±0.10, P≤0.05) and on the left side (0.22±0.3 vs. 0.03 ± 0.1, P≤0.05), compared to the control group. Conclusion: Progesterone suppositories in addition to aspirin, can reduce the prevalence of preterm birth and uterine artery PI and RI values.
Clinical Management and Epidemiology of Scorpion Stings in Khuzestan Province, Iran: A Five-year Study
Background: Scorpion stings are a significant public health concern in many countries, particularly in Iran’s Khuzestan province. This study investigates the clinical and laboratory correlations in patients hospitalized for scorpion stings at Razi Hospital, Ahvaz, Iran, from 2018 to 2022, aiming to enhance patient care and preventive strategies. Materials and Methods: This descriptive, cross-sectional, retrospective study employed census sampling. Age, gender, sting season, sting site, delay to visiting hospital, hospitalization duration, antiscorpion treatment vials prescription, clinical symptom and laboratory findings were collected from medical records of patients hospitalized for scorpion stings during the study period, using a standardized checklist for clinical and laboratory parameters. Results: Our analysis of 799 scorpion sting cases revealed a male predominance (55.9%) and the highest incidence among individuals aged 21–40 years, with most stings occurring in summer. The extremities, particularly hands and feet, were the most common sting sites. Pain, erythema, and swelling were the leading symptoms, with most patients seeking medical care within three hours. Hospitalization was common, typically lasting at least one day. Disturbances in urinalysis (U/A) were the most frequent laboratory abnormality. Younger women in intensive care exhibited severe symptoms, including seizures, jaundice, and hematuria, which correlated with abnormalities in CBC, biochemical markers, PT, and U/A. These findings highlight the importance of timely clinical and laboratory assessments to improve outcomes. Conclusion: Scorpion stings continue to represent a public health challenge with a range of clinical manifestations and laboratory correlations. By enhancing awareness and preparedness, we can mitigate the impact of this health concern and improve patient outcomes for those affected by scorpion envenomations.
Effect of Metformin on Clinical Course of Non-Diabetic Patients with Ischemic Stroke
Background: Metformin is commonly used in diabetic patients, but its neuroprotective effects in non-diabetic stroke patients are less understood. This study aimed to evaluate the effect of metformin on the clinical course of acute ischemic stroke in non-diabetic patients. Materials and Methods: In this double-blind randomized clinical trial, 70 non-diabetic patients with acute ischemic stroke confirmed by brain imaging (CT or MRI) within 24 hours of symptom onset were randomly assigned to receive either metformin (500 mg once daily) or placebo for three months, alongside standard care. NIHSS sub-scores were categorized into clinically relevant groups (0=no deficit, 1=mild, 2=moderate, 3=severe) to account for heterogeneity of stroke manifestations. Clinical outcomes, including motor, sensory, visual, and facial function, were assessed at baseline, one, two, and three months. Adverse events were monitored throughout the study. Results: No serious adverse events were observed; mild gastrointestinal symptoms occurred in 2 patients (5.7%) in the metformin group. Compared with placebo, metformin significantly improved overall NIHSS scores at two and three months (P=0.021 and P=0.003), with notable improvements in motor, sensory, facial, and visual functions. Best Gaze remained normal in most patients. These findings are consistent with previous RCTs reporting neuroprotective effects of metformin in non-diabetic stroke patients. Conclusion: Metformin at 500 mg daily for three months is well tolerated and significantly improves neurological outcomes in non-diabetic patients with acute ischemic stroke, particularly in motor, sensory, facial, and visual domains. These results support the potential use of metformin as an adjunct therapy in stroke rehabilitation.
The Value of Detecting Creatinine and Human Chorionic Gonadotropin (Hcg) Levels in Cervicovaginal Discharge in Identifying Leakage in Pregnant Women 24 to 37 Weeks with Clear Leakage or Positive Fern Test
Background: Premature birth is one of the most important midwifery problems, and its early diagnosis is essential in the treatment and prevention process. Therefore, the purpose of this study is the value of detecting the level of creatinine and human chorionic gonadotropin (HCG) in cervicovaginal secretions in detecting discharge in pregnant women of 24 to 37 weeks with clear discharge or a positive Fern test in Forghani Hospital in 2022. Materials and methods: This study was conducted on 230 pregnant women from 24 to 37 weeks suspected of having vaginal discharge. In all suspected women, the creatinine and HCG levels of cervicovaginal secretions were measured, and the results were analyzed based on clear discharge and Fern's test, then the diagnostic power was calculated based on Rock's curve. Results: Our study's findings showed that the average levels of creatinine and B-HCG in women with clear discharge or a positive Fern test were significantly higher than in other women. However, by examining the diagnostic accuracy, it was found that the degree of agreement between the two tests in diagnosing discharge Clear and positive Fern test is weak to moderate, and creatinine has high sensitivity and B-HCG has high specificity. Conclusion: Creatinine and BHCG can be used in the diagnosis of premature rupture along with standard tests, and due to the use of a valuable diagnostic method, the fatal complications of PROM can be prevented, and with the timely treatment of this complication, the dangerous consequences are reduced, a study with higher sample volume and careful control of confounders is required.
Management Protocols for Spinal Injuries in Adult Patients: A Clinical Guideline
Background: This research aimed to elucidate and establish management recommendations for patients with spinal cord injuries, tailored to the characteristics of Iranian society, through an exploratory mixed-methods study. Materials and Methods: The present study was executed in three phases. The initial phase was conducted to identify and elucidate the principal recommendations for the management of spinal cord injuries, comprising two sub-phases: a systematic review and a qualitative guided study. In the second stage, management recommendations were developed by integrating the findings from the first stage, and in the third stage, the clinical guide was prioritized and validated through two rounds of the Delphi method. Results: During the initial phase of the study (qualitative-review phase), 781 codes were derived from interviews with specialists in emergency medicine and neurosurgery, which were subsequently consolidated into six categories. During the second phase of the study, which involved the preparation of the primary draft, a review of pertinent texts was conducted, and researchers assessed 23 chosen clinical guidelines. In the third phase of the study (combination), the findings from the preceding two phases were integrated, and the questionnaire developed by 27 relevant experts was evaluated, culminating in the creation of the final clinical guide. Conclusion: This clinical guide, encompassing six categories—Pre-hospital, Immobilization, Diagnostic Imaging, Pain Management, Medication Recommendations, and Surgical Intervention—has been developed and compiled for the utilization of physicians in the emergency departments of hospitals in Iran.
Effect of Prolonged Ovarian Stimulation (24 and 48 Hours) Compared to Conventional Duration on IVF/ICSI Outcomes: A Single-Blind Randomized Clinical Trial
Background: Infertility is a global public health concern, and controlled ovarian stimulation (COS) plays a crucial role in assisted reproductive technologies (ART) by facilitating the retrieval of multiple oocytes. This single-blind randomized clinical trial aimed to evaluate whether extending the duration of COS by 24 and 48 hours beyond the conventional protocol would affect pregnancy rates in couples undergoing IVF/ICSI. Materials and Methods: Ninety patients were randomized into three groups: control (GC), 24-hours longer (G24), and 48-hours longer (G48), using block randomization. The GC group followed the standard COS protocol, while G24 and G48 received extended COS for their respective durations. Primary outcomes included imaging-proven pregnancy at six weeks gestation, chemical pregnancy, and clinical pregnancy post-embryo transfer. Secondary outcomes included follicle, oocyte, and embryo counts. Results: Baseline characteristics were comparable across groups. Antral follicle count (AFC) and anti-Müllerian hormone (AMH) levels were positively correlated with pregnancy outcomes. Significant associations were observed between AFC/AMH and follicle/oocyte/embryo counts. Although embryo counts varied among groups, no significant differences in primary or secondary outcomes were found. A trend towards improved outcomes was noted from GC to G48, but without statistical significance. Conclusion: The study did not find significant differences in pregnancy rates or other outcomes with prolonged COS durations compared to conventional protocols. However, the results suggest a need for further research to explore the effects of extended COS in specific patient subsets, as existing literature indicates potential benefits.
The Quality of Life beafore and after Hysterectomy in Premenopausal Women
Background: Hysterectomy in premenopausal women has become very common due to the presence of benign disorders of the reproductive system. The present study was conducted as a longitudinal prospective cohort study to evaluate the quality of life before and after hysterectomy in premenopausal women, assessed at 3, 6, and 12 months postoperatively. Materials and Methods: This longitudinal prospective cohort study was conducted on 130 women aged 35–50 years who underwent hysterectomy with ovarian preservation in Amiralmomenin Hospital of Semnan, Iran. Data were collected before the operation, three months, six months, and one year after the hysterectomy using demographic characteristics and a standard quality of life questionnaire (SF-36). Data were analyzed using SPSS 22 software (P<0.05). Results: In the present study, 28 patients (21.5%) were ≤40 years old and 102 (78.5%) were ≥40 years old. A significant increase was observed in the scores of quality of life, physical health, mental health, and general health (P≥0.001). However, there was no significant difference in physical and mental function. Also, there was no relationship between quality of life and demographic characteristics (age, marital status, education, underlying disease, number of children, and number of deliveries). This is while postoperative complications and employment had a significant relationship with the quality of life (P≥0.001). Conclusion: In the present study, the quality of life was improved one year after hysterectomy with ovarian preservation.
Comparison of the Analgesic Effect of Ketamine and Midazolam with Paracetamol (Acetaminophen) and Ketorolac in Renal Colic Patients: A Clinical Trail
Background: Renal colic is the most prevalent symptom of urinary stones, and it is quite painful. This study aimed to determine the effect of the Ketamine and Midazolam combination and compare it with the acetaminophen (paracetamol or Apotel) and Ketorolac (Toradol) combination in pain management of patients with renal colic in the emergency department (ED). Materials and Methods: In this double-blind clinical trial study, 200 renal colic patients admitted to the ED with more than 8 Numeric Rating Scale (NRS) of primary pain were divided into two groups by random blocking: one group received intravenous Ketamine (0.4 mg/kg), and intravenous Midazolam (at a dose of 0.016 mg/kg) and the other group received intravenous Ketorolac (30 mg) and intravenous acetaminophen (15 mg/kg). After that, we measured patients’ pain by NRS at 1, 5, 10, 15, 30, and 45 min after the procedure. The data were analyzed using IBM SPSS 21.0 software. Results: 124 (62.0%) of 200 patients were men. Initial pain scores were 9(10-9) for Ketamine + Midazolam and 10(10-9) for Acetaminophen + Ketorolac.Linear regression was performed to compare the two groups’ adjusted pain scores, correcting for initial pain. The ultimate pain score increased by.392 units for each unit of starting pain. Group and time had significant effects (5.553, -.035, P=.001, respectively). Acetaminophen + Ketorolac had a higher mean pain score than Ketamine + Midazolam at all post-intervention time intervals. During the trial, both groups’ discomfort decreased significantly. Conclusion: The combination of Ketamine and Midazolam was more effective than Acetaminophen and Ketorolac in relieving the pain in renal colic. Therefore, if routine medications are contraindicated, a combination of Ketamine and Midazolam is recommended for pain control in patients with renal colic.
Effect of Different Vaccines and Aluminum Nanoparticles (ALNPs) on Liver and Kidney of Rabbits
Background: Aluminum nanoparticles (ALNPs) have gained attention as potential vaccine adjuvants due to their immunostimulatory properties. However, their impact on organ health remains a critical concern. This study examines the histopathological effects of ALNP-based vaccination compared to conventional aluminum-adjuvanted vaccines, focusing on liver and kidney tissue alterations in rabbits. Materials and Methods A total of 30 male rabbits were randomly assigned to five groups (n=6 per group). The control group received normal saline (0.2 mL, IM). In contrast, the experimental groups received either ALNPs at low (0.05M, IM) or high (0.1M, IM) doses, or inactivated poliomyelitis (0.2 mL, IM) or diphtheria-tetanus-pertussis (DTP) vaccine (0.2 mL, IM). A single dose was administered, and histopathological assessments of liver and kidney tissues were conducted after a 30-day observation period. Results ALNP exposure resulted in significant histopathological damage, with the high-dose ALNP group exhibiting renal tubular necrosis, glomerular swelling, intertubular hemorrhage, and hepatocyte degeneration. The vaccine groups also showed notable but comparatively less severe pathological changes, including moderate hepatocyte degeneration and renal tubular apoptosis. The control group exhibited normal histological structures. Discussion The findings indicate that while both ALNPs and conventional aluminum-adjuvanted vaccines induce organ toxicity, ALNP exposure leads to more pronounced tissue damage. The extent of histopathological alterations suggests a dose-dependent effect, raising concerns about the safety of ALNPs as vaccine adjuvants. These results align with previous studies highlighting aluminum toxicity but underscore the need for further research into nanoparticle-specific mechanisms of tissue injury. This study provides comparative evidence of ALNP and vaccine-induced histopathological alterations in liver and kidney tissues. The severity of damage associated with ALNP exposure necessitates further investigation into their long-term safety and biocompatibility. Future studies should explore alternative nanoparticle formulations with reduced cytotoxicity while maintaining immunogenic benefits.
Developmental Outcomes at 6 Months in Neonates with First-minute Apgar Score Below 7 and Gestational Age More Than 35 Weeks: A Single-center Study
Background: The objective of this study was to investigate the relationship between the one-minute Apgar score and developmental outcomes at six months of age. Materials and Methods: This cohort study involved neonates with gestational age of more than 35 weeks and a first-minute Apgar score of less than 7, without major anomalies requiring admission during September 2018-2021. Clinical data and hospital course details were recorded. At 6 months old, participants were contacted, and parental questionnaires regarding age and stages questionnaire (ASQ) were completed. Data were analyzed by SPSS 21, using mean, standard deviation, frequency, and percentage. Dunn test and the Kruskal-Wallis test were also employed. Results: Out of 26,928 neonates born, 865 had an Apgar score of less than 7 and survived the first day, with 208 being more than 35 weeks gestational age and needing admission. Ultimately, 196 neonates were enrolled. The mean gestational age was 38.2± 1.75 and the mean 1st-minute Apgar score was 3.36 ± 1.84. A significant relationship was observed between the 5th-minute Apgar score and cord blood acidosis (P<0.001) and the 10th-minute Apgar score with the need for oxygen (P=0.02(. Most infants had normal ASQ evaluations, while one (0.5%) was in high-risk zone for each domain of fine motor, personal-social, and communication skills. Additionally, one (0.05%) was in the abnormal range for gross motor function, and another one (0.05%) was in the abnormal range for fine motor function. Conclusion: Our study did not identify a relationship between a low first-minute Apgar score and adverse developmental outcomes at 6 months of age.
Tumor Characteristics and D2 Lymph Node Involvement in Gastric Cancer: A Clinicopathological Analysis (2018–2023)
Background: Gastric adenocarcinoma is a leading cause of cancer-related mortality worldwide, with lymph node involvement, particularly at the level 2 lymph node dissection (D2), serving as a critical determinant of prognosis and surgical strategy. This study aimed to evaluate the association between primary tumor characteristics and D2 lymph node involvement and examine these factors' impact on overall survival (OS) and disease-free survival (DFS) in patients undergoing curative gastrectomy. Materials and Methods: A retrospective cohort study was conducted on 233 patients with histologically confirmed gastric cancer who underwent curative-intent surgery at Namazi Hospital (Shiraz, Iran) between April 2018 and March 2023. Clinicopathological variables, including tumor size, location, grade, and histologic type, were assessed with D2 lymph node involvement. Survival outcomes were analyzed using Kaplan–Meier estimates and compared using the log-rank test. Multivariate logistic regression and Cox proportional hazards models were employed to identify independent nodal involvement and survival predictors. Results: D2 lymphadenectomy in 38.1% of patients indicated no significant associations between D2 involvement and tumor grade (P=0.443), size (P=0.215), or location (P=0.522). However, D2 lymph node metastasis was associated with a significantly descending mean of overall survival (25.43 ± 3.36 months) compared to patients without D2 involvement (43.06 ± 2.59 months; P<0.001). Tumor stage and size were strong predictors of survival, with Stage 3C patients revealing a median overall survival of 13.45 months and tumors < 3 cm being associated with superior outcomes (P=0.002). Conclusion: D2 lymph node involvement reflects progressive disease biology and is an assertive prognostic marker in gastric adenocarcinoma. While tumor grade, size, and location were not independently predictive of D2 metastasis, tumor stage and nodal status were strongly associated with survival. These results reinforce the use of extended lymphadenectomy in selected patients and underscore
An Investigation of the Effects of Formononetin on Hypothalamic Gonadotropin-releasing Hormone, Kisspeptin and Tachykinin 2 Gene Expression in Rats
Background: Red clover and its main derivative, formononetin, belong to the phytoestrogens. They are clinically used to alleviate mood disorders, anxiety, and hot flashes. Formononetin may interfere with the reproductive axis due to its estrogenic potency and its ability to bind estrogen receptors. To find some molecular mechanisms mediating the effects of formononetin on the hypothalamus-pituitary-gonadal (HPG) axis, this research aimed to investigate the effects of formononetin on the hypothalamic mRNA levels of gonadotropin-releasing hormone (Gnrh), kisspeptin1(Kiss1) and tachykinin 2 (Tac2). Materials and Methods: Fifteen male Wistar rats weighing 200±10 g were divided into three groups (n=5). Group 1 as the control group, received saline. Groups 2 and 3 received 20 and 40 µg of formononetin via the third cerebral ventricle. The hypothalamic samples were dissected. The Gnrh, Kiss1 and Tac2 gene expression was measured by real-time PCR. Results: Injection of 20 µg formononetin did not significantly decrease the mRNA levels of Gnrh and Tac2 compared to the control group. However, injection of 40 µg formononetin significantly reduced the mRNA levels of Gnrh and Tac2 compared to the control group. Injection of 20 and 40 µg formononetin, significantly declined the mRNA levels of Kiss1 compared to the control group. Conclusion: Present results indicated that formononetin may be involved in the regulation of the reproductive axis via reducing the activity of hypothalamic GnRH neurons and downregulation of the kisspeptin and neurokinin B signaling pathways upstream of GnRH neurons.
Orthostatic Hypotension, Frailty, and Cognitive Impairments Among Older Adults: A Hospital-based Study
Background: Orthostatic hypotension (OH) is a common condition, affecting roughly 20% of community-dwelling older adults and up to 25% of those in long-term care facilities. Its presence in older adults has been linked to heightened risks of frailty, cognitive decline, and increased fall rates, yet few studies have comprehensively examined these associations in outpatient settings. This study investigates the relationships between OH, frailty, and cognitive impairments in older adults attending an outpatient geriatric clinic. Materials and Methods: A cross-sectional study was conducted among 250 older adults (aged 60 years and above) visiting the Outpatient Geriatric Clinic at Firoozabadi Hospital. Cognitive function was evaluated using the Abbreviated Mental Test Score (AMTS) and Mini-Cog, while frailty status was determined through the Fried Frailty Index. Results: Participants had an average age of 70.72 ± 7.24 years, with ages ranging from 60 to 90. Of the total participants, 38.8% (97) were male, and 61.2% (153) were female. Average systolic blood pressure (SBP) was 132.04 ± 21.64 mmHg, and average diastolic blood pressure (DBP) was 79.43 ± 13.01 mmHg. Among participants, 38% (95) reported a history of falls, and 34% (85) were on multiple medications (polypharmacy). Notably, 33.6% (84) were diagnosed with frailty syndrome, and 29.2% (73) exhibited prefrailty. Additionally, 34.4% (86) of the participants were found to have cognitive impairments. Conclusion: The study highlights significant associations between orthostatic hypotension, frailty, and cognitive impairment among older adults. participants displaying frailty, prefrailty, and cognitive impairments, these findings underscore the need for early screening and management of orthostatic hypotension in outpatient settings. Addressing OH could play a crucial role in mitigating frailty progression, preserving cognitive function, and reducing fall risk in older adults. Future research is warranted to explore intervention strategies that may improve the quality of life and functional outcomes in this vulnerable population.
Preoperative Intravenous Desmopressin and Perioperative Blood Loss in Patients Undergoing Major Spine Surgery
Background: Major spine surgeries often involve significant blood loss, increasing transfusion risks and postoperative complications. Desmopressin, a synthetic vasopressin analog, may reduce bleeding by enhancing clotting factor release, but its efficacy in spine surgery remains understudied. This study evaluated the efficacy of preoperative intravenous desmopressin in reducing perioperative blood loss and transfusion requirements in patients undergoing major spine surgery. Materials and Methods: A double-blind, randomized, placebo-controlled trial was conducted at Shahid Rajaei Hospital, Iran. Fifty-five patients undergoing major spinal surgery were randomized to receive either 0.3 µg/kg desmopressin (n=25) or placebo (n=30) during anesthesia induction. Primary outcomes included intraoperative blood loss (measured hourly) and transfusion volume. Secondary outcomes included postoperative sodium levels, creatinine, urine output, and hospital stay. Statistical analyses used Student’s t-test, Chi-square, and repeated measures ANOVA. Results: Desmopressin significantly reduced intraoperative blood loss during the first hour (336.00± 125.43 vs. 398.33±85.58 mL, P=0.034) and second hour (530.95±188.07 vs. 756.67 ± 242.65 mL, P=0.003) compared to placebo. Total transfusion volume was lower in the desmopressin group (724.79 ± 429.06 vs. 1396.55±325.94 mL, P=0.001), with fewer intraoperative packed red blood cell transfusions (16% vs. 40%, P = 0.050). Postoperative creatinine levels were lower with desmopressin (1.16 ± 0.30 vs. 1.40 ± 0.32 mg/dL, P=0.009), but sodium levels and urine output were comparable. Hemodynamic stability and hospital stay did not differ significantly. Conclusion: Preoperative desmopressin reduced early intraoperative blood loss and transfusion requirements in major spine surgery without significant adverse effects. These findings support its use as a hemostatic adjunct, though further studies are needed to confirm long-term safety and efficacy.
Comparative Analysis of Fetal Kidney Length, Descending Colon Diameter, and Arterial Indices in Intrauterine Growth Restriction Versus Normal Growth Fetuses: A Case-control Study
Background: Intrauterine growth restriction (IUGR) refers to poor fetal growth characterized by a multitude of neonatal complications, necessitating timely diagnosis and intervention. This study aimed to compare the descending colon diameter and kidney length between fetuses with IUGR and normal growth. Materials and Methods: In this case-control study, a total of 60 participants, 30 pregnant women with IUGR fetuses and 60 women with normal fetuses, referring to an institutional tertiary hospital in eastern Iran, in 2023, were surveyed. Variables included demographic data, fetal kidney length, descending colon diameter, and the pulsatility index (PI) and resistance index (RI) of maternal and fetal arteries. Statistical analysis was performed using IBM SPSS 18.0, with a significance threshold of P<0.05. Results: A total of 90 pregnant women with a mean age of 29.50 ± 6.61 years were included. The prevalence of patients with occupational employment was significantly higher in the IUGR group (P=0.012). The mean right and left kidney lengths and the anteroposterior diameter of the renal pelvis were significantly higher in normal fetuses compared to those with IUGR (P<0.05). However, no significant difference was found in descending colon diameter between the two groups (P=0.071). The RI and PI of the umbilical and uterine arteries were significantly higher in IUGR fetuses, while the RI and PI of MCA were higher in normal fetuses (P<0.05). Conclusion: Descending colon diameter is not a reliable marker for IUGR diagnosis. However, the use of RI and PI of umbilical, uterine, and cerebral arteries can be effective in identifying IUGR.
Geographical Correlation between Refined Sugar Consumption and Oral Cancer Incidence: A Global Ecological Study
Background: Refined sugar consumption is a known risk factor for metabolic disorders and has been linked to some cancers. However, its potential role in oral cancer remains poorly understood. Oral cancer significantly contributes to global cancer-related mortality and is driven by dietary, behavioral, and socioeconomic factors. This ecological study investigates the global correlation between refined sugar intake and oral cancer incidence, accounting for major confounders. Materials and Methods: We analyzed publicly available data from the World Health Organization (WHO) and World Bank databases. The primary variables included oral cancer incidence per 100,000 population and sugar consumption. Statistical analyses included descriptive statistics, Pearson correlation coefficients, and multiple linear regression models to assess associations and adjust for confounding factors. Results: The study analyzed data from multiple countries, revealing substantial regional variation in oral cancer incidence and refined sugar consumption. Correlation analysis showed a weak negative association between refined sugar consumption and oral cancer incidence (r = -0.05, P > 0.05). Also, Multiple linear regression confirmed refined sugar consumption was not associated with oral cancer (β = -0.0028, P = 0.606). Conclusion: This study did not identify a significant association between sugar consumption and oral cancer incidence at the population level. However, the absence of a detectable relationship in this ecological analysis does not preclude more complex mechanisms or indirect associations. For example, sugar's role in promoting metabolic disorders, which might interact with other risk factors like inflammation or oxidative stress, warrants further study. Public health efforts should prioritize tobacco and alcohol reduction, given their robust and well-documented links to oral cancer, while future research explores the broader health impacts of dietary sugars.
Association of Glycated Hemoglobin Levels with Amputation Outcomes in Patients with Diabetic Foot Ulcers: A Cross-Sectional Study in Southern Iran (2023–2024)
Background: Diabetic foot ulcer (DFU) is the most serious consequence of type 2 diabetes mellitus (T2DM). Glycated hemoglobin (HbA1c) acts as a marker of long-term glycemic control, but its prognostic value in predicting the severity in DFU patients remains undefined. This study aims to investigate the association between HbA1c levels and lower limb amputation risk at various anatomical levels in patients with DFU. Materials and Methods: This cross-sectional analytical study included 446 patients with T2DM and DFU admitted to Namazi Hospital, Shiraz, Iran, between February 2023 and January 2024. Patients were categorized into four groups based on the amputation level: above-knee, below-knee, foot/midfoot/forefoot, and toe/finger. HbA1c was measured and categorized into three groups (7–7.9%, 8–8.9%, and ≥9%). Univariate and multinomial logistic regression analyses were performed using the above-knee amputation group as the reference. Statistical analysis was conducted in R (v4.4.1), with significance set at P < 0.05. Result: Elevated HbA1c levels were significantly associated with increased odds of below-knee and foot amputations compared to above-knee amputation (OR = 6.27, P = 0.023 and OR = 8.16, P = 0.036, respectively, for HbA1c 8–8.9%). Similar associations were observed for HbA1c ≥9%. Additionally, patients who underwent less extensive amputations (i.e., foot and finger) tended to be younger and had shorter hospital stays compared to those who underwent above-knee amputations. Lower triglyceride levels were also associated with finger amputation (OR = 0.99, p = 0.031). These comparisons were made within all patients which had diabetic foot ulcers. Conclusion: Higher HbA1c levels are significantly associated with more distal amputation levels in patients with DFU. Patient characteristics such as younger age, shorter hospitalization, and lower triglyceride levels were more common among those undergoing less extensive amputations. These findings highlight the need for early glycemic control in DFU patients at risk of limb loss.
Accuracy of Point of Care Ultrasound in Assessment of Traumatic Eye Injuries
Background: A few studies have been conducted to assess the accuracy of point of care ultrasound in traumatic eye injuries. In the present study we aimed to examine the diagnostic value of Point of Care Ultrasound to assess eye injuries resulting from trauma. Materials and Methods: This observational study was performed on 221 consecutive patients with ocular trauma who admitted to emergency department of two teaching hospitals in 2016. On admission, all patients underwent ocular bedside ultrasonography to reveal ocular defects resulting from trauma. The diagnostic results of Point of Care Ultrasound were compared to the findings of clinical assessment of ophthalmologist as the gold standard. Results: Overalls, 13 lesions (5.9%) were revealed as ocular pathological lesions following trauma including retinal detachment in 6 cases, foreign body in 6 cases, and vitreous hemorrhage in one case. In this regard, Point of Care Ultrasound has a sensitivity of 86.7%, specificity of 94.7%, positive predictive value of 54.2%, negative predictive value of 98.9%, and an accuracy of 94.1%. The agreement coefficient between ultrasound and expert clinical assessment was 0.64 indicating an acceptable degree of agreement. (P<0.001). Conclusion: Along with clinical assessment, Point of Care Ultrasonography of eye can accurately assess traumatic eye lesions.
Evaluation of Effectiveness of Bio-Micro Injection in Treating Alopecia Universalis: A Non-Randomized Interventional Study
Background: Alopecia areata (AA) is an autoimmune disorder causing non-scarring hair loss, ranging from patchy baldness to total body hair loss. While mesotherapy has shown potential as a localized therapy, its efficacy in AU remains understudied. This study aims to assess the therapeutic impact of mesotherapy in a substantial cohort of 2,000 patients diagnosed with alopecia universalis at Dr. Shirzad Clinic between 2020 and 2024. Methods and Materials: We conducted a non-randomized interventional study on 2,000 alopecia universalis patients across four treatment groups. Participants were divided into four treatment groups: one group received BMI alone, another received a combination of BMI and JAK inhibitors, the third group received only JAK inhibitors, and the fourth group was treated with a combination of BMI, JAK inhibitors, and adalimumab. All of these drugs were administered through mesotherapy techniques. They received the treatment once a month, for a year. Outcomes, including scalp hair regrowth and patient satisfaction, were assessed monthly over a year. Results: A total of 2000 patients participated in this study, with an average age of 26.82 ±1.84 years. Treatment responses varied across groups, with children showing the highest success rates. In Group 1 (BMI only), 20% responded positively. Group 2 (BMI + JAK inhibitors) had a 30% had favorable outcomes. Group 3 (JAK inhibitors only) showed a 34% response rate. The combination treatment in Group 4 resulted in the highest success rate, with 42% of participants responding positively. Conclusion: This study highlights the unique contribution of mesotherapy, particularly when combined with systemic treatments such as BMI, JAK inhibitors, and adalimumab, as an effective and well-tolerated option for alopecia universalis. The large sample size and innovative application of mesotherapy enhance drug delivery, improve treatment outcomes, and reduce systemic side effects, underscoring its potential as a valuable treatment strategy for this challenging condition.
Lifestyle Experiences and Coping During the COVID-19 Pandemic: A Cross-sectional Study from Saudi Arabia
Background: The COVID-19 pandemic has prompted significant lifestyle changes worldwide. Despite extensive research on negative impacts, there’s a gap in understanding positive transitions; thus, this study explores adaptive behaviors and coping strategies during the pandemic in Saudi Arabia. Materials and Methods: A cross-sectional study recruited Saudi residents aged 18-70 via social media. Data collected through an electronic survey tool was analyzed using SPSS, focusing on demographic, health-related, and research-specific responses. Coping behaviors were interpreted using Lazarus and Folkman’s model and Carver’s Brief COPE framework. Results: Among 3,508 participants, 38.0% engaged in language learning and 55.6% read books or listened to audiobooks at a frequency of 1–3 times per month. Home cooking was reported by 79.2%, and 34.8% engaged in daily remote social interactions. Gender and nationality significantly influenced coping behaviors: reading books or audiobooks was more common among females (P<0.001) and non-Saudis (P<0.001), while exercising 2–4 days per week was also more prevalent among females (P=0.013). Programming interest was significantly higher among males and Saudi participants (P=0.035). Conclusions: Study Findings show that participants adopted a variety of adaptive coping strategies, such as book reading, exercise, social interaction, and engagement with online content. Framing these behaviors through established psychological coping models enhances understanding of their role in mental well-being. These findings can inform public health strategies to promote positive coping mechanisms and support mental well-being in Saudi Arabia and similar contexts.
Association of Gallstone and Polymorphisms of ABCB11 Gene among the Adult Patients in Iran: A Case Control Study
Background: Gallstone disease (GSD) is a prevalent gastrointestinal condition influenced by genetic, environmental, and dietary factors. The ATP-binding cassette subfamily B member 11 (ABCB11) gene, encoding the bile salt export pump (BSEP), plays a critical role in bile acid transport. Polymorphisms in ABCB11 have been implicated in gallstone pathogenesis, yet evidence from Middle Eastern populations, particularly Iran, remains limited. Our study seeks to address these knowledge gaps by evaluating the association between rs2287622 and hepatic function markers in a distinct population. Materials and Methods: This investigation, conducted in a medical facility with matched participants, involved 100 individuals diagnosed with GSD and 100 comparable healthy volunteers matched by age and gender. We used a targeted PCR method (ARMS-PCR) for variant detection. Laboratory tests evaluated blood fats and hepatic indicators. We applied logistic regression modeling to explore the connection between rs2287622 and GSD, controlling for influencing variables. Results: The mean age of cases was significantly higher than controls (56.74 ± 16.25 vs. 43.07 ± 14.68 years, P<0.001). Cases exhibited elevated serum levels of SGOT (P=0.021), SGPT (P=0.016), ALP (P=0.001), and direct bilirubin (P<0.001). No significant differences were observed in allele frequencies (P=0.78) or genotype distributions (P=0.24) of ABCB11 polymorphisms between groups. TT was the most prevalent genotype, with no significant associations found between genotype and clinical parameters or GSD risk. Conclusion: This study found no significant association between ABCB11 polymorphisms and GSD among Iranian adults. Future research with larger samples and functional analyses is recommended to clarify the genetic determinants of GSD in this population.
Myrtle Syrup Improves Proteinuria in Type 2 Diabetic Patients: A Randomized Double-blinded Placebo-controlled Clinical Trial
Background: The use of medicinal plants as an alternative to synthetic drugs is increasing due to their accessibility and safety. In Iranian traditional medicine, myrtle (Myrtus communis) is widely recommended for treating kidney diseases, but scientific evidence supporting this claim is lacking. This study aimed to investigate the therapeutic effect of myrtle syrup (M. syrup) on proteinuria in patients with type 2 diabetes. Materials and Methods: This randomized, double-blind, placebo-controlled trial included 62 subjects aged 18–75 years with type 2 diabetes. Participants were randomly assigned to receive either M. syrup (10 cc) twice daily or a placebo syrup for 24 days. Enzyme-based commercial kits were used to measure serum levels of hemoglobin A1c (HbA1c), fasting blood sugar (FBS), blood urea nitrogen (BUN), creatinine, and protein in both serum and urine. 24-hour urine volume was also measured. Data analysis was performed using likelihood ratio chi-square tests, with statistical significance set at P<0.05. Results: The results showed that M. syrup significantly improved proteinuria compared with the placebo group (P<0.001). The mean change in urine protein was a decrease of 129 units in the intervention group and an increase of 16.5 units in the placebo group. However, no significant effects were observed on FBS, HbA1c, BUN, urine volume, serum creatinine, and urine creatinine. The potential mechanism of action for M. syrup in reducing proteinuria may be attributed to its antioxidant and anti-inflammatory properties. Conclusion: M. syrup supplementation may be an effective adjunct therapy for proteinuria in patients with type 2 diabetes. Hence, this should be emphasized in this regard.
Futurology of the Situation of Public Hospitals in Iran Until 2032
Background: The changes in the role of hospitals in the future require planning for the changes in the structure of hospitals. This study aimed to explore the state of public hospitals in Iran by 2032. Materials and Methods: The participants were 20 hospital management and healthcare experts selected using purposive sampling. Structural interaction analysis and MICMAC software were used for data processing. Results: The findings indicated the growing budgetary constraints in the health sector due to the increasing economic and health burden of non-communicable diseases and emerging diseases caused by environmental changes, the structure of the purchase of drugs, consumables, and medical equipment, the share of the health sector in the national public budget, providing access to capital/loans for the development of hospital activities by the government, the cost-effectiveness ratio of each service, the overcharged tariff set for hospital services, and public health insurance and a shift from employer-based insurance coverage to government-oriented insurance coverage are the key drivers affecting the state of public hospitals in Iran. Conclusion: The identified factors play a vital role in the state of public hospitals in Iran. This can be useful for policymakers and hospital managers to recognize the future developments of hospitals and healthcare centers.
Comparison of Efficacy and Safety of Rivaroxaban, Heparin, and Enoxaparin in Preventing Thrombosis in Gynaecologic Oncology Surgeries
Background: Background: Venous thromboembolism (VTE) is a frequent and potentially serious complication following gynecologic oncology surgeries. Anticoagulants such as heparin, enoxaparin, and rivaroxaban are commonly used for thromboprophylaxis; however, their comparative efficacy and safety remain uncertain in this patient population. Materials and Methods: This pilot randomized controlled trial included 85 patients undergoing gynecologic oncology surgery, randomly assigned to receive enoxaparin (n=25), heparin (n=30), or rivaroxaban (n=30). Randomization was performed using block randomization (block size=3) with allocation concealment and double blinding of patients and outcome assessors. The trial was registered in the Iranian Registry of Clinical Trials (IRCT20151020024625N19) and approved by the Ethics Committee of Semnan University of Medical Sciences (IR.SEMUMS.REC.1402.223). Baseline data included age, BMI, cancer type, surgical procedure, and history of vascular events. Outcomes comprised transfusion requirement, dyspnea, chest pain, peripheral edema, lower limb pain, bleeding, infection, hematoma, recovery, and mortality. Data analysis was performed using SPSS v.22 (IBM Corp., Armonk, NY, USA). Results: Fourteen patients (16.5%) required intraoperative transfusion, with a significantly higher rate in the rivaroxaban group (33.3%) compared to enoxaparin (8.0%) and heparin (6.7%) (P=0.010). Peripheral edema was also more common with rivaroxaban (16.7%) than with heparin (3.3%) or enoxaparin (0%) (P=0.046). Other outcomes showed no significant between-group differences (all P>0.05). Conclusions: Rivaroxaban use was linked to increased intraoperative transfusion and short-term edema compared to heparin and enoxaparin. Larger multicenter trials are warranted to confirm these preliminary safety and efficacy findings.
Circadian Blood Pressure as An Indicator for Cardiovascular Complications
The circadian variation in blood pressure is an important factor influencing various changes in the body over a 24-hour cycle and it has recently been in the focus of research for its ability to act as a sign of cardiovascular health. The following paper examines the interconnection, between the rhythmic pattern that characterizes blood pressure and how this affects cardiovascular events. It integrates newly appearing data that explain the applicability, prognostic, and therapeutic importance of those changes in recognizing and preventing the cardiovascular comorbidities. In fact, research confirms the affiliation between the daily fluctuation of circulatory pressure and the enhanced propensity for cardiovascular disorder, underlining the need for round-the-clock blood pressure regulation. Furthermore, there is clear evidence connecting disruption of the standard diurnal cycle, for instance due to abnormally sleeping or shift work, with increased vulnerability of hypertension and unfavorable cardiovascular outcomes. It is also seen that such patterns of reasons are possible if there is an innovative therapy for addressing cardiac ailments.
Middle East Pain Registry (MEPAIN): Feasibility Study of Chronic Pain Registry and Pilot Phase Results
Background: Chronic pain is a significant public health concern due to its long-term disabling effects. To support systematic data collection and improve patient management, the Middle East Pain Registry (MEPAIN) was developed. This study outlines the registry’s design, evaluates its feasibility, and presents initial findings from its pilot phase. Materials and Methods: MEPAIN was launched on July 21, 2024, with data collected via the Zigorat® software platform through January 22, 2025 for this pilot study. Each patient record included demographic details, pain characteristics (pattern, location, intensity), physical exam findings, imaging results, diagnoses, interventions, and follow-up data. Results: A total of 3,903 patients were registered during the six-month pilot. The cohort was 59.5% female, with a mean age of 53.5 ± 14.8 years; 50.2% were Iranian and 49.5% Omani. Lumbar radiculopathy was the most frequent diagnosis. Osteoarthritis and carpal tunnel syndrome predominated among females, while lumbar radiculopathy and discogenic pain were more common in younger patients. Iranians reported higher pain intensity during exacerbations, while Omanis showed greater prevalence of discogenic pain, spinal stenosis, carpal tunnel syndrome, and failed back surgery syndrome. Paresthesia was the most frequently reported symptom, and transforaminal epidural steroid injection was the most common procedure performed. Conclusion: The MEPAIN registry successfully captures comprehensive clinical and procedural data on patients with chronic pain in the Middle East. It offers a robust platform for clinical evaluation and research, supporting future efforts to tailor pain management strategies in regional populations.
Comparison of the Effects of Tamarind Seed Extract (Tamarindus Indica L.) with Sertraline in Treating Premature Ejaculation: A Randomized Double-blind Trial
Background: Premature ejaculation (PE) is a prevalent male sexual disorder often untreated due to embarrassment. This study compares the efficacy of tamarind seed extract (Tamarindus indica L.) with sertraline in treating PE. Materials and Methods: In this randomized, double-blind, parallel-group trial, 41 men diagnosed with PE at urology and psychiatric clinics in Shiraz, Iran (2023) were enrolled. Participants were randomly assigned to receive either 80 mg tamarind seed extract capsules (Group A, n=20) or 50 mg sertraline tablets (Group B, n=21) daily for 4 weeks. The primary outcome was the Premature Ejaculation Diagnostic Tool (PEDT) score, with secondary outcomes including International Index of Erectile Function (IIEF) scores (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) and side effects. Data were analyzed using SPSS version 22 with t-tests and ANOVA (P<0.05). Results: Both treatments significantly improved PEDT scores (P=0.001, η_p^2=0.76, 95% CI for mean difference: [-6.95, -4.95]) and IIEF subscales (P<0.01). No significant differences were observed between groups (P=0.69, η_p^2=0.10) or in the time-group interaction (P=0.42, η_p^2=0.15). Side effects were minimal in both groups.Conclusion: The findings indicate a potential relationship between tamarind seed extract and improvements in premature ejaculation and related factors, comparable to sertraline; however, these results should be interpreted with caution and require further validation through additional research.Trial registration number: IRCT20140926019295N4.
Molecular Detection, Phenotypic and Genotypic Characters of The Antimicrobial Resistance and Virulenece Factors of Campylobacter Jejuni and Campylobacter Coli Isolated from Poultry Meat
oultry meat is recognized as a potential reservoir of Campylobacter jejuni and Campylobacter coli. This study was done to assess antibiotic resistance and virulence characteristics of C. jejuni and C. coli isolated from raw poultry meat. Raw poultry meat samples were collected. C. jejuni and C. coli were isolated after microbial examination. Disk diffusion was applied to apprise antibiotic resistance. Polymerase Chain Reaction was employed to determine the virulence and antibiotic resistance gene distribution. Raw poultry meat samples contamination rate with Campylobacter spp. was 19% (76 out of 400 samples). The highest contamination rate was observed amongst the raw duck meat samples (37.50%). Forty-three (56.57%) and twenty (26.31%) out of 76 Campylobacter spp. were recognized as C. jejuni and C. coli, respectively. C. jejuni and C. coli isolates harbored the uppermost rates of resistance toward tetracycline (67.44% and 50%), gentamicin (60.46% and 50%), ampicillin (48.89% and 40%), and erythromycin (48.89% and 35%), respectively. The prevalence of multidrug-resistant C. jejuni and C. coli was 81.39% and 75%, respectively. C. jejuni and C. coli bacteria harbored tetO (23.48% and 45%), cmeB (44.18% and 45%), and blaOXA (44.18% and 35%) antibiotic resistance genes, respectively. All isolates harbored fla and ciaB. Among the C. jejuni isolates, cadF (67.44%), racC (46.51%), and cdtB (46.51%) and amongst the C. coli isolates, pldA (50%), cdtA (35%), racC (30%), and cadF (30%) were major virulence factors. The role of raw poultry meat, particularly duck and goose, as antibiotic-resistant and virulent Campylobacter spp. reservoirs were confirmed.
Optimal Timing for Elective Cesarean Deliveries: Insights from a Comparative Study at 38- or 39-Weeks Gestation
Background: The optimal timing for elective cesarean deliveries remains a subject of debate, with concerns regarding consequences for mother and child at different gestational ages. Materials and Methods: This prospective cohort study was done in 2022 at hospitals associated with Shiraz University of Medical Sciences. Singleton pregnant women whose pregnancies were terminated at 38(38+0 to 38+6) or 39 (39+0 to 39+6) weeks gestation were enrolled. Data on demographic characteristics, maternal and neonatal outcomes, and complications were collected from hospital records. The maternal and neonatal pregnancy outcomes were compared between the two groups using SPSS version 21. T-test, Mann–Whitney U test, Chi-square test, and Fisher’s exact test were performed. Results: Among 1812 cesarean deliveries, 1274 (70.3%) were performed at 38 weeks gestational age and 538 (29.7%) at 39 weeks gestational age. Maternal complications, including infection at the surgical site (1.6% vs 0.4%, P=0.03) and uterine rupture( 0.6% vs 0, P=0.04), were more prevalent in the 38-week group. Growth indices were higher in neonates born at 39 weeks (length 49.55±2.36 vs 48.71±2.05 cm P=0.001 & weight 3.57±0.67 vs 3.37±0.59 kg P=0.001). No significant differences were observed in other maternal or neonatal complications between the two groups. Conclusion: Deliveries at 38 weeks were associated with a higher rate of maternal complications, possibly due to their emergent nature. However, there were no significant differences in most maternal and neonatal outcomes. Elective cesarean at 38 weeks may still be reasonable to avoid emergency operations and their risks.
Gestational Age-Specific Reference Ranges for Fetal Cavum Septum Pellucidum Width in an Iranian Population
Background: Cavum septum pellucidum (CSP) is a critical anatomical land mark of normal midline development of brain and its absent is associated with brain anomalies. On the other hand, the size of CSP differs among different populations. The aim of this study was the evaluation of the size (width) of CSP at various gestation age (18 to 40 weeks’ pregnancy) in Isfahan, Iran population. Materials and Methods: This cross-sectional study was performed at Isfahan hospitals (Al-Zahra and Shahid Beheshti) from December 2022 until December 2023. The CSP was measured in 1000 normal fetuses at trans-ventricular plane by trans-abdominal ultrasound by two expert operators. In these fetuses the HC and BPD were measured. Regression analysis revealed significant relationship between CSP width and gestational age, also between CSP width and HC and BPD. Results: The mean CSP width was 5.3 ± 2.08 mm, ranging from 2.15 mm to 8.85 mm. CSP width increased progressively from 18 to 33 weeks, plateaued at 33–37 weeks, and slightly declined near term. Strong correlations were found between CSP width and head circumference (HC) (r=0.644, P<0.01) and biparietal diameter (BPD) (r=0.631, P<0.01). The study defined normative fetal CSP development values using percentile distributions with a 5th percentile length-to-width ratio of 1.06. Conclusion: The present study provides normative data for fetal CSP width and useful information about the development of the CSP based on gestational age.
Investigating the Impact of LNA-anti-miR-92b, miR-181b, TNF-α, and Piperine on Gene Expression and Cell Viability in Jurkat Cells: Implications for Acute Lymphoblastic Leukemia
Background: Acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), a prevalent pediatric cancer, arises from precursor lymphoid cells and is affected by various risk factors. Abnormal microRNAs (miRs) and dysregulated expression of BCL-2 family proteins significantly contribute to leukemogenesis. Piperine, noted for its anti-tumor capabilities, has demonstrated potential in enhancing the sensitivity of cancer cells to treatment. We aimed in this study to investigate the influence of specific miRs (miR-92b, miR-181b) and TNF-α on the proliferation and viability of the Jurkat cell line, and examined the effects of piperine on miR expression and the genes BAX, BCL-2, and MCL-1. Materials and Methods: Jurkat T-cells were cultured and treated with LNA-miR inhibitors to selectively suppress miR-181b and miR-92b expression. Cell viability was assessed using the MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay, while miR-92b, miR-181b, MCL-1, BAX, and BCL-2 mRNA levels were quantified using SYBR Green Real-Time PCR (Polymerase Chain Reaction). SPSS software (version 18) was utilized for statistical analysis. Results: The study demonstrated effective inhibition of miR-181b and miR-92b through LNA-anti-miR technology. Treatment with LNA-anti-miR-92b and TNF-α reduced Jurkat cell survival, whereas inhibiting miR-181b enhanced viability. BAX expression decreased with LNA-anti-miR-181b and piperine treatment, while BCL-2 expression declined with LNA-anti-miR-92b and piperine treatment. Additionally, piperine treatment increased miR-181b expression while reducing miR-92b and TNF-α expression. Conclusion: Our findings suggest that inhibiting miR-92b, miR-181b, TNF-α, and BAX using LNA-anti-miR could be a promising strategy for treating ALL. Piperine may enhance this approach by upregulating BAX. Further research is needed to explore these possibilities and develop effective treatments.
The Clinicopathological Comparison of Diagnostic Curettage and Total Abdominal Hysterectomy Results in Patients with Endometrial Cancer Referred to Shahid Sadoughi Hospital, Yazd, During the Years 2019 To 2023
Background: The use of curettage in diagnosing endometrial disorders the most common diagnostic method. The previous studies showed that curettage is an inadequate diagnostic method for focal uterine lesions but has high diagnostic accuracy in endometrial hyperplasia and carcinoma. The objective is to compare the clinicopathological results of diagnostic curettage and total abdominal hysterectomy in patients with endometrial cancer. Materials and Methods: This cross-sectional analytical study was conducted on 85 women with endometrial cancer; 19 high and 66 with low tumor grade between 21.3.2019 and 19.03.2024 who underwent diagnostic curettage and total abdominal. All reports related to pathology samples were extracted according to the inclusion and exclusion criteria of the study. All the information required for the study including the pathological result of diagnostic curettage, the pathological result of a total abdominal hysterectomy, tumor grade was extracted. Furthermore, sensitivity, specificity, positive predictive value, negative predictive value and Kappa coefficient were obtained. Results: The mean age of the studied samples was 58.825 ± 11.324 (33-90) years. The most common clinical manifestations in the participants were reported postmenopausal bleeding with a frequency of (49.4%) for 42 patients and abnormal uterine bleeding with a frequency of (41.2%) for 35 patients, respectively. The sensitivity, specificity, positive and negative predictive values calculated for curettage were 84.21%, 83.33%, 59.25% and 94.82%, respectively and the kappa coefficient was reported equal to 0.587. it can be said that the results obtained from histopathology of curettage and hysterectomy are consistent (P-value = 0.001). Conclusion: Therefore, in the present study it is concluded that the diagnostic accuracy of curettage, compared to total hysterectomy, is a relatively suitable diagnostic method for evaluating endometrial cancer; this method may be used in the timely diagnosis of this disease. However, caution is required due to the lower PPV, necessitating further evaluation before definitive management.
Effect of Enhanced Psychological Nursing Combined with Graded Pulmonary Rehabilitation in Elderly Patients with COPD: A Randomized Controlled Trial
Background: This research aimed to investigate the therapeutic effectiveness of combining structured psychological support with a stepwise pulmonary rehabilitation regimen in older adults diagnosed with stable chronic obstructive pulmonary disease (COPD). Materials and Methods: In this randomized controlled trial, 120 elderly patients with stable COPD were evenly assigned into two groups (n=60). The control group underwent conventional pharmacologic therapy and standard nursing care. In contrast, the intervention group received additional enhanced psychological interventions along with a progressive pulmonary rehabilitation protocol aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations. Outcomes assessed before and after the intervention included psychological health indicators, lung function metrics, compliance with treatment, rate of acute exacerbations, six-minute walk distance (6MWD), and quality of life. Results: While both groups experienced notable improvements in anxiety, depressive symptoms, and psychological resilience, these changes were significantly more favorable in the intervention group (P<0.05). Pulmonary function indicators, namely FEV1%, FEV1/FVC, and peak expiratory flow (PEF), showed measurable improvements across both groups, with the intervention group exhibiting more marked progress. Additionally, patients in the intervention group showed higher adherence to treatment, fewer acute exacerbation episodes, and a greater increase in 6MWD over the 12-month follow-up period. Quality of life, assessed via the St. George’s Respiratory Questionnaire, demonstrated more pronounced enhancements in respiratory symptoms, physical activity, and overall disease burden in the intervention group (P<0.05 across all domains). Conclusion: Incorporating targeted psychological support and a graded pulmonary rehabilitation strategy yields substantial benefits in emotional well-being, pulmonary performance, adherence levels, and life quality in elderly COPD patients. This comprehensive care model may serve as an effective approach for sustained disease management in this population.
The Application of Ultrasonography in Risk Assessment of Reflux and Aspiration in Diabetes Patients Undergoing Gastroparesis Surgery
Background: Diabetic gastroparesis increases the risk of reflux and macro-aspiration during surgery. This study evaluated the predictive role of gastric antral ultrasound in identifying these events in diabetic gastroparesis patients undergoing surgical procedures. Materials and Methods: A cross-sectional study was conducted on 60 diabetic gastroparesis patients at Binhai County People’s Hospital (June 2023–June 2025). Gastric antral ultrasound was performed using a SonoSite M-Turbo system, measuring cross-sectional area (CSA), gastric volume (GV), and GV-to-weight ratio (GV/W). Reflux was defined as pharyngeal pH >4, and macro-aspiration was confirmed via bronchial assessment. Statistical analysis (SPSS 27.0) included independent t-tests, chi-square tests, and logistic regression. Results: Among 60 patients (34 male, 26 female; mean age 48.19 ± 7.23 years), 9 (15%) experienced reflux (n=6) or macro-aspiration (n=3). Patients with events had significantly higher CSA (3.28 ± 0.35 vs. 3.07 ± 0.29 cm², P=0.038), GV (12.15 ± 3.28 vs. 10.12 ± 2.76 mL, P=0.013), and GV/W (0.17 ± 0.05 vs. 0.15 ± 0.04 mL/kg, P=0.022). Postoperative SpO2 was lower (94.89 ± 2.11% vs. 97.45 ± 1.88%, P<0.001), and gastric protease levels were higher (62.78 ± 10.92 vs. 55.88 ± 11.34 ng/mL, P=0.006) in affected patients. Logistic regression confirmed CSA (OR=1.45, 95% CI: 1.02–2.06, P=0.039), GV (OR=1.22, 95% CI: 1.04–1.43, P=0.015), and GV/W (OR=1.38, 95% CI: 1.03–1.85, P=0.031) as significant predictors. Conclusion: Gastric antral ultrasound effectively predicts reflux and macro-aspiration risk in diabetic gastroparesis patients, with elevated CSA, GV, and GV/W serving as key indicators. These findings support preoperative ultrasound screening to mitigate perioperative complications.
Neurotoxicologically Outcomes of Perinatal Chlordiazepoxide Exposure on the Fetal Prefrontal Cortex Cells in Rat Pup
Background: Chlordiazepoxide is a benzodiazepine which is widely used as an anxiolytic, sedative and muscle-relaxant and its effects on neurodevelopment is yet to be identified. The aim of the current experimental study was to determine the effects of prenatal exposure to chlordiazepoxide on development of the prefrontal cortex (PFC). Materials and Methods: A total number of 9 pregnant Wister rats that were randomly assigned to three groups receiving standard rat food and drinking water ad libitum (n=3) or chlordiazepoxide (10 mg/kg) (n=3) and an equal volume of vehicle (0.9% NaCl) (n=3) intraperitoneal (i.p.) injection once daily from first to 21st day of gestation, respectively. At the end of the experiment, 14-day-old neonatal rat pups (n=8 per each group) were sacrificed and their PFC cells were extracted. Mitochondria were extracted from the PFC cells and their level of reactive oxygen species (ROS), protein density, Glutathione (GSH) content, mitochondrial membrane potential (MMP), swelling, cytochrome c release and ATP level was identified. We also performed the Nissl staining, DNA fragmentation assay and RNA extraction and real-time polymerase chain reaction (PCR) on PFC cells. Results: We found that isolated mitochondria from rat pups receiving chlordiazepoxide (E), had significantly higher ROS formation (P<0.001), decreased GSH (P<0.001), lower MMP (P<0.001), higher mitochondrial swelling (P<0.001), decreased ATP level (P<0.001), increased cytochrome c release (P<0.001) and higher Bax (P<0.001), p53 (P<0.001), cytochrome c (P<0.001) and caspase 8 mRNAs (P<0.001). The Nissle-stained neurons decreased while the apoptosis significantly increased (P<0.001). Conclusions: The results of this in vivo study provide evidence regarding negative effects of prenatal exposure to chlordiazepoxide on PFC.
To Evaluate the Effect of Vitamin D on MicroRNAs in Polycystic Ovary Syndrome in Rat; An Animal Study
Background: polycystic ovary syndrome (PCOS) is a metabolic disorder with menstrual and ovulatory irregularities and elevated risk factors for reproductive diseases that affects women in reproductive ages. A significant number of patients with PCOS have insufficient levels of vitamin- D (Vit-D). This study aimed to investigate the effect of Vit-D on the expression of micro-RNAs in PCOS in rats. Materials and Methods: 24 female rats randomly were divided into four groups, including: 1) Control., receiving no drug (testosterone enanthate or Vit-D), 2) Pos., receiving the solvent of testosterone enanthate and Vit-D (ethanol), 3) induction of PCOS, receiving testosterone enanthate, and 4) Vit-D: treatment with Vit-D. The blood serum, used for the extraction of miR-186, mir-29, mir-21, Lnc ROR, Lnc MALA1, and H19 Lnc exosomes and the exosomes were separated from the serum. Data analysis was conducted using the ANOVA statistical test and SPSS software version 16 to examine significance at the level of p<0.05. Results: The results showed that the expression of miR-186 was significantly increased in the Vit D group compared to the PCOS group (P<0.01). Similarly, miR-21 expression was significantly higher in the Vit D group than in the PCOS group (P<0.001). However, no significant difference was observed in miR-29 expression between the Vit D and PCOS groups (P>0.05). Additionally, the expression of LncRNA H19 (P<0.05), Lnc ROR (P<0.001), and Lnc MALAT1 (P<0.01) was significantly higher in the PCOS group compared to the Vit D group. Conclusion: These findings suggest that Vit-D plays a regulatory role in the expression of exosomal miRNAs and lncRNAs involved in PCOS pathogenesis. Given its potential to modulate genetic factors associated with PCOS, Vit-D supplementation could be considered as a supportive therapeutic strategy for managing PCOS. However, further studies are needed to explore its precise molecular mechanisms and clinical implications.
Evaluation of Gene Expression of Mirna 21 and 98 Effect on Liver Functions in Fibrotic Patients
Background: Liver fibrosis is one of concerning outcomes of hepatitis with a complex interaction of different pathological processes including the epigenetics. MicroRNAs (miRNA) like miRNA 21 and 98 are recently being emphasized in era of epigenetics of liver diseases. The current study aims to evaluate liver function and the role of miRNA 21 and 98 in the occurrence of liver fibrosis. Materials and Methods: This was a case-control study comparing liver fibrosis patients with healthy adults with intact liver function as the control group. Laboratory and clinical tests were performed to evaluate liver function, and the diagnosis of viral hepatitis was confirmed using ELISA kits. Reverse transcription polymerase chain reaction (RT-PCR) was used to analyze the expression levels of microRNA 21 and 98, following the extraction of RNA from the samples. Results: Our study included 44 cases and 44 controls. Results revealed significant differences in demographic, clinical, and biochemical properties. Cases had higher mean BMI (34.36 ± 9.14 kg/m2, P=0.0486), higher levels of TSB, ALP, ALT, AST, and CRP, and lower albumin levels (P< 0.05 for all). Gene expression analysis showed higher miRNA 21 (1.14, P< 0.05) and lower miRNA 98 (1.68, P< 0.05) in cases compared to controls. Among case group, females had higher expression of miRNA 21 (1.082 ± 0.23) and miRNA 98 (1.895 ± 0.41) compared to males (P<0.05). Additionally, cases infected with HBV had higher expression of miRNA 21 (1.201 ± 0.31) and miRNA 98 (2.985 ± 0.56) compared to those infected with HCV (P<0.05). Conclusion: In conclusion, miRNA 21 and miRNA 98 might be associated with liver fibrosis; while the exact pathophysiological explanation reminds unclear.
Post-Modern Medicine: A Framework for Integrating Traditional and Modern Healthcare
Long-Term Clinical Outcomes and Patient Satisfaction Following Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome: A Comprehensive Reviews
Carpal Tunnel Syndrome (CTS) is a prevalent condition caused by compression of the median nerve, leading to symptoms such as pain, numbness, and weakness in the hand. Traditional treatments, including splinting, corticosteroid injections, and surgery, offer varying degrees of symptom relief but are often associated with limitations such as short-term efficacy or long recovery times. Ultrasound-Guided Hydrodissection (USGH) has emerged as a minimally invasive alternative for treating CTS, utilizing real-time ultrasound imaging to guide fluid injection around the median nerve, reducing nerve compression and enhancing nerve gliding. This procedure has gained attention due to its precision, reduced complication rates, and faster recovery compared to surgical interventions. This review explores the long-term clinical outcomes and patient satisfaction associated with USGH for CTS. The analysis reveals that USGH provides sustained symptom relief, with patients experiencing reductions in pain, improved functional outcomes, and enhanced nerve conduction for up to a year or more. Patients report high satisfaction levels, largely attributed to the minimally invasive nature of USGH, shorter recovery times, and minimal postoperative discomfort. While most patients benefit from long-term symptom relief, some experience recurrence of symptoms after several months, though re-treatment remains a viable option. Complications associated with USGH are rare and typically minor, including temporary pain, swelling, or bruising at the injection site. Serious complications, such as nerve damage or infection, are infrequent due to the precision afforded by ultrasound guidance. Future research should focus on randomized controlled trials and the integration of regenerative medicine to improve long-term outcomes.
Prevalence of Interstitial Lung Disease in Patients with Primary Sjogren’s Syndrome: A Systematic Review and Meta-analysis of Observational Studies
Background: Interstitial Lung Disease (ILD) is the most common pulmonary manifestation in patients with primary Sjögren’s syndrome. Therefore, this study aimed to investigate the prevalence of ILD in patients with primary Sjögren’s syndrome (pSS). Materials and Methods: This study searched databases ProQuest, PubMed, Web of Science, Cochrane, Embase, and the search engine Google Scholar until February 8, 2025. Studies were combined using the sample size and variance of each study. The heterogeneity of the studies was examined using the Q Cochrane test and the I2 index. . Results: 34 observational studies, with a total of 9535 individuals, showed that the prevalence of ILD in all patients with pSS was 23.5% (95%CI: 18.6%, 28.4%), in women 31.2% (95%CI: 18.4%, 44.1%), and in men 45.5% (95%CI: 23.6%, 67.4%). Moreover, the prevalence of ILD in patients with pSS in the age group of 30 to 39 years was 22.2% (95%CI: 18.9%, 26%), 40 to 49 years 10.8% (95%CI: 8.7%, 12.9%), 50 to 59 years 27.6% (95%CI: 17.9%, 37.4%), and 60 to 69 years 23.3% (95%CI: 17.9%, 28.7%). Also, the prevalence of ILD in patients with pSS in case-control studies was 15.6% (95%CI: 7.1%, 24.1%), in cohort studies 25.7% (95%CI: 19%, 32.4%), and in cross-sectional studies 21.4% (95%CI: 11.9%, 31%). However, the prevalence of non-specific interstitial pneumonia (NSIP) was 48.8% (95%CI: 41.4%, 56.2%), usual interstitial pneumonia (UIP) 15% (95%CI: 10.5%, 19.5%), LIP 10.8% (95%CI: 6.6%, 15%), and organizing pneumonia (OP) 9.4% (95%CI: 5.4%, 13.4%). Conclusion: One out of every four patients with pSS has ILD, and the prevalence of ILD was higher in men than in women. Moreover, the most common type of ILD was NSIP, followed by UIP, OP, and LIP, and the highest prevalence of ILD was in the age group of 50 to 59 years.
The Impact of Strength/Resistance Training on Related Outcomes of Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis Study
Background: The aim of this study was to systematically evaluate and synthesize the available evidence on the effects of resistance/strength training on physical function, stiffness, pain, and quality of life of patients with knee osteoarthritis (KOA). Materials and Methods: A systematic search of electronic databases, including PubMed, Scopus, WOS, and the Cochrane Library, was performed to identify trials published up to December 2024 evaluating the effects of resistance/strength training on KOA. Eligible studies included interventions targeting pain, stiffness, physical function, or quality of life, compared to control or alternative exercise groups. Pooled effect sizes were calculated using fixed and random effects models based on the degree of heterogeneity observed among the studies, with the random effects model applied due to significant variability in outcomes. Results: A total of 21 randomized controlled trials, including 2,345 participants, were analyzed. Resistance training significantly improved physical function (MD=−3.02, P<0.01) and reduced stiffness (MD=−0.46; P=0.03). Pain outcomes showed mixed results, with significant reductions observed on the WOMAC pain scale (MD=−0.83, P=0.04), but not consistent effects across other measures such as the VAS. Conclusion: Resistance training improves physical function and stiffness in KOA, with mixed effects on pain and no significant impact on quality of life. High heterogeneity highlights the need for standardized protocols. Resistance training is a valuable component of knee OA management.
Daratumumab Versus Control Treatment: A Systematic Review and Meta-analysis Study of Survival Outcomes Among Multiple Myeloma Patients
Background: This meta-analysis aimed to evaluate the efficacy of Daratumumab compared to control treatments in multiple myeloma across subgroups, including relapsed or refractory (RRMM), newly diagnosed transplant-eligible (ND/ESCT), and transplant-ineligible (ND/ISCT) patients. Materials and Methods: A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science. Randomized controlled trials and comparative studies evaluating Daratumumab versus control treatments in multiple myeloma patients were included. A random-effects model was employed to calculate pooled effect estimates of overall response rate (ORR), progression or death (PRD), minimum residual disease (MRD) negativity, and mortality. Results: The analysis included data from 35 studies, 21 studies (n=7,604 patients) in the RRMM subgroup, 12 studies (n=10,216 patients) in the ND/ISCT subgroup, and 6 studies (n=4,619 patients) in the ND/ESCT subgroup, comprising 22,439 patients (including healthy controls). Daratumumab significantly improved ORR (OR: 2.58, 95% CI: 2.26–2.93, P<0.01) and MRD negativity rates across all subgroups. PRD risk was lower in the Daratumumab group (RD: -0.14, 95% CI: -0.16 to -0.12), with consistent efficacy across RRMM, ND/ESCT, and ND/ISCT patients. Conclusion: This meta-analysis confirms Daratumumab's significant efficacy across multiple patient subgroups, providing broad clinical benefits in multiple myeloma treatment. While some heterogeneity and potential publication bias were observed, Daratumumab remains a robust therapeutic option for extending progression-free and overall survival.
Exploring the Intersection of Diabetes and Musculoskeletal Health
Diabetes presents a significant health challenge worldwide, with profound implications extending beyond glycemic control to impact various bodily systems. This review explores the intricate relationship between diabetes and musculoskeletal disorders, shedding light on their epidemiology, pathophysiology, and clinical implications. Individuals with diabetes face a heightened risk of developing musculoskeletal conditions, particularly tendon disorders such as adhesive capsulitis rozen shoulder, rotator cuff tears, muscle atrophy, osteoarthritis and diabetic hand syndrome. Mechanisms underlying these disorders include inflammation, glycation, and impaired tendon homeostasis, exacerbated by factors like insulin resistance and oxidative stress. Furthermore, diabetes poses challenges in orthopedic surgery, leading to increased rates of surgical complications and poorer outcomes. Understanding the interplay between diabetes and musculoskeletal health is crucial for developing targeted interventions aimed at optimizing patient care and outcomes in this population.
Role of Herbal Plants for Treatment of Coronary Artery Disease; A Review
Background: Chronic stress is recognized as a significant risk factor for cardiovascular disease and can worsen the condition of patients with coronary artery disease (CAD). Traditional medicine is used to reduce stress and manage various diseases, with a particular focus on cardiovascular health. This study aimed to investigate the role of herbal supplements in the management of coronary artery disease, focusing on their potential to alleviate symptoms, enhance heart health, and reduce the risk of cardiovascular complications in CAD patients, alongside the mechanisms of action underlying their effects. Materials and Methods: This comprehensive review evaluates the impact of medicinal plants on stress and cardiovascular disease in research and studies with coronary artery disease. Scientific articles were sourced from databases including PubMed, Google Scholar, SID, and ScienceDirect, focusing on publications from 2000 to 2024. The selection criteria encompassed research and studies involving various dosages of medicinal plants under different conditions. Only articles in Persian and English were included, excluding those in other languages. Data from the selected articles were extracted, specifically focusing on medicinal plants effective as cardiac tonics within different regions of Iran. Results: The findings indicate that various medicinal plants, including marjoram (Origanum majorana), borage (Borago officinalis), lavender (Lavandula angustifolia), valerian (Valeriana officinalis), hops (Humulus lupulus), hawthorn (Crataegus spp.), rosemary (Rosmarinus officinalis), chamomile (Matricaria chamomilla), dracocephalum (Dracocephalum moldavica), mint (Mentha spp.), green tea (Camellia sinensis), and damask rose (Rosa damascena), have been employed for stress relief and the management of CAD, particularly in the context of mitigating cardiovascular disease risk factors. Conclusion: The combination of medicinal plants with other treatments can be an effective strategy to reduce stress and enhance cardiovascular health in coronary artery disease patients. Due to their low risk and broad therapeutic benefits, these plants can improve patients' quality of life when used alongside conventional therapies.
Radiographic Evaluation of Implant Stability and Osseointegration in Adult Orthodontic Patients
Radiographic evaluation is essential for assessing implant stability and osseointegration in adult orthodontic patients. The success of temporary anchorage devices (TADs) and mini-implants depends on primary stability, achieved through mechanical engagement, and secondary stability, influenced by bone remodeling. While traditional clinical methods, such as mobility testing, provide subjective assessments, radiographic imaging offers objective insights into bone-implant interactions. Periapical and panoramic radiographs are commonly used but are limited by their two-dimensional (2D) nature. Cone beam computed tomography (CBCT) has emerged as the gold standard, providing three-dimensional (3D) visualization of cortical bone thickness, marginal bone loss, and peri-implant adaptations. However, challenges such as image artifacts, radiation exposure, and observer variability persist. Implant stability is influenced by factors like bone density, cortical thickness, insertion torque, and patient-specific variables, including systemic conditions, genetic predisposition, and lifestyle habits. Emerging techniques such as resonance frequency analysis (RFA) complement radiographic findings by providing quantitative stability assessments. Additionally, artificial intelligence (AI)-driven radiographic analysis is improving diagnostic accuracy, automating bone density evaluation, and predicting implant success. Future advancements in low-dose CBCT protocols, AI-assisted diagnostics, and digital treatment planning aim to optimize implant placement and long-term stability assessment. By integrating multimodal imaging approaches with biomechanical and AI-driven predictive modeling, clinicians can enhance treatment planning, reduce implant failure rates, and improve orthodontic outcomes. This review underscores the importance of advanced imaging techniques in implant stability assessment and highlights the need for continued research in AI-driven diagnostics and minimally invasive evaluation methods.
Multimodal Neuroimaging and Electrophysiological Markers in Multiple Sclerosis: An Integrative Review of fMRI, EEG, and EMG Approaches
.Multiple sclerosis (MS) is a chronic neurological disease marked by demyelination, neurodegeneration, and widespread network dysfunction. While conventional MRI remains central to diagnosis, advanced techniques such as functional MRI (fMRI), electroencephalography (EEG), and electromyography (EMG) are increasingly recognized for their ability to capture dynamic functional changes that underlie clinical symptoms. This review explores the individual and combined applications of fMRI, EEG, and EMG in MS, emphasizing recent clinical findings from 2019 to 2024. fMRI provides high-resolution mapping of brain activation and connectivity, revealing compensatory plasticity in early stages and connectivity breakdowns associated with progression. EEG offers real-time monitoring of cortical activity, detecting spectral slowing, network reorganization, and neurophysiological correlates of fatigue and cognitive decline. EMG quantifies neuromuscular output, identifying spasticity, motor unit loss, and gait disturbances with high sensitivity. Integration of these modalities enhances spatial and temporal resolution; however, challenges such as data standardization and interpretive variability must be addressed to ensure robust biomarker development. Advances in machine learning, portable EEG/EMG systems, and big-data infrastructure are driving the translation of multimodal monitoring into clinical practice. Real-time assessments and individualized biomarker profiles could enable earlier diagnosis, more accurate prognosis, and personalized rehabilitation and therapy strategies. Although technical, interpretive, and standardization challenges remain, the convergence of fMRI, EEG, and EMG offers a promising path toward precision medicine in MS. Multimodal approaches not only deepen understanding of MS pathophysiology but also hold tangible potential to transform disease monitoring, treatment decision-making, and patient outcomes.
Early Versus Late Pediatric Palliative Care in Oncology: A Systematic Review of Outcomes, Disparities, and Implementation Barriers
This systematic review, conducted per PRISMA 2020 guidelines, synthesizes evidence on early pediatric palliative care (PPC) versus late or no PPC in children and young adults (0–21 years) with life-threatening oncologic illnesses. A comprehensive search of MEDLINE, Embase, Scopus, PsycINFO, Web of Science, Cochrane Central, and grey literature (ProQuest, ClinicalTrials.gov) from inception to 1 August 2025 identified 12 studies, including retrospective cohorts, surveys, and one randomized controlled trial across the USA, Canada, Taiwan, and Spain. Early PPC, variably defined as initiation from diagnosis to >12 months before death, consistently reduced end-of-life care intensity (fewer ICU admissions, mechanical ventilation, invasive interventions), increased hospice enrollment, home deaths, and improved quality of life and symptom management compared to late or no PPC. Disparities were evident, with minority groups and patients with hematologic malignancies less likely to receive early PPC, compounded by barriers such as provider misconceptions, systemic limitations, and clinical trial enrollment delays. Outpatient and integrated home-hospital PPC models significantly lowered hospital-based end-of-life care, though robust late PPC programs could achieve comparable outcomes. Narrative synthesis using the GRADE approach highlighted moderate to high confidence in reduced care intensity and improved family outcomes with early PPC, despite heterogeneous definitions and study designs precluding meta-analysis. Findings show the need for standardized PPC protocols, education to address provider barriers, and policy reforms to enhance equitable access, particularly for underserved populations. While oncology evidence is robust, further randomized trials are needed to strengthen findings across other conditions, supporting early PPC integration to optimize patient and family outcomes in pediatric oncology.
Comprehensive Coagulation Management in Cardiac Surgery: Anticoagulants, Heparin Resistance, Monitoring, and Bleeding Risks
Effective coagulation management is pivotal to optimizing outcomes in cardiac surgery, influencing bleeding risk, transfusion requirements, and overall perioperative safety. This comprehensive review examines current strategies, limitations, and emerging innovations across anticoagulant use, coagulation monitoring, and bleeding management. Unfractionated heparin remains the standard for cardiopulmonary bypass (CPB) anticoagulation, owing to its rapid reversibility, though challenges such as heparin resistance persist. Alternatives including low molecular weight heparins, direct thrombin inhibitors, and novel oral anticoagulants are reserved for select indications and carry specific limitations. Perioperative coagulation monitoring is essential; tools such as activated clotting time (ACT), anti-factor Xa assays, and viscoelastic tests (e.g., thromboelastography [TEG] and rotational thromboelastometry [ROTEM]) guide targeted therapy. Despite these advances, bleeding remains common due to factors including preoperative antithrombotic therapy, CPB-induced coagulopathy, and postoperative hemostatic deficits. Management strategies center on prophylactic antifibrinolytics, individualized transfusion protocols, and the judicious use of reversal agents. Emerging frontiers including machine learning–enhanced viscoelastic algorithms, targeted antithrombotics (e.g., factor XI inhibitors), AI-based bleeding prediction, and gene therapy for inherited coagulopathies promise to personalize and improve care. Continued research is warranted to validate novel therapies and refine evidence-based protocols for coagulation management in cardiac surgery.
Evaluation of the Association between Sjögren Syndrome and Thyroid Cancer Risk: A Systematic Review and Meta-analysis
Background: Sjögren’s syndrome affects the skin, joints, lungs, kidneys, liver, and thyroid. This research was aimed to assess the association of Sjögren’s syndrome with the thyroid carcinoma risk. Materials and Methods: The present study was used a systematic review and meta-analysis method. This study searched the databases ProQuest, PubMed, Web of Science, Cochrane, and the search engine Google Scholar until July 7, 2024. The level of significance was considered as P<0.05, and all data analyses were done in STATA 14 software. Results: A review of 11 studies revealed that Sjögren’s syndrome increased the thyroid carcinoma risk in all patients (OR: 2.08, (95%CI: 1.47, 2.94)), in patients aged 40 to 49 years (OR: 1.43, (95%CI: 1.23, 1.67)), 50 to 59 years (OR: 4.65, (95%CI: 1.87, 11.58)), 60 to 69 years (OR: 1.34, (95%CI: 1.08, 1.66)) and in women ((OR:1.83, (95%CI: 1.35, 2.48). However, there was no significant association between Sjögren’s syndrome and thyroid carcinoma risk in men ((OR: 1.49, (95%CI: 0.95, 2.34). Moreover, patients with Sjögren’s syndrome who had a follow-up period of <= 5 years ((OR: 1.68, (95%CI: 1.10, 2.54) and patients with a follow-up period of > 5 years ((OR: 5.77, (95%CI: 1.97, 16.97) were at risk of thyroid cancer. Moreover, the thyroid carcinoma risk was in Europe ((OR: 3.26, (95%CI: 1.24, 8.56) and in Asia ((OR: 1.87, (95%CI: 1.27, 2.74). Primary Sjögren’s syndrome also significantly increased the thyroid carcinoma risk ((OR: 2.37, (95%CI: 1.44, 3.90). Conclusion: Sjögren’s syndrome increased the thyroid carcinoma risk, and female gender, fifth decade of life, European race, and involvement duration of more than 5 years were the exacerbating factors.
Scoliosis as a Paradigm of Pathological Spinal Curvature: Molecular Mechanisms and Imaging Innovations
Pathological spinal curvature encompasses a broad spectrum of deformities that arise from a complex interplay of genetic, molecular, and biomechanical factors. This review synthesizes current knowledge on the molecular underpinnings of spinal deformities, with a focus on the dysregulation of non-coding RNAs, aberrant activation of the Wnt signaling pathway, inflammatory cytokine imbalances, and epigenetic modifications. In parallel, the article provides a detailed overview of both conventional and emerging imaging techniques used in the clinical assessment of spinal curvature. Traditional radiographic methods, such as Cobb angle measurement and Ferguson’s method, are critically compared with advanced modalities—including surface topography, ultrasound imaging, and computer-aided 3D reconstructions—that promise enhanced diagnostic accuracy while minimizing radiation exposure. By bridging molecular insights with clinical imaging advancements, this review underscores the importance of an integrated diagnostic approach for early detection and effective management of scoliosis and related spinal deformities. The convergence of these disciplines not only enriches our understanding of the pathogenesis of spinal curvature but also lays the foundation for the development of personalized therapeutic strategies.
Different Intensities of Exercise and Cardiovascular Performance: A Review
Cardiovascular diseases [CVDs] remain a major global health concern, with arterial stiffness and atherosclerosis contributing significantly to their prevalence, especially with aging. Regular physical activity is crucial for prevention, improving endothelial function and lipid profiles. This paper examines the effects of different exercise modalities including aerobic training, Moderate-Intensity Continuous Training [MICT], High Intensity Interval Training [HIIT], resistance training [RT] and on cardiovascular health. Aerobic exercise consistently benefits blood pressure, lipid metabolism, and mitochondrial density. HIIT, in particular, often surpasses MICT in enhancing peak oxygen uptake [VO2 peak] and endothelial function. Resistance training improves muscle strength, blood pressure, and insulin sensitivity. However, its impact on arterial stiffness is debated with low to moderate intensity RT appears beneficial, while high intensity RT shows mixed or potentially detrimental effects. Inconsistencies across studies are largely attributed to variations in protocols, intensities, and participant characteristics. Ultimately, exercise is a vital CVD management strategy, underscoring the need for personalized prescriptions based on specific exercise types and intensities to optimize cardiovascular benefits.
Oxytocin and the Default Mode Network: New Insights into Attachment and Self-Referential Processing
Recent advances in neuroscience have revealed a significant interplay between the neuropeptide oxytocin and the brain’s Default Mode Network (DMN), suggesting a pivotal role in modulating attachment and self-referential processing. This review synthesizes current findings from neuroimaging, behavioral studies, and clinical research to explore the “oxytocin-DMN axis” and its impact on social cognition and emotional regulation. We discuss how oxytocin influences intrinsic connectivity within the DMN, enhancing self-referential thought and social bonding by modulating key network nodes involved in autobiographical memory, empathy, and social awareness. Emerging evidence indicates that dysregulation in this axis may contribute to the neurobiological underpinnings of psychiatric disorders such as autism, social anxiety, and depression. Moreover, we evaluate the therapeutic potential of targeting oxytocin signaling pathways to restore or enhance DMN functionality. By integrating multidisciplinary perspectives, this review provides novel insights into the mechanistic links between hormonal modulation and intrinsic brain network dynamics, underscoring the importance of the oxytocin-DMN axis in the neurobiology of attachment and self-referential processing.
Platelet-rich Plasma in Orthopedics: Unraveling Cellular Mechanisms, Therapeutic Potential, and Limitations
The growing interest in autologous biological therapies, such as Platelet-Rich Plasma (PRP), within orthopedic surgery and sports medicine, necessitates refined strategies for post-surgical tissue repair. Despite technological advancements, the proliferation of PRP preparation devices has raised concerns about preparation quality consistency. The absence of consensus on standardization and condition-specific formulations contributes to conflicting outcomes in the literature. Moreover, the potential of personalized treatment protocols, platelet dosage optimization, and PRP’s angiogenic, antimicrobial, and analgesic properties in orthopedic surgery remains underexplored. This review delves into recent advancements in PRP preparation techniques and therapeutic effects, drawing from published data on its applications in orthopedic surgery for tendon injuries, bone repair, spinal fusion, and major joint replacements. Despite promising preclinical study results, clinical trials have shown varying efficacy compared to traditional repair methods. Mechanisms underlying PRP’s actions, including its impact on tendon fibroblasts and macrophage polarization, are scrutinized. While PRP elicits an inflammatory response in tendon fibroblasts, its effect on macrophage polarization remains ambiguous. Additionally, inconclusive findings from studies on PRP’s effectiveness in shoulder surgery underscore the need for standardized protocols and further investigation due to challenges like preparation discrepancies and application techniques. This review focusing on influence on healing quality and pace.
A Comprehensive Systematic Scoping Review of Preventive Medicines and Public Health Systems in Saudi Arabia in the Context of Vision 2030
Background: The Kingdom of Saudi Arabia's Vision 2030 seeks to improve public health and healthcare but struggles to include preventative medicine. Sustainable development, innovation, and preventative care are prioritized to build a society with enough healthcare assistance. The purpose is to improve people's health. This study examined how recent improvements in the Saudi Arabian public health system have affected preventative medicine, health justice, and public health. Materials and Methods: This scoping review examined Saudi Arabia's public health system and preventive medicine, following Arksey and O'Malley. Vision 2030 reforms are prioritized, and systematic searches, research selection, and theme analysis improve health equity and population health. All is done according to PRISMA-ScR. Inclusion criteria included studies addressing public health system reforms in Saudi Arabia, focusing on preventive medicine initiatives, assessment of health outcomes, original research, and published between January 2017 and January 2023. Results: The review focused on the healthcare delivery model, preventative services, public health policies, and interventions. Saudi Arabia's public health strategies focus on improving healthcare delivery through telehealth, combining preventive services like health education and access to preventive care, controlling infectious diseases and involving the community, educating the public, and getting the government involved to improve results. Conclusion: Overall, Saudi Arabia has improved health intervention outcomes, public health policies, healthcare delivery techniques, and preventative programs. Policymakers, healthcare workers, and researchers can use these findings to improve public health. It ends by identifying research topics and areas for further study to support the Kingdom's Vision 2030 aims.
Microvascular Dysfunction as a Bridge between Chronic Obstructive Pulmonary Disease and Ischemic Events
Chronic obstructive pulmonary disease (COPD), traditionally viewed as a localized pulmonary disorder, is now recognized as a systemic disease with far-reaching vascular consequences. Among its most concerning comorbidities are ischemic events such as myocardial infarction and stroke, which occur at disproportionately high rates in these patients, even after adjusting for shared risk factors like smoking. This unexpected persistence of risk has driven interest in the underlying mechanisms that might link lung dysfunction to vascular pathology. Emerging evidence suggests that microvascular dysfunction (MVD), characterized by endothelial injury, capillary rarefaction, and impaired vasoreactivity, may serve as a pivotal intermediary in this relationship. Systemic inflammation and oxidative stress, initiated in the lungs, appear to spill over into the circulation, damaging the vascular endothelium and setting the stage for atherosclerosis and ischemic injury. This review synthesizes current findings from molecular, imaging, and epidemiological studies to propose MVD as a central mechanistic bridge between COPD and ischemic events. We also examine therapeutic strategies that target endothelial health and highlight potential opportunities for early intervention. By reframing COPD as a disease with significant vascular implications, this review underscores the need for an integrated clinical approach that goes beyond pulmonary function and addresses systemic vascular health.
Optimizing Angioplasty in Elderly Patients with Multimorbidity: A Paradigm Shift in Risk Assessment
Solid Cancer Treatment with Electric-Induced Field Emission Materials: A Hypothesis for Targeting Deep-Seated Tumors
A Short Report of Mental Health Issues among the Young people: Insight from the Fasa Cohort Study
A Case Report of Right Heart Failure: An Uncommon Presentation
Background: Aortic dissection poses diagnostic challenges due to its varied symptoms. Prompt diagnosis and intervention are essential to reduce mortality and morbidity. Case Report: A 53-year-old woman presented with dyspnoea, palpitations, Epigastric and right upper quadrant pain, following recent chest tightness. She initially was diagnosed with a non-ST elevation myocardial infarction (NSTEMI) based on the electrocardiogram (ECG) and cardiac enzymes. The transthoracic echocardiogram (TTE) showed right heart impairment, mild aortic regurgitation, and significant tricuspid regurgitation. A coronary angiogram showed normal left coronary vessels but failed imaging of the right coronary artery which raised suspicion of aortic dissection due to an abnormal aortic root shape and a history of hypertension. Urgent CT aortography (CTA) confirmed acute Stanford type A aortic dissection with false lumen supplying the RCA ostia. Initially, conservative management was chosen due to right ventricular dysfunction. The patient then presenting with recurring symptoms 8 days later, after a multidisciplinary team meeting surgical intervention was decided. Comprising of full aortic root, aortic arch, and aortic valve replacement, plus tricuspid valve repair and annuloplasty. The patient was discharged post successful surgery. Conclusion: This case highlights the challenges of diagnosing and managing acute aortic syndromes, especially with atypical symptoms. Having a low threshold for cross sectional imaging techniques in such cases is likely to prompt accurate diagnosis and treatment in critical cases.
Treatment of Angiomyoblastoma in a Young Lady in Saudi Arabia: A Case Report and Literature Review
Background: Angiomyofibroblastoma (AMFB) is a rare, benign soft tissue tumor that belongs to the mesenchymal tumor category and affects the female genital tract. Aggressive angiomyxoma, a distinct stroma myxoedematous mesenchymal tumor with a significant risk of local recurrences, must be histomorphologically distinguished from AMFB. Radiography and histopathology are used for accurate diagnosis. The treatment depended on the complete surgical excision. Case presentation: Herein, we presented a case of a 36-year-old female (P3+0) presented with a left vaginal mass noted two years prior. The radiology report suggested angiomyxoma or myxoid liposarcoma as possible differentials. Surgical resection revealed a benign genital stromal tumor, specifically angiomyofibroblastoma (AMFB). After complete surgical excision, the immunohistochemical analysis supported the diagnosis of angiomyofibroblastoma. Two months postoperatively, an MRI Post-resection images show complete resection with no feasible scar, residual tumor, or recurrence. Conclusion: Our case is rare AMFB. AMFB may be missed when diagnosed with other masses, such as angiomyxoma or myxoid liposarcoma, so we need to do the necessary tests to diagnose and differentiate AMFB accurately from other masses. Ultrasound and MRI are initial diagnostic tools, while histopathology ensures the correct diagnosis. Surgical removal with free margins remains the appropriate treatment. Long-term follow-up is essential to monitor for potential recurrence, though AMFB typically carries an excellent prognosis.
Effect of Innovative Low-level Laser Therapy Protocol for Stress Urinary Incontinence: A Case Series Study
Stress urinary incontinence (SUI) is a prevalent condition characterized by involuntary urine leakage during physical activities. This condition can significantly impact a woman’s quality of life. Treatment options for SUI include behavioral therapy, medication, and surgery. However, non-pharmacological methods such as low-level laser therapy (LLT) have demonstrated the potential to promote tissue repair, reduce inflammation, and improve pelvic floor muscle function in various pelvic floor disorders. Despite these benefits, the effectiveness of combined transvaginal and intra-bladder LLT for managing SUI has not been extensively studied. This case series aimed to assess the safety and efficacy of a novel regimen using concurrent transvaginal and intra-bladder LLT for the treatment of stress urinary incontinence in perimenopausal and postmenopausal women. The results appear promising, and further investigation is recommended. Trial Registration: This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20231203060255N2, on 30 June 2024 (retrospectively registered).
Dual Primary Gastric and Rectal Adenocarcinoma: A Case Report with Management Insights
Background: Dual primary malignancies, including colorectal (CRC) and gastric cancers (GC), are complicated cases due to the complexity of managing patients. Case Report: This case report presents a 62-year-old male patient with rectal and gastric adenocarcinomas. Initially, rectal adenocarcinoma after a complaint of hematochezia was diagnosed by prognostic modalities. The patient received total neoadjuvant therapy with FOLFOX chemotherapy and chemoradiotherapy. After surgery, a complete pathological response was obtained. A few months later, gastric adenocarcinoma with persistent heartburn was detected through esophagogastroduodenoscopy (EGD). total neoadjuvant therapy with FOLFOX chemotherapy and chemoradiotherapy followed by total gastrectomy were prescribed. After gastrectomy, a complete pathological response was obtained. Conclusion: This case of synchronous CRC and GC, diagnosed 5 months apart, underscores the pivotal role of early detection and multidisciplinary management in achieving favorable outcomes. Complete pathologic responses in both malignancies following tailored TNT with FOLFOX and FLOT regimens, combined with surgical interventions, highlight the efficacy of personalized treatment strategies, even in resource-constrained settings. Continued research is essential to optimize diagnostic protocols, refine therapeutic approaches, and improve access to genetic testing for synchronous and metachronous malignancies, promoting equitable cancer care globally.