Iranian Journal of Medical Sciences最新文献

Background: Microwave ablation (MWA) is a newly introduced technique for selective fetal reduction in complicated monochorionic (MC) pregnancies. This study aimed to describe maternal and neonatal outcomes after implementing MWA for selective fetal reduction in complicated MC pregnancies and analyze the procedure's success rate.

Methods: This is a case series of 21 complicated MC pregnancies that underwent MWA in the Fetal-Maternal Center affiliated with Shiraz University of Medical Sciences (Shiraz, Iran) to occlude fetal blood circulation from May 2021 to May 2022. The participants were followed until delivery. Gestational age at the time of the procedure, duration of the procedure, survival rate, procedure-to-delivery time, gestational age at delivery, as well as maternal and neonatal outcomes were evaluated.

Results: MWA was successfully performed in all 21 cases. The median (Q1-Q3) gestational age at the time of the procedure was 18 weeks. The fetus's blood circulation was completely stopped in all cases. The median (Q1-Q3) total ablation time was 4 (3-6) min, and the total ablation voltage was 100 (100-200) W. Fetal loss occurred in 19% (4/21) of cases after MWA. The duration of the surgery showed a significant negative correlation with the surgical outcome (P=0.012). The overall procedure-to-delivery time was 16 (14.5-19.5) weeks, with a survival rate of 81%. The median gestational age at delivery was 34 (30.5-37.5) weeks. Among the babies, 70.6% required admission to the neonatal intensive care unit; however, all survived the neonatal period. No maternal complications were observed.

Conclusion: MWA represents a potentially effective alternative modality for selective fetal reduction in complicated MC twin pregnancies. As a newly introduced technique, it is still in its early stages of implementation, and there is a need for reporting and discussing the specific details of its application. The abstract of this article was presented at the International Fetal Medicine Foundation Congress in the Emirates (28-29 September 2024).

Background: Over the past two decades, radiofrequency catheter ablation (RFCA) has emerged as a leading treatment for cardiac arrhythmias due to its high efficacy, despite potential complications. This study evaluated success rates, complications, and the procedure's impact on quality of life (QoL) and anxiety in patients with supraventricular arrhythmia (SVT).

Methods: This prospective cohort study involved patients diagnosed with SVT who were treated in Babol, Iran, between 2018 to 2019. The primary outcomes that were assessed included the immediate procedural success rate, success at 3 months post-ablation, associated complications, and their relationship with demographic and clinical factors. Additionally, changes in patients' QoL and anxiety levels before and after the procedure were analyzed. Procedures included recording His bundle electrograms using quadripolar catheters, performing programmed stimulations, autonomic blockade with atropine and propranolol, and delivering radiofrequency energy at target sites for at least 10 min. Complications and recurrence rates were monitored over a follow-up period of 3 months. Data were analyzed using SPSS software (version 23).

Results: Immediate success was achieved in 98% of cases, with two failures due to complications. Recurrence occurred in 13% of patients within 3 months, significantly associated with higher BMI and diabetes (P=0.024; P=0.026), respectively. Post-procedure, anxiety levels decreased significantly (P<0.001), and all QoL dimensions improved substantially (P<0.001), highlighting the holistic benefits of the procedure.

Conclusion: Overall, RFCA is an effective and well-tolerated treatment for SVT, demonstrating high success rates and significant improvements in patient outcomes, including reduced anxiety and enhanced QoL.

Background: Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for benign prostatic hyperplasia (BPH). Despite its widespread use, monopolar TURP carries a risk of significant complications, particularly transurethral resection (TUR) syndrome leading to hyponatremia and fluid overload. The study evaluates whether prophylactic furosemide prevents hyponatremia and TUR syndrome in monopolar TURP.

Methods: This study was a triple-blind randomized clinical trial conducted in Al-Zahra and Khorshid educational hospitals of Isfahan, Iran, in 2022-2023. Patients undergoing monopolar TURP, were divided into two groups: those receiving preoperative furosemide and a control group. The primary outcomes were changes in serum sodium levels and the incidence of hyponatremia. Secondary outcomes included fluid balance, complication rates, and recovery times. Continuous data were analyzed using t test/Mann-Whitney U, categorical data with Fisher's exact test, and time-based changes with repeated measures ANOVA. Normality was checked via Kolmogorov-Smirnov, and power analysis determined sample size.

Results: The furosemide group demonstrated a significantly lower incidence of hyponatremia than the control group (P=0.008). Additionally, serum sodium levels were significantly higher in the furosemide group after surgery (P=0.011), while potassium levels were lower (P=0.003). Mild hypokalemia was observed as a manageable side effect, primarily in patients with baseline potassium levels below 4.1 mmol/L.

Conclusion: Preoperative administration of furosemide effectively reduces the risk of TUR syndrome during monopolar TURP. Furosemide effectively reduces hyponatremia but may increase hypokalemia in some cases, limiting its clinical utility during monopolar TURP. Patient-specific assessment and further research are needed to ensure its safe and effective use.Trial Registration Number: IRCT20211208053328N2.

Cavernous malformations, also known as cavernous hemangiomas or cavernomas, are abnormal vascular lesions that can occur in various parts of the body, including intracranially. Surgical resection is often the preferred treatment for symptomatic or high-risk lesions located in eloquent or critical brain or spinal cord regions. However, cerebral cavernous malformation surgery presents unique challenges due to the risk of neurological deficits and the proximity of these lesions to vital neural structures. Intraoperative neurophysiological monitoring (IONM) plays a crucial role in enhancing surgical safety, minimizing complications, and optimizing patient outcomes. This review aimed to provide an overview of the various IONM techniques employed during cerebral cavernous malformations resection, particularly the relationship between intraoperative stimulation intensity and distance to fiber tracts or specific brain nuclei as monitored by IONM.

The role of microRNAs (miRNAs) in human reproduction represents an area of research, as these regulatory molecules appear to play essential roles in reproductive function. However, the current understanding of miRNAs' regulatory mechanisms in male and female reproduction remains incomplete, with considerable contradictory evidence in the literature. This targeted review aimed to analyze high-quality studies published to date on miRNA expression patterns in female and male reproduction to elucidate their biological roles and associations with infertility, thereby updating knowledge in this field. A comprehensive review of the literature was conducted using different electronic databases and search engines, including PubMed Central, MEDLINE, and Google Scholar from the earliest available records up to 2023. This search identified 18,100 articles related to miRNA expression in infertility, polycystic ovary syndrome (PCOS), endometriosis, and biomarkers, of which 72 met our criteria for further analysis. The findings of the present study revealed that specific, stable miRNA populations exist in different tissues and cells, potentially influencing spermatogenesis and oogenesis. The extensive review of studies suggested a consistent relationship between aberrant miRNA expression patterns and infertility. Consequently, the miRNAs identified in this review might serve as valuable biomarkers for both male and female infertility and could lead to the development of novel and specialized treatments. This manuscript has been released as a preprint at Authorea: (https://doi.org/10.22541/au.169609839.97787658/v1).

Background: Diagnosis of cytomegalovirus (CMV) in biopsies relies on detecting classic viral cytopathic effects (CPE) in tissue. These effects are not always apparent, and confirmatory tests are necessary. This study aimed to compare the results of the different diagnostic tests for CMV detection in colitis, including PCR on fresh and formalin-fixed paraffin-embedded (FFPE) tissue, immunohistochemistry (IHC), histology, and plasma PCR, in association with the clinical course.

Methods: In this prospective study, CMV-PCR was performed on fresh tissue (FT) and FFPE tissue, and IHC was conducted on colon biopsies from 153 children with colitis referred to Children Medical Center Hospital (Tehran, Iran) from 2015 to 2019. The results of different diagnostic methods were evaluated in association with the clinical and histopathological findings.

Results: Fifty out of 153 (32%) cases had positive FT-CMV PCR. Forty of these fifty positive samples and 21 of 103 negative ones had concomitant FFPE biopsy tissue. FFPE-PCR and IHC were positive in 17 (42.5 %) and 2 (5%) out of 40 FT-PCR-positive cases, respectively. The two IHC-positive cases had positive FFPE-PCR and high CMV-DNA plasma levels and showed histologically active colitis and CPE. Remarkably, 14 (35%) cases were identified with positive FT-PCR without any evidence of colitis in histopathology. During follow-up, FT-PCR-positive inflammatory bowel disease (IBD) cases treated with antiviral drugs showed a poorer outcome than the non-treated cases (P=0.03).

Conclusion: A high positive rate was observed for both FT- and FFPE-CMV PCR, with a poor association with histology. IHC positivity was associated with high plasma CMV DNA levels and the presence of CPE. The efficacy of anti-CMV treatment in colitis cases should be verified through randomized controlled clinical trials. A preprint version of this article is available online at doi: 10.22541/au.168052684.43457923/v1.

Background: Vitiligo is an autoimmune skin disorder in which apoptosis plays an exceptionally vital role in its occurrence. Research has shown a strong association between the presence of polymorphisms and the occurrence of diseases. This study aimed to determine the association of BAX-248G>A and BCL2-938C>A polymorphisms with vitiligo.

Methods: This cross-sectional study utilized the tetra-primer amplification refractory mutation system polymerase chain reaction (ARMS PCR) in a cohort of vitiligo patients referred to the esteemed dermatology department of Shahid Faqihi Hospital in Shiraz between 2022 and 2023. The Chi square test and t test were used to analyze data, and logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for vitiligo risk associated with BAX-248G>A, BCL2-938 C>A polymorphisms. P values<0.05 indicated statistical significance.

Results: From 112 healthy individuals and 107 vitiligo patients, our research uncovered a significant association between the C allele (BCL2-938C>A) and the chance of vitiligo, with the CC genotype increasing the risk of developing this disease (OR=2.59, 95% CI=1.66-4.05, P<0.001). We also found that in individuals with the GG genotype (BAX-248G>A), the risk of vitiligo is higher (OR=4.576, 95% CI=1.19-17.60, P=0.027). Parental kinship was strongly correlated with vitiligo (OR=1.83, 95% CI=1.00-3.33, P=0.048). Moreover, no significant association was observed between smoking and vitiligo.

Conclusion: The results showed that BCL2-938C>A and BAX-248G>A polymorphisms may play a role in the pathogenesis of vitiligo and can be used as prognosis markers. However, further studies in larger groups and different populations are needed.

The supratrochlear foramen of the humerus (septal aperture) refers to the absence of the septum between the coronoid and olecranon fossae at the distal end of the humerus. Knowledge of this anatomical variation is important for anatomists, anthropologists, orthopedic surgeons, and radiologists in clinical practice. This study aimed to evaluate non-metric anatomical traits in skeletons discovered in an Iron Age cemetery in Tabriz. To date, multiple tombs have been uncovered beneath one meter of sterile soil, covered by a substantial layer of medieval building debris. Among the 40 adult skeletons found in this cemetery, no prior scientific data on burials in this area had been collected. This study documented the presence of a supratrochlear foramen in both humeri of a female skeleton from this Iron Age site in Tabriz (Iran). The bilateral incidence of this trait was 2.5%, which was lower than reported in previous anthropological studies. Notably, this is the first documented case in Iran comparable to European and white American populations. The closure of this foramen serves as a criterion of age estimation in sub-adult humans. Given existing reports on its clinical implications, greater attention should be paid to this diversity, particularly in Iran. The findings might prove valuable not only for anatomists and anthropologists but also for radiologists and orthopedic surgeons.

Background: Klebsiella pneumoniae is a Gram-negative encapsulated opportunistic pathogen, which presents a major threat to public health due to its ability for multi-antibiotic drug resistance. It is responsible for 30% of Gram-negative bacterial infections, including nosocomial infections, pneumonia, septicemia, and urinary tract infections. The study aimed to analyze the key phenotypic and genetic features of clinical K. pneumoniae isolates.

Methods: Between 2022 and 2023, a total of 91 strains of Klebsiella pneumoniae were collected from Al-Imamian Al-Kadhimiyain Medical City (IKMC) and characterized using the VITEK-2 technique. Whole-genome sequencing (WGS) was employed to characterize the extreme drug-resistant strain. The whole genome was extracted and sequenced using the Next Generation Sequencing (NGS) technique. The genome of our bacterial isolate was analyzed using different bioinformatics tools such as Galaxy workflow, SPAdes, PROKKA, and Staramr.

Results: The analysis identified Klebsiella pneumoniae serotype K36:O2a and sequencing type ST-437, containing 15 different plasmids carrying 54 resistance genes and more than 100 virulence genes with one region of CRISPR and no Cas. The sample obtained four intact bacteriophages and two questionable ones. Seven insertion sequences were revealed in the analysis as part of Other Mobile Genetic Elements (OMG). Additionally, the 16SrRNA phylogenetic tree identified a higher relationship of the bacteria to the strains from the USA and India than from Iraq.

Conclusion: It is the first study in Iraq to utilize WGS to comprehensively characterize an opportunistic pathogen. The study emphasizes the need for WGS to track the development of resistance and virulence patterns in clinical strains of K. pneumoniae.