Iranian Journal of Medical Sciences最新文献

Background: Decompressive craniectomy (DC) is effective in reducing mortality and improving outcomes in stroke patients. However, there is a need for a better understanding of the outcomes and complications of stroke, particularly in regions such as Iran, where comprehensive studies on DC outcomes are scarce. This study investigated the effects of DC in stroke patients.

Methods: This cohort study was conducted at Nemazi Hospital in Shiraz, Iran, from 2018 to 2020. All patients aged over 18 years with ischemic stroke requiring DC were included using census sampling. Data on demographics, clinical history, and imaging findings were collected. Outcomes were assessed using the modified rankin scale (mRS), Glasgow outcome score extended (GOSE), and aphasia severity rating (ASR).

Results: A total of 144 cerebral infarction patients underwent DC; 22 (15.3%) were lost to follow-up, and 67 (55%) of the remaining patients died either during hospitalization or within at least 6 months of follow-up. Patients over 60 years old (OR=0.152), those with a history of stroke (OR=0.227), and those with COVID-19 infection (OR=0.164) were associated with a decreased likelihood of survival. However, an increase in the Glasgow Coma Scale (GCS) score on admission was associated with an increased probability of survival (OR=1.199). The ordered logistic regression analysis showed that an increase in GCS score was associated with a higher probability of achieving better outcomes across all models: GOSE (OR=1.177), mRS (OR=0.839, with lower scores indicating better outcomes), and ASR (OR=1.354). The analysis showed that patients over 60 had a lower probability of achieving better outcomes in the GOSE model (OR=0.185) and were likely to have worse outcomes in the mRS model (OR=5.182).

Conclusion: These findings underscored the critical role of comorbidities (such as COVID-19 and prior stroke) and GCS scores in predicting patient survival and functional outcomes following DC. In particular, the higher mortality rates and poorer functional outcomes observed in older patients highlighted the need for careful consideration in this age group.

The utilization of e-cigarettes among youth in Pakistan is increasing due to their attractive appearance, user-friendly design, reduced smoking discomfort, and availability in a variety of flavors. Although e-cigarettes are often perceived as less toxic than traditional cigarettes, they still pose significant health risks such as respiratory issues, cardiovascular problems, potential neurodevelopmental effects in adolescents, and increased likelihood of transitioning to conventional tobacco products due to the presence of harmful chemicals and ingredients such as nicotine and other toxic substances. Adolescents in Pakistan have strong opinions about e-cigarette use, primarily influenced by sociocultural values; Westernization and globalization have made vaping appear to be a chic and sophisticated lifestyle choice. Moreover, views on addiction, dependency, and substance use are shaped by social backgrounds, religious beliefs, and cultural norms. Aggressive marketing techniques are employed by e-cigarette manufacturers, mainly targeting tech-savvy youth through digital platforms and social media influencers, which have also contributed to the rapid rise in e-cigarette use among young people in Pakistan. The current study underscores the necessity for culturally compatible interventions and policies, including educational programs, stringent regulations to limit access for young people, and comprehensive public health campaigns that counteract the influence of marketing by e-cigarette manufacturers. Additionally, healthcare providers should be trained to offer culturally sensitive cessation programs that support adolescents in quitting e-cigarettes and provide resources to mitigate the health hazards associated with e-cigarette use, including nicotine addiction and other adverse health effects, and to promote tobacco cessation in Pakistan.

Background: Iron accumulation in the spleen of thalassemia patients disrupts macrophage polarization, impairs immune function, and increases mortality. Sappan wood (Biancaea sappan L.) extract exhibits iron-chelating and immunomodulatory properties, making it a potential adjuvant with Deferiprone (DFP). This study aimed to assess the effects of Sappan wood extract (SWE) as a DFP adjuvant in rat models of iron overload.

Methods: This experimental study was conducted from January to March 2024 at Padjadjaran University, Indonesia. Thirty-five rats were divided into seven groups: normal, iron overload (IO) induced by iron dextran (ID) at a cumulative dose of 60 mg/Kg body weight (BW), positive control receiving DFP, and four groups receiving DFP+SWE at different doses of 50, 100, 150, and 200 mg/Kg BW. Iron levels and macrophage polarization (pro-inflammatory M1 and anti-inflammatory M2) in the spleen were assessed.

Results: SWE at 50 mg/Kg BW significantly reduced spleen iron levels to 60.77 ppm/mg and increased M2 intensity (P<0.001 compared to the IO group). At 100 mg/Kg BW, SWE effectively decreased M1 macrophage intensity (P=0.001 compared to the IO group).

Conclusion: SWE at 50 mg/Kg BW was comparable to DFP in reducing the spleen iron levels and M1 macrophage intensity, while 100 mg/Kg BW enhanced M2 macrophage polarization. These findings highlighted SWE's potential as a therapeutic adjuvant in IO conditions.

Background: Glaucoma causes irreversible damage to the optic nerve and can lead to blindness if it is not treated appropriately. Evaluation of longitudinal changes in the visual field (VF) and detecting progression in a timely manner are critical for effective disease management. This study aimed to identify factors associated with VF impairment and disease progression using a Bayesian joint model.

Methods: A total of 129 glaucoma patients (228 eyes) were recruited from an ongoing cohort study initiated in 1998 at the Rotterdam Eye Hospital in the Netherlands. Standard Automated Perimetry (SAP) was performed for each patient at regular 6-month follow-up intervals. Covariates included sex, age at baseline, mean intraocular pressure (IOP), and disease severity. A Bayesian joint model was employed, integrating a linear mixed effects model (LMM) for longitudinal mean deviation (MD) values and a Cox proportional hazards model for progression time. The statistical analyses were conducted using R software and the 'JMbayes2' package.

Results: Progression was observed in 33.8% of eyes. A significant association was found between MD changes and progression risk (α=-0.39, P<0.001). Older age (P=0.01), early-stage disease (P<0.001), and higher mean IOP (P<0.001) were associated with an increased risk of progression.

Conclusion: Considering longitudinal MD changes, age at baseline, mean IOP, and disease severity were significantly associated with the time to progression detection. Sex was not found to be a significant factor in glaucoma progression.

Background: Given that poisoning patterns vary by region and no comprehensive data exist on chemical/drug-induced rhabdomyolysis in Yazd province (Iran), this investigation was conducted to assess rhabdomyolysis incidence among patients with drug or chemical poisoning.

Methods: This descriptive cross-sectional study was conducted on all patients with chemical or drug poisoning in Shah Vali (Yazd) and Shahid Beheshti (Taft) Hospitals, Iran, from March 2015 to 2020. All data were extracted from medical records.

Results: Among 7800 patients with poisoning, 788 individuals (10.1%) were diagnosed with rhabdomyolysis. The predominant drug poisoning agents causing rhabdomyolysis were methadone, with 327 cases (41.5%), and benzodiazepines, with 80 cases (10.1%). The most common chemical poisoning agent was lead, occurring in 18 cases (2.28%). Acute kidney injury (AKI) requiring dialysis and death occurred in 96 (12.2%) and 55 (7%) patients, respectively. Methadone was associated with the highest frequencies of death and AKI requiring dialysis, accounting for 23 (41.8%) and 41 (42.7%) cases, respectively. A significant relationship was found between death and AKI requiring dialysis (P=0.002).

Conclusion: The frequency of rhabdomyolysis was approximately 10%, with a 7% mortality rate among affected patients. Rhabdomyolysis was more frequently associated with drug poisoning than chemical poisoning, with methadone and benzodiazepines being the most frequently causative agents. Notably, methadone poisoning was associated with significantly higher rates of both AKI requiring dialysis and mortality. Moreover, AKI necessitating dialysis was identified as a significant predictor of mortality in these patients.

Anogenital warts, caused by human papillomavirus (HPV) infection, are characterized by papular lesions in the anogenital region. Acetowhite examination and dermoscopy are non-invasive methods that might aid in confirming the clinical diagnosis. This study aimed to evaluate the diagnostic accuracy of acetowhite examination and dermoscopy compared to histopathological findings in anogenital warts. This cross-sectional study included patients diagnosed with anogenital warts at Dr. M. Djamil Padang Hospital (Padang, Indonesia) from January 2023 to December 2023. Using the purposive sampling method, 62 lesions from 54 patients (28 men and 26 women) aged 16-59 years were analyzed. Each lesion underwent acetowhite examination, dermoscopy, and histopathological examination. Descriptive analyses were performed on subject characteristics and dermoscopic features, while sensitivity and specificity were calculated using a 2×2 table. The majority of lesions were found in the perianal area in men (44%) and the vulva in women (39%). The acetowhite examination demonstrated a sensitivity of 91% but lacked specificity and negative predictive value (NPV), indicating limitations in identifying negative results. In contrast, dermoscopy exhibited 100% sensitivity and specificity. The findings indicated that both acetowhite examination and dermoscopy were effective diagnostic tools for anogenital warts, with dermoscopy providing exceptional accuracy. These non-invasive methods could potentially reduce the need for more invasive histopathological procedures. Dermoscopy, in particular, serves as a sensitive and specific adjunct tool, offering reliable diagnostic capabilities that can enhance clinical practice.

Background: Targeted temperature management (TTM) is a standard care intervention following resuscitation, known to improve neurological outcomes in patients. However, there is a lack of comprehensive studies on the application of TTM, specifically therapeutic hypothermia, in pregnant patients. Considering the critical importance of maternal and fetal health, this study aimed to investigate the use of TTM in pregnant women following cardiac arrest.

Methods: This systematic review was conducted by searching multiple databases, including Web of Science, PubMed Central, MEDLINE, Scopus, EMBASE, and Cochrane, up to October 2024. The search was conducted with no restrictions on time, place, or language. Articles were selected based on predefined inclusion criteria, which included case reports detailing the use of TTM in pregnant women after cardiac arrest. The quality of the included studies was assessed using the Jonna Briggs Institute (JBI) checklist for case reports.

Results: A total of nine articles met the inclusion criteria. Among the reported cases, there was 1 (11.1%) case of maternal death and 2 (22.2%) cases of fetal death, neither of which appeared to be directly attributable to the use of hypothermia. Neurological outcomes were favorable for all surviving mothers and fetuses following the application of TTM. The most common maternal complications during hypothermia for mothers were decreased blood pressure and heart rate, occurring in 2 (22.2%) cases. For the fetuses, bradycardia was the most frequently reported complication, occurring in 5 (55.5%) cases.

Conclusion: The use of TTM in pregnant patients following cardiac arrest might be considered on a case-by-case basis with the involvement of a multidisciplinary team. Pregnancy does not appear to be an absolute contraindication for TTM. However, close fetal monitoring is essential to ensure fetal well-being during the procedure.

Background: Percutaneous closure of perimembranous ventricular septal defects (pmVSD) with Amplatzer duct occluder type II (ADO II) is a novel method. The present study aimed to evaluate the short and mid-term outcomes of this method in children and adolescents.

Methods: This retrospective study was conducted at Shiraz University of Medical Sciences from July 2019 to September 2023. It evaluated the outcomes of pmVSD closure using the ADO II. The effects on tricuspid regurgitation (TR), mitral regurgitation (MR), and aortic regurgitation (AR) were assessed, along with the presence of residual shunts and conduction disturbances. Data were analyzed using SPSS software (version 24.0). Fisher's exact test and the Chi square test were employed for statistical analysis. P<0.05 was considered statistically significant.

Results: This study included 102 patients. 31 patients had a short-term follow-up with a median of 79 (71.02, 97.01) days, and 71 patients had a mid-term follow-up with a median of 900 (384.25, 1044.75) days. The severity of TR, MR, and AR dropped to lower levels in most patients during follow-ups (P=0.003, P=0.030, and P=0.033, respectively). There was no significant difference in the valvar regurgitation changes between patients weighing more or less than 10 Kg or between those with short and mid-term follow-ups (P>0.05). There were no hemolysis, clot, embolization, death, or third-degree atrioventricular blocks. However, 2 (2%) patients developed a small residual shunt.

Conclusion: Overall, ADO II appeared to be a safe transcatheter occlusion device for patients with pmVSD, and this method could reduce the severity of TR, MR, and AR with few complications.