Iranian Journal of Medical Sciences最新文献

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.

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Background: Investigations have shown that estrogen affects wound healing through skin receptors. Astragalus floccosus Boiss. contains estrogen-like isoflavonoids. This study examined the effects of A. floccosus Boiss (A. floccosus) extract on wound healing in vitro and in vivo.

Methods: For the in vitro test, Human Fetal Foreskin Fibroblast 2 (HFFF2) cells treated with the root extract of A. floccosus were followed over a 48-hour period. For the in vivo test, rats were categorized into five groups and received daily applications of a cream containing different concentrations of the extract: 5%, 10%, silver sulfadiazine, the ointment base, and no treatment for a duration of 21 days. The wound size and full-thickness wound healing were measured throughout the inspection, and a histological study was conducted as well. The two-way repeated measures ANOVA test was employed, with a significance level of 0.05 (P≤0.05) being used in all cases.

Results: A. floccosus at 125 ppm significantly improved the closer region and wound healing in HFFF2 cells over all periods of time and showed a significant healing effect during 8-12 h (P=0.0234). Moreover, an increase in fibrosis (compared to the base (P=0.0005), the 10% extract (P<0.0001), silver (P=0.0005), and free (P<0.0001) groups), epithelization (compared to base (P=0.0006), the 10% extract (P=0.0008), silver (P=0.0007), and free (P=0.0006) groups), and proliferation of fibroblasts (compared to the 10% extract and free groups (P=0.0020 and P=0.0024, respectively) were seen in the 5% extract sample on day 10.

Conclusion: Wound healing processes were observed in rats treated with a 5% A. floccosus extract cream. This finding highlights the potential for future studies on wound healing processes using this extract.

Background: Liver transplantation (LT) is a critical intervention for pediatric patients with advanced liver failure. This study aimed to assess the impact of perioperative factors on LT outcomes in pediatric patients.

Methods: This retrospective cohort study, conducted from 2010-2020, included 563 pediatric patients who underwent LT in Shiraz, Iran. Most patients received liver grafts from living donors due to cholestatic and metabolic diseases, and all had complete medical and laboratory records. Data were analyzed using various regression models (Cox, linear, and logistic) in SPSS software (version 22).

Results: Of the 563 patients who underwent LT, 436 received livers from living donors and 127 from deceased donors. The primary diagnoses included cholestatic diseases (44.4%) and metabolic diseases (34.1%). Post-transplant rejection and mortality rates were 21.1% (119 patients) and 36.1% (203 patients), respectively. Preoperative factors associated with rejection included weight (HR=1.01, P=0.01) and albumin (HR=0.69, P=0.03). Postoperative factors influencing rejection included platelet transfusion (HR=2.12, P=0.03), primary non-function (PNF) (HR=4.6, P=0.01), cytomegalovirus (CMV)(HR=1.78, P=0.005), and convulsion (HR=1.93, P=0.007). Preoperative factors that affect mortality were age (HR=0.89, P<0.001), alanine aminotransferase (ALT) (HR=1, P=0.047), and hemoglobin levels (HR=0.91, P=0.03). Intraoperative factors influencing mortality included cold ischemia duration (HR=0.98, P=0.048) and anhepatic blood loss (HR=1.02, P<0.001). Postoperative factors associated with mortality included fresh frozen plasma (FFP) transfusion (HR=1.7, P=0.004), bleeding (HR=2.17, P=0.009), bowel perforation (HR=2.55, P=0.01), and PNF (HR=11.24, P<0.001).

Conclusion: Optimizing perioperative care practices could significantly improve LT outcomes in pediatric patients.

Background: Scorpion stings are one of the major medical problems in tropical and subtropical regions of underdeveloped countries, causing several complications including severe local skin reactions, renal, neurological, cardiovascular, and respiratory complications, and sometimes death. The present study attempted to develop a minimum data set for a national registry of scorpion stings.

Methods: This study was conducted from 2022 to 2023 in two phases. First, information relevant to the data elements was extracted from scientific and medical databases such as PubMed Central/Medline, Embase, Web of Science, SID, and Cochrane Library. In the second step, a Delphi questionnaire was developed using the information obtained in the first step and given to five experts. Two Delphi steps were used to determine the minimum data set for scorpion stings. Data analysis in both steps was performed using descriptive statistics in SPSS software (version 22).

Results: The number of data elements was 124 items in eight sections, including demographic information, scorpion characteristics, time and place of sting data, patient history, clinical signs and symptoms, medicine, tests, admission, and discharge information.

Conclusion: The design of the minimum data set of scorpion stings can help in timely access to medical records, registration of information related to patient care, and patient follow-up. By ensuring continuous care for patients and recording their information in a valid database, communication among care providers can be enhanced. This approach also allows for analysis of care effectiveness for patient and the broader community affected by scorpion stings.

Background: In the treatment of low- and mid-complex rectovaginal fistulas (RVF), the use of the Martius flap between the vagina and rectum following fistula repair was shown to enhance healing rates. This study reported long-term outcomes from a referral colorectal center, focusing on the use of the Martius flap for managing low- and mid-complex RVFs.

Methods: This study included eligible patients who underwent Martius flap repair at Shahid Faghihi Hospital (Shiraz, Iran), between 2013 and 2023. Continence status and sexual function were assessed using the Cleveland Clinic Incontinence Score (CCIS) and the female sexual function index (FSFI) score. Fistula recurrence was defined as the postoperative passage of gas, feces, or mucosal discharge from the vagina. Statistical analyses were performed using SPSS software. Within-group comparisons were conducted using Wilcoxon signed-rank tests, and between-group analyses were performed using independent samples t tests, Mann-Whitney U tests, and Fisher's exact tests. P<0.05 was considered statistically significant.

Results: Of the 27 cases, 37% were classified as low RVF and 63% as mid RVF. Recurrent RVF was observed in 63% of patients, with a median of 2.00 previous fistula surgeries (interquartile range [IQR]=1.50-4.50). After a median follow-up of 48 months (IQR=24.00-84.00), the total success rate was 88.9%. The CCIS significantly decreased postoperatively compared to preoperative levels (P=0.003). Postoperative FSFI scores were within an acceptable range (22.2±4.22).

Conclusion: The Martius flap procedure was safe, with low morbidity and favorable functional and cosmetic outcomes. It could be considered a first-line treatment option for low- and mid-complex RVFs.

Background: Child sexual abuse (CSA) is one of the most sensitive crimes in the world. Some perpetrators of CSA suffer from paraphilic disorders, including pedophilia (PE). This research is designed and implemented with the aim of neurocognitive evaluation of CSA perpetrators.

Methods: A case-control study was conducted over a period of 6 months from October 2022 to the end of March 2023 in Shiraz, Iran on the Experimental group (EG) (CSA perpetrators) (n=12) and the Control group (CG) (n=13). During these evaluations, information was obtained about sexual orientation, history of sexual activity, cognitive distortions, and cognitive performance of both groups. Physiological arousal factors were also measured using a polygraph device while participants viewed half-naked digital paintings of immature and adult individuals. Additionally, the study utilized functional near-infrared spectroscopy to measure hemodynamic changes in the left frontal pole (Fp1) and the right frontal pole (Fp2) while participants performed the Stroop task (ST).

Results: Compared to CG, EG showed a greater tendency towards homosexuality in the past (P=0.017), present (P=0.019), and ideal (P=0.022). Using the mini-mental state examination, cognitive distortion was shown more common in the EG group (P=0.001). Additionally, there was a significant relationship between sexual abuse between the ages of 12 and 16 and committing a crime (P=0.041). Cognitive performance during ST was poorer in EG than CG. Moreover, in the statistical comparison between groups, the amount of oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) was significantly different in areas Fp1 (HbO: P=0.006 and HbR: P=0.014) and Fp2 (HbO: P=0.008 and HbR: P=0.005). Based on polygraph data, EG exhibited less emotional control than CG when viewing half-nude images of children (skin conductance: P<0.001 and heart rate: P=0.004).

Conclusion: Based on the results of this study, the CSA perpetrators seem to have a poorer neurocognitive function than the control group.

The mean value is commonly used as a measure of central tendency. It is frequently reported along with either the standard deviation (SD) or the standard error of the mean (SEM). While the SD reflects the dispersion of the data in both the sample and population, SEM indicates the precision of the mean. SEM is not commonly used in reporting science; however, the 95% confidence interval, which is calculated based on SEM, is frequently reported in scientific literature.