Archives of Iranian Medicine最新文献

Background: The current study evaluated the effects of prior metabolic and bariatric surgery (MBS) on complications after total knee/hip arthroplasty (TKA/THA). We performed a meta-analysis to assess the impact of prior MBS on TKA/THA outcomes.

Methods: Our systematic search was conducted on PubMed, Embase, Scopus, and Web of Science until September 2024. Thirteen studies were included in total, one of which was an RCT, and the others were retrospective studies.

Results: According to our findings, MBS was linked to decreased risk of peri-prosthetic joint infection in 853 MBS vs. 835 non-MBS patients (OR: 0.55, 95% CI : 0.31, 0.97, P value: 0.04), deep venous thromboembolism in 1074 MBS vs. 11948 non-MBS patients (OR: 0.50, 95% CI: 0.28, 0.86, P value: 0.01), and shorter length of hospital stay in 2,221 MBS vs. 12,201 non-MBS patients (mean difference: -0.42 days, 95% CI : -0.71, -0.13, P value<0.001) after TKA/THA. Aseptic loosening, blood transfusion, peri-prosthetic fracture, postoperative manipulation, readmission, reoperation, dislocation, pulmonary thromboembolism, revision, and wound complications were not significantly associated with MBS.

Conclusion: MBS prior to TKA/THA can considerably reduce some post-operative complications, such as the risk of PJI, DVT, and LOS at the hospital. It can be offered to patients with severe obesity before undergoing TKA/THA.

Background: De novo solid tumors are considered major causes of mortality in liver transplant recipients. This retrospective cohort study aimed to assess the risk factors of all-causes mortality and de novo solid malignancy, as co-primary outcomes, following liver transplantation.

Methods: The medical records of 2,600 patients who underwent liver transplantation at Abu-Ali Sina Charity Hospital in Shiraz, Iran, between 2010 and 2023, were evaluated to collect data of eligible patients. Cox proportional hazards regression was used to determine factors affecting mortality and de novo malignancy.

Results: A total of 419 patients were included. Among them, 127 individuals (30.3%) died and 53 patients (12.6%) received a de novo solid malignancy diagnosis during the study period. The 1-, 5-, 10-, 15-, and 20-year survival rates of patients were 85%, 76%, 69%, 61%, and 58%, respectively, and the 1-, 5-, 10-, 15-, and 20-year proportion of patients free from de novo malignancy were 97%, 90%, 83%, 78%, and 78%. Age (hazard ratio [HR]=1.03, 95% confidence interval [CI]: 1.02 to 1.05, P value<0.001) and sirolimus (HR=0.44, 95% CI: 0.31-0.63, P value<0.001) were significantly associated with survival, and age (HR=1.05, 95% CI: 1.02-1.07, P value<0.001) and azathioprine (HR=5.85, 95% CI: 2.47-13.87, P value<0.001) were linked to an increased risk of de novo solid malignancy.

Conclusion: Recipient's age and immunosuppressive regimen are independently associated with mortality and malignancy development following liver transplantation. However, this study is limited by its retrospective design and single-center setting.

Background: Considering the geographic and socio-economic heterogeneity across Iranian provinces, studying carbon monoxide poisoning (COP) mortality trends can provide insight for decision-making and necessary interventions. This study aimed to model the trend of COP mortality across 31 provinces of Iran from 2011 to 2022.

Methods: The current study used data from the Iranian Legal Medicine Organization (ILMO), the official body responsible for certifying and registering all suspected COP deaths in Iran, from 2011 to 2022. The annual and 10-year cumulative mortality rates were calculated by sex for all provinces. The growth mixture model (GMM) was employed to classify provinces according to the magnitude of alterations in the COP mortality rate concerning the intercept and slope parameters, utilizing the R software and the lcmm package.

Results: From 2011 to 2022, 9555 deaths due to COP were reported. The national 10-year cumulative mortality rate was 10.04 (95% CI: 8.34-11.75) per 100,000 for both sexes, 14.74 (12.37-17.12) for males, and 5.02 (4.06-6.34) for females. The Alborz Province for both sexes and males and the East Azerbaijan Province for females reported the highest mortality over ten years: 18.69 (17.25-20.19), 26.21 (23.93- 28.6), and 11.13 (7.34- 9.88) per 100,000 persons, respectively. The GMM results indicated that the overall COP mortality rate in class 2 and class 4 increased approximately by three and two times, respectively.

Conclusion: The rising trend of COP mortality in several provinces requires urgent interventions, focusing on safety and modern heating. Public awareness and CO detector installation, especially in colder regions, are crucial for preventing CO poisoning.

Background: Diseases resulting from animal bites have been a public health concern globally, including in Iran, and continue to show annual growth. Therefore, this study aimed to investigate the epidemiological patterns of animal bites in Babol city over 8 years.

Methods: This cross-sectional study was conducted on all individuals injured by animal bites from March 2015 to February 2022. The data for these cases were recorded by trained professionals at the Central Rabies Center in the county.

Results: A total of 13,550 cases with a mean age of 36.18±35.86 years were examined. Three-quarters of the cases (76.0%) were male, and 48.7% were urban residents. Additionally, 11,504 individuals (84.9%) received three doses of the rabies vaccine. The trend of animal bites showed an increase from 199.07 cases per 100,000 population in 2015 to 547.98 cases per 100,000 population in the final year of the study (2022) (P<0.001). This increasing trend was also observed in both males (from 327.03 in 2015 to 783.36 in 2022) and females (from 69.35 in 2015 to 309.36 in 2022). In terms of gender, the prevalence of animal bites in males was 1.3 times higher than females, and the prevalence of animal bites in rural areas was 59% higher than urban areas.

Conclusion: The occurrence of animal bites showed an increasing trend during the study years, indicating growing concern and the need for effective preventive measures. Furthermore, the results can assist in developing strategies, policies, and public health interventions in Babol.

In the article titled "Comparison of Medical Associations in Iran with Europe and America," published in Archives of Iranian Medicine (2025;28(5):296-302; doi: 10.34172/aim.20125), the School name in Affiliation number 1 was not formatted correctly. The correct affiliation format is as follows: Medical Surgical Nursing Department, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran. This correction has been updated in both the PDF and HTML versions of the article.

Mirza Kazem Mahallati (Mirza Kazem Shimi) was one of the first graduates of Dar Al-fonun Academy who went on to become the founder of modern pharmacy and chemistry in Iran. This article looks at Mirza Kazem's biography and his efforts in foundation of modern pharmacy in Iran.

Xanthogranulomatous pyelonephritis (XGP) is a rare, chronic inflammatory kidney disease characterized by progressive destruction of the renal parenchyma, typically associated with obstructive uropathy and nephrolithiasis. It is especially uncommon in pediatric patients and may be mistaken for malignancy or other renal infections, leading to delays in diagnosis. We present the case of a 13-year-old socioeconomically disadvantaged and immigrant (SDI) girl who developed advanced XGP due to unmonitored renal stones and limited access to healthcare. She presented with prolonged fever, flank pain, weight loss, and fatigue. Imaging revealed a non-functioning, enlarged right kidney with multiple staghorn calculi. Despite initial antibiotic therapy and percutaneous nephrostomy drainage, her condition progressed, necessitating nephrectomy. Histopathological examination confirmed XGP with lipid-laden macrophages, granulomatous inflammation, and fibrosis. Stone analysis revealed a mixed composition, primarily calcium oxalate and apatite variants, consistent with chronic infection-related calculi. This case highlights the potential severity of XGP when diagnosis and management are delayed, particularly in SDI populations. Clinicians should consider XGP in children presenting with recurrent urinary tract infections, renal calculi, and nonspecific systemic symptoms. Early recognition and timely surgical intervention, guided by a multidisciplinary team, are essential to prevent irreversible renal damage and reduce morbidity in pediatric patients with complicated urinary tract conditions.

Background: The healthcare system is a crucial indicator of government performance, especially in developing countries like the Islamic Republic of Iran, which has seen significant reforms in recent decades. This study explores healthcare workers' perceptions of recent government health policies.

Methods: This study was conducted as a national survey. An anonymous questionnaire containing 22 key challenges facing the healthcare sector was distributed via social media to healthcare employees. The aim was to gather insights on the challenges confronting Iran's healthcare system. After collecting the responses, we evaluated and analyzed the data.

Results: Over one week, we received responses from 805 healthcare workers. The findings revealed that the following issues were considered as the most important priorities across various categories: the healthcare system's entitlement from the gross national product; addressing the problems of doctors, including their income; preventing migration; combating non-scientific health practices; the challenges of medical education for future healthcare providers (such as reduced career hopes, desires to emigrate, drug use, and mental health issues like suicide); and tackling corruption in the country's pharmaceutical market.

Conclusion: The most significant challenges identified were economic issues and the medical education process, from admission to graduation. Notably, as people's ages increased, the scores related to economic challenges and job burnout also rose.

Background: PMM2-CDG, also known as congenital disorder of glycosylation type 1a, is the most common N-linked glycosylation disorder, characterized by a wide range of neurological and multisystem manifestations. Understanding the genotype-phenotype correlations is essential for accurate diagnosis and patient management. This study aims to identify the genetic cause of PMM2-CDG in an Iranian family with multiple affected members, and to analyze the genetic and clinical spectrum of the disorder through a comprehensive literature review.

Methods: Exome sequencing re-analysis was performed to detect disease-causing variants in three affected siblings. Additionally, a literature review was conducted, analyzing 91 previously reported cases of PMM2-CDG to determine the most prevalent variants and associated clinical features.

Results: A novel splice site variant (c.640-9T>A) was identified alongside a previously reported missense mutation (c.647A>T; p.N216I) in the affected individuals. The literature review revealed that the most frequent PMM2 variants were p.R141H (28.8%), p.V231M (12.8%), p.N216I (6.4%), and p.V129M (5.8%), with 77.6% of mutations occurring in exons 5 and 8. The most common clinical findings included developmental delay, ocular abnormalities (hypertelorism, strabismus), muscular system defects (hypotonia, muscle weakness), neurological symptoms (abnormal MRI findings), cardiovascular involvement (pericarditis, pericardial effusion), and clotting disorders.

Conclusion: We expect that our detailed clinical study will improve the genotype-phenotype interpretation of causal PMM2-CDG variants and the analysis of next-generation sequencing data, leading to clarification of the cause of complicated cases of rare diseases.