Hasheminejad Kidney Center

ABSTRACTBackgroundCancer of unknown primary (CUP) presents diagnostic and management challenges, particularly when associated with rare subsets such as pelvic squamous cell carcinoma (SCC) of unknown primary origin. Human papillomavirus (HPV) is increasingly recognized as a prognostic and potentially predictive biomarker. HPV‐associated SCCs often demonstrate better response to treatment and improved outcomes.CasesWe present two cases of pelvic SCC with unknown primary origin, both positive for HPV genotype 16. Case 1 involved a 54‐year‐old woman with persistent abdominal pain who was diagnosed with an infiltrative 110 × 100 × 65 mm tumoral mass on the right side of the pelvic cavity, significantly involving the right iliac bone and right iliopsoas muscle; despite chemotherapy, the patient developed metastases. Case 2 featured a 46‐year‐old woman with progressive left lower limb pain, whose pelvic SCC was incidentally discovered on imaging with an 80 × 75 mm mass with an abnormal signal in the left iliac bone with extension to the left iliopsoas muscle involving the lower aspect of the iliopsoas muscle, and also involving the anterior aspect of the left sacral bone. She achieved a complete response to chemotherapy and chemoradiotherapy, with no evidence of recurrence during follow‐up.ConclusionHPV‐associated pelvic SCC of unknown primary presents both diagnostic complexity and therapeutic opportunity. The detection of HPV genotype 16 in both cases supports a growing body of case‐based evidence suggesting a potential association with a favorable prognosis. However, further studies are needed to clarify its role in guiding management.

Introduction: Urinary tract infection (UTI) is among the most common bacterial infections in children, and evidently, it is associated with vitamin D deficiency. Accordingly, the present study intended to examine the frequency of vitamin D deficiency in children with UTI. Materials and Methods: Databases Scopus, PubMed, Embase, Web of Science, Cochrane, and Google Scholar Search Engine were used for articles published until August 1, 2025. Data was analyzed using STATA 14. Tests with P values <0.05 were considered statistically significant. Results: The frequency of vitamin D deficiency in the total population of children with UTI was, in case-control studies, and in cohort studies were 42%, 44%, and 38%, respectively. Furthermore, the rates of vitamin D deficiency in children with UTI aged under 3 years, those aged 3 to 5 years, and children older than 5 years were 21%, 46%, and 71%, respectively. Additionally, vitamin D insufficiency frequency in the total population of children with UTI, in case-control studies, and cross-sectional studies was 30%, 34%, and 22%, respectively. Moreover, the rates of vitamin D insufficiency in children with UTI aged under 3 years and those aged 3 to 5 years were 30% and 33%, respectively. Vitamin D deficiency was observed in 60% of the girls and 42% of the boys with UTI. Approximately 47% of the Asian and 20% of the European children with UTI suffered from vitamin D deficiency, and the frequency of vitamin D insufficiency in Asian and European children with UTI was 34% and 24%, respectively. Conclusion: Approximately half of the children with UTI suffered from vitamin D deficiency, and one-third of them faced vitamin D insufficiency. The increase in the age of the children added to the percentage of children with vitamin D deficiency or insufficiency. Furthermore, Asian children were at higher risk compared with European children, and females were exposed to higher risks than males. Registration: This study has been compiled based on the PRISMA checklist, and its protocol was registered on the PROSPERO (ID: CRD420251122224) and Research Registry (UIN: reviewregistry2033) websites.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Spontaneous rupture of the urinary bladder (SRUB) is a rare urological emergency. SRUB often results from over-distension due to acute urinary retention (AUR), which is more common in males but can also occur in females, particularly after surgeries like hemorrhoidectomy. This case highlights SRUB in a woman following hemorrhoidectomy, a rare complication that requires early recognition and management. A 42-year-old woman presented with abdominal pain and obstructive urinary symptoms after undergoing hemorrhoidectomy. She had no prior abdominal trauma or gastrointestinal symptoms. Initial examination revealed abdominal distention and suprapubic dullness. A Foley catheter was inserted, providing temporary relief. Laboratory findings showed a significant rise in serum creatinine (6.2mg/dL). CT cystography confirmed an intraperitoneal bladder rupture. The patient underwent open surgery, and her postoperative recovery was uneventful, with a return to normal creatinine levels. SRUB can be associated with anorectal surgeries like hemorrhoidectomy, where iatrogenic nerve injury leads to AUR. The bladder retention can cause an increase in intra-vesical pressure, ultimately resulting in rupture. Early diagnosis is critical, as symptoms may be nonspecific. While ultrasonography provides some clues, CT cystography is the gold standard for diagnosis. Timely surgical intervention for intraperitoneal ruptures prevents life-threatening complications. SRUB following hemorrhoidectomy is a rare but serious complication. Clinicians should consider SRUB in patients presenting with urinary symptoms, abdominal pain, and elevated creatinine level in the absence of hydronephrosis after pelvic surgeries.

The Ottawa and Emerald rules were developed to aid in the diagnosis of subarachnoid hemorrhage (SAH) and to determine whether a CT scan is necessary for patients presenting with non-traumatic acute headaches in the emergency department. Numerous studies have been conducted to validate these clinical decision rules. In this study, we aimed to investigate the pooled diagnostic accuracy of these rules and their impact on imaging utilization. In this PRISMA-DTA-compliant systematic review, a comprehensive search was done in databases including PubMed, Scopus, Embase, and Web of Science. Then, screening, selection of studies, and data extraction were performed and the QUADAS-2 tool was used for critical appraisal. The true positives (TP), false negatives (FN), false positives (FP), and true negatives (TN) were extracted to calculate pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, and Diagnostic Odds Ratio (DOR) with 95% CIs. The effect of Ottawa rule on CT scan utilization was assessed by calculating pooled odds ratios for the number of CT scans in SAH and non-SAH groups before and after applying the rule. The pooled sensitivity, specificity, negative LR, and positive LR for the Ottawa SAH rule were 99% (95% CI: 92%-100%), 23% (95% CI: 16%-32%), 0.025 (95% CI: 0.003%-0.193%), and 1.29 (95% CI: 1.16%-1.42%) respectively. Similarly, these measures for the Emerald SAH rule were 99% (95% CI: 71%-100%), 27% (95% CI: 15%-43%), 0.065 (95% CI: 0.004%-1.072%), and 1.34 (95% CI: 1.1%-1.62%), respectively. The pooled odds ratio for CT scan utilization for the Ottawa rule was 1.15 (95% CI: 0.62%-2.13%). Both rules are highly sensitive for excluding SAH in patients with non-traumatic acute headaches presenting to the emergency department but have low specificity and do not significantly reduce CT scan utilization. PROSPERO registration number: CRD42023476444.

Spinal anesthesia (SA) is preferred over general anesthesia for lower extremity surgeries, but the optimal method of needle placement is debated. Although the paramedian approach reduces the risks of dural puncture, it presents technical difficulties. The modified paramedian technique may increase safety and patient satisfaction by facilitating subarachnoid access and overcoming anatomical challenges, particularly in obese or elderly patients. This study aimed to compare the paramedian and modified paramedian techniques from the perspective of anesthesiologists and their impact on postoperative patient satisfaction. This triple-blind randomized clinical trial investigated the effects of two SA techniques - paramedian and modified paramedian - on patient satisfaction and procedural ease. A total of 112 patients meeting inclusion and exclusion criteria were enrolled. Data were collected using the Iowa Satisfaction with Anesthesia Care Questionnaire. Demographic information was recorded in coded form, and data analysis was performed using SPSS version 19. Statistical methods included the independent t-test for comparing continuous means between groups, the chi-square test for categorical variables, and logistic regression analysis to assess the impact of individual characteristics (age, gender, weight) on the ease of performing spinal anesthesia. The results indicated that the modified paramedian group demonstrated superior performance in terms of success on the first attempt (P = 0.006), reduced need for repositioning (P = 0.038), and fewer repeated attempts (P = 0.017). Additionally, patient satisfaction scores were significantly higher in the modified paramedian group (P = 0.001). Multivariate regression confirmed age and Body Mass Index (BMI) as independent predictors of procedural difficulty (P < 0.05). The modified paramedian technique significantly enhanced the ease of SA administration and patient satisfaction compared to the traditional approach. These findings indicate its potential to improve the anesthesia process, reduce side effects, and elevate patient experience. This study supports broader adoption of the technique in surgical and healthcare settings, advancing anesthesia care quality.

<ns3:p>Background: Atopic dermatitis is a chronic inflammatory allergic disease linked to sleep disturbances in infants, often causing agitation in children and concern for parents. Aims: This research aimed to evaluate the topical application of chamomile and oserin oil on improving atopic dermatitis healing in Iran. Methods: It was a randomized double-blind clinical trial involving 52 infants (26 in the test group and 26 in the control group) aged from birth to 12 months. Drug usage was thoroughly explained and instructed, with scores assigned and medication prescribed for two weeks.The test group were given 60 cc of chamomile oil, while those in the control group received 60 cc of Oserin for treatment at no cost. Follow-up assessments were scheduled at zero, 7, and 14 days post-treatment, with recorded data. Improvement in infants' skin conditions was assessed using the Scorad index. Data analysis was performed using the SPSS version 24 software, including group statistics, independent sample tests, paired sample tests, and chi-square tests. Results: The study revealed no significant statistical difference in the severity and extent of atopic dermatitis between the two groups in preintervention(P&gt;0.05). However, qualitative and quantitative aspects of atopic dermatitis treatment in the test group were statistically significant, with no observed side effects during the study(P&lt;0.001). Conclusion: The clinical study highlighted significant and definite benefits of this treatment, including alleviation of skin itching, hydration of dry skin, and overall skin restoration, without necessitating additional drug usage due to acute side effects.</ns3:p>