Imam Hossein Hospital

Background: Hypertensive disorders of pregnancy, including preeclampsia and eclampsia, represent a significant global maternal health challenge, affecting 2-8% of pregnancies worldwide and contributing to 11-14% of maternal deaths. The complex, multisystemic nature of these conditions, coupled with their unpredictable clinical trajectories, presents substantial challenges for anesthetic management. This narrative review examines the emerging integration of artificial intelligence (AI) technologies in obstetric anesthesia care for hypertensive disorders, exploring current applications, technological foundations, implementation challenges, and future directions. We synthesize evidence demonstrating AI's potential in continuous monitoring, predictive analytics, personalized care delivery, and clinical decision support. While significant barriers to implementation exist-including technological, regulatory, and ethical considerations-the integration of AI into obstetric anesthesia represents a paradigm shift toward precision, predictive, and personalized maternal care. This narrative review synthesizes current evidence to argue that the primary value of AI in this context is not the replacement of clinical judgment, but its augmentation through the synthesis of high-dimensional, time-series data, thereby enhancing anesthesiologist situation awareness and enabling proactive, rather than reactive, management.

• CMV colitis can occur in truly immunocompetent adults. • Renal involvement included both minimal change disease and tubulointerstitial nephritis. • Tissue biopsy with IHC is essential for diagnosing invasive CMV colitis. • Functional immunosuppression from systemic illness may enable CMV reactivation. • Early antiviral therapy led to full recovery. Cytomegalovirus (CMV) is classically associated with opportunistic infections in immunocompromised hosts. However, it can also cause significant morbidity in immunocompetent individuals, particularly under physiological stress. This case highlights an unusual presentation of CMV colitis coexisting with minimal change disease (MCD) and tubulointerstitial nephritis (TIN) in an immunocompetent adult. Case Presentation: A 39-year-old woman presented with progressive lower extremity weakness, diarrhea, substantial weight loss, and reduced urine output. Initial labs revealed anemia, hypoalbuminemia, acute kidney injury, and elevated inflammatory markers. Despite negative infectious workup, renal biopsy demonstrated MCD with TIN. Colonoscopy revealed ulcerations; histology with CMV-positive immunohistochemistry confirmed CMV colitis. The patient was treated initially with ganciclovir 350 mg twice daily, followed by valganciclovir 900 mg twice daily and supportive therapy, resulting in rapid clinical and laboratory improvement. This case demonstrates how CMV can affect immunocompetent individuals, mimicking inflammatory bowel disease and precipitating renal complications. Coexisting use of pennyroyal herbal tea may have contributed to nephrotoxicity. A multidisciplinary approach, including timely endoscopy and renal biopsy, was critical for diagnosis and management. CMV colitis should be included in the differential diagnosis of chronic diarrhea in immunocompetent adults. Secondary forms of MCD and TIN should be considered in systemic inflammatory contexts.

Vancomycin-resistant Staphylococcus aureus (VRSA) endocarditis is a rare, life-threatening infection typically linked to healthcare exposure or immunocompromised hosts. We report the first case of community-acquired native mitral valve endocarditis caused by VRSA in a previously healthy 20-year-old woman without traditional risk factors, complicated by cerebral embolization and necrotizing pneumonia. The patient presented with acute-onset fever (41°C), hemorrhagic conjunctivitis, periorbital edema, and hypoxemia progressing to respiratory failure. Initial empiric therapy with meropenem and vancomycin failed; blood cultures confirming methicillin-resistant VRSA (vancomycin minimum inhibitory concentrations [MICs] >16 µg/mL) susceptible to linezolid and gentamicin. Echocardiography revealed a 1.2 cm mitral valve vegetation, and brain MRI revealed embolic infarcts in the midbrain and parietotemporal regions. A 4-week regimen of linezolid (600 mg q12h) and gentamicin (5 mg/kg/day) achieved microbiological clearance and clinical stabilization without surgical intervention. Residual right hemiparesis (MRC grade 4/5) improved with neurorehabilitation, and 3-month follow-up confirmed sustained recovery. This case highlights VRSA’s emergence as a community pathogen and exposes critical gaps in empiric therapy guidelines reliant on vancomycin. Urgent integration of molecular resistance profiling and updated treatment algorithms are essential to counter this escalating antimicrobial threat. • First reported community-acquired VRSA native mitral valve endocarditis in an immunocompetent young adult without risk factors. • The VRSA isolate exhibited high-level resistance (MIC >16 µg/mL) to vancomycin and pan-resistance to most guideline-recommended agents (daptomycin, ceftaroline, etc.), retaining susceptibility only to linezolid, gentamicin, tigecycline, and quinupristin-dalfopristin. • Successful 4-week medical management with linezolid/gentamicin despite large vegetation and cerebral embolization. • Unusual hemorrhagic conjunctivitis presentation with necrotizing pneumonia and stroke complications. • Critical need for guideline updates incorporating rapid vanA PCR testing and alternative empiric regimens.

This study aimed to compare the efficacy of low-power laser therapy (LPLT) and low-frequency ultrasound (LFU) in reducing pain and improving quality of life in patients with diabetic polyneuropathy (DPN).A randomized controlled trial was conducted involving 55 patients with DPN, randomly assigned to three groups: LPLT (n = 18), LFU (n = 15), and control (n = 22). The LPLT group received treatments three times weekly for four weeks at 6J/cm² using 808nm and 905nm wavelengths. The LFU group received treatments three times weekly for four weeks at 1MHz, 0.5W/cm², and 20% duty cycle. All interventions were administered alongside standard medical care. Baseline and post-intervention assessments included the Michigan Neuropathy Screening Instrument (MNSI) and Quality of Life in Diabetic Neuropathy (QOL-DN) measures.At baseline, significant differences were observed in patient-reported MNSI scores (p = 0.001), with the LPLT group reporting the highest scores. Post-intervention, all groups showed reductions in MNSI scores, but between-group differences were not significant (p = 0.292). The LPLT group exhibited the largest mean reduction (-2.39) in patient-reported MNSI scores, though the change only approached significance (p = 0.057). For QOL-DN, the LPLT group showed the greatest improvement in symptom scores (Mean=-2.55, p = 0.023) and problem scores (Mean=-7.05, p < 0.001). ANCOVA confirmed a significant group effect for QOL-DN problem scores (p = 0.007), with the LPLT group showing significantly greater improvement than controls (p = 0.006).LPLT may have potential for improving quality of life and neuropathy symptoms in DPN patients, but the limited between-group differences indicate that its clinical utility remains uncertain. Larger, multicenter trials with longer follow-up are needed to confirm these preliminary findings and establish clinical relevance.

BACKGROUND:The lengthy and multi-stage nature of assisted reproductive technology (ART) can impose financial and social burdens on couples while also affecting their psychological well-being. Mindfulness-based stress reduction techniques help individuals cope effectively and cultivate inner calm. Additionally, lifestyle choices can impact fertility outcomes. In this study, we investigated the effects of mindfulness and health-promoting lifestyles on in vitro fertilization outcomes in infertile couples.MATERIALS AND METHODS:We conducted a randomized controlled clinical trial involving 300 infertile couples who were candidates for ART. The block randomization method randomly assigned participants to the intervention or control groups. The intervention group received an educational program of eight weeks of face-to-face interactive sessions supplemented by social media support. The control group received standard care. We compared the number of clinical pregnancies, health-promoting lifestyle scores, and anxiety levels between the two groups using Chi-square tests and independent t-tests.RESULTS:The clinical pregnancy rate in the intervention group (39.3%) was significantly higher than that in the control group (22%) (P < 0.001). After the intervention, the mean health-promoting lifestyle scores were significantly higher in the intervention group compared to the control group (P < 0.001). Additionally, anxiety scores were significantly lower in the intervention group (P < 0.001).CONCLUSION:Simultaneously improving lifestyle choices, cultivating awareness of body and soul, and maintaining a non-prejudiced attitude toward the environment can lead to better outcomes in achieving the desire for a child.

Obsessive–compulsive disorder (OCD) is a multifactorial condition, and interest in gut–brain interactions is increasing. We conducted a systematic two-step review, registered in PROSPERO (CRD420251083936). Step 1 mapped core OCD biology to gut-relevant pathways, including neuroimmune activation, epithelial barrier function, microbial metabolites, and stress circuitry, to clarify plausible mechanisms. Step 2 synthesized evidence from human and preclinical studies that measured or manipulated microbiota. Searches across PubMed, EMBASE, Web of Science, PsycINFO, and Cochrane (September 2025) yielded 357 biological and 20 microbiota-focused studies. Risk of bias was assessed using the Joanna Briggs Institute checklist for human studies and SYRCLE’s tool for animal studies. Although taxonomic findings in human cohorts were heterogeneous, functional patterns converged: reduced short-chain fatty acid capacity, enrichment of pro-inflammatory pathways, and host markers of barrier disruption and inflammation correlating with OCD severity. Transferring patient microbiota to mice induced OCD-like behaviors with neuroinflammatory changes, partly rescued by metabolites or barrier-supporting strains. Mendelian randomization suggested possible causal contributions at higher taxonomic levels. Diet, especially fiber intake, and psychotropic exposure were major sources of heterogeneity. Evidence supports the microbiota as a modifiable co-factor in a subset of OCD, motivating diet-controlled, stratified clinical trials with composite host–microbe endpoints.

Introduction: Behcet's disease (BD) is a systemic vasculitis that can affect the gastrointestinal system. Case Presentation: This report discusses a 41-year-old woman with a history of bariatric surgery who later developed gastrointestinal symptoms and arthralgia consistent with BD. Diagnosing BD is challenging because there are no specific diagnostic tests; instead, diagnosis is based on the constellation of clinical signs and symptoms such as recurrent oral and genital ulcers, uveitis, and multisystem involvement, which can overlap with other diseases. It remains unclear whether surgical procedures influence the onset or progression of the disease. Conclusions: The relationship between surgical interventions and the onset of BD requires further investigation. This case underscores the importance of considering BD in the differential diagnosis of post-surgical GI symptoms and highlights the role of tailored immunosuppressive therapy in achieving resolution of GI ulceration or arthralgia. Future studies must clarify the interplay between surgical procedures and immune-mediated diseases like BD.

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 &lt;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.

Poly (ADP-ribose) polymerase-1 (PARP-1) is a key enzyme in DNA repair pathways and has been implicated in cancer susceptibility. The rs1136410 polymorphism in the PARP-1 gene has shown inconsistent associations with gastrointestinal cancer risk across populations. This meta-analysis aimed to evaluate the association between PARP-1 rs1136410 polymorphism and the risk of colorectal cancer (CRC) and gastric cancer (GC), with a focus on ethnic differences. A systematic literature search was performed in PubMed, Scopus, EMBASE, Web of Science, Cochrane Library, BIOSIS, LILACS, CNKI, CBM, Wan Fang, and other regional databases up to February 1, 2025. Eligible case-control studies assessing the association between PARP- 1 rs1136410 polymorphism and CRC or GC were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated under five genetic models using Comprehensive Meta-Analysis software. Thirteen case-control studies were included, comprising 3.591 patients and 5.433 controls. For GC (8 studies; 1,784 cases and 2,521 controls), significant associations were observed under multiple genetic models: allele comparison (C vs. T: OR=2.01, 95% CI 1.04-3.91, p=0.039), homozygous comparison (CC vs. TT: OR=1.77, 95% CI 1.24-2.52, p=0.002), heterozygous comparison (CT vs. TT: OR=1.36, 95% CI 1.18-1.57, p<0.001), and recessive comparison (CC vs. CT+TT: OR=1.54, 95% CI 1.08-2.20, p=0.017). No significant association was detected for CRC (5 studies; 1.807 cases and 2.912 controls). Ethnic subgroup analysis revealed a protective effect against CRC in Caucasians but increased susceptibility in Asians. The PARP-1 rs1136410 polymorphism is associated with elevated GC risk but not CRC, with ethnicity-dependent effects suggesting differential genetic susceptibility. These findings highlight the importance of considering population-specific genetic backgrounds in gastrointestinal cancer risk assessment, prevention, and precision medicine strategies.