Novelty in Biomedicine

Background: Acute lymphoid leukemia (ALL) represents a prevalent form of cancer in pediatric populations. Mercaptopurine is one of the proposed treatments for these patients. This treatment may cause multiple side effects, including liver-related effects. Allopurinol has been proposed as a means to mitigate hepatotoxicity, but the previous studies in this regard remain scarce. This study aimed to investigate the effect of allopurinol on preventing increases in liver enzymes in children with ALL during the maintenance phase of drug treatment.

Materials and Methods: This is a double-blind clinical trial conducted on children with ALL receiving maintenance treatment with mercaptopurine during the maintenance phase of the disease. Patients were categorized into two groups. The initial cohort of 25 individuals was administered mercaptopurine tablets in combination with allopurinol tablets. The second group, comprising an equivalent number of patients, was administered mercaptopurine tablets and a placebo. Laboratory studies were evaluated. The patients' data were analyzed at the 0.05 significance level.

Results: The mean age in group A was 7.64 ± 3.78 years, while in group B it was 6.92 ± 3.19 years. In group A, the proportion of boys was 44%, whereas in group B, it was 72%. In both groups, the majority of patients tolerated less than 75 mg of mercaptopurine per body surface area, whereas, for methotrexate, most patients tolerated less than 20 mg per body surface area. Allopurinol significantly reduced mercaptopurine-induced hepatotoxicity in pediatric patients with ALL (P-value < 0.05). Allopurinol significantly reduced alanine transaminase (ALT) and aspartate aminotransferase (AST) levels compared to placebo (P-value<0.05). The intra-group analysis indicated that allopurinol significantly reduced enzyme levels over time (all P-values < 0.05).

Conclusion: Allopurinol reduces hepatotoxicity in ALL patients receiving mercaptopurine.

Background: Molar pregnancy is a rare and benign disease. If a molar pregnancy is diagnosed, treatment should be given immediately. Misoprostol is a synthetic prostaglandin analog commonly used for cervical ripening. This study was performed to determine the effects of misoprostol on cervical ripening in molar pregnancy.

Materials and Methods: This double-blind, randomized clinical trial was performed on 150 pregnant women candidates for the termination of a molar pregnancy. Patients were divided into two intervention groups, receiving vaginal misoprostol at a dose of 400 μg four hours before suction-curettage, and the control group, treated by suction-curettage and using a vaginal placebo. Information, including age, education, history of abortion, curettage, molar pregnancy, time of last menstruation, gestational age, and consequences of misoprostol use, and bleeding during and after curettage, was included in a questionnaire. Data were analyzed using Stata ver 13MP using descriptive statistics, t-tests, chi-square tests, and Bonferroni post hoc tests. A P value < 0.05 was considered significant.

Results: The study included 150 patients with an average age of 28 years. There was a significant association between the misoprostol group as an intervention and variables including age (p=0.003), gravidity (p<0.001), parity (p=0.011), delivery type (p=0.021), dilators (p<0.001), duration of surgery (p<0.001), and decreases in hemoglobin after curettage (p<0.001).

Conclusion: Our study indicated that vaginal administration of misoprostol was a simple and effective treatment for terminating molar pregnancy and seemed to have significant advantages over the current methods.

Background: To investigate differences in disease severity and outcomes among COVID-19 patients with a history of hypertension using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and other antihypertensive drugs.

Materials and Methods: Based on drug exposure, 153 hypertensive patients with COVID-19 were divided into three groups: angiotensin-converting enzyme inhibitor group, angiotensin receptor blocker group, and other antihypertensive drugs group. The outcomes, laboratory and clinical results, were compared.

Results: The frequency of ICU admission among patients in the angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, and other antihypertensive drug groups was 25.5%, 27.8%, and 23.2%, respectively. The intubation frequency was 23.6%, 27.8%, and 30.4%, respectively. The longest hospital stay was observed in the angiotensin-converting enzyme inhibitor group, but the difference was not significant (P>0.05). The mortality rates were highest in the other antihypertensive drug groups.

Conclusion: Patients with COVID-19 who consume angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have lower mortality rates compared to patients consuming other antihypertensive drugs.

Background: Medication nonadherence in psychiatric patients can lead to symptom exacerbation, relapse, and prehospitalization. Regular follow-up visits with psychiatrists are also an important behavioral indicator of treatment adherence. This study aimed to evaluate the prevalence and factors associated with medication nonadherence and irregular visits to a psychiatrist among psychiatric patients after hospital discharge in Qazvin, Iran, in 2024.

Materials and Methods: This prospective cohort study included all psychiatric patients admitted to the psychiatric clinic of Qazvin, Iran, during one month (23 August 2024 to 22 September 2024) using a census sampling method. Patients were followed by telephone at 6 and 12 months post-discharge to assess medication adherence and follow-up behaviors. Data were collected using a self-designed checklist covering demographic characteristics, psychiatrist visits, medication use, reasons for nonadherence, and relapse. Statistical analysis was performed using SPSS version 24, and associations were examined using Chi-Square Tests and t-tests, with significance set at p < 0.05.

Results: A total of 97 patients were included (66 males, 68.0%). Forty-nine patients (61.9%) had irregular psychiatrist visits, and 21 (21.6%) did not use prescribed medications after discharge. The most common reason for avoiding psychiatrist visits was drug-related complications (38.1%). Irregular follow-up was significantly associated with a higher number of prior hospitalizations (p = 0.04), non-use of prescribed medications (p < 0.01), disease recurrence (p < 0.01), and readmission (p < 0.01).

Conclusion: Both irregular psychiatrist visits and non-use of prescribed medications were common indicators of medication nonadherence among psychiatric patients after hospital discharge. Drug-related complications were the most frequently reported cause of poor adherence. Improving post-discharge monitoring, side-effect management, and patient education may enhance treatment adherence.

Background: In this study, we examine the association between renal function and asymptomatic bacteriuria in women of reproductive and Postmenopausal age.

Materials and Methods: This cross-sectional study was performed during 2 years (2022-2023) in Tehran, Iran. One hundred eighty-eight women of reproductive and Postmenopausal age with and without asymptomatic bacteriuria were enrolled in our study. The estimated glomerular filtration rate of all participants was evaluated. The association between reduced estimated glomerular filtration rate and asymptomatic bacteriuria was assessed, and the correlation between specific uropathogens and estimated glomerular filtration rate was analysed accordingly.

Results: The mean level of creatinine in all culture-positive samples (including E. coli and non-E. coli positive samples) was 0.85 mg/dl. At the same time, it was 0.77 mg/dL in culture-negative samples (P value < 0.05). The mean eGFR was 84.65 mL/min/1.73 m2 and 101.06 mL/min/1.73 m2 in culture-positive and culture-negative urine samples, respectively (P value < 0.05).

Conclusion: The estimated glomerular filtration rate was significantly lower in the culture-positive group, indicating a meaningful correlation between estimated glomerular filtration rate and asymptomatic bacteriuria. The blood urea nitrogen levels, however, were almost equal across the two culture result groups, indicating no meaningful correlation between blood urea nitrogen and asymptomatic bacteriuria. When comparing the etiologies of infection (E. coli vs. other bacterial culprits), there was no significant difference in estimated glomerular filtration rate between culture-positive patients.

Background: Identifying pre-transplant predictors of postoperative complications and survival following liver transplantation can improve patient outcomes and resource allocation. This study aimed to assess the predictive role of laboratory biomarkers and imaging-based parameters in post-transplant complications and patient survival.

Materials and Methods: In this cross-sectional study, data from patients aged 17–75 years undergoing liver transplantation from deceased donors between October 2019 and December 2023 were retrospectively analyzed. Patients with malignancy, cardiovascular diseases, living donor transplants, or incomplete data were excluded. Preoperative clinical variables included demographics, MELD score, vascular features, biochemical laboratory parameters, and imaging-based muscle metrics (Skeletal Muscle Area, Skeletal Muscle Index, Skeletal Muscle Radiodensity Assessment, myosteatosis). Postoperative complications, survival status, and associated predictors were evaluated using appropriate statistical tests.

Results: Of 79 patients (mean age 49.4 ± 12.2 years, 58.2% male), complications occurred in 39 (49.4%). Male sex (p=0.015) and lower SMRA (p=0.008) were significantly associated with postoperative complications. Patients who died had substantially higher MELD scores (23.3 ± 10.6) than survivors (17.3 ± 7.7; p=0.037). Portosystemic collaterals were significantly less frequent among patients with complications (23% vs. 50%, p=0.019). Routine biochemical laboratory parameters, SMA, SMI, myosteatosis, and vascular diameters were not significantly associated with outcomes. Kaplan-Meier survival analysis demonstrated an 85% survival rate at one year, with mortality primarily occurring within the first three months post-transplant.

Conclusion: Pre-transplant MELD score tends to predict survival, whereas lower SMRA, male sex, and the absence of portosystemic collaterals may predict postoperative complications. Identifying these factors can enhance risk stratification and perioperative management in liver transplant recipients.

Background: Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus that burdens patients’ psychophysical activities. Some studies mentioned that antidepressants, as common drugs that are widely prescribed to diabetics because of their psychiatric problems, may worsen diabetic foot ulcers and their outcomes. However, the results of studies lack consensus. In this study, we aimed to review the results of previous studies regarding the relationship between antidepressant use and diabetic foot ulcer.

Materials and Methods: The keywords “antidepressant” AND/OR “diabetic foot ulcer” AND/OR “diabetic foot” were searched in the PubMed, MEDLINE, and Elsevier databases (from the beginning of 2015 to the end of 2025). Review articles, in-vitro studies, meta-analyses, systematic reviews, editorials, non-English full-text, and not-reachable full-text studies were excluded.

Results: Seven studies were assessed from 87 articles. Most of them (5 of 7) showed that antidepressant use worsened DFU or amputation-related conditions like re-infection. However, one study revealed that antidepressants improved the related condition, and another study mentioned that there is no association between antidepressants and DFU.

Conclusion: Although some studies revealed that antidepressants may increase the risk of DFU and amputation, further studies should investigate this relationship because there are limited studies in this respect.

Background: Post-bariatric surgery weight regain, or lack of optimal weight loss, are two common problems after bariatric surgery. Some studies recommend the administration of glucagon-like peptide-1 (GLP-1) agonists for weight loss in these conditions. In this study, we aimed to review prior studies evaluating the effects of GLP-1 after bariatric surgery.

Materials and Methods: In this narrative review, we reviewed studies from 2015 to 2025 using the keywords “bariatric surgery,” “GLP1,”  “Glucagon-like peptide-1,” “sleeve gastrectomy,” “Roux-en-Y,” and “Gastric Bypass.” Keywords were searched in PubMed/MEDLINE, Web of Science, EMBASE/Elsevier, Scopus, and CENTRAL. After considering the exclusion criteria, ten studies were enrolled in the review.

Results: GLP1 agonists significantly reduced weight in patients who did not experience weight loss as expected and in patients who experienced weight regain. Different types of GLP1 agonists had different effectiveness; in this respect, semaglutide had better effects than Liraglutide. Side effects of GLP1 agonists were tolerable and primarily gastrointestinal.

Conclusion: GLP1 agonists are safe and effective therapies for weight regain or suboptimal weight loss after bariatric surgery.

Background: Fluid-electrolyte balance is regulated within a narrow range in diabetes insipidus (DI). Coexisting Primary Polydipsia and the related phenomenon of hyponatremia cause considerable mortality and morbidity.

Cases Report: A 70-year-old woman with a history of central diabetes insipidus was referred to our center with a provisional diagnosis of acute-onset hyponatremia due to increased usage of DDAVP spray, who was admitted and treated carefully. According to daily monitoring of electrolytes and urine output, switching from spray to nightly melt DDAVP administration,  the patient continued to display symptoms of polyuria, polydipsia, and low sodium levels. It led to a psychiatric consultation due to suspicion of accompanying Primary Polydipsia after experiencing a stressful event.

Prescription of anti-anxiety and sedative medications showed successful resolution of hyponatremia, highlighting the importance of personalized strategies in managing the multifactorial aspects of DI and PP.

Conclusion: This case underscores the complexities and potential remedies for handling DI in patients with underlying psychiatric conditions, emphasizing the necessity of a collaborative approach to optimize patient outcomes.