Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Background: Venous insufficiency (acute and chronic) represents a significant vascular pathology, particularly prevalent in patients with increased body mass index (BMI). Overweight and obesity are associated with impaired venous hemodynamics, higher disease severity, and distinct therapeutic outcomes.

Objectives: To systematically evaluate the impact of overweight and obesity on acute and chronic venous insufficiency, with emphasis on surgical and endovascular intervention outcomes.

Methods: Databases (PubMed, ScienceDirect and others) were systematically searched for clinical and surgical studies comparing outcomes of venous interventions among normal-weight, overweight, and obese patients. Adult human studies published in English were included. Evidence was graded according to study design and clinical outcomes.

Results: Higher BMI correlates with greater severity of chronic venous insufficiency (CVI) and reduced improvement after procedural interventions such as thermal ablation or phlebectomy. Surgical outcomes are variably affected by BMI, with some studies showing poorer efficacy in patients with BMI ≥35 kg/m². Bariatric surgery–related weight loss may improve CVI manifestations. Evidence for acute venous insufficiency in overweight cohorts remains limited.

Conclusion: Evidence indicates that overweight and obesity negatively influence chronic venous insufficiency severity and surgical outcomes. Preoperative weight management and tailored surgical approaches are recommended for optimal outcomes.

Abstract Introduction: Re‑expansion pulmonary edema is a rare but serious complication following rapid lung re‑expansion in patients with massive pleural effusion. Chest tube insertion and video‑assisted thoracoscopic surgery are commonly used interventions, yet their relative risks for this condition remain unclear. Understanding incidence patterns and contributory factors is essential for optimizing procedural choice and improving patient safety.

Material and methods: This prospective clinical study enrolled adult patients with massive pleural effusion who were allocated to four intervention groups based on drainage volume and technique. Pleural fluid was evacuated via thoracoscopy or chest tube insertion under general anesthesia. Postoperative hypoxemia was evaluated using arterial blood gas analysis and chest radiography to identify re‑expansion pulmonary edema, with outcomes systematically recorded and analyzed.

Results: Baseline characteristics were comparable between groups. Video assisted thoracoscopic surgery was associated with a significantly lower incidence of re expansion pulmonary edema, improved post procedural oxygenation, fewer ICU admissions, and shorter hospital stay compared with chest tube drainage (all P ≤ 0.02), particularly in patients with massive pleural effusion, indicating superior early clinical outcomes with thoracoscopic management.

Conclusion: The results primarily reflect early postoperative outcomes and may not capture long term respiratory or functional differences between interventions. Additionally, procedural expertise and institutional experience with thoracoscopic surgery may influence outcomes and limit generalizability to settings with limited thoracoscopic resources.

Abstract Backroad and aim: One of the most common spinal disorders is spondylolisthesis, which leads to chronic pain, functional limitations, and neurological symptoms in the individual. Open surgery is the standard treatment for it, but it is associated with significant complications. Minimally invasive methods have been introduced, but strong comparative evidence on their effectiveness is limited. Therefore, the present study aimed to evaluate the efficacy and safety of minimally invasive versus open spinal fusion techniques for spondylolisthesis.

Method: In the present study, PubMed, Embase, Cochrane Library, and Web of Science databases were searched between 2015 and 2025 with targeted keywords. Ten relevant studies, including randomized clinical trials and retrospective and prospective cohorts, were included in the analysis. The quality of the studies was assessed using the Cochrane RoB2 tool and the Newcastle–Ottawa Scale, and the evidence was assessed using the GRADE framework. Meta-analysis was performed using stata.v17 software.

Result: The meta-analysis showed that MI methods significantly reduced patients' leg pain and functional disability (MD = -1.44 for leg pain, -2.91 for ODI). The mean difference in back pain between the two groups was not significant (MD = -1.04, p=0.069). The quality of evidence for most outcomes was moderate to high.

Conclusion: Minimally invasive procedures are a suitable and effective option for treating spondylolisthesis for OS replacement; however, it is important to consider the patient's clinical condition and treatment goals.

Abstract Background and aim: Cervical spine surgeries are associated with a risk of neurological complications. Intraoperative neurological monitoring (IONM) is used as a tool to prevent these complications, but the results of previous studies are conflicting. , the present study aimed to investigate the effectiveness of IONM in preventing neurological complications during cervical spine surgery.
Method: present systematic review and meta-analysis included 12 cohort studies from international databases, PubMed, Scopus, Web of Science, and Embase, from January 1, 2015 to May 10, 2025, using keywords aligned with the study objective. The statistical analysis was performed with Stata/MP.v17 as fixed effect models.
Result: The sensitivity of IONM was 0.916 (95% CI: 0.872–0.960) and specificity was 0.851 (95% CI: 0.827–0.876). The positive predictive value (PPV) was estimated to be 0.926 (95% CI: 0.902–0.951) and the negative predictive value (NPV) was estimated to be 0.833 (95% CI: 0.751–0.916).
Conclusion: IONM is a highly sensitive and specific tool for preventing neurological complications during cervical spine surgeries. Despite the positive effect, heterogeneity between studies and differences in protocols indicate the need for further studies and standardization of monitoring protocols.

Abstract Introduction: Traumatic nasal surgery commonly leads to early postoperative complications that may affect airway stability, patient comfort, and overall recovery quality. Understanding the frequency and pattern of these events is essential for improving perioperative management. By systematically evaluating outcomes within the first 24 hours after surgery, this study aims to provide clearer insight into the early postoperative course of affected patients.

Material and methods: The study was designed as an observational investigation conducted at Imam Reza Hospital in Tabriz, enrolling 50 patients based on a sample size estimated using the standard population mean formula. All participants underwent general anesthesia with midazolam, fentanyl, propofol, atracurium, and lidocaine, followed by structured postoperative monitoring to assess early complications within the first 24 hours after traumatic nasal surgery.

Results: The study population consisted of young, mostly healthy patients, predominantly male, with stable baseline characteristics. Post‑anesthesia complications were generally mild, with nausea being the most common, followed by dizziness and shivering. Vomiting and bradycardia occurred infrequently. Age‑ and gender‑based synthetic comparisons showed similar patterns, suggesting minimal influence of demographic factors within this narrow clinical profile.

Conclusion: Overall, the findings demonstrate that postoperative complications in this young and clinically stable cohort were limited in severity and largely dominated by nausea, dizziness, and shivering. The uniform distribution of events across age and gender groups suggests that demographic factors played a minor role in early postoperative risk.

Abstract Introduction: Acute postoperative pain is common after traumatic nasal surgeries, even when regional anesthesia is used. Pethidine remains an essential rescue analgesic for breakthrough pain. Evaluating its usage trend helps assess the adequacy of nerve blocks, identify rebound pain, and optimize multimodal analgesia strategies to ensure effective, individualized postoperative pain management in these patients.

Material and methods: This observational study at Imam Reza Hospital (Tabriz University of Medical Sciences) evaluated trends in pethidine requirements after traumatic nasal surgery under regional anesthesia. A convenience sample of 50 adults was enrolled based on the single population proportion formula. Standardized anesthesia with midazolam, fentanyl, lidocaine, and supplemental propofol was used, and postoperative pain and complications were assessed over 24 hours.

Results: The analysis showed that most patients were young adults with BMI values clustered within the normal to overweight range. Pethidine requirements peaked shortly after recovery-room discharge and declined steadily over 24 hours. Patients with higher BMI demonstrated noticeably greater opioid consumption, suggesting that anthropometric characteristics play a meaningful role in shaping postoperative pain intensity and analgesic demand.

Conclusion: These findings indicate that acute postoperative pain following traumatic nasal surgery is most intense during the early hours and that BMI is a key determinant of increased pethidine need. While regional anesthesia effectively reduces overall analgesic demand, patients with elevated BMI may benefit from reinforced pain control strategies. Overall, adopting individualized, risk adjusted analgesic plans could enhance patient comfort, limit opioid exposure, and improve postoperative recovery outcomes.

Abstract Background: The interval between completion of neoadjuvant chemotherapy (NACT) and definitive surgery is variably reported to influence pathological complete response (pCR) rates across tumor types. This systematic review synthesizes evidence on how surgery timing after NACT affects pCR rates and examines the role of radiological assessment (MRI, CT, PET/CT, ultrasound) in guiding timing decisions.

Methods: We searched PubMed, Embase, Web of Science, and Cochrane CENTRAL from inception to [search date] for studies comparing different time-to-surgery (TTS) intervals after NACT with reported pCR outcomes and reporting radiological response measures. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Outcomes were summarized qualitatively and, where feasible, meta-analyzed using random-effects models. Heterogeneity was quantified with I² and explored via subgroup and sensitivity analyses.

Results: [Number] studies (n = [total patients]) across breast, rectal, esophageal, gastric, lung, and other cancers met inclusion criteria. Studies used a range of TTS cutpoints (e.g., <4 vs ≥4 weeks; <8 vs ≥8 weeks; 6–12 weeks windows). Several retrospective and cohort studies reported higher pCR rates with modestly longer intervals (commonly 6–12 weeks) after NACT/nCRT in certain tumor types (rectal cancer, esophageal, gastric), while other reports—especially in breast and NSCLC—showed mixed or null effects and potential trade-offs with postoperative complications or oncologic outcomes.

Conclusions: Current evidence suggests that modest delays (approximately 6–12 weeks from NACT completion) may be associated with increased pCR rates in some cancers treated with neoadjuvant chemoradiation or chemotherapy, but benefits are heterogeneous and tumor-specific.