Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: Acute postoperative pain remains a common concern following laparoscopic hysterectomy despite its minimally invasive nature. Pain severity is influenced by a complex interplay of patient characteristics, preexisting pain, psychological factors, surgical technique, and perioperative management. Identifying high‑risk patients is essential for optimizing analgesic strategies, enhancing recovery, and preventing long‑term pain‑related complications.

Material and methods: This observational study prospectively collected demographic and perioperative clinical data and followed patients through structured telephone interviews up to six months after surgery. Acute and chronic postoperative pain were assessed using validated numeric scales, alongside analgesic use and functional impact, allowing comprehensive evaluation of pain severity, distribution, and its influence on daily activities.

Results: In this cohort of women undergoing laparoscopic hysterectomy, postoperative pain declined progressively over time, with most patients achieving minimal pain by six months. Although chronic postsurgical pain affected a minority, pelvic and incisional pain predominated. Analgesic requirements varied, while functional impairment was generally limited, highlighting favorable pain recovery trajectories overall.

Conclusion: these findings reinforce the effectiveness of laparoscopic hysterectomy as a minimally invasive procedure with generally favorable pain and functional outcomes, while also highlighting the complexity of pain recovery in a minority of patients.

Abstract Introduction: Pediatric abdominal surgery is associated with significant postoperative morbidity, influenced not only by surgical factors but also by perioperative anesthetic management. Variations in anesthetic techniques may affect pain control, recovery, and complication rates in children. Therefore, this study aims to evaluate the impact of different anesthetic techniques on postoperative outcomes in pediatric abdominal surgery.

Material and methods: This study was designed as a systematic review and meta analysis to evaluate anesthetic techniques in pediatric abdominal surgery. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Embase to synthesize available evidence on postoperative outcomes in children.

Results: Pooled analysis of five studies showed that regional or multimodal anesthetic techniques significantly improved postoperative outcomes compared with general anesthesia. These approaches reduced pain intensity (SMD = −0.82, 95% CI −1.15 to −0.49; I² = 42%) and shortened hospital stay (MD = −1.34 days, 95% CI −1.98 to −0.70; I² = 46%), indicating consistent clinical benefits.

Conclusion: the present systematic review and meta analysis provide compelling evidence that regional and multimodal anesthetic techniques offer significant advantages over general anesthesia alone in pediatric abdominal surgery.

Abstract Introduction: Critically ill patients with COVID 19 exhibit a pronounced hypercoagulable state, predisposing them to deep vein thrombosis during ICU admission. Inflammation driven endothelial dysfunction, hypoxia, and immobilization contribute to this elevated risk. Determining the true prevalence of DVT in this population is essential for optimizing thromboprophylaxis strategies and improving clinical outcomes.

Material and methods: This retrospective observational study evaluated critically ill patients with concurrent COVID 19 and active malignancy admitted to a tertiary ICU. Clinical records, laboratory parameters, and imaging confirmed thrombotic events were systematically analyzed. Multivariable logistic regression was applied to identify independent risk factors for vascular thrombosis, providing clinically relevant insights for risk stratification and management in this high risk population.

Results: Thrombotic complications occurred in 28.3% of critically ill ICU patients with concurrent COVID 19 and active malignancy, while 71.7% remained free of thrombosis (P < 0.001). Among affected patients, venous thromboembolism predominated, with lower extremity deep vein thrombosis and pulmonary embolism being the most frequent manifestations, whereas arterial, cerebral, and coronary events were uncommon.

Conclusion: In conclusion, thrombotic complications remain a common and clinically significant problem among ICU patients with concurrent COVID 19 and active malignancy. Venous thromboembolism predominates, and its occurrence is associated with older age, higher BMI, specific cancer types, greater comorbidity burden, prolonged ICU stay, increased need for mechanical ventilation, and higher mortality.

Abstract Introduction: Gastroesophageal junction cancers show variable responses to chemo-induction, highlighting the need for predictive biomarkers. PD-L1, through its role in tumor–immune interactions, may help identify patients more likely to benefit from preoperative treatment. This study aimed to retrospectively evaluate chemo-induction outcomes in GEJ cancers with emphasis on PD-L1 as a predictive pathologic biomarker.

Material and methods: This retrospective cross-sectional study, approved by the Tabriz University of Medical Sciences Ethics Committee, evaluated 100 gastroesophageal junction cancer patients at Shahid Madani Hospital. Using accessible sampling, clinical data and PD-L1 expression were analyzed. Statistical analyses, including chi-square tests and logistic regression, were performed to identify predictors of pathological response.

Results: In 100 patients, baseline variables were comparable between the dexmedetomidine and lidocaine groups (all p > 0.05). Infusion duration, surgery time, anesthesia time, treatment completion, pathological findings, treatment response, and PD-L1 positivity did not differ significantly between groups. Only total study drug dose differed significantly (92.6 ± 18.4 µg vs. 248.3 ± 41.7 mg, p < 0.001).

Conclusion: These findings indicate that dexmedetomidine and lidocaine were associated with broadly similar perioperative, pathological, and immunohistochemical outcomes in this cohort. The absence of significant between-group differences in pathological response and PD-L1 expression suggests that neither intervention demonstrated clear superiority in influencing tumor-related postoperative characteristics.

Abstract Introduction: Serum creatinine continues to serve as a key marker for evaluating renal function in the perioperative setting. The early postoperative period, particularly the first 48 hours after major surgery, is a critical timeframe during which subtle biochemical changes may signal evolving kidney stress or injury.

Material and methods: This prospective observational study was conducted in 2025 at Shohada Hospital, Tabriz, to evaluate serum creatinine changes during the first 48 postoperative hours following intraoperative furosemide administration in major surgery patients. Fifty participants were enrolled through convenience sampling. Serum creatinine was measured preoperatively and every six hours postoperatively.

Results: Serum creatinine increased significantly during the first 48 postoperative hours following intraoperative diuretic administration, rising from a baseline median of 0.96 mg/dL (IQR: 0.84–1.10) to a peak of 1.15 mg/dL (IQR: 1.00–1.35) at approximately 30 hours (P < 0.001). Patients aged ≥45 years demonstrated greater postoperative elevations than younger individuals (P=0.018), while female patients showed slightly higher mid postoperative creatinine levels compared with males (P=0.041). Despite these differences, creatinine values gradually declined toward baseline by 48 hours.

Conclusion: Intraoperative diuretic administration was associated with temporary postoperative changes in serum creatinine that remained clinically modest and largely reversible. Advanced age and female sex appeared to influence the magnitude of renal biochemical responses. Careful perioperative renal monitoring, particularly in older patients, may help optimize postoperative management and facilitate early identification of transient renal function changes.

Abstract Introduction: Given the importance of maintaining cardiovascular stability during anesthesia and the potential influence of age on opioid responsiveness, further investigation into the hemodynamic effects of fentanyl across different age groups is warranted. The present study was designed to compare the hemodynamic responses associated with administration of 50 micrograms of fentanyl during general anesthesia among patients of different age categories.

Material and methods: This prospective study was conducted in 2025 at Shohada Hospital to evaluate age related hemodynamic responses to fentanyl during general anesthesia. A total of 100 patients were enrolled using convenience sampling and categorized into four age groups. All participants received 50 µg intravenous fentanyl during anesthetic induction. Hemodynamic parameters, including heart rate and blood pressure, were recorded every five minutes for one hour.

Results: Younger patients (18–30 years) exhibited higher baseline hemodynamic values and greater early fluctuations, whereas patients older than 50 years showed lower baseline values and more sustained declines. Significant time–age interactions were observed for heart rate (P = 0.021), systolic blood pressure (P = 0.014), and diastolic blood pressure (P = 0.018). Supplemental opioid requirements showed only modest intergroup variation.

Conclusion: Age significantly influences cardiovascular responses to fentanyl during general anesthesia. Older patients demonstrated greater hemodynamic vulnerability and less physiologic stability, while younger individuals exhibited more dynamic but transient cardiovascular changes. Despite these differences, supplemental opioid requirements remained relatively comparable among age groups, emphasizing the importance of individualized intraoperative monitoring and anesthetic management rather than opioid dosing based solely on chronological age.

Abstract Introduction: Given the ongoing interest in opioid sparing anesthesia and the importance of maintaining hemodynamic stability during surgery, investigation of reduced fentanyl dosing during anesthetic induction is clinically justified. Understanding the intraoperative consequences of administering half the conventional fentanyl dose may help clarify whether lower opioid exposure can effectively balance sympathetic suppression, cardiovascular stability, anesthetic adequacy, and postoperative recovery.

Material and methods: This prospective observational study was conducted at Shohada Hospital in 2025 on 50 patients undergoing surgery under general anesthesia to evaluate postoperative serum creatinine changes following intraoperative furosemide administration. Serum creatinine levels were measured every 6 hours during the first 48 postoperative hours using standardized laboratory methods.

Results: Heart rate and blood pressure parameters demonstrated significant temporal fluctuations during the first hour after anesthetic induction, with all hemodynamic changes reaching statistical significance (P<0.001). Heart rate showed an early transient increase followed by stabilization, while systolic and diastolic blood pressures initially decreased and gradually recovered over time. In addition, supplemental opioid requirement increased progressively during the first 6 intraoperative hours, with a significant overall variation in analgesic demand (P=0.032), indicating dynamic perioperative nociceptive responses.

Conclusion: Anesthetic induction was associated with transient but clinically controlled hemodynamic alterations during the early intraoperative period. Despite significant fluctuations in heart rate and blood pressure, overall cardiovascular stability was maintained throughout monitoring. Furthermore, the progressive increase in opioid requirement highlights the evolving nature of intraoperative nociceptive stimulation and emphasizes the importance of continuous analgesic titration during surgical procedures.

Abstract Introduction: In contemporary orthopedic practice, bone cement continues to play a vital role in achieving successful surgical outcomes and improving patient mobility and quality of life. Nevertheless, its utilization is accompanied by important physiological effects that demand careful consideration. Hemodynamic changes associated with bone cement application represent a significant perioperative challenge due to their unpredictable nature and potential severity.

Material and methods: This prospective observational study was conducted at Shohada Hospital in 2025 to evaluate hemodynamic changes and complications associated with bone cement use during orthopedic surgery. A total of 200 patients were enrolled through convenience sampling. Perioperative cardiovascular and respiratory parameters were continuously monitored and recorded at predefined intervals.

Results: Among 200 patients undergoing cemented orthopedic surgery, hypotension was the most common intraoperative complication (29.00%), followed by tachycardia (20.50%) and hypertension (17.00%). Suspected Bone Cement Implantation Syndrome (BCIS) occurred in 11.00% of cases, while severe Grade 3 BCIS was identified in 1.00% of patients. Hemodynamic complications were significantly associated with older age, higher ASA class, cardiovascular comorbidities, prolonged surgery duration, and the use of general anesthesia.

Conclusion: Bone cement utilization in orthopedic procedures is associated with clinically important hemodynamic alterations and varying degrees of BCIS. Although most complications were transient and manageable, elderly patients and those with significant comorbidities demonstrated a higher risk of perioperative instability.