Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: Breast cancer outcomes vary widely, creating a need for accessible biomarkers that reflect tumor burden and systemic inflammation during chemotherapy. CA15 3 and CRP may provide complementary prognostic and predictive information. This study aims to evaluate the prognostic value and predictive utility of CA15 3 and CRP in patients with breast cancer undergoing chemotherapy.

Material and methods: This descriptive cross-sectional study will be conducted at Shahid Madani Hospital, Tabriz University of Medical Sciences, using convenience sampling to enroll 70 breast cancer patients undergoing chemotherapy. Demographic, clinicopathological, and treatment data, along with serum CA15-3 and CRP levels, will be collected and analyzed using appropriate descriptive and inferential statistics.

Results: In 70 patients with breast cancer undergoing chemotherapy, the mean age was 49.8 ± 10.7 years; 80.0% had invasive ductal carcinoma, 70.0% had lymph node involvement, and 18.6% had metastasis. Median CA15-3 and CRP levels were 31.5 U/mL and 8.9 mg/L, respectively.

Conclusion: These findings indicate that CA15-3 and CRP reflect related but non-identical biological dimensions in patients with breast cancer undergoing chemotherapy. While CA15-3 appears to represent tumor-associated activity, CRP likely captures the accompanying systemic inflammatory response.

Abstract Dysphagia is a frequent and clinically significant complication following esophageal surgery, particularly esophagectomy, and it poses substantial challenges in the postoperative management of critically ill patients. Impaired swallowing after surgery may arise from multiple mechanisms, including anatomical alterations, neural injury, postoperative inflammation, motility disorders, and anastomotic strictures. These factors can disrupt the coordinated physiological process of swallowing and increase the risk of serious complications. In the intensive care unit (ICU), early identification and appropriate management of dysphagia are essential to prevent adverse outcomes such as aspiration pneumonia, malnutrition, dehydration, and prolonged hospitalization. Comprehensive evaluation strategies—including bedside clinical assessment, standardized screening tests, and instrumental diagnostic methods such as videofluoroscopic swallow study and fiberoptic endoscopic evaluation of swallowing—play a crucial role in detecting swallowing dysfunction and guiding clinical decisions. Nutritional management is another key component of postoperative care, as patients with dysphagia often experience inadequate oral intake during the early recovery phase. Early initiation of nutritional support, preferably through enteral routes, helps maintain metabolic stability and supports tissue healing. Multidisciplinary collaboration among intensivists, surgeons, dietitians, and speech language pathologists is fundamental for optimizing patient outcomes. Rehabilitation strategies, including swallowing therapy, postural adjustments, and targeted muscle exercises, can facilitate functional recovery and reduce aspiration risk. In addition, structured ICU protocols and enhanced recovery pathways may contribute to improved postoperative outcomes by promoting safe nutritional progression and coordinated care.

Abstract Introduction: Cardiac surgery is associated with substantial oxidative stress due to surgical trauma, cardiopulmonary bypass, and ischemia–reperfusion injury, which may contribute to postoperative organ dysfunction. Dexmedetomidine has shown potential antioxidative and organ-protective effects. Therefore, this study aimed to systematically review the effect of intraoperative intravenous dexmedetomidine on oxidative stress in patients undergoing cardiac surgery.

Material and methods: This systematic review followed PRISMA guidelines to identify clinical studies on intraoperative intravenous dexmedetomidine and oxidative stress in cardiac surgery. Multiple databases were searched without time limits by two independent reviewers using Boolean-based keywords. Eligible studies were screened, quality-assessed with the Cochrane Risk of Bias tool, and relevant study, patient, intervention, and outcome data were extracted.

Results: Across clinical and experimental cardiopulmonary bypass-related settings, intraoperative intravenous dexmedetomidine showed a broadly protective profile. It attenuated perioperative stress responses, reduced selected markers of myocardial injury and inflammation, improved hemodynamic and recovery outcomes, and lowered postoperative atrial fibrillation. Experimental evidence further indicated direct cardiomyocyte protection through antioxidant, antiapoptotic, autophagy-regulating, electrophysiological, and transcriptional mechanisms.

Conclusion: The available evidence suggests that intraoperative intravenous dexmedetomidine may mitigate oxidative stress-related injury during cardiac surgery through both systemic and cellular mechanisms. Its benefits appear to include attenuation of surgical stress, reduction of selected inflammatory and myocardial injury markers, and improvement in postoperative recovery. These findings support dexmedetomidine as a promising cardioprotective adjunct in cardiac surgical care.

Abstract Introduction: Intravenous dexmedetomidine may influence cardiomyocyte biology through effects on apoptosis, inflammation, oxidative stress, and mitochondrial function, with possible relevance in perioperative and critical care settings. However, available evidence remains heterogeneous and translationally uncertain. This study aims to systematically evaluate its cellular effects on cardiomyocytes and clarify their clinical relevance.

Material and methods: This systematic review followed PRISMA guidelines, searched PubMed, Scopus, Web of Science, and Embase without time restriction using Boolean operators, and included original English studies on intravenous dexmedetomidine and cardiomyocyte biology. Study selection and quality assessment were performed independently by two reviewers, and key methodological and outcome data were extracted from each article.

Results: Dexmedetomidine consistently exerts direct cardiomyocyte-protective effects by attenuating apoptosis, oxidative stress, and inflammation across various stress models. Key mechanisms include activation of antioxidant pathways, enhanced autophagic flux via adrenergic signaling, and epigenetic regulation of anti-inflammatory axes. Additionally, it modulates electrophysiological properties by suppressing sodium and calcium currents, demonstrating a pleiotropic capacity to preserve cellular homeostasis and functional integrity.

Conclusion: Dexmedetomidine functions as a potent pleiotropic modulator of cardiomyocyte biology, providing robust protection against ischemic and oxygen-related stress. Beyond its sedative properties, it directly influences survival signaling, redox balance, and electrophysiology through diverse molecular pathways. These findings underscore its potential as a targeted cardioprotective agent, necessitating further clinical exploration to translate these cellular benefits into perioperative patient care.

Abstract Enhanced Recovery After Surgery (ERAS) has emerged as an important perioperative framework for improving outcomes after thoracotomy, particularly in patients requiring intensive postoperative care. This review examines current evidence and practical strategies for applying ERAS principles in the intensive care unit after thoracic surgery. Key components include preoperative optimization through patient education, pulmonary assessment, smoking cessation, nutritional support, and anesthetic planning; intraoperative measures such as appropriate surgical technique selection, goal-directed fluid therapy, targeted anesthesia, multimodal analgesia, and tissue-sparing practice; and postoperative ICU management focused on hemodynamic monitoring, ventilatory support, pain control, chest tube care, mobilization, respiratory physiotherapy, and early nutritional intervention. Collectively, these measures aim to reduce pulmonary complications, shorten ICU and hospital stay, improve functional recovery, and enhance quality of life. The review also highlights important barriers to implementation, including protocol variability, limited resources, and the complexity of critically ill thoracic patients. Overall, ERAS provides a structured and multidisciplinary approach that aligns perioperative care with modern goals of safety, efficiency, and patient-centered recovery after thoracotomy.

Abstract Introduction: Laparoscopic hysterectomy is widely performed due to its minimally invasive nature and faster recovery compared with open surgery; however, acute postoperative pain remains a common clinical challenge that may affect recovery and patient satisfaction. Various patient-related factors may influence pain perception. Therefore, this study aimed to investigate the association between age and the incidence of acute postoperative pain following laparoscopic hysterectomy.

Material and methods: This cross sectional study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences and included 73 patients undergoing laparoscopic hysterectomy, with sample size determined using the single proportion prevalence formula. Variables assessed included age, BMI, comorbidities, surgical duration, anesthesia type, and acute postoperative pain severity measured by the Visual Analog Scale within 24 hours after surgery.

Results: Postoperative pain was common, with a mean VAS score of 4.28 ± 1.86 and an incidence of 76.71%. Moderate pain was most frequent, and younger patients reported significantly higher pain levels, while pain decreased progressively with age (ANOVA p = 0.018). Age showed a strong negative correlation with VAS scores (r = −0.711, p = 0.001), indicating markedly lower pain intensity in older patients.

Conclusion: Age demonstrated a clear inverse relationship with acute postoperative pain following laparoscopic hysterectomy, with younger patients reporting higher pain intensity and greater analgesic needs. These findings highlight the importance of age responsive pain management protocols to ensure individualized postoperative care and optimized recovery outcomes.

Abstract Introduction: Esophagectomy-induced systemic inflammation, specifically elevated TNF-α, significantly contributes to postoperative delirium. Dexmedetomidine may mitigate this cognitive decline through its potent anti-inflammatory and neuroprotective effects. This study investigates whether dexmedetomidine prevents postoperative delirium by modulating TNF-α levels in patients undergoing esophagectomy.

Material and methods: This prospective randomized study was conducted in 2023 at Imam Reza Hospital, Tabriz University of Medical Sciences. Fifty patients (25 per group), determined using the two independent sample formula, were enrolled. The primary variables included perioperative TNF α levels and the incidence of postoperative delirium, along with demographic characteristics, intraoperative hemodynamics, anesthetic requirements, and ICU stay duration.

Results: Dexmedetomidine significantly attenuated postoperative TNF α elevation compared with control, with a significant time by group interaction (P = 0.002) and lower TNF α levels at the end of surgery (P = 0.003) and 24 hours postoperatively (P < 0.001). The incidence of postoperative delirium was reduced (16.00% vs. 40.00%, P = 0.048), with delayed onset (P = 0.011), shorter duration (P = 0.004), and lower CAM ICU scores (P = 0.002). Peak TNF α levels correlated positively with delirium severity (r = 0.79, P < 0.001).

Conclusion: Perioperative dexmedetomidine administration reduced postoperative delirium and mitigated its severity following esophagectomy, likely through suppression of TNF α–mediated inflammatory responses. The observed association between inflammatory burden and delirium severity supports a mechanistic link between systemic inflammation and postoperative neurocognitive dysfunction.

Abstract Introduction: Prosthetic joint infection (PJI) remains one of the most serious complications following total knee arthroplasty, leading to substantial morbidity, repeated surgical procedures, and increased healthcare burden. These infections are primarily driven by bacterial colonization and biofilm formation on implant surfaces. Given the variability in reported causative microorganisms, the aim of this study was to systematically review the literature to identify the bacterial pathogens most commonly associated with PJI after total knee arthroplasty.

Material and methods: This systematic review followed PRISMA guidelines to identify bacterial pathogens associated with prosthetic joint infection after total knee arthroplasty. Studies were retrieved from PubMed, Web of Science, ScienceDirect, and Google Scholar using structured keywords. Two reviewers independently screened articles, and methodological quality of eligible observational studies was assessed using the Joanna Briggs Institute appraisal tools.

Results: Across four published case reports (n = 4), Ruminococcus/Mediterraneibacter gnavus was implicated in prosthetic joint infection (25%), deep surgical site infection (25%), bacteraemia (25%), and septic arthritis (25%), predominantly in elderly or immunocompromised patients. Identification relied on MALDI-TOF and/or 16S rRNA sequencing in all cases (100%), and favorable clinical outcomes were achieved with combined surgical management and targeted antibiotic therapy in the majority of reported infections.

Conclusion: Mediterraneibacter gnavus should be recognized as a rare but clinically significant opportunistic pathogen capable of causing orthopedic and systemic infections. Accurate diagnosis depends on advanced microbiological techniques, and outcomes appear favorable with timely surgical intervention and targeted antimicrobial therapy. Increased awareness may facilitate earlier detection and appropriate management.