Yekta Ghane

Background and Aims: In anesthesia and analgesia, opioids alone or in combination with local anesthetics (bupivacaine, lidocaine, and ropivacaine) have been investigated to prolong peripheral nerve blocks. Ultra‐low‐dose naloxone administration in local anesthetic solutions could lengthen sensory and motor blocks through enhanced opioid effects or direct antagonistic effects on the receptors. We aim to assess the role of ultra‐low‐dose naloxone as an additive in anesthesia duration, motor, and sensory block duration, visual analog scale (VAS) scores, opioid consumption, and the incidence of postoperative complications. Methods: A systematic search was conducted in PubMed/Medline, Ovid Embase, and Web of Science up to November 23rd, 2023, and 840 records were retrieved and screened. Accordingly, seven randomized controlled trials met the eligibility criteria and were included for data extraction. The National Institute of Health's (NIH) Quality Assessment Tool for Clinical Trials was used for critical appraisal of the studies. Results: The effects of ultra‐low‐dose naloxone on intravenous regional anesthesia and various nerve blocks (including axillary and supraclavicular brachial plexus, peribulbar, femoral, and intercostal nerve block) were assessed. The administration of naloxone at doses of 100 and 50 ng as an additive to bupivacaine, lidocaine, and ropivacaine was associated with longer postoperative analgesia, prolonged motor and/or sensory block, lower postoperative opioid or analgesic consumption, and lower VAS pain scores in several included studies. Besides, in most studies, postoperative complications did not significantly differ between the groups. Conclusion: The available evidence suggests that ultra‐low‐dose naloxone may be associated with prolonged postoperative analgesia and, in some studies, longer motor and/or sensory block duration and reduced postoperative opioid consumption. These findings should be interpreted as observations reported by individual studies rather than definitive treatment effects. Although no major safety concerns were identified, the available evidence is insufficient to establish the overall safety or efficacy of ultra‐low‐dose naloxone.

Background: Ferula assa-foetida L. has traditionally been used to treat various diseases, including infections, asthma, stomach aches, and flatulence. Previous studies have highlighted its anti-inflammatory, anti-oxidative, anti-diabetic, neuroprotective, and nerve-stimulating properties. Objective: This study aimed to evaluate the therapeutic effects and molecular mechanisms of action of the oleo-gum resin from Ferula assa-foetida L. in an animal model of diabetic neuropathy (DN). Methods: The essential oil of oleo-gum resin from Ferula assa-foetida L. was analyzed using Gas Chromatography-Mass Spectrometric Analysis. Forty-two male Wistar rats were included in the study, with diabetes induced via streptozotocin (STZ) injection. The rats were randomly assigned to seven groups (n=6 per group) and treated with different doses of Ferula assa-foetida L. extract (100, 200 mg/kg/day) or oil (10, 20 mg/kg/day), alongside appropriate control groups. After a five-week treatment period, samples of dorsal root ganglia (DRG), pancreatic tissue, and blood were collected. Key parameters assessed included blood glucose and insulin levels, motor function tests, oxidative stress protein generation, pro-inflammatory cytokine gene expression, and histopathological analyses. Results: Treatment with various doses of Ferula assa-foetida L. extract or oil, as well as gabapentin, led to significant improvements. These included reduced blood sugar levels, increased insulin levels, and improved glycemic control. Motor function was enhanced, while the expression of pro-inflammatory cytokines and oxidative stress markers was significantly reduced. Conclusion: These findings indicate a promising therapeutic approach for managing DN. Further studies are warranted to elucidate the underlying mechanisms of Ferula assa-foetida L.'s beneficial effects in DN.

Background: Coronary artery disease (CAD) is the leading cause of death worldwide. Among women, CAD is often underestimated, resulting in underdiagnosis and undertreatment. This study aimed to assess the prevalence of CAD and its risk factors in adult women, using data from the Tehran Cohort Study (TeCS). Methods: We analyzed data from 4478 women with complete CAD information collected during the TeCS recruitment phase. The age‐weighted prevalence of CAD was estimated using the 2016 national census data and previous CAD diagnoses. Logistic regression models were applied to identify factors independently associated with CAD in women. Results: The overall prevalence of CAD was 4.48% (mean age: 53.0 ± 12.37 years), with an age‐weighted prevalence of 4.1% (95% CI: 3.1%–5.4%). Increasing age was strongly associated with CAD, with women aged ≥ 75 years showing markedly higher odds (OR: 11.94, 95% CI: 3.93–36.31, p < 0.001). Hypertension (OR: 2.58, 95% CI: 1.75–3.80, p < 0.001), hyperlipidemia (OR: 2.25, 95% CI: 1.55–3.24, p < 0.001), and diabetes mellitus (OR: 2.07, 95% CI: 1.49–2.88, p < 0.001) were also significant determinants of CAD. Older age groups exhibited a higher prevalence of CAD risk factors. Within the CAD group, a greater proportion of women had multiple comorbid risk factors compared with their non‐CAD counterparts in the same age categories. Conclusion: The prevalence of CAD and its associated risk factors among women in Tehran is substantial. These findings highlight the need for targeted preventive strategies to reduce CAD incidence in vulnerable female populations.

Background and aim Autoimmune blistering diseases (AIBDs), including pemphigus diseases, pemphigoid diseases, linear immunoglobulin A (IgA) bullous dermatosis (LABD), epidermolysis bullosa acquisita (EBA), and dermatitis herpetiformis (DH), are a group of diseases clinically characterized by erosions and blisters that involve the skin and mucosa. Tumor necrosis factor-alpha (TNF-α), a key inflammatory cytokine, plays a critical role in their pathogenesis. TNF-α inhibitors are used for their immunomodulatory effects but may also induce paradoxical autoimmune blistering. This systematic review aimed to synthesize current evidence on therapeutic and paradoxical effects of TNF-α inhibitors in these diseases. Method A systematic search of PubMed, Scopus, and Embase was conducted up to March 7th, 2025, following PRISMA guidelines. Studies eligible for inclusion were original human research articles in English reporting therapeutic or paradoxical effects of TNF-α inhibitors, including infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab, on autoimmune bullous diseases. Risk of bias was evaluated using the NIH and Murad et al. assessment tools. Results A total of 35 studies with 68 patients were included in the treatment application group and 29 studies with 31 subjects were included in the paradoxical reaction group. Infliximab was most frequently associated with favorable outcomes in pemphigus vulgaris (PV), bullous pemphigoid (BP), and EBA, with multiple reports of sustained remission. Etanercept showed partial to complete responses in some cases of PV and BP; however, it was associated with paradoxical induction of BP in several patients. Adalimumab demonstrated therapeutic efficacy in PV and MMP, yet was the most common agent implicated in paradoxical BP and LABD. Paradoxical effects were most often observed in patients treated for non-dermatologic conditions such as rheumatoid arthritis or Crohn’s disease. Conclusion TNF-α inhibitors, particularly infliximab, show therapeutic promise in refractory AIBDs. However, their potential to paradoxically induce blistering diseases, especially with adalimumab and etanercept, necessitates careful patient selection, close monitoring, and individualized risk–benefit assessment.

Background and aims : Primary localized cutaneous amyloidosis (PLCA) is a persistent dermatological disorder characterized by the accumulation of amyloid deposits within the dermal papillae, resulting in pigmentation alterations, pruritus, and textural modifications of the skin. Given the lack of a standardized treatment for this condition, this review aims to evaluate the efficacy and safety of various procedural modalities for PLCA management. Methods: PubMed/Medline, Scopus, and Web of Science were systematically searched until August 25th, 2024. The study selection was restricted to English-language clinical studies, excluding case reports and case series. Our study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. Results: Based on our inclusion criteria, 16 studies with 432 patients were included, assessing fractional CO₂ laser, Nd: YAG laser, Er: YAG laser, microneedling, and phototherapy for PLCA treatment. Fractional CO₂ laser effectively improved pigmentation and pruritus, especially when combined with corticosteroids or vitamin C. Nd: YAG and Er: YAG lasers demonstrated favorable outcomes, with combination therapies enhancing efficacy. Microneedling and phototherapy (PUVA/UVB) also showed benefits, with PUVA being superior for pruritus. Conclusion: Fractional CO₂ laser, especially with corticosteroids or vitamin C, showed the most effective results for pigmentation, pruritus, and amyloid reduction in PLCA. Nd: YAG and Erbium lasers, microneedling, and phototherapy also demonstrated benefits. However, further comparative clinical trials are needed to determine the most effective approach and establish standardized treatment protocols.

Background Colorectal cancer (CRC) is a prevalent and deadly malignancy, often characterized by cellular heterogeneity and resistance to therapy. CD133, a proposed cancer stem cell marker, has been implicated in poor clinical outcomes, but its prognostic value remains controversial, particularly in diverse populations. Objective This study aimed to evaluate the relationship between CD133 expression and overall survival (OS) in patients with colorectal adenocarcinoma treated at Mousavi Hospital in Zanjan, Iran. Methods This retrospective cohort study analyzed 55 patients who underwent surgical resection for histologically confirmed colorectal adenocarcinoma between 2012 and 2017. CD133 expression was assessed using immunohistochemistry (IHC) and categorized as positive or negative. Associations with clinicopathological features and 5-year survival were examined using logistic regression and Cox proportional hazards (PH) models. Results CD133 expression was detected in 47.3% of tumors. It was significantly more prevalent in high-grade tumors (83.1% vs 18.7%, p = 0.001) and in female patients (66.7% vs 32.2%, p = 0.015). Five-year survival was significantly lower in CD133-positive patients (19.2%) compared to CD133-negative individuals (75.9%, p < 0.001). In multivariable Cox regression adjusted for tumor grade and age, CD133 positivity was associated with increased hazard of death (adjusted hazard ratio(HR) = 5.03; 95% confidence interval (CI) 1.66–15.25; p = 0.004). Because of the modest sample size and wide confidence intervals, this association should be considered preliminary. In crude analyses, tumor grade impacted survival; in the adjusted model, only CD133 remained remarkable, while age, sex, and tumor location showed no significant associations. Conclusions CD133 expression is significantly associated with high tumor grade and poor survival in Iranian CRC patients, but findings should be interpreted with caution, given the small cohort. Its evaluation could aid in identifying high-risk individuals and guiding personalized treatment strategies in larger confirmatory studies.

Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and discoid lupus erythematosus (DLE) are lymphocytic cicatricial alopecias causing irreversible follicular loss. Procedural therapies have been proposed to control inflammation, remodel scarred tissue, and, occasionally, promote hair regrowth. We performed a PRISMA-guided systematic review of PubMed/Medline, Ovid Embase, and Scopus through July 28, 2025, selecting original studies of procedural interventions for LPP, FFA, and DLE. We assessed methodological quality using NIH and Murad et al. tools. Thirty-eight studies comprising 411 patients were included, reporting lasers/light therapies, platelet-derived products, adipose/exosome injections, low-level light therapy (LLLT), intralesional corticosteroids (ILCS), carboxytherapy, microneedling, and hair transplantation. Outcomes reported were both subjective (patient-reported symptom change, global physician assessment) and objective (LPPAI/FFASS activity scores, terminal hair counts, hair shaft diameter, and photographic density). Platelet products most consistently reduced activity scores and improved symptoms; several reports also documented increases in terminal hair counts or shaft diameter. LLLT led to improved patient-reported outcomes and modest, measurable gains in hair counts/thickness in small series. ILCS reliably achieved disease stabilization and reductions in activity scores but yielded inconsistent objective regrowth. Hair transplantation resulted in good early cosmetic density in quiescent patients, with several studies documenting quantitative density at 6–24 months but progressive graft loss by 3–5 years. Adipose and exosome injections showed promising case-level increases in density/thickness, although the results remained preliminary. Adverse events were generally mild and procedure-specific. In hair transplantation, long-term graft durability remains a major concern. Procedural modalities may serve as useful treatments for symptom control and limited regrowth in selected patients with scarring alopecia. These modalities are best considered adjuncts to medical therapy pending standardized, controlled trials.

Introduction: Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus, affecting up to 15% of diabetic patients and leading to high rates of hospitalization, morbidity, and lower limb amputation. Case Presentation: This case study details the management of a 67-year-old diabetic male patient with a DFU complicated by osteomyelitis. The patient, with a long history of diabetes and multiple comorbidities, was treated with a comprehensive regimen that included antibiotics, debridement, and platelet-rich plasma (PRP) therapy. PRP was administered weekly for 15 weeks. Clinical, laboratory, and imaging data were employed for the evaluation of the disease improvement. As a result, a marked improvement in wound healing was observed, characterized by reduced wound size, accelerated closure of the wound, and enhanced tissue regeneration. However, the patient developed deep vein thrombosis, which was successfully managed with anticoagulants. Conclusion: The study highlights PRP';s potential in DFU treatment due to its regenerative properties despite the risk of adverse effects. The efficacy of PRP aligns with previous studies, showing improved healing rates and infection control. Future research should focus on large-scale trials to optimize PRP protocols and confirm the safety and efficacy of this therapeutic method in DFU.

Adipose‐derived exosomes may offer a novel therapeutic approach for lichen planopilaris (LPP) unresponsive to standard treatments, with preliminary evidence suggesting potential benefits in symptom control and hair preservation.

Background: Dissecting cellulitis of the scalp (DCS) is a type of neutrophilic scarring alopecia identified by the development of folliculitis with clusters of perifollicular pustules and then progresses to abscesses and intercommunicating sinus formation. In the absence of evidence-based guidelines, the treatment of DCS remains a therapeutic challenge. Our study aimed to assess the safety and efficacy of biologics, including tumor necrosis factor-α (TNF-α) blockers, anti-interleukins (ILs), and small molecule inhibitors, including Janus kinase (JAK) inhibitors and phosphodiesterase inhibitors in treating DCS. Methods: PubMed/Medline, Scopus, and Ovid Embase databases were systematically searched until February 4th, 2024. Study selection was restricted to case reports, case series, cohort studies, and clinical trials published in English-language. NIH and Murad et al.’s quality assessment tools were utilized for critical appraisal. Results: A total of 34 articles involving 81 patients met the inclusion criteria. The immunomodulators studied for the treatment of DCS include adalimumab, infliximab, certolizumab pegol, ustekinumab, secukinumab, guselkumab, risankizumab, tildrakizumab, apremilast, upadacitinib, and baricitinib. Our findings implied that TNF-α blockers and IL inhibitors were associated with clinical improvement in most individuals with moderate-to-severe DCS, especially in those who had failed earlier treatments. Moreover, certolizumab pegol could be a safe option for DCS in pregnancy. In addition, the prescription of small molecule inhibitors, including JAK inhibitors and apremilast in DCS patients, demonstrated a significant amelioration in DCS symptoms with a desirable safety profile. Nevertheless, the available data was limited, warranting further investigation. Besides, all aforementioned immunomodulators are still debated for their effectiveness on hair regrowth and reversing the scarring process. Conclusions: The application of immunomodulators in treating DCS was associated with satisfactory outcomes, although there is still a need to assess the long-term safety and effectiveness of these therapeutic agents in preventing disease progression and new flare-ups.