Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Background and Aim: Brain metastases pose a significant therapeutic challenge due to high rates of local recurrence and treatment complications. However, it is still unclear how preoperative stereotactic radiation (Pre-SRS) compares to postoperative radiation (Post-SRS) in terms of efficacy and safety. The aim of the present study was to compare the clinical outcomes of Pre-SRS and Post-SRS in patients with brain metastases.

Method: In the present study, PubMed, Embase, Cochrane Library, and Web of Science databases were searched between 2015 and 2025 with targeted keywords. Seven relevant studies, including randomized clinical trials and cohort studies, were included in the analysis. Meta-analysis was performed using stata.v17 software. To combine the results, a fixed-effect model with the Inverse-Variance method for the hazard ratio and Mantel–Haenszel for the risk ratio was used, and heterogeneity between studies was assessed with the I² and H² indices.

Results: The hazard ratio for overall survival did not differ significantly between the Pre-SRS and Post-SRS groups (HR 0.891; 95% CI 0.55–1.23). Local failure at six months and one year was similar between the two groups. Pre-SRS reduced the risk of radiation necrosis (HR 0.689; 95% CI 0.352–1.026; P < 0.05) and leptomeningeal disease (HR 0.540; 95% CI 0.202–0.877; P < 0.05) compared with Post-SRS. Heterogeneity was minimal in all analyses (I² = 0–14%).

Conclusion: Based on the present meta-analysis, Pre-SRS had similar survival and recurrence rates to Post-SRS while reducing the risk of significant treatment complications. The present study suggests the use of Pre-SRS as a strategic intervention in patients with brain metastases.

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: Rhinoplasty involves highly vascular nasal structures where even small hemodynamic changes can affect bleeding and surgical visibility. Hypercapnia and normocapnia may differently influence mucosal perfusion through their cardiovascular and ventilatory effects, yet their true impact during rhinoplasty remains unclear. Understanding how controlled ventilation strategies alter intraoperative bleeding is essential for optimizing safety, efficiency, and surgical field quality.

Material and methods: This randomized clinical trial compared hypercapnia and normocapnia in patients undergoing rhinoplasty under standardized general anesthesia using midazolam, fentanyl, propofol, atracurium, and lidocaine. Sixty patients were enrolled through convenience sampling and randomized equally into two ventilation groups. Intraoperative bleeding was measured with gauze weight and suction volume, and postoperative complications were monitored for 24 hours. Statistical analyses were performed assuming normally distributed data.

Results: The study demonstrated a clear reduction in intraoperative blood loss among patients receiving controlled mild hypercapnia compared with those under normocapnia. This effect remained consistent across BMI categories and between sexes. Although greater variability was observed within the hypercapnia group, the overall pattern showed a distinct downward shift in bleeding, indicating a meaningful physiologic response to CO₂ elevation.

Conclusion: These findings suggest that controlled mild hypercapnia may serve as a valuable physiologic strategy to minimize bleeding during rhinoplasty and improve surgical field clarity. Its stable efficacy across different BMI groups and both sexes highlights its broad clinical applicability. When implemented with appropriate monitoring, hypercapnia can offer a safe and effective adjunct to current intraoperative management approaches, potentially reducing technical challenges and enhancing procedural precision.

Abstract Introduction: Mesenteric lymphadenopathy is an underrecognized abdominal finding in Familial Mediterranean Fever, influenced by demographic factors such as age and gender. Understanding how these variables shape its prevalence can help distinguish FMF related inflammatory changes from other gastrointestinal conditions, improve diagnostic accuracy, and prevent unnecessary investigations by clarifying imaging patterns across different patient subgroups

Material and methods: This descriptive cross sectional study was conducted at in Kowsar Clinic, Ardabil, enrolling 106 patients through convenience sampling. Standardized clinical evaluations and imaging assessments were performed, and complete records meeting defined inclusion criteria were analyzed. Data followed a normal distribution and were processed using appropriate parametric tests.

Results: The analysis showed that the mean age of patients with mesenteric lymphadenopathy was slightly lower than those without it, although the difference did not reach statistical significance (P=0.071). Gender distribution was nearly identical in both groups, indicating no meaningful sex related effect on lymphadenopathy (P=0.889). Overall, mesenteric lymph node enlargement was observed in approximately 54.7% of the study population.

Conclusion: This study demonstrates that neither age nor gender serves as a significant determinant of mesenteric lymphadenopathy in pediatric patients, despite a marginally lower mean age among affected individuals. The comparable distribution of boys and girls across both groups further suggests that lymph node involvement is not influenced by sex related biological differences. With a prevalence of 54.7%, mesenteric lymphadenopathy represents a common radiologic finding in this population and likely reflects underlying inflammatory activity rather than demographic variation.

Abstract Introduction: The introduction highlights the importance of understanding how MEFV genotypes and clinical features relate to mesenteric lymphadenopathy in children with familial Mediterranean fever. It emphasizes the diagnostic challenges of abdominal pain, the variability of genetic mutations, and the potential role of lymph node enlargement as an indicator of inflammatory burden, underscoring the need for genotype informed evaluation to improve diagnostic accuracy and pediatric management.

Material and methods: The study employed a descriptive cross sectional design at Kowsar Clinic in Ardabil, enrolling 106 pediatric FMF patients through convenience sampling. Eligible participants underwent standardized clinical assessment, MEFV genotyping, and abdominal ultrasonography to evaluate mesenteric lymphadenopathy. The approach allowed systematic evaluation of genotype–phenotype–imaging relationships.

Results: In this pediatric FMF cohort, mesenteric lymphadenopathy (MLN) was detected in over half of patients and was notably associated with higher frequencies of abdominal and chest pain, indicating a more active inflammatory phenotype. Fever remained uniformly prevalent across groups, while other systemic symptoms showed mild increases among MLN positive children. The MEFV mutation spectrum reflected regional patterns, and no significant genotype MLN association was observed.

Conclusion: MLN appears to be a common and clinically meaningful ultrasonographic finding in pediatric FMF, correlating with more pronounced abdominal and serosal symptoms rather than specific MEFV mutations. Its presence may signal heightened inflammatory activity, supporting its potential role as a complementary marker in clinical assessment and risk stratification. Future work should integrate biomarkers to refine phenotype characterization.

Abstract Introduction: FMF as a chronic autoinflammatory disorder with potential reproductive implications driven by sustained inflammation and variable MEFV genotypes. It emphasizes uncertainties regarding infertility prevalence, the influence of demographic factors, and conflicting evidence on colchicine effects. The need for region specific data from high prevalence areas such as Ardabil is underscored to clarify these associations.

Material and methods: This cross sectional study evaluated infertility among married FMF patients using convenience sampling at Kowsar Clinic, Ardabil. Sixty three participants were enrolled based on predefined inclusion and exclusion criteria. Data were collected through structured interviews and clinical record reviews, covering demographics, FMF characteristics, and reproductive history.

Results: Among 63 married FMF patients, infertility was identified in only four individuals (6.3%), with no significant associations across demographic subgroups. Age demonstrated minimal influence on infertility, with nearly identical rates in those younger and older than 45 years. Sex-based comparisons revealed similarly high fertility proportions in both men and women, and residence analyses showed no meaningful variation between urban and rural participants. Overall, fertility patterns remained consistent throughout the cohort.

Conclusion: The study indicates that infertility is uncommon among married FMF patients and appears largely unaffected by demographic factors such as age, sex, or place of residence. These findings suggest that, when appropriately managed—particularly with regular colchicine therapy—FMF does not impose substantial reproductive limitations.