The Immunology of Endometriosis and the Therapeutic Potential of Bispecific Antibodies: A Hypothesis

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrial lesions outside the uterus. Current treatment methods primarily focus on hormone-based therapy or invasive procedures. However, given the crucial role of the immune system in disease initiation and progression, there is an opportunity to explore new treatment approaches. Bispecific antibodies, which bind two different cells using their bivalent arms, have shown promise in treating cancers and autoimmune diseases. This study postulates that due to the similarities in pathogenesis between endometriosis and the aforementioned diseases, a novel therapeutic method based on this new target could be introduced. This could potentially lead to a reduction in limitations to patients' quality of life. In addition, it is important to highlight that future studies should prioritize the identification of specific binding markers on endometrial cells. This could contribute to the development of new diagnostic tools for the disease. Furthermore, the production of bispecific antibodies that selectively bind to these receptors on immune cells may prove effective in improving immune response

Metachronous Gallbladder Metastasis from Clear Cell Renal Cell Carcinoma with Atypical Immunohistochemical Profile: A Case Report and Comprehensive Literature Review

Background: Renal cell carcinoma (RCC) is a malignancy known for its high metastatic potential, commonlyspreading to the lungs, bones, brain, liver, and adrenal glands. Gallbladder metastasis from RCC is exceedinglyrare and poses significant diagnostic challenges due to its asymptomatic nature and nonspecific imaging findings.Case Presentation: We report the case of a 58-year-old Persian man with a history of clear cell RCC treatedwith left radical nephrectomy 34 months prior. The patient presented with right upper quadrant abdominal pain. Imaging studies, including contrast-enhanced computed tomography and ultrasound, revealed two hypervascular polypoid lesions within the gallbladder. An open cholecystectomy was performed due to the suspicion of malignancy. Histopathological examination confirmed metastatic clear cell RCC invading the gallbladder wall. Notably, immunohistochemical analysis showed tumor cells positive for cytokeratin 19, alpha-methylacyl- CoA racemase, and vimentin, but negative for paired box gene 8, cytokeratin 7, cytokeratin 20, and cluster of differentiation 117 (C-Kit). The absence of paired box gene 8 expression is atypical for RCC metastasis and posed a diagnostic challenge. The patient had an uneventful postoperative recovery but unfortunately passed away two months later due to a cerebrovascular accident unrelated to his oncological condition.Conclusions: This case underscores the importance of considering gallbladder metastasis in the differentialdiagnosis for patients with a history of RCC presenting with gallbladder lesions. The atypical immunohistochemical profile observed expands the known spectrum of metastatic RCC presentations and highlights the necessity for comprehensive diagnostic evaluation. Surgical intervention through cholecystectomy can lead to favorable outcomes and should be considered in similar cases

Rapid Progressive Synovial Sarcoma of Right Knee: A Rare Case Presentation

Background: Synovial sarcoma is a rare malignant soft tissue tumor that commonly emerges in the para-articular area, with the knee as the predominant location. The preferred intervention for this tumor is still currently debated Case description: We presented a 29-year-old male with a very large mass in the right knee. The physical examination revealed impairment of the right lower extremities, particularly the knee. MRI confirmed the extent of the pathology, but the first pathology analysis was inconclusive. A wide resection was performed without prior neoadjuvant therapy. The second pathology analysis from the resected tissue confirmed the diagnosis of biphasictype synovial sarcoma. The patient was able to walk with no assistance, had an increased range of motion, and the utmost preservation of the limb.Conclusions: We presented a successful case of wide resection of synovial sarcoma with a promising clinicaloutcome. The complexity of the case leads to the need for a tailored approach that should be limited tomusculoskeletal oncologists

The Rate of Hernia Recurrence in Surgical Patients with Mesh Repair and Non-Mesh Repair

Background: Hernia repair is one of the most common procedures in general surgery, which is performed byvarious methods. One of the consequences of hernia repair is the recurrence of hernia in the short or long term. In this study, the rate of hernia recurrence in surgical patients with mesh and non-mesh repair methods was investigated.Methods: This prospective cohort study was conducted on 138 patients who underwent repair surgery withmesh (28 individuals) and without mesh (110 individuals) due to hernia in Hamadan Ba’ath Hospital in 2019and 2014. The authors investigated and compared in terms of frequency of recurrence and complications. Part of the required data was obtained from the patient’s medical records and part was obtained through telephone calls. Data analysis was done with SPSS software version 26.Results: The average age of the patients was 41.2±26.25 years, 88.4% were male and 11.6% were female.The frequency of hernia recurrence was 3.6% in total, all of which were in the non-mesh repair group. Nosignificant difference was observed between hernia repair with and without mesh in terms of frequency ofrecurrence (P=0.583) and complications (P=0.964). Also, no significant relationship was observed betweenhernia recurrence with gender, age, smoking, employment status, and body mass index (P>0.05).Conclusions: Hernia repair with both methods with and without meshing have a relatively favorable short-termoutcome. Although meshing reduces hernia recurrence; However, there was no significant difference between the two methods of hernia repair with and without meshing in terms of recurrence and complications

Successful Term Pregnancy After Cesarean Scar Molar Pregnancy

Background: Cesarean scar molar pregnancy (CSMP) is an exceptionally rare clinical entity, combining twouncommon obstetric conditions: cesarean scar pregnancy and molar gestation. The diagnosis is often delayed due to nonspecific symptoms and misinterpretation of imaging findings, and there is limited data regarding fertility outcomes following such cases Case Presentation: We report the case of a 32-year-old woman, gravida 2 para 1, who presented with vaginal bleeding and a diagnosis of missed abortion at 12 weeks gestation. Despite medical management with misoprostol, she experienced severe hemorrhage requiring surgical intervention. Intraoperative findings revealed thinning of the previous cesarean section scar and abnormal tissue suspicious for ectopic gestation. Pathologic examination confirmed a partial molar pregnancy implanted at the cesarean scar site. Following surgical repair and appropriate follow-up, including serial β-hCG monitoring until undetectable levels were reached, the patient conceived spontaneously two years later. The subsequent pregnancy progressed uneventfully to term and was delivered via cesarean section.Conclusions: This case highlights the importance of considering CSMP in the differential diagnosis of atypicalpregnancies in patients with a history of cesarean section, especially when imaging shows abnormal sac location or persistent bleeding. Early diagnosis and prompt management are crucial for patient safety and preserving fertility. To our knowledge, this is one of the rare reports of a successful term pregnancy following CSM

Prevalence of Post-Traumatic Stress Disorder among Intensive Care Unit Survivors: A Prospective Study in Rasht, Iran

Background: Post-traumatic stress disorder (PTSD) is a psychological disorder resulting from a previoustraumatic experience. The objective of the present study was to investigate the prevalence of PTSD and its related risk factors among Intensive Care Unit (ICU) survivors.Methods: A total of 152 patients were followed up prospectively for one month. All included participants hadGlasgow Coma Scale scores ranging from 12 to 15. PTSD was assessed using a Persian-translated version of thePTSD Checklist (PCL). Data were analyzed using SPSS 22.0 software.Results: Among the participants, seventy-two (47.4%) men and eighty (52.6%) women with a mean age of 54.5± 19.19 years responded to the questionnaire. The prevalence of post-discharge PTSD was 87.5%. There wasa significant correlation between PTSD mean score and clinical factors such as hospitalization reason, self andfamilial history of psychological disorders, and Richmond Agitation Sedation Score (RASS) (p < 0.05).Conclusions: Our findings suggest that, despite often being ignored, post-discharge PTSD is a significantpsychological issue for ICU survivors. This highlights the importance of supportive care plans for patients witha history of mental disorders and agitation. The involvement of psychotherapists is crucial to improving postdischarge quality of life

Modification in Brachytherapy Catheter Inset in the Keloid Bed

Background: Keloids are troublesome for both patients and surgeons who encounter recurrent lesions. Patients often seek newly developed treatments in hopes of alleviating the pain and manifestations associated with this condition. Surgery alone is generally ineffective and requires adjuvant therapies, one of which may bebrachytherapy.Case presentation: We introduced a modification in catheter placement following surgical excision of keloids.In the two presented cases, after lesion removal and closure of the deep cavity up to the subcutaneous tissue, the wound margins were closed while leaving a limited route for the catheter to prevent its displacement. The skin was then closed. The results of immediate post-surgical brachytherapy for keloids were highly encouraging.Conclusions: Brachytherapy following surgical keloid excision yields significant results. This combinationneeds more concise catheter inset especially in subcutaneous field

Dexamethasone and Pain After Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Background: Laparoscopic cholecystectomy is a surgical procedure used to remove the gallbladder in patients experiencing gallstones or acute cholecystitis. Pain is a common side effect of surgery. Objective: This study evaluates the effectiveness of intraperitoneal dexamethasone injection from the umbilical port site in alleviating pain after laparoscopic cholecystectomy.Methods: This research followed a triple-blind clinical trial that included 80 randomly selected patients who were hospitalized at Shahid Mohammadi Hospital in Bandar Abbas and deemed eligible for laparoscopic cholecystectomy. Patients were randomly divided into two groups, each containing 40 participants. In the test group, 8 mg of dexamethasone was injected into the intraperitoneal space through the umbilical port site during surgery, while no drug was administered in the control group. Pain scores were measured postoperatively using the VAS questionnaire at 6, 12, and 18 hours after surgery. The collected data were analyzed using SPSS version 21 statistical software, employing independent t-tests and chi-square tests. Results: The experimental group exhibited significantly lower levels of nausea, vomiting, analgesic consumption, and pain compared to the control group (p<0.000).Conclusions: Study confirmed that intraperitoneal dexamethasone infusion from the port site significantly reduced postoperative pain, nausea, vomiting, and the consumption of painkillers

Outcome of hemorrhoid artery ligation as a novel procedure for hemorrhoidal disease, case series in Shariati hospital of TUMS

Background: Hemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR) is a minimally invasiveprocedure designed to treat grades III and IV hemorrhoidal disease by addressing both vascular supply and tissue prolapse.Methods: This study retrospectively evaluated patients undergoing HAL-RAR between January 2024 andJanuary 2025. Data collected included demographics, disease severity, postoperative pain (Days 1 and 3),hospital stay, and time to first non-problematic defecation.Results: A total of 16 patients were included. Postoperative pain was low, with 62.5% reporting no pain onDay 1 and 88% on Day 3. Median pain scores decreased over time and were not significantly affected by sex.Defecation function recovered rapidly, with 100% achieving non-problematic defecation within two dayspostoperatively. Age showed a non-significant trend toward delayed recovery and slightly increased pain. Nomajor complications were observed, and all patients were discharged after one night.Conclusions: HAL-RAR appears to be a safe, well-tolerated, and effective short-term treatment for advancedhemorrhoidal disease, offering minimal pain and rapid functional recovery. However, larger studies with controlgroups and long-term follow-up are required to confirm these findings and evaluate durability

Assessment of Chest CT Scan Findings in Multiple Trauma Patients Admitted to the Emergency Department of Khatam-al-Anbia Hospital in Zahedan in 2023

Background: This study investigates the clinical predictors of chest CT scan findings in patients with chesttrauma presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan in 2023.Methods: A cross-sectional study was conducted on 460 patients with multiple traumas. Data were collected from CT scan reports and analyzed using SPSS 22 software, employing independent t-tests, correlation coefficients,and chi-square tests.Results:The mean age of the patients was 40.2 ± 20.36 years (range: 16–97). Gender distribution included 28.7%women and 71.3% men. Significant differences in CT scan findings were observed based on gender (P = 0.032),trauma mechanism (P = 0.029), and clinical complaint type (P = 0.017). Patients under 20 years old exhibitedmore normal findings, whereas those over 40 had a higher prevalence of rib and thoracic vertebra fractures.Traffic accidents and collisions frequently resulted in rib and thoracic vertebra fractures, while altercations weremore commonly associated with pneumothorax. Clinical complaints of chest pain and deformity were frequently linked to pneumothorax and rib fractures.Conclusions: These findings underscore the importance of age, trauma mechanism, and clinical complaints indiagnosing chest trauma, facilitating more informed decision-making and diagnosis