Journal of Research in Medical Sciences最新文献

{"title":"Evaluation and comparison of patency rate and complications of synthetic arteriovenous grafts in the groin and upper extremities among hemodialysis patients.","authors":"Abbas Saroukhani, Mohammad Tohidi, Mohammad Javad Tarrahi","doi":"10.4103/jrms.jrms_243_24","DOIUrl":"10.4103/jrms.jrms_243_24","url":null,"abstract":"<p><strong>Background: </strong>Arteriovenous (AV) grafts are frequently used for hemodialysis when an AV fistula is not feasible. Recent improvements in prosthetic materials have led to comparable performance of upper and lower extremity grafts. We aimed to evaluate the patency rate (the time from initial placement to failure or intervention) and complications of groin versus upper extremity AV grafts.</p><p><strong>Materials and methods: </strong>In this cross-sectional study, conducted from October 2018 to October 2020 at a tertiary referral center, patients with either a lower extremity (groin) or upper extremity AV graft were included and followed for at least 2 years. Graft adequacy was defined as the ability to deliver a blood flow ≥350 mL/min with two-needle cannulation in ≥5 dialysis sessions in 1 month. Outcomes included infection, ischemia, neuropathy, and thrombosis. Statistical tests (Chi-square for categorical variables and <i>t</i>-test for continuous variables) were used, with <i>P</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Among 213 hemodialysis patients (mean age: 54.4 ± 17.4 years, 68.5% of males), 183 had upper extremity AV grafts and 30 had groin AV grafts. No significant differences were observed between the two groups for patency duration (<i>P</i> = 0.088) or rates of infection, ischemia, neuropathy, thrombosis, and graft adequacy (all <i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>In this cohort, groin AV grafts had similar patency and complication profiles compared to those in the upper extremities. Groin placement can be a viable alternative when upper extremity access is not suitable. Further studies using standardized graft materials and longer follow-up intervals are recommended.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"16"},"PeriodicalIF":1.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13516005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Janus kinase 1 and 2 expression with clinical indices in diabetic kidney disease.","authors":"Mahboobeh Freidoon, Naghmeh Sayadi, Sara Assadiasl, Hadi Kazemzadehghadim, Narjes Soleimanifar, Maryam Sadr, Hanieh Mojtahedi, Maryam Ahmadi, Mohammad Hossein Nicknam","doi":"10.4103/jrms.jrms_680_24","DOIUrl":"10.4103/jrms.jrms_680_24","url":null,"abstract":"<p><strong>Background: </strong>Diabetic Kidney Disease (DKD) is a prevalent complication of uncontrolled hyperglycemia that imposes a considerable burden on the health system due to the need for renal replacement therapy in the long term. Therefore, early diagnosis and prevention of renal damage in diabetic patients is critical. In the present study, we investigated the expression level of Janus kinase (Jak) 1, 2, and 3 genes, which play a role in the signal transduction of inflammatory cytokines and growth factors, for therapeutic or diagnostic purposes.</p><p><strong>Materials and methods: </strong>Sixty patients with DKD, 60 diabetic patients without nephropathy, and 60 healthy individuals were recruited, and the expression level of the Jak1, Jak2, and Jak3 genes was evaluated using real-time polymerase chain reaction in peripheral blood mononuclear cells.</p><p><strong>Results: </strong>The results showed that Jak1 and Jak2 gene expression was significantly upregulated in DKD patients compared to healthy controls (<i>P</i> values: 0.02 and 0.002, respectively). A significant negative correlation was observed between the expression of Jak1 and 2 genes and glomerular filtration rate in patients (<i>P</i> values: 0.047 and 0.03, respectively). There was also a positive correlation between the urine albumin-creatinine ratio of the DKD group with Jak1 and 2 gene expression levels (<i>P</i> values: 0.008 and 0.015, respectively). Moreover, receiver operating characteristic curve analysis showed a fair diagnostic value for Jak2 expression in DN (0.71, 95% confidence interval: 0.59-0.834 [<i>P</i> = 0.002]).</p><p><strong>Conclusion: </strong>Gene expression evaluation showed an increased expression of Jak1 and Jak2 in DKD, suggesting Jak1/2 inhibition for the treatment of patients. In addition, Jak2 expression might have diagnostic or predictive value in diabetes.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"19"},"PeriodicalIF":1.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13516004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability assessment of the Persian version of the User Mobile Application Rating Scale.","authors":"Rezvaneh Sheybak, Rahele Samouei, Ahmad Papi, Rasool Nouri","doi":"10.4103/jrms.jrms_131_25","DOIUrl":"10.4103/jrms.jrms_131_25","url":null,"abstract":"<p><strong>Background: </strong>Smartphone health applications have gained popularity among users; however, the accuracy of the health information they provide often goes unchecked, potentially compromising user safety. This highlights the need for assessing mobile health applications. While several evaluation tools exist, including the User Mobile Application Rating Scale (uMARS), there is currently no available Persian version of uMARS. This study aims to validate the Persian version of uMARS.</p><p><strong>Materials and methods: </strong>This cross-sectional study involved students from the management and medical information science, modern medical technologies, and rehabilitation science programs at Isfahan University of Medical Sciences. Participants were selected using cluster random sampling and nonrandom quota sampling, resulting in a total of 106 undergraduate, master's, and PhD students. Nonrandom quota sampling was then conducted among undergraduate, master's, and PhD students from the aforementioned schools. One hundred and six students were chosen using nonrandom quota sampling. First, this questionnaire was translated by two English-Persian language expert translators and backtranslated, and this was compared with the original uMARS. After assessing face and content validity, convergent and divergent validity were assessed. To determine reliability, the Cronbach's alpha method and test-retest was used.</p><p><strong>Results: </strong>Face, content, convergent, and divergent validity scale of uMARS was affirmed, and internal consistency for all subjective and objective quality dimensions with Cronbach's alpha of 0.929 was affirmed. The reliability of all subscale test-retest was also acceptable. Considering calculated indicators, the Persian version of uMARS in this study has a good reliability and validity and is expected to be useful for mobile health applications as a standard tool.</p><p><strong>Conclusion: </strong>uMARS Persian version is a reliable tool to assess the quality of mobile health applications from the user's perspective. This assessment framework offers a comprehensive evaluation of various aspects of mobile health applications, including their engagement, functionality, esthetics, information, and subjective quality.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"17"},"PeriodicalIF":1.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13516003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of dietitian-guided nutritional support on intensive care units length of stay and nutritional risk in critically Ill patients.","authors":"Shakiba Rahimi, Omid Moradi-Moghadam, Mehdi Yadollahzadeh, Pardis Irandoost, Marzieh Nojomi, Mojtaba Mahjour, Parvin Hassanzadeh, Azadeh Mottaghi","doi":"10.4103/jrms.jrms_919_25","DOIUrl":"10.4103/jrms.jrms_919_25","url":null,"abstract":"<p><strong>Background: </strong>Nutritional support is essential for the recovery of critically ill patients in intensive care units (ICUs). However, the clinical impact of dietitian-guided interventions, particularly on ICU length of stay and nutritional risk scores, remains underexplored. This study evaluated the effect of personalized, dietitian-guided nutritional support (DGNS) versus physician-directed care on ICU length of stay and nutritional status.</p><p><strong>Materials and methods: </strong>In this quasi-experimental study conducted at two centers in Tehran between June 2022 and February 2023, adult ICU patients with an expected stay of five days or more received either DGNS or physician-directed care. The primary outcome was ICU length of stay. Secondary outcomes included changes in nutritional risk scores, assessed using the Nutrition Risk Screening (NRS-2002) tool and the Nutrition Risk in Critically Ill (NUTRIC) score. Parametric and nonparametric tests were used to compare the two groups, and multivariable linear regression was performed to adjust for potential confounders.</p><p><strong>Results: </strong>Among 107 patients (52 intervention, 55 control), adjusted analysis showed significantly shorter ICU stay in the intervention group β: -2.53; (95% confidence interval [CI]: -4.66, -0.39); <i>P</i> = 0.021. Nutritional risk scores improved more in the intervention group (median change in NRS-2002: -2.0 [interquartile range (IQR): -3.0 to - 1.0] vs. 0.0 [IQR: -1.0-0.0]; <i>P</i> < 0.001); NUTRIC: -1.0 [IQR: -2.0-0.0] vs. 0.0 [IQR: 0.0-0.0]; <i>P</i> < 0.001). New infections (7.7% vs. 38.2%) and pressure ulcers (3.8% vs. 18.2%) were less frequent in the intervention group (<i>P</i> < 0.05). No difference in 28-day mortality was noted.</p><p><strong>Conclusion: </strong>Dietitian-guided personalized nutrition reduced ICU stay and improved nutritional status, emphasizing dietitians' role in ICU care. Further randomized trials are warranted to confirm these findings.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"20"},"PeriodicalIF":1.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13516013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148834365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher anxiety score in patients with non-obstructive coronary artery disease.","authors":"Zulkefli Sanip, Aida Hanum Ghulam Rasool, Nurnajwa Pahimi, Azizah Othman, Nur Adilah Bokti, W Yus Haniff W Isa","doi":"10.4103/jrms.jrms_1068_25","DOIUrl":"10.4103/jrms.jrms_1068_25","url":null,"abstract":"<p><strong>Background: </strong>There is insufficient evidence on the relationship between psychological distress and patients with non-obstructive coronary artery disease (NOCAD) who experience angina symptoms despite having non-significant narrowing or normal coronary arteries. Therefore, our aim is to evaluate the psychological distress status in patients with NOCAD.</p><p><strong>Materials and methods: </strong>In this prospective cross-sectional study, patients with symptomatic angina scheduled for coronary angiography were screened and invited to participate, alongside a control group of non-symptomatic individuals. Symptomatic patients were categorized as having obstructive (OCAD) or NOCAD based on angiogram results. All participants completed the Hospital Anxiety and Depression Scale (HADS) to assess their psychological state and provided blood samples for stress biomarker analysis.</p><p><strong>Results: </strong>A total of 124 subjects participated in this study. The prevalence of anxiety and depression (HADS score ≥8) in patients with OCAD and NOCAD were 26.2% and 25%, respectively. The HADS anxiety (HADS-A) score was higher in both OCAD (<i>P</i> < 0.001) and NOCAD (<i>P</i> = 0.001) patients compared to controls. In addition, the HADS depression score was higher in OCAD patients as compared to the control. Notably, the HADS-A score was associated with NOCAD (odds ratio [95% confidence interval], 1.213 [1.029, 1.499]; <i>P</i> = 0.021). Furthermore, cortisol levels were higher in OCAD as compared to controls (<i>P</i> = 0.028).</p><p><strong>Conclusion: </strong>Higher anxiety scores indicate significant emotional distress in patients with NOCAD. Furthermore, anxiety shows a notable association with NOCAD in patients presenting with angina.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"12"},"PeriodicalIF":1.7,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing interventions including psychological support and quality of life determinants in patients with dysphagia following stroke.","authors":"Aihua Liu, Xuehong Liu, Ping Zhou","doi":"10.4103/jrms.jrms_1233_25","DOIUrl":"10.4103/jrms.jrms_1233_25","url":null,"abstract":"<p><strong>Background: </strong>Poststroke dysphagia (PSD) affects nearly half of stroke survivors and impairs health-related quality of life. Nursing interventions increasingly integrate psychological support, yet their effectiveness remains unclear. This systematic review and meta-analysis evaluated the impact of nursing strategies incorporating psychological support on QOL in PSD patients and examined the influence of intervention duration and type.</p><p><strong>Materials and methods: </strong>This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, EMBASE, Scopus, Web of Science, and CINAHL were searched up to August 2025. Randomized controlled trials (RCTs) assessing nursing interventions with psychological components, such as counseling or education, cognitive behavioral therapy-informed strategies, relaxation or stress management, emotional support, and motivational interviewing, and reporting QOL outcomes were included. Standardized mean differences (SMDs) were pooled using random-effects models. Subgroup analyses compared short (≤4 weeks) versus longer (>4 weeks) interventions and psychological-only versus combined approaches.</p><p><strong>Results: </strong>Nine RCTs involving 693 participants were included. Nursing interventions improved QOL compared with control conditions (SMD = 0.95; 95% confidence interval [CI]: 0.48-1.41; <i>P</i><0.001), with substantial heterogeneity (I2 = 84.5%). Interventions lasting ≤4 weeks showed larger effects (SMD = 1.21; 95% CI: 0.13-2.29) than longer interventions (SMD = 0.82; 95% CI: 0.32-1.31). Psychological-only interventions produced greater benefits (SMD = 1.25; 95% CI: 0.68-1.82) than combined approaches (SMD = 0.82; 95% CI: 0.20-1.43). No publication bias was detected (Egger's test, <i>P</i> = 0.79).</p><p><strong>Conclusion: </strong>Nursing interventions incorporating psychological support enhance QOL in PSD. Short-duration and psychological-only approaches appear most effective, supporting integration into stroke rehabilitation.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"13"},"PeriodicalIF":1.7,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Latent autoimmune diabetes mellitus and its characteristics amongst adults diagnosed with type 2 diabetes at a single diabetes center in Medina, Saudi Arabia.","authors":"Eman Alfadhli, Walaa Mohammedsaeed, Amal Surrati, Mashael Alharbi, Mansour Alharbi, Zain Alghamdi","doi":"10.4103/jrms.jrms_438_25","DOIUrl":"10.4103/jrms.jrms_438_25","url":null,"abstract":"<p><strong>Background: </strong>To estimate the frequency and characteristics of Latent Autoimmune Diabetes in Adults (LADA) in patients diagnosed with type 2 diabetes mellitus (T2DM) at a single diabetes center in Medina, Saudi Arabia.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study involving patients with T2DM aged 30-70 years with a disease duration of ≤5 years, and who had not received insulin for at least 6 months post-T2DM diagnosis. Demographics, anthropometrics, autoantibodies to Glutamic Acid Decarboxylase Autoantibodies (GADA) and islet cell antibodies (ICA), serum C-peptide, glycated hemoglobin (HbA1C), and lipid data were collected. LADA was diagnosed according to GADA and/or ICA positivity. Participants were classified into two groups: LADA and non-LADA. The clinical and biochemical characteristics of both groups were compared.</p><p><strong>Results: </strong>A total of 157 participants (mean age 50 years, 52.9% male) were enrolled, with 30 (19.1%) testing positive for GADA and/or ICA. Among them, 16 (10.2%) were positive for GADA alone, 9 (5.7%) tested positive for ICA alone, and 5 (3.2%) tested positive for both GADA and ICA. GADA was significantly more prevalent in younger individuals (30-49 years, <i>P</i> = 0.02) and males, who also had higher rates of dual autoantibodies compared to females (<i>P</i> = 0.03). LADA patients had a significantly shorter duration of diabetes, along with lower body mass index, C-peptide, and triglyceride levels, but exhibited higher HbA1c and greater insulin use.</p><p><strong>Conclusion: </strong>The study reveals a high rate of LADA within this cohort of Saudi patients diagnosed with T2DM. LADA patients display some clinical and biochemical characteristics that set them apart from conventional T2DM cases. Screening for β-cell autoantibodies in individuals with these features could aid in earlier diagnosis of LADA and allow for more tailored treatment approaches.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"11"},"PeriodicalIF":1.7,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Comparison of the performance of machine learning algorithms for the task-switching functional magnetic resonance imaging data for distinguishing attention deficit hyperactivity disorder from bipolar disorder.","authors":"","doi":"10.4103/jrms.jrms_243_26","DOIUrl":"10.4103/jrms.jrms_243_26","url":null,"abstract":"<p><p>[This corrects the article 56 in vol. 30, PMID: 41306624.].</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"15"},"PeriodicalIF":1.7,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13278248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma versus granulocyte colony-stimulating factor in addressing recurrent implantation failure: A randomized, double-blind clinical trial.","authors":"Hatav Ghasemi Tehrani, Elnaz Mostajeran, Reihaneh Dehghani-Mohammadabadi, Elham Naghshineh","doi":"10.4103/jrms.jrms_736_23","DOIUrl":"10.4103/jrms.jrms_736_23","url":null,"abstract":"<p><strong>Background: </strong>The aim of the study is to evaluate the effect of platelet-rich plasma (PRP) versus granulocyte colony-stimulating factor in addressing recurrent implantation failure.</p><p><strong>Materials and methods: </strong>Fifty patients were randomly assigned to two treatment groups: PRP and granulocyte colony-stimulating factor (GCSF). All patients were followed up to 12 weeks after implantation. The rate of positive pregnancy tests (chemical pregnancy), implantation rate (clinical pregnancy), and pregnancy reaching 12 weeks old (ongoing pregnancy) in these two groups was compared.</p><p><strong>Results: </strong>Biochemical pregnancy, gestational sac formation, fetal heart formation, and 12-week pregnancy occurred in 6 (24%), 6 (24%), 6 (24%), and 5 women (20%) in the PRP group and occurred in 7 women (28%), 5 women (20%), 5 women (20%), and 5 women (20%) in the GCSF group. There was no statistically significant difference regarding biochemical pregnancy, gestational sac formation, fertile heart formation, and 12-week-old pregnancy between study groups (<i>P</i> = 0.747, 0.737, 0.737, and 1, respectively).</p><p><strong>Conclusion: </strong>Our study showed no difference in the efficacy of plasma-rich platelets and GCSFs in treating recurrent implantation failure.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"14"},"PeriodicalIF":1.7,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13274941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148279555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral perfusion-guided versus routine fluid therapy in sepsis: A randomized controlled pilot trial.","authors":"Nima Vaziri, Babak Alikiaii, Shadi Farsaei, Sarah Mousavi","doi":"10.4103/jrms.jrms_974_25","DOIUrl":"10.4103/jrms.jrms_974_25","url":null,"abstract":"<p><strong>Background: </strong>Sepsis remains a leading cause of morbidity and mortality among critically ill patients. Fluid resuscitation is essential, but conventional protocols often lack individualized assessment of tissue perfusion, risking underresuscitation or fluid overload. The peripheral perfusion index (PPI), derived from pulse oximetry, offers a practical, noninvasive way to dynamically guide fluid therapy and may improve outcomes. The objective of the study was to evaluate whether PPI-guided targeted fluid therapy improves clinical and microvascular outcomes in septic intensive care unit patients compared with conventional fluid therapy.</p><p><strong>Materials and methods: </strong>In a prospective, randomized trial, 60 septic adults were assigned to standard fluid therapy or PPI-guided resuscitation. The primary outcome was microvascular perfusion improvement within 72 h. The secondary outcomes included 7-day mortality, acute kidney injury (AKI), fluid balance, lactate clearance, and renal biomarkers (including cystatin C).</p><p><strong>Results: </strong>PPI-guided therapy significantly improved microvascular perfusion (<i>P</i> = 0.001) and reduced cystatin C levels by day 7 (<i>P</i> = 0.0001), suggesting renal protection. Although there were fewer deaths at 7 days and less AKI in the intervention group, these differences did not reach statistical significance. Trends favored lactate clearance and more favorable fluid balance with PPI guidance.</p><p><strong>Conclusion: </strong>PPI-guided fluid therapy is a feasible, low-cost approach to individualized resuscitation in septic patients, associated with short-term improvements in microvascular perfusion and renal biomarkers. The observed physiological benefits warrant confirmation in larger multicenter trials to determine any impact on long-term clinical outcomes.</p>","PeriodicalId":50062,"journal":{"name":"Journal of Research in Medical Sciences","volume":"31 ","pages":"9"},"PeriodicalIF":1.7,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12994866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147482156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}