Eurasian Journal of Chemical, Medicinal and Petroleum Research

Abstract Introduction: Ventilator-associated pneumonia (VAP) remains a major intensive care unit complication, contributing to prolonged mechanical ventilation, antimicrobial overuse, multidrug resistance, and increased mortality. Despite advances in prevention and conventional antibiotics, treatment failure remains frequent. This study aims to review and highlight novel therapeutic strategies for improving clinical outcomes in patients with VAP.
Material and methods: This systematic review was conducted according to PRISMA guidelines. PubMed, Scopus, Web of Science, EMBASE, Google Scholar, SID, and Magiran were systematically searched using keywords including “ventilator-associated pneumonia,” “VAP,” “novel therapeutic strategies,” “bacteriophage therapy,” “immunotherapy,” “monoclonal antibodies,” “inhaled antibiotics,” and “multidrug-resistant pathogens,” combined with Boolean operators to identify eligible studies on emerging VAP treatments.
Results: Synthesis of six eligible studies (n = 6; RCTs: 33.3%, cohort designs: 33.3%) demonstrated that novel VAP strategies enhanced microbiological clearance and clinical cure against MDR/XDR pathogens. Rapid molecular diagnostics reduced time to targeted therapy, whereas resistance-guided regimens improved treatment adequacy. Overall methodology exhibited low risk of bias across key Cochrane domains (>80% domain adequacy), validating the clinical reliability of these precision-guided and adjunctive therapeutic modalities.
Conclusion: Novel therapeutic strategies, including inhaled antibiotics, bacteriophages, monoclonal antibodies, and rapid diagnostic-guided regimens, offer effective alternatives for managing multidrug-resistant VAP. Integrating these precision-driven and adjunctive modalities optimizes targeted pathogen clearance, mitigates systemic toxicity, and improves clinical management in intensive care settings. Future large-scale clinical trials remain essential to standardize protocols and validate long-term clinical efficacy.

Abstract Introduction: ACVRL1 (ALK1) mutations are critical drivers of pulmonary hypertension, significantly influencing endothelial dysfunction and vascular remodeling. Despite its clinical importance, the precise prognostic impact of ALK1 on disease progression remains insufficiently characterized across diverse populations. This systematic review aims to evaluate the prognostic role of ACVRL1/ALK1 in the development and outcomes of pulmonary hypertension.
Material and methods: This systematic review was conducted according to PRISMA guidelines to evaluate the prognostic role of ACVRL1/ALK1 in pulmonary hypertension. Eligible human studies were systematically identified from international and national databases, screened against predefined inclusion and exclusion criteria, and assessed for methodological quality. Data on study characteristics, sample size, mutation status, hemodynamic parameters, disease progression, survival, and clinical outcomes were extracted using a standardized approach.
Results: Synthesis of 11 studies (n=11; cohort, case-control, and genetic designs) confirms that ACVRL1/ALK1 mutations independently correlate with earlier disease onset and accelerated clinical decline. Carriers exhibited significantly worse hemodynamic profiles (e.g., higher pulmonary arterial pressures) and increased right ventricular strain compared to non-carriers. Qualitative synthesis indicates higher risk stratification scores and diminished survival rates, underscoring ACVRL1 as a pivotal genetic determinant of aggressive pulmonary hypertension phenotypes and poor clinical outcomes.
Conclusion: ACVRL1/ALK1 mutations serve as a critical prognostic biomarker in pulmonary hypertension, identifying a high-risk cohort characterized by early-onset disease and rapid hemodynamic deterioration. Incorporating ACVRL1 genotyping into clinical risk stratification is essential for optimizing surveillance and initiating aggressive, personalized therapeutic interventions. Future prospective multicenter trials are necessary to refine genotype-specific survival estimates and standardize long-term management protocols for this vulnerable patient population.

Abstract Introduction: Pregnancy-related hormonal and vascular changes may increase nasal mucosal congestion, particularly during the third trimester, when sleep disturbance is also common. Nasal obstruction can promote mouth breathing, nocturnal discomfort, and fragmented sleep. This study aimed to evaluate the effect of NOSE score on sleep quality in primigravid women during the third trimester of pregnancy.

Material and methods: This descriptive cross-sectional study will be conducted at Tabriz University of Medical Sciences in 2026 on 66 primigravid women in the third trimester of pregnancy, selected by convenience sampling. The main variables will include demographic and obstetric characteristics, NOSE score, sleep quality indices, and pregnancy-related sleep disruptors such as nocturia, reflux, back pain, fetal movement-related awakening, and nocturnal breathing discomfort.

Results: Among 66 primigravid women, poor sleep quality was associated with significantly higher NOSE scores than good sleep quality (56.84 ± 18.27 vs. 31.46 ± 14.92, p < 0.001), with severe nasal obstruction occurring more often in poor sleepers (39.47% vs. 10.71%, p = 0.012). NOSE score correlated with worse sleep quality (r = 0.58, p < 0.001) and remained an independent predictor in adjusted analysis (B = 0.07, p = 0.001).

Conclusion: Poor sleep quality in third-trimester primigravid women was significantly associated with greater nasal obstruction severity. Higher NOSE scores independently predicted worse sleep quality, suggesting that nasal symptoms may represent an important and potentially modifiable contributor to sleep disturbance during late pregnancy.

Abstract Introduction: Nasal bone fracture is a common facial injury with potential early postoperative consequences, including pain, bleeding, edema, airway symptoms, and residual deformity. Fracture severity may influence these outcomes by reflecting the extent of structural and soft-tissue damage. This study aimed to determine short-term postoperative complications according to nasal bone fracture severity.

Material and methods: This descriptive cross-sectional study of 75 patients at Tabriz University of Medical Sciences in 2024 investigated the association between nasal bone fracture severity and early outcomes. Measured variables included demographics, fracture characteristics, surgical parameters, and short-term complications, including VAS pain score, epistaxis, edema, ecchymosis, and septal hematoma. Data were analyzed using normality testing, t-tests, Mann-Whitney U, and chi-square tests.

Results: Among 75 patients, severe/complex nasal fractures (n = 34) were associated with worse short-term postoperative outcomes than mild/moderate injuries (n = 41). Severe fracture patients experienced longer operations (41.53 ± 11.47 vs. 28.64 ± 8.12 minutes, p < 0.001), higher 24-hour VAS pain (4.85 ± 1.56 vs. 3.42 ± 1.18, p < 0.001), increased moderate/severe edema (61.76% vs. 26.83%, p = 0.002), and more unplanned visits (26.47% vs. 7.32%, p = 0.027). Severe fracture independently predicted early complications (adjusted OR = 3.86, p = 0.020).

Conclusion: Severe nasal bone fractures are independently associated with an increased risk of short-term postoperative complications. Patients with complex fracture patterns experience higher pain levels, more pronounced soft-tissue edema, and greater rates of early residual deformity, leading to more frequent unplanned clinical evaluations. Preoperative severity stratification can identify high-risk cases requiring closer early postoperative surveillance.

Abstract Introduction: Scaphoid waist nonunion with avascular necrosis is a difficult reconstructive problem because impaired blood supply, instability, and deformity can compromise healing and function. Vascularized grafting has therefore emerged as a biologically appealing option to improve union in selected patients. The aim of this study was to evaluate the early outcomes of the Mathoulin technique in scaphoid waist nonunion with avascular necrosis.

Material and methods: This descriptive cross-sectional study was conducted at Shahid Madani Hospital, Tabriz, with a convenience sample of 50 eligible patients selected using the standard descriptive sample-size formula. Patients underwent evaluation and treatment with the Mathoulin technique, and demographic, clinical, radiographic, and early postoperative outcome variables were recorded to assess short-term surgical results.

Results: The cohort comprised 50 patients (mean age 34.8±9.6 years), predominantly men (64.0%), with avascular necrosis in all cases and a mean nonunion duration of 15.2±6.4 months. After the Mathoulin technique, pain, wrist motion, and grip strength improved significantly (VAS 6.9±1.2 to 2.1 1.0; flexion 41.3±8.7° to 55.6±7.9°; grip strength 19.4±5.3 to 28.7±6.1 kg; all P<0.001), and union was achieved in 88.0% of patients at 11.8±2.6 weeks. Smoking, prior surgery, longer nonunion, severe AVN, and humpback deformity were associated with poorer outcomes.

Conclusion: The Mathoulin technique provided encouraging early clinical and radiographic results for scaphoid waist nonunion with avascular necrosis, with high union rates and significant functional improvement. Outcomes were less favorable in patients with smoking, prior surgery, prolonged nonunion, severe AVN, or deformity, suggesting that careful patient selection remains important.

Abstract Introduction: Pediatric complete forearm fractures may redisplace after closed reduction, potentially causing functional impairment and requiring repeat intervention. Although long-arm and sugar-tong splints can restrict motion and accommodate swelling, the effectiveness of their combined use remains uncertain. This study aimed to evaluate the effect of combined sugar-tong and long-arm splinting on fracture displacement in children with complete forearm fractures.

Material and methods: This randomized clinical trial at Shohada Hospital, Tabriz, evaluated 50 children with complete forearm fractures requiring closed reduction (25 per group, calculated via the two-independent-means formula). Participants were randomly assigned to combined sugar-tong and long-arm splinting or standard long-arm splinting alone. Serial radiographs were obtained from post-reduction through early follow-up to evaluate changes in fracture angulation and translation between the two immobilization methods.

Results: The combined splint group maintained better alignment than the standard splint group, with lower AP angulation, lateral angulation, translation, and shortening at follow-up (week 1 and 2, all P≤0.001); it also had fewer losses of reduction (8.0% vs. 36.0%,P=0.014) and remanipulations (4.0% vs. 24.0%, P=0.037), while parental satisfaction was higher (8.6±1.1 vs. 6.8±1.5, P<0.001).

Conclusion: Combined sugar-tong and long-arm splinting was more effective than standard splinting in preserving reduction and preventing secondary displacement in children with complete forearm fractures, without increasing complications. This simple immobilization strategy may improve early fracture stability and reduce the need for repeat intervention.

Abstract Background: Postoperative pain remains a significant clinical challenge, affecting up to 80% of surgical patients and impeding recovery. Standardized pain management protocols, including Enhanced Recovery after Surgery (ERAS) pathways and opioid-sparing analgesia strategies, have developed to address this issue through systematic, multimodal approaches.

Objective: This study aims to assess the effectiveness of standardized pain management protocols in improving postoperative recovery outcomes among surgical patients.

Methods: A systematic review and meta-analysis conducted following PRISMA guidelines. PubMed, Embase, Web of Science, and Cochrane Library searched for randomized controlled trials and comparative studies evaluating standardized pain protocols versus conventional care. Primary outcomes included postoperative pain scores, opioid consumption, and length of hospital stay, opioid-related adverse effects, and patient satisfaction. 58 studies (5,614 patients) were included in the final analysis.

Results: Standardized pain protocols were associated with significantly reduced 24-hour morphine consumption (MD: -9.47 mg, 95% CI: -13.00 to -5.95), lower pain scores at 24 hours (MD: -0.72, 95% CI: -0.97 to -0.47), reduced PONV incidence (OR: 0.73, 95% CI: 0.59-0.90), and improved patient satisfaction (MD: 0.88, 95% CI: 0.36-1.40). Length of stay showed a reduction from 3.0 to 2.1 days (p

Abstract Introduction: Tibial fractures present substantial healing challenges because limited soft-tissue coverage, vulnerable blood supply, fracture complexity, and host-related factors increase the risk of impaired union. Although plate fixation restores alignment and stability, it may contribute to infection, nonunion, malunion, and implant-related complications. This study aimed to evaluate healing time and complications following tibial fracture plating from a pathologic perspective.

Material and methods: This descriptive cross-sectional study included 52 patients who underwent plate fixation for tibial fractures at Shahid Madani Hospital, Tabriz, selected through convenience sampling. Demographic, clinical, fracture-related, laboratory, operative, and postoperative data were collected from medical records and follow-up assessments. Healing time was determined using clinical and radiographic evidence of union, while postoperative complications, including infection, impaired union, malalignment, and implant-related failure, were documented.

Results: Patients with postoperative complications were older and had more severe injuries, including higher rates of open and comminuted fractures, longer time to surgery, and worse preoperative inflammatory and nutritional profiles (all significant variables, P<0.05). Healing time was markedly prolonged in complicated cases (23.2 ± 4.6 vs 15.9 ± 3.2 weeks, P<0.001). Independent predictors included age (OR=1.04), open fracture (OR=2.86), CRP (OR=1.17), surgical delay (OR=1.38), and operative duration (OR=1.21).

Conclusion: These findings indicate that postoperative complications after tibial plate fixation are driven by both fracture severity and adverse preoperative biological status. Early surgical management, control of inflammation, and optimization of hemoglobin and albumin levels may improve healing and reduce complication risk. Preoperative CRP and operative burden appear particularly valuable for risk stratification and perioperative decision-making.

Abstract Macrophages, as central components of the innate immune system, play a pivotal role in orchestrating inflammatory responses. Recent evidence highlights that macrophage function is closely governed by metabolic reprogramming, a process in which shifts in cellular metabolism modulate immune phenotypes and effector functions. During chronic inflammation, macrophages exhibit altered utilization of glycolysis, oxidative phosphorylation (OXPHOS), fatty acid oxidation, and glutamine metabolism. These metabolic shifts determine the polarization state of macrophages, driving pro-inflammatory (M1-like) or anti-inflammatory (M2-like) phenotypes. Persistent metabolic dysregulation contributes to uncontrolled inflammation and tissue damage in chronic diseases such as atherosclerosis, diabetes, rheumatoid arthritis, and cancer. In atherosclerosis, macrophages accumulate lipids and undergo metabolic stress that sustains inflammatory activation. In diabetes, hyperglycemia-induced metabolic reprogramming enhances macrophage glycolysis and inflammatory cytokine production. In tumors, the hypoxic microenvironment reshapes macrophage metabolism to support immunosuppressive and pro-tumorigenic activity. Understanding how metabolic pathways regulate macrophage function reveals therapeutic opportunities. Targeting key enzymes such as hexokinase 2, isocitrate dehydrogenase, or AMP-activated protein kinase (AMPK) offers potential to reprogram macrophages toward inflammation resolution. This review integrates findings from immunometabolism and pathophysiology to demonstrate that macrophage metabolic reprogramming acts as a central mechanism linking cellular metabolism to chronic inflammation and disease progression. Therapeutic strategies that correct macrophage metabolic imbalance may provide novel approaches for managing chronic inflammatory disorders and improving patient outcomes.

Abstract Introduction: Acute myocardial infarction remains a leading cause of morbidity and mortality, with impaired myocardial reperfusion and electrical instability playing key roles in adverse outcomes. Atrial conduction abnormalities may reflect ischemic burden and microvascular dysfunction. This study aimed to evaluate the clinical and prognostic significance of atrial electrical indices in relation to reperfusion quality and coronary disease severity.

Material and methods: This retrospective cross‑sectional study included 315 consecutive patients admitted to Shahid Madani Hospital, Tabriz, between March 2023 and March 2024. Clinical, laboratory, electrocardiographic, and angiographic data were extracted from medical records. Standardized ECG measurements, angiographic assessment, and post‑PCI outcomes were analyzed to evaluate electrophysiological and clinical associations.

Results: Among 315 cardiomyopathy patients, ischemic etiology was associated with a significantly higher prevalence of isoelectric T waves in lead aVR compared with non‑ischemic cardiomyopathy (P=0.004 and P=0.030). Other T‑wave amplitude categories showed no significant differences between etiologic groups, nor any significant association with the severity of left ventricular systolic dysfunction (all P>0.05).

Conclusion: This study demonstrates that while traditional cardiovascular risk factors are highly prevalent in patients with cardiomyopathy, T‑wave amplitude in lead aVR provides limited functional insight into left ventricular systolic impairment.

Abstract Introduction: Right ventricular pacing can alter physiological ventricular activation, potentially leading to mechanical dyssynchrony and regional myocardial dysfunction. Advanced echocardiographic techniques, particularly segmental peak systolic strain analysis, allow sensitive detection of these changes. The aim of this study was to evaluate and compare segmental peak systolic strain in patients with septal versus apical right ventricular pacing.

Material and methods: This randomized clinical study with a historical control design was conducted at Shahid Madani Hospital, Tabriz, between 2011 and 2013. Sixty patients requiring permanent pacing were enrolled by census sampling and allocated to septal or apical right ventricular pacing. Segmental peak systolic strain was assessed using speckle‑tracking echocardiography, with blinded analysis and appropriate statistical comparison between groups.

Results: In this cohort, septal right ventricular pacing demonstrated relatively preserved and homogeneous segmental peak systolic strain compared with apical pacing. Both pacing strategies significantly reduced mid and basal septal strain compared with normal values (p < 0.001), with no significant difference between RVS and RVA in Sep.M and Sep.B (p > 0.05). In contrast, anterior septal angle and motion were significantly altered in RVA compared with RVS and normal reference values (p < 0.05).

Conclusion: This study demonstrates that the site of right ventricular pacing plays a critical role in determining regional left ventricular myocardial mechanics. Although both septal and apical pacing are associated with deviations from physiological strain patterns, septal pacing consistently preserves a more uniform and coordinated deformation profile across myocardial segments.

Abstract Introduction: Right ventricular pacing can profoundly influence left ventricular mechanics, particularly when non‑physiological activation patterns induce mechanical dyssynchrony and impaired myocardial deformation. Global peak systolic strain is a sensitive marker for detecting pacing‑related alterations in ventricular function. This study aimed to evaluate and compare global peak systolic strain in patients undergoing right ventricular apical versus septal pacing to determine the pacing site associated with more preserved myocardial mechanics.

Material and methods: This randomized historical control study included 60 patients undergoing permanent right ventricular pacing at a tertiary cardiac center. Participants were equally assigned to apical or septal pacing. Standardized echocardiography with speckle tracking analysis was performed to quantify global peak systolic strain, and outcomes were compared using appropriate statistical methods under blinded assessment and ethical approval.

Results: Right ventricular pacing was associated with significant impairment of left ventricular myocardial deformation. Global longitudinal strain showed a stepwise reduction from normal subjects to septal pacing and was most severely attenuated with apical pacing (p < 0.001). Inferior and mid‑inferior segmental strain was preserved with septal pacing but significantly reduced with apical pacing compared with both normal and septal groups (p ≤ 0.01).

Conclusion: This study demonstrates that the site of right ventricular pacing is a critical determinant of left ventricular mechanical performance. Although septal pacing does not fully replicate physiological ventricular activation, it is associated with relatively preserved global and regional myocardial deformation and reduced mechanical heterogeneity compared with apical pacing.

Abstract Cosmetic facial filler injections have become a cornerstone in aesthetic dermatology; however, associated complications, ranging from mild erythema to severe vascular compromise, necessitate effective and timely intervention. This study proposes a treatment algorithm grounded in the biological stages of wound healing: hemostasis, inflammation, proliferation, and remodeling. By aligning therapeutic strategies with these stages, clinicians can address adverse events more systematically and promote tissue recovery. Early-stage complications such as edema or erythema can often be managed with conservative measures, whereas mid- to late-stage events like granuloma formation or tissue necrosis require more invasive approaches, including hyaluronidase administration, corticosteroids, or surgical debridement. The algorithm emphasizes the importance of early diagnosis, risk stratification, and individualized care, considering patient history, filler type, and injection technique. Additionally, adjunctive therapies—such as hyperbaric oxygen, laser treatment, or platelet-rich plasma—may enhance healing outcomes. This framework aims to reduce long-term morbidity and provide practitioners with a clear, biologically informed decision-making pathway to manage filler-related complications effectively.

Abstract The present study examined the mechanisms of cardiac remodeling in heart failure with preserved ejection fraction. Heart failure is a condition in which the heart does not pump blood well or does not fill with blood well. As a result, the heart falls behind in its work of moving blood around the body. This condition causes symptoms such as edema (swelling), shortness of breath and fatigue. The ejection fraction, or EF, of the heart measures the ability of the heart to pump oxygen-rich blood throughout the body. In a healthy heart, the ejection fraction is higher. A lower ejection fraction means that the heart is having difficulty meeting the body's needs. The results of the present study showed that heart failure with preserved ejection fraction (HFpEF) is one of the most common types of heart failure, which occurs due to normal left ventricular function in terms of contraction, but impaired filling or relaxation of the heart. It commonly seen in older adults, women, and patients with type 2 diabetes, obesity, hypertension, and kidney disease. As the population ages and the prevalence of chronic diseases increases, the prevalence of HFpEF is also increasing. The results of this study also showed that patients with low ejection fraction (EF) often excluded from rehabilitation programs due to concerns about the possibility of sudden death or other adverse cardiovascular events during exercise sessions. Recent studies have highlighted the fact that cardiac rehabilitation can improve exercise capacity, cardiac function, and health-related quality of life in patients with congestive heart failure.

Abstract Asthma is a chronic inflammatory disease of the airways characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and underlying inflammation. This condition affects millions worldwide, leading to significant morbidity and healthcare costs. Traditional therapies, such as inhaled corticosteroids (ICS) and bronchodilators, have long been the cornerstone of asthma management. These medications primarily aim to reduce inflammation and relax airway muscles, providing symptomatic relief and preventing exacerbations. However, a subset of patients with severe asthma remains inadequately controlled despite optimal conventional therapy. This unmet need has spurred the development of novel pharmacological agents targeting specific pathways involved in asthma pathophysiology. These novel drugs include biologics, small molecules, and new inhaled formulations. Biologics, such as anti-IL-5, anti-IL-4/IL-13, and anti-IgE therapies, offer targeted treatment options for patients with severe asthma by modulating specific immune responses. Small molecule drugs, like PDE4 inhibitors and tyrosine kinase inhibitors, provide new mechanisms to control inflammation and bronchoconstriction. Additionally, advancements in inhaler technology and formulation have led to the development of new inhaled therapies, improving drug delivery and efficacy. This review discusses these novel drugs, highlighting their mechanisms of action, efficacy, and safety profiles, offering hope for better asthma management and improved patient outcomes.

Abstract This type of MRI is used to evaluate the brain and is very accurate and practical, and is a common method for examining brain structures and functions. For the clarity of the images and more accurate diagnosis, a substance called contrast is used in MRI, the contrast substance causes more differentiation between different brain tissues. This test can be used to check brain function and diagnose brain diseases and disorders, check cerebral vessels, birth defects and any inflammation and swelling, infection, injury or brain trauma, structural problems, abnormal masses and bleeding inside the brain. In general, if you have any metal parts in your body, especially in the head area or inside the eyeball, you must inform the expert, because the MRI machine has a strong magnet, and you are also usually asked to remove any metal objects that may be on your body. Do not carry them with you if they are affected by the magnetic field. Some of these items include: pens, pocket knives and glasses, jewelry, watches, credit cards and hearing aids, pins, hairpins, metal zippers, body piercings, artificial teeth, screws and plates or platinum or metal clips. Keep the doctor informed about your health status, history of surgery, drug use, and drug sensitivity. If you have claustrophobia (fear of closed or narrow spaces), be sure to let us know before imaging because your doctor may recommend an open MRI.

Abstract Background: The Systemic Immune-Inflammation Index (SII) has emerged as a reliable marker of systemic inflammation and has been associated with various postoperative outcomes in surgical patients. However, its relationship with acute postoperative pain in patients undergoing hip arthroplasty for femoral fractures remains underexplored. Objective: This study aims to investigate the correlation between the SII and acute pain intensity in patients undergoing hip arthroplasty for femoral fractures, along with its association with postoperative clinical outcomes such as length of hospital stay (LOHS), ICU admission, and platelet count.

Methods: This prospective observational study was conducted with 112 patients who underwent hip arthroplasty for femoral fractures. Preoperative blood samples were used to calculate the SII, and pain intensity was measured at various time points postoperatively using a visual analog scale (VAS). Clinical outcomes, including LOHS, ICU admissions, and platelet counts, were recorded.

Results: A significant positive correlation was found between the SII and postoperative pain intensity, with higher SII values associated with increased pain levels at 2 and 4 hours postoperatively (r = +0.745, p = 0.005). Additionally, patients with elevated SII values had significantly longer hospital stays (22 days vs. 17 days, p = 0.006), higher ICU admission rates (27.94% vs. 16.60%, p = 0.036), and elevated platelet counts. The SII was also significantly correlated with neutrophil and lymphocyte counts, highlighting its role in reflecting the inflammatory response.

Conclusion: The SII appears to be a promising predictor of postoperative pain intensity and adverse clinical outcomes in patients undergoing hip arthroplasty for femoral fractures. Elevated SII values are associated with increased pain, prolonged hospital stays, and higher rates of ICU admission. These findings suggest that the SII could serve as a useful biomarker for assessing postoperative complications and guiding clinical management in surgical patients.