Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Beyond the Scalpel: Integrating Mental Health Support in Surgical Patient Care 1 3 735168 10.22088/caspjs.2026.2087202.1053 EN Pouya Tayebi Associate Professor of Vascular and Endovascular Surgery, Department of Vascular and Endovascular Surgery, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. 0000-0002-6923-0221 Journal Article 2026 04 19 Surgical procedures, while crucial for physical healing, often impose substantial psychological stress on patients, impacting recovery and overall well-being. This editorial advocates for a paradigm shift towards integrating mental health support throughout the surgical journey. It highlights the prevalence of perioperative psychological challenges, including preoperative anxiety and postoperative mood disturbances, and their detrimental effects on clinical outcomes. The piece emphasizes the necessity of a multidisciplinary approach, incorporating systematic psychological screening, enhanced patient communication, optimized pain management, and robust postoperative support. By moving beyond a purely biomedical focus, healthcare providers can foster holistic patient recovery, improve satisfaction, and ultimately enhance the effectiveness of surgical interventions.

https://www.caspjs.com/article_735168_733dce9bbbadb8ae7dd4a6039ab5fb20.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Effectiveness of Ultrasound-Guided Median Nerve Methylprednisolone Hydrodissection Vs. Open Surgery in Treatment of Carpal Tunnel Syndrome: A Parallel-Group, Single-Blinded, Randomized Clinical Trial 4 12 735314 10.22088/caspjs.2026.2079247.1054 EN Danial Hosseinzadeh Clinical Research Development Unit of Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, I.R. Iran, Department of Orthopedics, Babol University of Medical Sciences, Babol, Iran 0000-0003-2906-7068 Parmida Abdavi Student Research Committee, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0002-6684-4703 Payam Ghafouri Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran 0009-0008-5470-2135 Mehrafza Mir Department of Anesthesiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0001-6356-7117 Amirhossein Zohrehvand Department of Neurosurgery, School of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0002-9441-2107 Journal Article 2026 04 21 Background: Carpal tunnel syndrome (CTS) is one of the most prevalent entrapment neuropathies of the upper extremity. Hydrodissection, a technique guided by ultrasound, has gained increased interest in the last decade for managing entrapment neuropathies. However, the comparison of ultrasound-guided hydrodissection versus open surgery for the treatment of CTS remains challenging due to uncertainty in current findings from limited studies. This trial compared the effects on function and severity of ultrasound-guided hydrodissection with methylprednisolone against open surgery in patients with moderate-to-severe CTS. Methods: In this randomized parallel-group, single-blinded clinical trial, 46 patients with CTS aged 20 to 65 were randomly allocated to either hydrodissection (injection of methylprednisolone, n=23) or open surgery (n=23) group. The functional status and severity scores of the Boston Carpal Tunnel Questionnaire (BCTQ) were the primary outcome and were assessed at baseline and one and three months after each intervention. Results: 44 patients, with a mean age of 48±10.3, successfully completed the study. Adjusting for baseline outcomes, the mixed model ANCOVA did not reveal significant Group*Time interactions for either severity (F=1.006; P=0.330; ηp2 =0.056) nor function (F=0.856; P=0.368; ηp2 =0.048) scales of the BCTQ. Both groups experienced similar improvements in both severity (one month: Δ0.1, 95%CI -0.4 to 0.6; three months: Δ0.4, 95%CI -0.25 to 1.05) and function (one month: Δ0.25, 95%CI -0.3 to 0.8; three months: Δ0.5, 95%CI -0.2 to 1.2) outcomes. Conclusions: This clinical trial showed that ultrasound-guided methylprednisolone hydrodissection and open surgery were similarly effective in moderate-to-severe CTS patients in the short term.

https://www.caspjs.com/article_735314_8eb3eba07f35fd49b8b9b25ef21496f6.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Quality of Life After Colorectal Cancer Surgery and Its Association with Spousal Caregiver Burden: A Cross Sectional Study 13 20 735334 10.22088/caspjs.2026.2087375.1055 EN Mina Alvandipour Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 0000-0003-4131-798X Shima Afzali Department of Surgery, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 0000-0002-5877-3300 Eisa Nazar Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran 0000-0002-2860-6034 Gooya Tayyebi Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 0000-0001-5516-0798 Journal Article 2026 04 23 Background: Colorectal cancer surgery improves outcomes but often leads to long-term physical and psychosocial challenges for patients and families. Limited evidence exists on the relationship between postoperative quality of life (QoL) and spousal caregiver burden, especially in non-Western settings. This study aimed to assess the QoL of colorectal cancer patients post-surgery and examine its association with the psychological burden experienced by their spouses. Methods: This descriptive cross-sectional study recruited 99 colorectal cancer patients and their spouses from two hospitals in northern Iran in 2023. Patients’ QoL was measured using the WHO Disability Assessment Schedule II (WHODAS II), and caregiver burden was assessed using the Zarit Burden Interview (ZBI). Adults with confirmed colorectal cancer living with a caregiving spouse were included; those with severe cognitive impairment or incomplete data were excluded. Associations were analyzed using Pearson correlation and Chi-square tests. Results: The patients’ mean age was 61.84 ± 12.10 years, while spouses averaged 51.14 ± 13.12 years. The majority underwent anterior resection (55.6%) or low anterior resection (30.3%). Patients reported moderate disability (mean WHODAS II score 22.20), particularly in social participation. The average caregiver burden was 6.98. Significant correlations existed between social participation difficulties and caregiver burden (r=0.308, p=0.002) and communication difficulties (r=0.202, p=0.045). Conclusion: Postoperative QoL among colorectal cancer patients was suboptimal, with lower QoL associated with higher caregiver burden. These findings underscore the need for family-centered care and support strategies for caregivers.

https://www.caspjs.com/article_735334_894545bda76ec7a307e54d8da53d7013.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Comparative Efficacy of Bupropion versus Escitalopram for Treating Depression After Coronary Artery Bypass Graft Surgery 21 27 735735 10.22088/caspjs.2026.2076723.1042 EN Romina Hamzehpour Department of Psychiatry, School of Medicine, Social Determinants of Health Research Center, Health Research Institute, Shahid Yahya Nezhad hospital, Babol University of Medical Sciences, 0000-0003-2544-687X Ghasem Faghanzadeh-Ganji Department of Surgery, School of Medicine,Rouhani Hospital Babol University of Medical Sciences 0000-0001-5220-9285 Mahboobe Khoozan Department of psychiatry, school of medicine. iran university of medical sciences(IUMS),Tehran,Iran 0000-0001-6968-1498 Saeedeh Eshghi Department Psychiatry, Babol University of Medical Sciences, Babol, Iran 0009-0005-1216-7195 Journal Article 2025 11 05 Background: Depression is highly prevalent in patients following coronary artery bypass graft (CABG) surgery and negatively affects recovery and prognosis. Selecting an appropriate antidepressant in this cardiac population remains a clinical challenge. Objective: This study aimed to compare the efficacy and safety of bupropion versus escitalopram in the treatment of major depressive disorder (MDD) in post-CABG patients. Both medication have limited cardiac side effects and drug intraction. Methods: In a double-blind, randomized controlled trial, 100 patients diagnosed with post-CABG depression based on DSM-5 criteria were assigned to receive either bupropion (150–300 mg/day) or escitalopram (10–20 mg/day) for 8 weeks. Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory-II (BDI-II) at baseline, and after 2, 4, and 8 weeks of treatment. Primary outcome was change in HAM-D score; secondary outcome was change in BDI-II. Results: Both groups demonstrated significant improvements in depression scores over time. At week 8, mean HAM-D scores decreased from 15.8 to 8.1 in the bupropion group and from 16.3 to 7.8 in the escitalopram group (p > 0.05). Similar patterns were observed in BDI-II scores. No serious adverse events were reported. Conclusion: Following cardiac surgery, the risk of developing symptoms of depression and anxiety is high. Identifying and determining of suitable medication with low cardiac vascular side effects and interaction is helpful in clinical decision making for physician. Both tracs were equally effective and well-tolerated in treating post-CABG depression. The findings support flexible antidepressant selection based on individual patient profiles.

https://www.caspjs.com/article_735735_7a4124932d7594aae36da296dc3a0fea.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Microbiological Profile and Antibiotic Resistance Patterns of Bacteria Isolated from Extruded Lumbar Discs in Patients Undergoing Lumbar Discectomy 28 36 736958 10.22088/caspjs.2026.2090240.1065 EN Mojtaba Shakiba Student Research Committee, Babol University of Medical Sciences, Babol, Iran 0000-0001-6855-5166 Abazar Pournajaf Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 0000-0001-6855-5166 Hadi Ebrahimi Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran 0000-0001-6855-5166 Journal Article 2026 05 31 Background: Lumbar intervertebral disc herniation and degenerative disc disease have traditionally been considered consequences of mechanical stress and degenerative changes. This study aimed to evaluate the microbiological profile and antimicrobial resistance patterns of bacteria isolated from extruded lumbar disc specimens obtained from patients undergoing lumbar discectomy. Methods: In this cross-sectional study, 115 patients undergoing lumbar discectomy were evaluated. Demographic data, clinical characteristics, and MRI findings were recorded. Disc samples were collected intraoperatively under sterile conditions and immediately transported for microbiological analysis. Specimens were homogenized and cultured on blood agar, MacConkey agar, and thioglycollate broth under aerobic and anaerobic conditions at 37°C. Isolated colonies were identified using standard microbiological techniques. Antimicrobial susceptibility testing was conducted according to CLSI guidelines, and multidrug resistance patterns were assessed. Results: The mean age of patients was 44.7 ± 5.76 years, and 60% were male. Spondylolisthesis (38.3%) was the most frequent MRI finding. Microbiological analysis revealed no bacterial growth in 62.6% of samples. Among positive cultures, anaerobic bacteria (9.5%) were the most common isolates, followed by coagulase-negative staphylococci (6.1%) and diphtheroids (6.1%). Antimicrobial susceptibility testing demonstrated multidrug resistance patterns, particularly among E. coli and P. aeruginosa, with concerning carbapenem resistance observed in Pseudomonas isolates. Conclusion: The observed antimicrobial resistance patterns highlight potential clinical concerns. These findings support the hypothesis that bacterial involvement may contribute to disc pathology in a subset of patients; however, further large-scale studies using advanced molecular techniques are required to clarify causality.

https://www.caspjs.com/article_736958_90954519c91d93396c16540878c17277.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Surgical Site Infections: A Silent Public Health Concern in Surgery 37 46 735571 10.22088/caspjs.2026.2087462.1057 EN Marzie Mahdizade Ari Clinical Research Development, Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran. 0000-0002-6285-5886 Mahyar Mahdizade Ari Department of Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran 0000-0002-0109-8690 Journal Article 2026 04 25 Abstract Background: Surgical site infections (SSIs) are common healthcare-associated infections that increase mortality, prolong hospital stays, and impose substantial economic costs. Aim: This review aims to clearly summarize the current evidence on the definition, classification, risk factors, common pathogens (including multidrug resistant organisms), and principles of management and prevention of SSIs, with emphasis on global guidelines to reduce infection related morbidity. Key findings: SSIs occur within 30 days post surgery and are classified as superficial incisional, deep incisional, or organ/space. Risk factors include patient related (smoking, obesity, age) and procedure related (prolonged surgery, implants, contamination) variables. Staphylococcus aureus and methicillin resistant S. aureus (MRSA) are predominant pathogens. Management involves surgical exploration, microbiological sampling, and appropriate antibiotic therapy. Prevention strategies are outlined in WHO based recommendations. Conclusion: Improving post discharge surveillance, validating risk tools, and conducting high quality trials on dressings and negative pressure therapy are future priorities. A multidisciplinary approach is essential for better outcomes.

https://www.caspjs.com/article_735571_423b0d261ce7ee75e7bc3c80296c4f4f.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Biliary Ileus: An Intraoperative Observation of Gallstone Impaction in the Ileum 47 49 733798 10.22088/caspjs.2026.2084105.1049 EN Rezvan Zabihollahi Department of General Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0001-5061-3436 Maedeh Akhlaghi Department of General Surgery, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran. 0000-0003-1198-1986 Journal Article 2026 01 30 Biliary ileus is a rare but notable cause of mechanical intestinal obstruction, often seen in patients with a history of gallbladder disease. This image captures the intraoperative removal of a gallstone that had impacted in the ileum, obstructing the bowel. The case highlights the diagnostic and surgical importance of recognizing biliary ileus in the context of small bowel obstructions.

https://www.caspjs.com/article_733798_6bcbac74b9dee78d90d90804ce683637.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 A Probable Paraneoplastic Cerebellar Degeneration during Neoadjuvant Chemotherapy in High-Grade Serous Ovarian Carcinoma: A CARE-Compliant Case Report 50 54 735572 10.22088/caspjs.2026.2087114.1052 EN Soheila Abbaszadeh Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran Shahla Yazdani Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran Ariya Abedisamakoosh Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran Mina Galeshi Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol,I.R.Iran 0000-0002-1883-9838 Mohammad Ranaei Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran Majid Nabipour Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran Journal Article 2026 04 15 Background: Paraneoplastic neurological syndromes (PNS) are rare immune-mediated disorders associated with malignancies, often preceding or complicating cancer diagnosis and treatment. Among them, paraneoplastic cerebellar degeneration (PCD) is a severe subtype. Case Presentation: A 41-year-old woman with high-grade serous ovarian carcinoma developed progressive cerebellar symptoms including dizziness, diplopia, gait instability, and dysarthria approximately two months after initiation of neoadjuvant carboplatin/paclitaxel chemotherapy. Neurological examination revealed nystagmus, positive Romberg test, and ataxic gait. Brain and spinal MRI were unremarkable. Differential diagnoses including cerebellar stroke, multiple sclerosis relapse, chemotherapy-induced neurotoxicity, and metabolic encephalopathy were excluded. Although onconeural antibody testing (Anti-Hu, Anti-Yo, Anti-Ri, and Anti-Ma2) was not available, the clinical presentation supported a probable diagnosis of PNS. The patient received high-dose intravenous immunoglobulin (0.4 g/kg/day for 5 days), corticosteroids (methylprednisolone 1 g/day for 5 days), and plasmapheresis, resulting in partial neurological improvement. Outcome: Following cytoreductive surgery and continuation of oncologic management, gradual improvement in neurological symptoms was observed over four months, although residual gait impairment persisted. Conclusion: PNS should be considered in patients with ovarian cancer presenting with unexplained neurological symptoms despite normal imaging. Early recognition and immunotherapy may improve outcomes.

https://www.caspjs.com/article_735572_365302a13d4c124d7e831aee9423f4b0.pdf

Babol University of Medical Sciences Caspian Journal of Surgery 3115-9087 2 1 2026 03 01 Retrorectal Epidermiod Cyst Following Fistulecctomy: A Case Report 55 59 736903 10.22088/caspjs.2026.2087999.1060 EN Mina Alvandipour Mina Alvandipour, Colorectal Surgeon, Department of General Surgery, Mazandaran University of Medical Sciences, Sari, Iran 0000-0003-4131-798X Parastoo Kanani Parastoo Kanani, Department of General Surgery, Mazandaran University of Medical Sciences, Sari, Iran. 0009-0008-7533-4052 Journal Article 2026 05 03 Introduction: Retrorectal tumors are rare and often present with nonspecific symptoms, leading to delayed diagnosis. Epidermoid cysts constitute an uncommon subgroup of retrorectal lesions and are typically benign; however, they may rarely undergo malignant transformation or develop secondary to trauma or surgery. Case Presentation: We report a very rare case of a retrorectal epidermoid cyst in a 66-year-old man that developed following a fistulectomy. The patient presented with an erythematous bulge in the sacrococcygeal region associated with mild tenderness and a palpable mass on the right side of the rectum. Imaging studies revealed a retrorectal cystic lesion. Surgical excision was performed, and the specimen was submitted for histopathological examination, which confirmed the diagnosis of an epidermoid cyst. Discussion: Retrorectal epidermoid cysts are rare and may be either congenital or acquired. Surgical implantation of epithelial elements following procedures such as fistulectomy may contribute to their development. Despite their benign nature, these cysts carry a risk of recurrence and, rarely, malignant transformation, necessitating complete surgical excision. Conclusions: Retrorectal epidermoid cysts should be considered in patients presenting with presacral masses, particularly those with a history of prior anorectal surgery. Early diagnosis and complete surgical excision are essential to achieve optimal outcomes and prevent recurrence. Keywords: Retrorectal tumor; Epidermoid cyst; Epidermal inclusion cyst; Fistulectomy; Presacral mass; Case report

https://www.caspjs.com/article_736903_034f5cb3dacd3e62f08a032e08674c1d.pdf