Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: Mechanical prosthetic valve thrombosis is a life threatening complication associated with substantial in hospital mortality, and early prognostic stratification remains clinically challenging. Given the overlap between cardiovascular comorbidities and adverse outcomes, this study aimed to evaluate the prognostic value of the CHA₂DS₂ VASc score for predicting in hospital mortality among hospitalized patients with mechanical prosthetic valve thrombosis.

Material and methods: This hospital based case–control study enrolled 100 patients with mechanical prosthetic valves at Shahid Madani Hospital, Tabriz, between 2017 and 2022. Using census sampling, clinical, echocardiographic, and anticoagulation data were collected, the CHA₂DS₂ VASc score was calculated at admission, and its association with in hospital mortality was analyzed using multivariable statistical models.

Results: Baseline characteristics were comparable between patients with and without thrombosis, indicating a well-balanced study population. The CHA₂DS₂‑VASc score did not differ significantly between thrombotic and non‑thrombotic groups (P = 0.23) and showed no significant association with mortality in either subgroup (P = 0.461 and P = 0.127). ROC analysis demonstrated poor discriminatory performance for prosthetic valve thrombosis.

Conclusion: In patients with mechanical prosthetic valves, the CHA₂DS₂ VASc score demonstrated limited clinical utility for predicting thrombotic events and mortality. Despite its established role in thromboembolic risk stratification for atrial fibrillation, the score failed to effectively discriminate patients at risk for prosthetic valve thrombosis or adverse survival outcomes.

Abstract Introduction: ST-segment elevation myocardial infarction (STEMI) demands rapid risk stratification, often limited by the availability of complex scores. The Modified Shock Index (MSI), derived from routine vital signs, reflects acute circulatory stress. This study aims to determine the predictive correlation between admission MSI values and the underlying angiographic coronary anatomy, specifically the number and type of involved vessels, thereby assessing MSI’s utility as a simple bedside marker for disease complexity in STEMI patients.

Material and methods: This cross-sectional study analyzed 234 consecutive STEMI patients via census sampling at Shahid Madani Hospital in Tabriz between 2018 and 2019. The core procedure involved calculating the Modified Shock Index (MSI) from vital signs recorded at admission. The study then correlated these pre-treatment MSI values with the detailed coronary anatomy determined by subsequent angiography to assess the extent of vessel involvement.

Results: Patients with high MSI (>0.897) were older (61 vs. 57 years, p = 0.002) and had higher rates of hypertension (p = 0.008), diabetes mellitus (p = 0.002), and dyslipidemia (p = 0.009), along with longer chest pain duration (p = 0.004) and elevated WBC (p = 0.001), troponin (p = 0.002), and creatinine levels (p = 0.001). MSI did not differ by number or type of involved vessels (all p > 0.05) but showed moderate predictive value for MACE (pre‑PPCI AUC = 0.677; post‑PPCI AUC = 0.631; both p < 0.001).

Conclusion: In conclusion, this study demonstrates that the Modified Shock Index is closely associated with patient‑level vulnerability and acute disease severity rather than the anatomical extent or distribution of coronary artery involvement in STEMI.

Abstract Demographic advances and the increasing elderly population have made it necessary to review the professional training and attitudes of future dentists. The present study aimed to investigate the effect of dental students' attitudes towards elderly patients on the satisfaction of these patients with receiving a removable complete denture. The therapist's attitude plays a central role in the formation of the clinical relationship, the manner of communication, the level of attention, and supportive behavior. Factors that can all shape the patient's treatment experience and affect his satisfaction with the treatment. This descriptive-correlation study was conducted with the participation of 150 dental students and 150 elderly patients receiving removable complete dentures at three universities of medical sciences in the country. Data collection tools included a standard questionnaire on attitudes towards the elderly for students and a questionnaire on satisfaction with dentures for patients. Data analysis was performed using descriptive statistical tests, Pearson correlation, multiple regression, and independent t-test. The findings showed that there was a positive and significant relationship between students' general attitude towards the elderly and patients' satisfaction with prosthesis. In particular, the emotional and behavioral components of attitude towards the elderly were stronger predictors of patient satisfaction, while the cognitive component had no significant effect. Finally, the present study, emphasizing the importance of professional attitude in geriatric dentistry, suggests that universities should reform curricula, design attitude-based educational interventions, and strengthen effective clinical experiences.

Abstract Advances in maxillofacial surgery increasingly rely on interdisciplinary approaches that integrate principles from engineering, digital imaging, and design sciences. Architectural methodologies, particularly those related to proportion, structural analysis, parametric modeling, and spatial visualization, offer a powerful conceptual and practical framework for understanding and reconstructing the human face. This article examines how architectural thinking can inform surgical planning, simulation, and outcome evaluation in contemporary maxillofacial practice. Drawing on literature from craniofacial surgery, computational design, and architectural theory, the study analyzes parallels between facial anatomy and built structures, emphasizing load distribution, symmetry, modularity, and hierarchical organization. Three methodological intersections are explored: geometric proportioning based on classical and modern architectural ratios; digital workflows employing three-dimensional scanning, virtual surgical planning, and computer-aided design; and patient-specific reconstruction strategies that mirror adaptive architectural design processes. The discussion highlights the benefits of visual communication tools, iterative modeling, and scenario testing, which allow surgeons to predict functional and aesthetic outcomes with greater accuracy. Ethical and practical limitations are also considered, including the risk of overstandardization and the need to preserve individual anatomical variation and cultural perceptions of facial aesthetics. The article concludes that adopting architectural methodologies does not merely enhance technical precision but also encourages a holistic perspective in which the face is understood as a dynamic, structural, and expressive system shaped by both biological and design principles. Future research should further investigate quantitative metrics for evaluating aesthetic harmony, long-term functional stability, and patient-reported outcomes, while fostering collaboration among surgeons, architects, biomedical engineers, and digital designers to develop standardized yet flexible frameworks capable of addressing diverse clinical conditions and cultural expectations worldwide through longitudinal studies, multicenter trials, and open interdisciplinary data sharing initiatives.

Abstract Introduction: In the present study, the evaluation of cardiopulmonary problems in cancer patients suffering from embolism has been investigated with clinical and radio-oncological points. Having cancer as well as its treatment can bring many complications for the patient. Cancer treatments such as radiotherapy, surgery and chemotherapy are very complicated and may have significant side effects in the short term or even after several years. People who have previously suffered from this disease and are currently treated are at a higher risk of contracting and dying from cardiovascular diseases compared to normal people in the society.

Methodology: Various studies have been conducted in this field and its various aspects have been investigated. A study published in 2021 looked at the increased risk of cardiovascular disease within 3 years of cancer patients finishing treatment. The present study investigated the issue by reviewing more than 60 articles with keywords including " Cardiopulmonary Problem”, “Cancer”, “Clinical and Radio Ecological Points” and “Patient”.

Results: This study showed that the probability of cardiovascular disease in people with cancer was higher than in healthy people. Among the existing cancers, those who were diagnosed with bladder, kidney, prostate, colon, rectal, lung, melanoma, and testicular cancers, compared to those who were diagnosed with other cancers, had a higher probability of developing cardiovascular disease.

Conclusion: The results obtained from this study showed that in people who were between the ages of 60 and 69, the probability of developing cardiovascular disorders within 3 years after the completion of cancer treatment was 1.24 times the normal state. This study showed that people with a history of cancer have a higher chance of developing cardiovascular disease after treatment.

Abstract Introduction: Early detection of lung cancer can be effective in the treatment process. However, it is difficult to detect this cancer in its early stages. Because its symptoms are similar to a respiratory infection.

Material and method: In the current study, the issue investigated by reviewing 42 articles and considering key words such as "radiological images", "diagnosis", "airway tumors", "clinical care", “Systematic Review” in Scopus, Google scholar and PubMed databases.

Findings: Lung cancer treatments are designed to get rid of the cancer in the body or slow its growth. Treatments can eliminate cancer cells, help destroy them, or prevent them from multiplying, or teach your immune system to fight them. Some treatments are also used to reduce symptoms and relieve pain. Your treatment will depend on the type of lung cancer, its location, how far it has spread, and many other factors.

Conclusion: Graphene oxide was prepared using the Hammer method. The structural integrity of the synthesized graphene oxide was verified and confirmed using FT-IR, UV-Vis spectroscopies, and TEM imaging. The different responses of the biosensor Nano sensor to healthy and mutated DNA enabled the detection of lung cancer. Therefore, by relying on nanotechnology, it is possible to detect lung cancer through fast, easy and cost-effective methods.

Abstract Facial reconstruction in plastic and reconstructive surgery represents a unique intersection of art and science, requiring a deep understanding of human aesthetic and anatomical structures. In recent years, the application of architectural concepts such as form, proportion, and harmony has emerged as a guiding framework for designing facial reconstructions. Form refers to the overall shape and three-dimensional volume of facial components, proportion addresses the mathematical relationships between these components, and harmony reflects the visual balance and aesthetic coherence among facial features. Integrating these concepts enhances surgical precision, improves aesthetic outcomes, and produces a more natural and balanced appearance. Research indicates that combining architectural principles with surgical techniques can improve preoperative planning, the selection of appropriate reconstructive methods, and the prediction of final outcomes. Moreover, this approach enables surgeons to correct complex deformities in a manner that respects individual patient characteristics while maintaining visual harmony. This article presents a framework based on form, proportion, and harmony for facial reconstruction and explores its applications in both reconstructive and cosmetic surgery. Findings demonstrate that incorporating architectural concepts not only enhances aesthetic outcomes but also increases patient satisfaction and reduces the need for secondary procedures. The study emphasizes that facial reconstruction surgeons can employ architectural principles as guiding tools for precise and harmonious design, bridging the boundaries between art and science in medicine.

Abstract Introduction: Cancer patients receiving chemotherapy are particularly vulnerable to COVID 19–associated thrombotic complications. The coexistence of SARS CoV 2 infection, malignancy related hypercoagulability, and treatment induced immunosuppression may adversely affect mechanical thrombectomy outcomes. Understanding this interaction is essential for optimizing acute stroke management and improving neurological and survival outcomes in this high risk population.

Material and methods: Following ethical approval, data were prospectively collected at Imam Reza Hospital using standardized forms. Demographic characteristics, comorbidities, cancer type, laboratory findings, thrombotic sites, anticoagulant use, ICU course, and clinical outcomes were systematically recorded for eligible cancer patients with COVID‑19. Statistical analyses were conducted to evaluate associations between clinical variables and patient outcomes.

Results: Critically ill cancer patients with concurrent COVID‑19 exhibited marked inflammatory and hypercoagulable profiles, with frequent multisite thrombosis, predominantly pulmonary and cerebral. Clinical outcomes were poor, characterized by prolonged ICU stays, high mechanical ventilation use, and substantial mortality. Active chemotherapy was associated with significantly reduced overall survival, underscoring its prognostic relevance in this high‑risk population.

Conclusion: the findings of this study support the concept that COVID 19 and malignancy act synergistically to create a uniquely severe thromboinflammatory state with profound clinical consequences. The combination of systemic inflammation, diffuse thrombosis, prolonged critical illness, and reduced survival—particularly among patients receiving chemotherapy—highlights the need for heightened vigilance, early identification of thrombotic complications, and tailored management strategies in this population.

Abstract Introduction: Older adults undergoing major emergency orthopedic surgery face high risks of postoperative delirium (POD), a debilitating complication. Inflammation and stress, reflected by the neutrophil-to-lymphocyte ratio (NLR), may contribute to POD. This study evaluates NLR as a predictor of POD in this vulnerable cohort.

Material and methods: This study employed a descriptive cross-sectional design at Shohada Hospital, Tabriz, Iran, with 88 elderly patients undergoing major emergency orthopedic surgery. Convenience sampling and Cochran’s formula determined sample size. Inclusion criteria focused on age (≥65), surgery type, preoperative CBC availability, and post-op assessment capability, while excluding pre-existing cognitive impairment or confounding conditions. Data on demographics, clinical factors, and NLR were collected, with postoperative delirium as the primary outcome.

Results: A total of 88 patients were evaluated, with 26 (29.5%) developing postoperative delirium. Advanced age (P < 0.001), higher ASA status (P = 0.007), longer surgery (P = 0.018) and delay times (P = 0.005), lower albumin (P = 0.001), and elevated NLR (P < 0.001) were associated with delirium. Preoperative NLR (OR = 1.89, 95% CI: 1.29-2.77, P = 0.001) independently predicted delirium.

Conclusion: Preoperative NLR is a significant independent predictor of postoperative delirium in elderly patients undergoing major orthopedic surgery, suggesting its utility in risk stratification and early intervention strategies for this vulnerable population.

Abstract Background: Conscientiousness, one of the Big Five personality traits, is consistently linked to better health outcomes and longevity. It is thought to influence behavior through enhanced self-regulation, adherence to medical recommendations, and lower stress reactivity. Hair cortisol concentration (HCC) has emerged as a reliable biomarker for chronic physiological stress. However, the relationship between conscientiousness, HCC, and health behaviors remains underexplored, particularly in older adults.

Objective: This study aims to investigate how conscientiousness relates to health behaviors and chronic stress, as measured by HCC, in older men and women. It also explores potential sex differences in these associations.

Methods: A cross-sectional sample of 350 older adults (aged 65–85) was recruited. Participants completed standardized assessments of personality traits, including conscientiousness, and reported on health-related behaviors (diet, physical activity, smoking, alcohol use, and medication adherence). Hair samples were collected and analyzed for cortisol concentration using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Statistical analyses included regression modeling and interaction terms for sex.

Results: Higher levels of conscientiousness were significantly associated with healthier behaviors and lower HCC. These associations remained robust after controlling for age, education, and socioeconomic status. Furthermore, the inverse relationship between conscientiousness and HCC was stronger in women, suggesting possible sex-related moderating effects.

Conclusion: Findings support the role of conscientiousness as a protective factor against chronic stress and unhealthy behaviors in aging populations. Interventions that enhance conscientiousness-related traits may improve stress regulation and health outcomes, particularly among older women.

Abstract Abstract

This article explores a cross-disciplinary framework linking architectural design principles with facial surgery, arguing that both fields address structure, aesthetics, function, and human perception through comparable logics. Architecture organizes space through proportion, symmetry, load distribution, and material behavior; facial surgery similarly reshapes bone and soft tissue to restore balance, stability, and expression. Drawing on architectural theories of form, modularity, and structural hierarchy, the paper proposes an analytical model for understanding the face as a dynamic, inhabitable structure rather than a static surface. Concepts such as scale, rhythm, tectonics, and contextual integration are translated into surgical planning tools that support more predictable functional and aesthetic outcomes. The study synthesizes literature from architecture, craniofacial surgery, biomechanics, and visual psychology, and illustrates how architectural thinking can enhance preoperative analysis, three-dimensional modeling, and patient-specific design. Conversely, insights from facial surgery—particularly adaptability, biological constraints, and healing processes—are shown to offer architecture valuable perspectives on responsive design and human-centered construction. By framing facial surgery as a form of micro-architecture and architecture as a macro-expression of embodied form, the article highlights shared epistemologies that transcend disciplinary boundaries. This integrative approach encourages collaboration between architects and surgeons, promotes innovative educational models, and opens new research pathways in digital simulation, biomimetic design, and aesthetic evaluation. Ultimately, the paper argues that understanding faces and buildings through a unified structural and perceptual lens can lead to more ethical, functional, and aesthetically coherent interventions in both the built environment and the human body. Such a perspective reframes professional responsibility, emphasizing long-term impact, interdisciplinary literacy, and the careful alignment of technique, meaning, and lived experience within complex social, cultural, and ethical contexts across contemporary practice globally today.

Abstract Background: Clinical deterioration in hospitalized patients often precedes adverse events such as cardiac arrest, unplanned intensive care unit (ICU) admission, and mortality. While traditional early warning systems (EWS) based on vital signs have improved detection, their predictive accuracy and integration into nursing workflow remain suboptimal. Artificial intelligence (AI)-driven systems leveraging nursing surveillance data may enhance early detection and response.

Objective: To evaluate the effectiveness of an AI-driven early warning system integrated into nursing practice on early detection of clinical deterioration, nursing response time, and patient safety outcomes in adult medical-surgical wards.

Methods: A pragmatic randomized controlled trial conducted across 12 medical-surgical units in two tertiary hospitals. Adult patients (N = 4,286) were randomized to either the AI-driven EWS (intervention, n = 2,143) or standard EWS care (control, n = 2,143). The AI system analyzed nursing documentation patterns and vital signs in real time, generating risk scores displayed within the electronic health record. Primary outcomes included time to clinical deterioration detection, nursing response time to alerts, and composite patient safety outcomes (in-hospital mortality, unplanned ICU transfer, and cardiac arrest). Data were analyzed using intention-to-treat principles with mixed-effects models.

Results: The AI-driven EWS significantly reduced time to deterioration detection (median 2.1 vs. 4.8 hours; p < 0.001) and nursing response time (median 18 vs. 42 minutes; p < 0.001). The composite patient safety outcome occurred in 11.2% of intervention patients versus 16.8% of controls (adjusted odds ratio 0.64, 95% CI 0.53–0.78; p < 0.001). Unplanned ICU transfers were higher in the intervention group (24.9% increase; p = 0.001), suggesting appropriate escalation.

Conclusion: AI-driven EWS integrated into nursing practice substantially improved early detection, response time, and patient safety outcomes. These findings support implementation of AI-enhanced surveillance systems in acute care settings.

Abstract Introduction: Pelvic fractures are severe injuries commonly resulting from high-energy trauma, such as motor vehicle accidents and falls. These fractures can be complicated by missed diagnoses, particularly when patients are admitted to non-orthopedic wards. This study aimed to assess the incidence of undiagnosed pelvic fractures in trauma patients treated in non-orthopedic settings at Tabriz University of Medical Sciences.

Materials and Methods: A retrospective, cross-sectional analysis was conducted on trauma patients with pelvic fractures admitted to non-orthopedic wards from January 2020 to December 2024. Patient demographics, injury mechanisms, fracture types, and missed diagnoses were reviewed from medical records. Data were analyzed using descriptive and inferential statistics.

Results: A total of 300 patients were included, with a mean age of 46.35 years. The majority were male (60.67%), and the primary injury mechanism was motor vehicle accidents (50.33%). Pelvic ring disruptions (42.33%) were the most common fracture type. The incidence of missed fractures was 34%, with pelvic ring disruptions being the most frequently missed (10.33%).

Conclusion: Missed pelvic fractures represent a significant challenge in trauma care, particularly in non-orthopedic wards. The findings highlight the need for comprehensive diagnostic protocols, including early orthopedic consultation and advanced imaging, to reduce the risk of undiagnosed fractures and improve patient outcomes.

Abstract Introduction: Obese postmenopausal women undergoing thoracic surgery represent a high‑risk population due to the combined effects of hormonal deprivation, metabolic dysfunction, and reduced cardiopulmonary reserve. These factors significantly increase postoperative complications, ICU admission rates, and mortality, underscoring the need for tailored perioperative and critical care strategies in this vulnerable group.

Material and methods: This retrospective cross sectional study reviewed medical records of postmenopausal women admitted to the intensive care units of Imam Reza Hospital over a five year period. Clinical, demographic, and outcome data were collected using predefined criteria, and statistical analyses were performed with SPSS to evaluate associations between obesity, ICU outcomes, and mortality.

Results: Obese postmenopausal women admitted to the ICU after thoracic surgery exhibited significantly worse clinical outcomes compared with non obese patients. Obesity was associated with higher disease severity, increased need for mechanical ventilation and vasopressor support, longer ICU and hospital stays, and elevated ICU and 28 day mortality rates. These findings highlight obesity as a major determinant of postoperative morbidity and short term mortality in critically ill postmenopausal women.

Conclusion: In conclusion, our study demonstrates that obesity markedly deteriorates short term clinical outcomes among postmenopausal women admitted to the ICU following thoracic surgery. The data reveal higher disease severity, prolonged intensive care utilization, increased organ failure, and substantially greater mortality rates compared with non obese patients.

Abstract Introduction: Postoperative infections are a significant complication following surgical fixation of upper limb fractures, leading to increased morbidity, prolonged hospitalization, and potential implant failure. Early and accurate diagnosis is crucial for optimizing patient outcomes, yet distinguishing between normal postoperative inflammatory responses and infection remains challenging. This study aimed to evaluate the diagnostic utility of inflammatory markers, including C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count, in detecting postoperative infections.

Material and Methods: This prospective cohort study included patients undergoing upper limb fracture surgery. Inflammatory markers were measured at postoperative days (POD) 3 and 7. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) analysis, with sensitivity, specificity, and area under the curve (AUC) calculated.

Results: CRP and PCT demonstrated the highest diagnostic accuracy for detecting infections. At POD 3, CRP (AUC = 0.863) and PCT (AUC = 0.893) significantly differentiated infected from non-infected patients (p < 0.001). ESR and WBC count showed moderate diagnostic accuracy. Serial CRP and PCT measurements improved infection detection.

Conclusion: CRP and PCT are the most reliable markers for early detection of postoperative infections in upper limb fracture surgery. Incorporating these biomarkers into routine postoperative monitoring can improve early diagnosis and patient outcomes.

Abstract Introduction: Implant-associated infections after femur surgery are severe, and early diagnosis is challenging due to overlapping postoperative inflammation. While CRP and albumin are commonly used markers, their combined ratio may offer better insight into host reserve and inflammatory burden. This study aims to assess the preoperative albumin-to-C-reactive protein ratio for detecting early acute infection following femur implant insertion.

Material and methods: This descriptive cross-sectional study at Shohada Hospital, Tabriz, enrolled 85 patients undergoing femoral implant surgery using convenience sampling. Preoperative data on demographics, comorbidities, surgical details, and laboratory markers (including serum albumin and CRP to calculate the Alb/CRP ratio) were collected to assess early acute postoperative infection.

Results: Preoperative albumin-to-C-reactive protein ratio was significantly suppressed in infected patients compared with non-infected controls [median 0.22 (IQR 0.15–0.30) vs. 0.50 (IQR 0.36–0.68); p < 0.001]. Receiver operating characteristic analysis established superior discriminatory performance for Alb/CRP (AUC = 0.988; 95% CI: 0.82–0.98; cutoff ≤ 0.34; sensitivity 100.0%, specificity 95.6%). Multivariable logistic regression identified Alb/CRP ≤ 0.34 as an independent predictor of early acute infection (aOR = 9.10; 95% CI: 3.20–25.80; p < 0.001) alongside operative duration ≥ 120 minutes (aOR = 2.45; p = 0.028).

Conclusion: Preoperative albumin-to-C-reactive protein ratio serves as an outstanding, independent biomarker for early acute infection risk stratification following femur implant placement.

Abstract Temple volumization has become an integral component of facial rejuvenation, aiming to restore youthful contours and address age-related soft tissue loss. Despite the increasing use of dermal fillers in the temporal region, variability exists regarding filler type, injection depth, technique, and clinical outcomes. This systematic review and meta-analysis aimed to evaluate the efficacy, safety, and patient satisfaction associated with temple filler injections. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases from January 2000 to December 2025. Studies reporting on outcomes of hyaluronic acid (HA), poly-L-lactic acid (PLLA), and calcium hydroxylapatite (CaHA) in temple rejuvenation were included. Data extraction focused on injection technique, depth, volume, longevity of effect, adverse events, and patient-reported satisfaction. A total of 66 studies encompassing 3,214 patients met inclusion criteria. Meta-analytic pooling demonstrated significant improvement in temporal volume restoration with HA, PLLA, and CaHA, with standardized mean differences (SMD) of 1.12 (95% CI: 0.85–1.39), 1.05 (95% CI: 0.77–1.32), and 0.98 (95% CI: 0.70–1.26), respectively. Complication rates were low, predominantly mild bruising and transient edema, with no serious adverse events reported. Patient satisfaction scores were consistently high, with pooled satisfaction rates exceeding 90% across all filler types. Comparative analysis suggested slightly longer-lasting results with PLLA and CaHA compared to HA. The findings underscore that temple filler injections are effective, safe, and yield high patient satisfaction when performed with proper technique and depth awareness. Limitations include heterogeneity in study designs, follow-up duration, and reporting standards. Future research should focus on standardized injection protocols, long-term outcomes, and comparative studies between filler types. Overall, this meta-analysis provides evidence-based guidance for clinicians to optimize temple rejuvenation strategies and enhance patient-centered outcomes.

Abstract Introduction: One-anastomosis gastric bypass (OAGB) with a 150 cm biliopancreatic limb is increasingly used as a bariatric surgery option, offering effective weight loss and metabolic benefits. However, micronutrient deficiencies are common following this procedure due to altered gastrointestinal physiology. This study aims to evaluate changes in key micronutrient levels during the first three months after OAGB.

Materials and Methods: This prospective observational study included 25 patients who underwent OAGB with a 150 cm biliopancreatic limb. Blood samples were collected at three time points: preoperatively, 1 month postoperatively, and 3 months postoperatively. Serum levels of iron, ferritin, vitamin B12, folate, calcium, vitamin D, and fat-soluble vitamins (A, D, E, K) were measured. Statistical analysis was performed using repeated measures ANOVA and Friedman’s test to assess changes in micronutrient levels over time.

Results: The study found significant decreases in ferritin, vitamin B12, calcium, and fat-soluble vitamins (A, E, and K) from baseline to 3 months post-surgery (p < 0.05 for all). Ferritin and vitamin B12 levels declined sharply, indicating potential iron and vitamin B12 deficiencies, while vitamin D and calcium levels also decreased, raising concerns about bone health. Fat-soluble vitamin levels decreased significantly, pointing to malabsorption of these vitamins.

Conclusion: Significant micronutrient deficiencies, particularly in iron, vitamin B12, calcium, and fat-soluble vitamins, were observed within the first three months after OAGB. These findings highlight the need for careful monitoring and tailored supplementation to prevent nutritional deficiencies and associated complications in the early postoperative period.

Abstract Introduction: Geriatric femoral fractures frequently precipitate severe acute postoperative complications, yet early risk stratification remains suboptimal. Given the potential of systemic inflammatory markers to reflect perioperative stress, identifying reliable biomarkers is clinically critical. Therefore, this study aimed to evaluate the predictive value of the systemic immune-inflammation index for acute postoperative complications in elderly patients undergoing femoral fracture surgery.

Material and methods: This descriptive cross-sectional study at Shohada Hospital, Tabriz, enrolled 118 elderly patients with femoral fractures, determined by Cochran’s formula. Preoperative systemic immune-inflammation index (SII) values were calculated from complete blood counts. Participants were prospectively evaluated to assess the association between admission SII and acute postoperative complications, with statistical models utilized to determine the index’s prognostic accuracy in predicting adverse surgical outcomes.

Results: This study comprehensively analyzed preoperative inflammatory biomarkers for predicting acute postoperative complications in elderly patients with femoral fractures. Key findings indicate that elevated SII (AUC=0.865), NLR (AUC=0.782), and PLR (AUC=0.714) are significantly associated with increased complication risk. The multivariable model demonstrated superior predictive accuracy (AUC=0.912), highlighting the clinical utility of these indices for early risk stratification and tailored perioperative management.

Conclusion: Preoperative assessment of systemic inflammatory indices, particularly SII, offers valuable insights into the risk of acute postoperative complications in elderly hip fracture patients, enabling targeted interventions for improved outcomes.

Abstract Introduction: Opioids such as fentanyl and remifentanil are commonly used for anesthesia induction and maintenance, each with distinct pharmacokinetic and pharmacodynamic properties. This study aimed to compare their effects on hemodynamic stability, intraoperative excitability, neuromuscular blockade requirement, postoperative nausea, and recovery characteristics.

Materials and Methods: This prospective, randomized clinical trial included 400 patients, equally divided into fentanyl (n=200) and remifentanil (n=200) groups. Baseline characteristics, intraoperative hemodynamics, anesthesia recovery parameters, and postoperative complications were recorded. Data were analyzed using appropriate statistical tests, with P < 0.05 considered statistically significant.

Results: The remifentanil group exhibited significantly lower heart rate and blood pressure at all measured time points post-induction (P < 0.05). Intraoperative excitability and neuromuscular blocker requirement were higher in the remifentanil group (P = 0.014, P = 0.009). Postoperative nausea and antiemetic use were significantly higher in the fentanyl group (P = 0.041, P = 0.038). The remifentanil group had faster induction, earlier respiratory recovery, and shorter awakening time (P < 0.05).

Conclusion: Remifentanil ensures faster recovery with reduced postoperative nausea but causes greater hemodynamic suppression and intraoperative excitability. These findings support tailored opioid selection based on surgical needs and patient-specific factors.

Abstract Introduction: Effective postoperative pain management is essential for enhanced recovery in gastric cancer surgery. Enhanced Recovery After Surgery (ERAS) protocols emphasize multimodal, opioid-sparing strategies to improve outcomes, but their impact specifically in gastric cancer patients remains underexplored.

Methods: A systematic review was conducted to evaluate pain management methods integrated within ERAS protocols for patients undergoing gastric cancer surgery. Databases including PubMed, Scopus, and Web of Science were searched for studies published between 2018 and 2024. Inclusion criteria were adult patients undergoing elective gastric cancer surgery with reported postoperative pain outcomes under ERAS protocols. Data on study characteristics, analgesic methods, pain scores, opioid consumption, and recovery outcomes were extracted and analyzed.

Results: Five studies met inclusion criteria, encompassing 529 patients. Regional analgesia (e.g., epidural, TAP block) combined with non-opioid systemic medications significantly reduced 24-hour postoperative pain scores (VAS range: 2.86–4.14) and opioid consumption (15.33–21.78 mg morphine equivalents). ERAS-compliant groups also showed faster ambulation, earlier return of bowel function, shorter hospital stays, and lower complication and readmission rates.

Conclusion: Incorporating multimodal, regional pain management within ERAS protocols improves pain control and accelerates recovery in gastric cancer surgery. Standardized implementation can enhance postoperative outcomes and reduce opioid use.

Abstract Background and Objective: Pneumonia is an inflammatory respiratory disease that can affect the patient's adaptive patterns. Nurses play a key role in facilitating the adaptation process of the patient. Therefore, this study aimed to explore the use of Roy’s Adaptation Model in the care of a patient with pneumonia.

Materials and Methods: This case report study was conducted in May 2025 at a hospital in Lahore, focusing on a patient with pneumonia. Nursing care based on the Roy’s Adaptation Model was implemented in six stages according to the nursing process.

Results: The results showed a significant reduction in the patient's maladaptive behaviors across four modes: physiological, self-concept, role function, and interdependence and independence.

Conclusion: Nursing care based on the Roy's Adaptation Model effectively reduced maladaptive behaviors in patients with pneumonia. Therefore, the implementation of organized nursing care based on appropriate nursing models is essential to improve patient health.

Abstract The aesthetic rejuvenation of the lower third of the face, particularly the jawline, has become a pivotal focus in modern cosmetic dermatology. This study introduces “Contouring Plus,” a novel, minimally invasive approach that combines the biostimulatory properties of Calcium Hydroxylapatite (CaHA) with the versatile volumizing and contouring capabilities of Hyaluronic Acid (HA) fillers. The protocol involves a strategic layering technique where CaHA is injected supraperiosteally along the mandibular border to provide structural support and stimulate neocollagenesis, while HA fillers are administered in the subcutaneous plane to refine contours and enhance soft tissue projection. The article presents a case series involving four patients aged 29 to 54, treated in a single session and evaluated over a 90-day period using clinical photography and three-dimensional imaging. Results demonstrated significant improvement in jawline definition and patient satisfaction, with minimal adverse events such as mild bruising and swelling. The safety profile is supported by adherence to precise anatomical landmarks and injection planes, minimizing risks of vascular complications. The combined filler technique capitalizes on the long-term collagen-stimulating effects of CaHA alongside the immediate, moldable benefits of HA, resulting in durable and natural-looking facial rejuvenation. This hybrid approach provides clinicians with an evidence-based, adaptable protocol for addressing age-related volume loss and contour irregularities in the lower face. Future studies are warranted to assess long-term outcomes and optimize filler combinations.

Abstract Artificial intelligence (AI) is rapidly transforming dermatology, particularly in the realm of aesthetic procedures such as injectable filler administration. The integration of AI technologies into filler treatments offers promising advancements in precision, safety, and personalization, addressing longstanding challenges associated with manual injection techniques. AI-driven imaging and diagnostic tools enable detailed analysis of facial anatomy, volume loss patterns, and skin characteristics, allowing clinicians to develop highly individualized treatment plans tailored to each patient’s unique facial structure and aesthetic goals. Machine learning algorithms can predict patient outcomes by analyzing vast datasets of previous treatments, helping practitioners optimize filler type, volume, and injection sites to maximize efficacy and minimize adverse effects. Moreover, AI-powered real-time guidance systems, including augmented reality, provide dynamic visualization of critical anatomical landmarks and vascular structures during injection procedures, reducing the risk of complications such as vascular occlusion and nerve injury. These technologies also support less experienced clinicians by enhancing accuracy and confidence in filler placement. Furthermore, AI facilitates post-procedure monitoring through automated assessment of treatment results and early detection of potential complications, enabling timely interventions. The adoption of AI in filler administration not only improves clinical outcomes but also elevates patient satisfaction by enabling more predictable and natural-looking rejuvenation. Despite its potential, challenges remain in integrating AI into routine dermatological practice, including data privacy concerns, algorithm transparency, and the need for comprehensive clinical validation. Nonetheless, ongoing research and technological development position AI as a critical tool to revolutionize facial aesthetic treatments, making filler administration safer, more effective, and personalized.

Abstract Brain tumors remain among the most challenging malignancies in both adult and pediatric populations due to their heterogeneity, limited accessibility for biopsy, and variable clinical outcomes. Recently, circulating microRNAs (miRNAs) have emerged as promising minimally invasive biomarkers for cancer detection and prognosis. This systematic review and meta-analysis aimed to evaluate the diagnostic and prognostic value of circulating miRNAs in adult and pediatric brain tumors. A comprehensive literature search conducted across major electronic databases to identify eligible studies assessing circulating miRNAs in blood, serum, plasma, or cerebrospinal fluid of patients with primary brain tumors. Studies reporting diagnostic accuracy measures (sensitivity, specificity, area under the curve [AUC]) or survival outcomes (overall survival, progression-free survival, hazard ratios) were included. Data extracted and pooled using random-effects models. Study quality assessed using standardized appraisal tools. The meta-analysis demonstrated that circulating miRNAs exhibit significant diagnostic performance in differentiating brain tumor patients from healthy controls, with pooled sensitivity and specificity indicating moderate-to-high accuracy. Several miRNAs, including tumor-specific expression signatures, showed consistent upregulation or downregulation across gliomas, medulloblastomas, and other central nervous system tumors. Prognostically, elevated or reduced levels of specific circulating miRNAs were significantly associated with overall survival and disease progression, suggesting their potential role as independent prognostic indicators. Subgroup analyses revealed differences between adult and pediatric populations, reflecting underlying biological diversity. In conclusion, circulating miRNAs represent promising non-invasive biomarkers for the diagnosis and prognosis of brain tumors in both adults and children. However, heterogeneity in study design, sample processing, and analytical methods underscores the need for standardized protocols and large-scale prospective validation before clinical implementation.