Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Background: Venous insufficiency (acute and chronic) represents a significant vascular pathology, particularly prevalent in patients with increased body mass index (BMI). Overweight and obesity are associated with impaired venous hemodynamics, higher disease severity, and distinct therapeutic outcomes.

Objectives: To systematically evaluate the impact of overweight and obesity on acute and chronic venous insufficiency, with emphasis on surgical and endovascular intervention outcomes.

Methods: Databases (PubMed, ScienceDirect and others) were systematically searched for clinical and surgical studies comparing outcomes of venous interventions among normal-weight, overweight, and obese patients. Adult human studies published in English were included. Evidence was graded according to study design and clinical outcomes.

Results: Higher BMI correlates with greater severity of chronic venous insufficiency (CVI) and reduced improvement after procedural interventions such as thermal ablation or phlebectomy. Surgical outcomes are variably affected by BMI, with some studies showing poorer efficacy in patients with BMI ≥35 kg/m². Bariatric surgery–related weight loss may improve CVI manifestations. Evidence for acute venous insufficiency in overweight cohorts remains limited.

Conclusion: Evidence indicates that overweight and obesity negatively influence chronic venous insufficiency severity and surgical outcomes. Preoperative weight management and tailored surgical approaches are recommended for optimal outcomes.

Abstract Introduction: Mechanical mitral valve replacement is associated with a persistent risk of thrombotic complications despite appropriate anticoagulation. Identifying reliable clinical predictors of thrombosis remains a major challenge in this high risk population. This study aimed to evaluate the predictive value of the CHA₂DS₂ VASc score for thrombotic events in patients following mechanical mitral valve replacement.

Material and methods: This case-control study was conducted at Shahid Madani Hospital, Tabriz University of Medical Sciences, from 2017 to 2021. It included 100 consecutive patients who underwent mechanical mitral valve replacement. The primary objective was to evaluate the predictive value of the CHA₂DS₂-VASc score for thrombotic events in this cohort.

Results: In this cohort of 100 patients with mechanical mitral valve replacement, no significant differences were observed between patients with and without thrombosis regarding age (p = 0.148), sex (p = 0.944), comorbidities, valve type, left ventricular ejection fraction (p = 0.723), warfarin dose (p = 0.447), INR levels (p = 0.620), or individual CHA₂DS₂‑VASc components (all p > 0.05).

Conclusion: This study demonstrates that traditional clinical and demographic risk factors, including those incorporated into the CHA₂DS₂ VASc score, do not independently predict prosthetic valve thrombosis in patients with mechanical mitral valves when anticoagulation intensity is considered.

Abstract Introduction: Mechanical aortic valve replacement requires lifelong anticoagulation, yet prosthetic valve thrombosis (PVT) can occur even with therapeutic INR levels, suggesting additional mechanisms beyond standard risk factors. This study aimed to determine whether the CHA₂DS₂ VASc score independently predicts PVT in mechanical aortic valve recipients, providing insight into whether classical thromboembolic predictors apply to this distinct clinical condition.

Material and methods: This case–control study was conducted at Shahid Madani Heart Center, Tabriz, Iran, between 2017 and 2021. Using a census sampling method, 100 patients with mechanical mitral valve replacement were enrolled. Clinical, echocardiographic, and anticoagulation data were retrospectively collected to compare patients with confirmed prosthetic valve thrombosis and matched controls without thrombosis.

Results: After excluding patients with subtherapeutic anticoagulation, 22 patients with prosthetic valve thrombosis and 78 controls were analyzed. Baseline demographic, clinical, and anticoagulation parameters were comparable between groups, with no significant differences observed. The mean CHA₂DS₂ VASc score was numerically higher in the thrombosis group but did not differ significantly between groups (p = 0.23).

Conclusion: In this cohort of patients with mechanical prosthetic valves who maintained therapeutic anticoagulation, traditional clinical and demographic factors were not associated with the development of prosthetic valve thrombosis.

Abstract Background: Midface volumization is a widely practiced aesthetic procedure for restoring facial volume and improving facial contours. Calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) are two commonly used dermal fillers, yet comparative evidence regarding their efficacy in midface augmentation remains inconclusive.

Objective: To systematically review and quantitatively analyze clinical outcomes comparing CaHA and HA for midface volumization.

Methods: We conducted a systematic search across PubMed, Embase, Cochrane Library, and Web of Science from inception to October 2025. Randomized controlled trials (RCTs), cohort studies, and comparative observational studies evaluating CaHA and HA for midface volumization were included. Primary outcomes were patient reported aesthetic improvement and objective volumetric enhancement. Secondary outcomes included duration of effect, safety, and adverse events. Meta analysis was conducted using a random effects model. Heterogeneity was assessed using I² statistics.

Results: Eight studies (N = 1,245 patients) met inclusion criteria. Both CaHA and HA demonstrated significant midface volume augmentation compared with baseline (p < 0.001). Meta analysis indicated no significant difference between CaHA and HA in aesthetic improvement scores at 6 months (standardized mean difference [SMD] 0.08, 95% CI −0.11 to 0.27, I² = 42%). However, CaHA showed a longer duration of effect at 12 months post treatment (SMD 0.31, 95% CI 0.12–0.50, I² = 35%). Safety profiles were comparable; transient swelling and erythema were most common.

Conclusion: Both CaHA and HA are effective and safe for midface volumization. While early aesthetic outcomes are similar, CaHA may confer longer durability. Further large scale RCTs with standardized outcome measures are recommended.

Abstract Facial surgery, whether aesthetic or reconstructive, increasingly relies on interdisciplinary frameworks to enhance both functional and visual outcomes. Among these frameworks, architectural principles provide a valuable conceptual and practical lens for understanding facial form, proportion, and spatial harmony. This article explores how architectural thinking—particularly concepts such as balance, proportion, symmetry, rhythm, scale, and structural integrity—can inform facial surgical planning and execution. By treating the face as a dynamic three-dimensional structure rather than a collection of isolated anatomical units, surgeons can achieve results that are more harmonious, durable, and individualized. Spatial thinking, a core element of architectural design, enables surgeons to evaluate the relationships between facial subunits, soft tissue volumes, skeletal foundations, and light-shadow interactions. This approach is especially relevant in complex reconstructive cases, where restoring facial identity requires more than anatomical repair, and in aesthetic surgery, where subtle changes can significantly influence overall facial perception. Architectural concepts such as load-bearing structures can be analogized to skeletal support, while façade design parallels soft tissue contouring and skin redraping. Furthermore, the integration of architectural principles supports preoperative visualization, surgical simulation, and long-term outcome prediction. Advances in three-dimensional imaging and digital modeling have strengthened this interdisciplinary connection, allowing surgeons to plan procedures with architectural precision. By adopting spatial and architectural thinking, facial surgeons can bridge the gap between science and art, improving patient satisfaction and surgical predictability. This article argues that architectural principles should be considered an essential cognitive tool in facial surgery education and practice. Incorporating these concepts fosters a holistic understanding of facial anatomy and aesthetics, ultimately contributing to more balanced, functional, and aesthetically pleasing surgical outcomes.

Abstract Introduction: Re‑expansion pulmonary edema is a rare but serious complication following rapid lung re‑expansion in patients with massive pleural effusion. Chest tube insertion and video‑assisted thoracoscopic surgery are commonly used interventions, yet their relative risks for this condition remain unclear. Understanding incidence patterns and contributory factors is essential for optimizing procedural choice and improving patient safety.

Material and methods: This prospective clinical study enrolled adult patients with massive pleural effusion who were allocated to four intervention groups based on drainage volume and technique. Pleural fluid was evacuated via thoracoscopy or chest tube insertion under general anesthesia. Postoperative hypoxemia was evaluated using arterial blood gas analysis and chest radiography to identify re‑expansion pulmonary edema, with outcomes systematically recorded and analyzed.

Results: Baseline characteristics were comparable between groups. Video assisted thoracoscopic surgery was associated with a significantly lower incidence of re expansion pulmonary edema, improved post procedural oxygenation, fewer ICU admissions, and shorter hospital stay compared with chest tube drainage (all P ≤ 0.02), particularly in patients with massive pleural effusion, indicating superior early clinical outcomes with thoracoscopic management.

Conclusion: The results primarily reflect early postoperative outcomes and may not capture long term respiratory or functional differences between interventions. Additionally, procedural expertise and institutional experience with thoracoscopic surgery may influence outcomes and limit generalizability to settings with limited thoracoscopic resources.

Abstract Introduction: This prospective study investigates the prognostic significance of routine liver and renal function tests in breast cancer patients undergoing chemotherapy. Given their central role in drug metabolism, systemic inflammation, and treatment tolerability, these readily available laboratory parameters may provide valuable prognostic information and support improved risk stratification and individualized clinical decision‑making in breast cancer management.

Material and methods: This prospective cohort study enrolled 150 patients with stage I–III breast cancer receiving adjuvant or neoadjuvant chemotherapy. Baseline and serial assessments of liver and renal function and related laboratory biomarkers were performed during treatment. Clinical response, chemotherapy related toxicity, overall survival, and progression free survival were prospectively evaluated across molecular subtypes.

Results: Multivariable analysis identified stage III disease as the strongest predictor of poorer overall survival compared with stages I–II (P < 0.001), a finding corroborated by Kaplan–Meier analysis. Older age (P = 0.014), HER2‑positive (P = 0.011) and basal‑like subtypes (P < 0.001), and neoadjuvant chemotherapy (P = 0.043) were associated with increased mortality, whereas higher serum albumin (P = 0.006) and eGFR (P = 0.017) independently predicted improved survival.

Conclusion: These results underscore that prognosis in breast cancer is shaped by both tumor related and host related factors. While tumor stage and molecular subtype remain the cornerstone of risk stratification, routinely available clinical parameters such as albumin and renal function provide meaningful complementary prognostic information.

Abstract Introduction: Bacterial sepsis remains a major challenge in intensive care units due to its nonspecific presentation and high mortality. Inflammatory biomarkers such as C‑reactive protein and procalcitonin are widely used to support early diagnosis and prognostication. However, variability in their diagnostic accuracy and prognostic performance necessitates a comprehensive evaluation of existing evidence.

Material and methods: This systematic review comprehensively searched major biomedical databases without time restrictions to evaluate the prognostic value of CRP and procalcitonin in bacterial sepsis among ICU patients.

Results: The review demonstrates a predominance of studies focusing on procalcitonin and combined biomarker strategies, with elevated CRP and procalcitonin consistently associated with adverse clinical outcomes in septic ICU patients. Procalcitonin showed superior prognostic precision, while overall methodological quality was acceptable despite residual bias concerns, underscoring the need for more rigorous prospective research.

Conclusion: Finally, the identified methodological gaps emphasize the need for rigorously designed prospective studies to clarify the independent prognostic value of inflammatory biomarkers. Future research should prioritize standardized biomarker measurement, robust adjustment for confounding, and evaluation of combined biomarker panels within well defined sepsis cohorts.