Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Maxillofacial abnormalities involving chin deformities often lead to significant aesthetic and functional concerns. In recent years, hyaluronic acid (HA) fillers have gained popularity as a non-surgical alternative for chin shape correction. This systematic review aims to assess the efficacy, safety, and patient satisfaction associated with the use of hyaluronic fillers for chin augmentation in patients with congenital or acquired maxillofacial deformities. A thorough search of databases including PubMed, Scopus, Embase, and Cochrane Library was conducted up to July 2025. Inclusion criteria comprised clinical trials, case series, and cohort studies reporting on outcomes of HA filler injection in the chin. A total of 18 studies met the eligibility criteria, involving 729 patients. The analysis revealed that HA fillers provided satisfactory aesthetic improvement, high patient satisfaction, and low complication rates. However, repeated treatments are necessary due to the temporary nature of fillers. Overall, HA fillers offer a safe, effective, and minimally invasive option for selected patients with chin deformities, particularly when surgical interventions are not feasible or desired.

Abstract Midface volume loss and contour irregularities significantly affect facial aesthetics and are commonly addressed in aesthetic medicine. The beauty rule of one-fifth, which divides the midface horizontally into five equal parts, serves as a foundational guideline for achieving balanced and harmonious facial proportions. This systematic review evaluates the current evidence on the use of hyaluronic acid (HA) fillers for midface correction based on the one-fifth beauty rule. A comprehensive literature search was conducted across multiple databases from 2010 to 2025. Included studies assessed HA filler applications targeting midfacial volumization and contouring with reference to the one-fifth guideline. Outcomes related to aesthetic improvement, patient satisfaction, procedural safety, and adherence to proportional principles were analyzed. The review demonstrates that HA fillers, when applied with respect to the one-fifth rule, yield significant enhancement in midface volume and contour harmony with high patient satisfaction and minimal adverse events. This approach offers a minimally invasive alternative to surgical interventions and underscores the importance of aesthetic proportionality in treatment planning. Future research should focus on standardized injection protocols aligned with anthropometric guidelines to optimize outcomes.

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 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 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: Rapid molecular diagnostic techniques have emerged as critical tools for optimizing targeted antimicrobial therapy in critically ill ICU patients with multidrug‑resistant bacterial infections. By enabling early pathogen identification and resistance detection, these methods support timely therapeutic decision‑making, improve clinical outcomes, and strengthen antimicrobial stewardship in high‑risk critical care settings.

Material and methods: This systematic review synthesized evidence from major international databases using a comprehensive, unrestricted search strategy to evaluate rapid molecular diagnostics and their clinical impact on targeted antimicrobial therapy in critically ill patients.

Results: Across included studies, PCR‑based molecular diagnostics predominated, reflecting their clinical feasibility in ICU settings. Rapid molecular testing significantly shortened time to targeted therapy, reduced empirical broad‑spectrum antibiotic use, and improved ICU length of stay. Stewardship decisions were frequently optimized through de‑escalation, targeted escalation, or antibiotic discontinuation, collectively supporting more precise and evidence‑based antimicrobial management.

Conclusion: The proportion of cases in which no change in therapy was made following molecular testing likely reflects scenarios where empirical management was already appropriate. Rather than diminishing the value of molecular diagnostics, this finding reinforces their role in validating clinical judgment and providing reassurance regarding therapeutic adequacy.