Medicinal, Psychological, and Health Research Journal (MPHRJ)

Abstract Introduction: Post mastectomy radiotherapy significantly improves locoregional control and survival in breast cancer patients but may lead to late complications such as fibrosis, cardiopulmonary toxicity, and lymphedema, which adversely affect long term quality of life. Identifying patients at higher risk is essential for personalized survivorship care. This study aims to determine predictive factors for late radiotherapy induced complications in post mastectomy breast cancer survivors.

Material and methods: This cross-sectional analytical study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences and included 73 post-mastectomy breast cancer survivors. The study evaluated predictive factors for late radiotherapy-induced complications using demographic, clinical, surgical, oncologic, and dosimetric variables, along with treatment-related characteristics and late toxicity outcomes.

Results: Among 73 post mastectomy survivors, late complications were common, particularly skin fibrosis (30.14%) and shoulder limitation (28.77%). Severe toxicity (CTCAE ≥2) occurred in 35.62% and was associated with higher BMI (P = 0.004), smoking (P = 0.037), mean heart dose (P = 0.001), and lung V20 (P = 0.002). Lung V20 predicted severe events (AUC = 0.84; cut off = 20.57%; sensitivity = 84.62%; specificity = 72.34%).

Conclusion: Late radiotherapy induced complications remain prevalent in post mastectomy breast cancer survivors. Elevated BMI, smoking, and higher cardiopulmonary dose parameters—particularly lung V20—were associated with severe toxicity. These findings highlight the importance of optimizing radiation planning and addressing modifiable risk factors to reduce long term morbidity and improve survivorship outcomes.

Abstract Introduction: Colorectal cancer surgery outcomes are influenced not only by tumor characteristics but also by the patient’s nutritional and inflammatory status. Serum albumin, a widely available biomarker, reflects both physiological reserve and systemic inflammation and has been linked to postoperative prognosis. This study aimed to evaluate the clinical significance of preoperative serum albumin levels in predicting survival after colorectal cancer surgery.

Material and methods: This observational analytical study was conducted in 2025 at hospitals affiliated with Tabriz University of Medical Sciences. A total of 85 colorectal cancer patients undergoing surgical resection were enrolled using convenience sampling. Demographic characteristics, clinical variables, tumor features, preoperative serum albumin levels, and postoperative survival outcomes were collected and analyzed to evaluate the prognostic value of albumin.

Results: Among 85 patients undergoing colorectal cancer surgery, hypoalbuminemia (<3.5 g/dL) was present in 36.47%. Lower albumin was associated with higher BMI (P = 0.041) and advanced tumor stage (P = 0.032). Patients with low albumin had shorter survival (24.83 ± 9.71 vs 33.47 ± 11.26 months; P = 0.006) and higher mortality (35.48% vs 16.67%; P = 0.047). Hypoalbuminemia independently predicted mortality (HR = 2.47, 95% CI: 1.29–4.73; P = 0.006) with good ROC performance (AUC = 0.80).

Conclusion: Preoperative hypoalbuminemia was significantly associated with poorer survival after colorectal cancer surgery and remained an independent predictor of mortality. These findings highlight the importance of assessing nutritional and inflammatory status before surgery. Serum albumin, as a simple and accessible biomarker, may assist clinicians in identifying high risk patients and improving preoperative risk stratification.

Abstract Introduction: Total knee arthroplasty is an effective treatment for advanced knee disorders but remains vulnerable to postoperative infections, including periprosthetic joint infection, which can lead to serious complications and increased healthcare burden. Antibiotic prophylaxis is widely used to reduce this risk, yet optimal strategies remain debated. Therefore, this study aims to systematically review the evidence regarding the effectiveness of antibiotic prophylaxis in preventing infection following TKA.

Material and methods: This systematic review was conducted according to PRISMA guidelines. Eligible studies included randomized and observational research evaluating antibiotic prophylaxis in adult patients undergoing total knee arthroplasty with reported postoperative infection outcomes. Multiple databases were searched using MeSH terms and related keywords by two independent reviewers. Study quality was assessed using the Newcastle–Ottawa Scale and the Cochrane Risk of Bias tool.

Results: The literature search identified 851 records, of which nine studies met the inclusion criteria after screening and full text assessment. Overall, intravenous antibiotic regimens demonstrated moderate to high treatment success across studies, with reported success rates ranging from 63% to 90% and follow up durations varying between 3.5 and 72 months. Most regimens involved glycopeptide or rifampicin based therapies administered for approximately 2–6 weeks, with generally favorable clinical outcomes.

Conclusion: The available evidence suggests that intravenous antibiotic therapy provides generally favorable outcomes in the management of infection related complications. Across the included studies, treatment success was consistently moderate to high despite variations in antimicrobial regimens, treatment duration, and follow up periods. Glycopeptide and rifampicin based therapies appear to play a central role in achieving effective infection control.

Abstract Background: Treatment-resistant depression (TRD) represents a significant clinical challenge, affecting approximately 30% of individuals with major depressive disorder who fail to respond to conventional antidepressant pharmacotherapy. Cognitive Behavioral Therapy (CBT) has emerged as a promising intervention for this population, yet the specific mechanisms and long-term efficacy remain incompletely understood. Objective: This study systematically examines the efficacy of CBT in treating TRD, investigating psychological and neurobiological mechanisms of change and evaluating long-term outcomes.

Methods: A comprehensive review was conducted of randomized controlled trials, meta-analyses, and key observational studies published between 2000 and 2025, identified from PubMed, PsycINFO, and Cochrane Library databases. Special attention was given to studies examining CBT as an augmentation strategy, sudden gains in treatment response, and neural correlates of therapeutic change.

Results: Robust evidence supports CBT as an effective augmentation strategy for TRD, with effect sizes comparable to pharmacological augmentation approaches (ES = 1.58, 95% CI: 1.09–2.07). Psychological flexibility emerged as a key mechanism predicting long-term outcomes at 12-month follow-up. Neuroimaging findings reveal both treatment-responsive prefrontal and parietal regions and treatment-resistant cerebellar regions, suggesting that CBT may not uniformly normalize all neural abnormalities. Long-term relapse rates among TRD patients receiving CBT augmentation range from 25-50% at 12 months, with the greatest durability observed in those who achieve sudden therapeutic gains early in treatment.

Conclusion: CBT constitutes an essential component of the TRD treatment arsenal, offering durable benefits beyond pharmacotherapy alone. Future research must prioritize standardized TRD definitions, biomarker-driven personalization, and scalable delivery models to optimize clinical implementation.