Background: The employment of oncoplastic techniques for the treatment of central breast cancer is becoming increasingly popular. Objectives: Our study aimed to evaluate the oncological safety of oncoplastic techniques in central breast cancer patients, and to assess resulting breast aesthetics and patient satisfaction. Methods: This descriptive study examined 68 patients with central breast cancer who were operated consecutively between March 2017 and March 2020. Demographic characteristics of the patients, biological characteristics of the tumor, surgical techniques and adjuvant treatments, postoperative complications, and follow-up (oncological, aesthetic, and satisfaction) results were evaluated. Results: Sixty-eight patients were monitored for an average of 25 months post-operatively. Re-excision was required in 2 (2.9%) cases because of positive surgical margins. Local recurrence ensued in a total of 2 (2.9%) cases, and overall survival was 100%. During the postoperative follow-up period, an independent panel scored breast aesthetics at 76/100, while the patient satisfaction score was obtained at 7.5 on a 9-point Likert-type scale. Complications developed in 10 (14.7%) cases in our series. Conclusion: According to our study findings, oncoplastic techniques can be considered safe in terms of oncological results for the surgical treatment of central breast cancer. This approach may provide high patient satisfaction.

Tetanus could be a genuine and possibly dangerous neurological infection caused by the tetanus poison delivered by the bacterium Clostridium tetani. Infection occurs through contaminated wounds, burns, surgical wounds, and insect bites. Related symptoms include muscle spasms, autonomic instability, and respiratory failure. Complications occur in the form of fractures, sprains, muscle tears, and death. Early diagnosis and prompt treatment are crucial to prevent complications and improve outcomes. Risk factors for tetanus infection include the lack of routine vaccinations, wound contamination with C. tetani-contaminated soil, and improper hygiene practices during childbirth. We presented a case report of a 32-year-old woman with a history of breast cancer, who developed a rapidly growing and foul-smelling mass. Despite early diagnosis and treatment measures, the patient did not respond to treatment and died due to the severity of mixed infections. The case highlights the importance of early diagnosis, prompt treatment, and routine vaccinations to prevent complications and improve outcomes in tetanus infection.

Background: Although numerous mechanisms regarding the no-reflow phenomenon (NRP) have been mentioned, they have not yet been fully elucidated. The NRP can impact the success rate even in a technically flawless percutaneous coronary intervention (PCI), which can be annoying. Before the procedure, there is no specific parameter or index that can assess a significant factor such as NRP that has a direct impact on the success of the PCI. Objectives: The present study aimed to evaluate the relationship between the systemic immune-inflammation index (SII) and NRP in patients who underwent PCI for saphenous vein graft (SVG). Methods: In this retrospective cohort study, 312 coronary artery bypass grafting (CABG) patients admitted to primary or elective SVG and those who underwent PCI between January 2014 and December 2021 were selected. Routine blood samples were taken from the patients at the time of admission, and SII was calculated as the ratio of the product of the total neutrophil count and the total platelet count to the lymphocyte count. The reperfusion rates after PCI were evaluated according to the thrombolysis in myocardial infarction (TIMI) grade flow and myocardial blush grade (MBG). Following the procedure, those with an angiographic TIMI flow grade of ≤ 2 or TIMI flow grade of 3 and a final MBG of < 2 were considered NRP. Results: The number of 85 patients (27.2%) were diagnosed with NRP. The SII and ST-elevation myocardial infarction were found to be independent predictors for NRP in multivariate logistic regression analysis (P<0.05). The SII predicted NRP with a sensitivity of 86% and a specificity of 80% (AUC: 0.866, 95% CI: 0.823 to 0.910, P<0.001) using a cut-off point of 13.45. Conclusion: The SII is an independent predictor that can be easily calculated from the whole blood test to predict no-reflow development, which is a frustrating complication in patients following the PCI to the saphenous vein. This predictor can enable us to pre-evaluate the non-operational reasons affecting the procedure's success.

Background: Melanoma is an aggressive tumor caused by melanocytes characterized by a poor prognosis at the stage of metastasis. Therefore, it is crucial to identify biomarkers for progression and prognosis for the treatment of melanoma. Objectives: The study aimed to identify the specific genes related to the prognosis of melanoma utilizing bioinformatics analyses. Methods: Differentially expressed genes (DEGs) between melanoma tissues and normal tissues were screened from the GSE 3,189 gene expression profile of Gene Expression Omnibus (GEO). A co-expression network was constructed by weighted correlation network analysis (WGCNA). Functional enrichment analysis for DEGs was performed. The risk prognostic model and nomogram predictive model were established utilizing the least absolute shrinkage and selection operator (LASSO) and Cox regression analysis. Results: Using the differential expression analysis and WGCNA, 1,408 DEGs were screened between melanoma tissues and normal tissues. Functional enrichment analysis proved that these genes primarily participated in the cell cycle and mitotic phase regulation in cancer. In addition, 17 optimal DEGs were identified for constructing the risk score prognostic model. Cox regression analysis further revealed that ectonucleotide pyrophosphatase/phosphodiesterase 4 (ENPP4) and FGR proto-oncogene, Src family tyrosine kinase (FGR) were the key genes significantly associated with survival. A nomogram prediction model was established for individual survival probability by integrating pathological T/N/M stage, age, ENPP4, and FGR. High FGR or ENPP4 expression indicated a better prognosis in melanoma patients. Conclusion: This study identified FGR and ENPP4 as potentially useful prognostic biomarkers for melanoma. The corresponding risk score prognostic model and nomogram may be a reliable tool for predicting the prognosis of melanoma patients.

Background: The Arbaeen foot-pilgrimage in the Holy City of Karbala is one of the world's most significant religious events, attracting millions of pilgrims yearly. Health and hygienic issues in this gathering have always been a cause of concern for the communities involved. Objectives: The study aimed to examine the challenges Ehsan Field Hospital faced in the Arbaeen of 2022 and its approach to providing services to referring pilgrims. Methods: The present study was a cross-sectional study with a 10-day interval conducted on 19,800 patients referred to Ehsan Field Hospital between the 9th and 19th of September, 2022. The research tool was a two-part checklist; the first part included the patients’ demographic information, and the second part included information about the disease (e.g., laboratory information, the disease symptoms, and the disease diagnosis). The SPSS software (version 26) was used for data analysis. Moreover, a brief qualitative investigation based on the experiences of the personnel working on-site was conducted to assess the challenges and their solutions in this foot-pilgrimage.Results: A total of 13,860 (70%) patients were male, 5,940 (30%) were female, and the majority of them were between the ages of 25-55 (63.8%). Most hospitalizations (58.5%) were related to problems caused by gastroenteritis. Conclusion: Considering the importance of people's health and hygiene in gatherings similar to Arbaeen, the necessity of building and operating field hospitals and mobile treatment camps for serving people is crucial, starting a few days before and continuing after the gathering. Furthermore, universities of medical sciences can provide a platform to facilitate and carry out valid research projects and studies to clarify the health and treatment problems dealt with during the Arbaeen foot-pilgrimage. Furthermore, they can provide practical and efficient solutions to improve the level of health and hygiene.

Background: In times of pandemic and quarantine, it is necessary to use new educational methods. The aim of this study was to compare the effectiveness of multimedia and booklet educational methods on knowledge, attitude, and job performance of healthcare providers in community health centers regarding COVID-19 in women during pregnancy, childbirth, and breastfeeding. Objectives: The aim of this study was to compare the effectiveness of multimedia and booklet educational methods on knowledge, attitude, and job performance of healthcare providers in community health centers regarding COVID-19 in women during pregnancy, childbirth, and breastfeeding. Methods: The population of this quasi -experimental study consisted of 90 Iranian health care providers in the community health centers of Gonabad city in eastern Iran) 2021, who were selected using the non-probability, purposive sampling method and randomly divided into three groups using a permuted block randomization design: Control group, Multimedia group and Textbook group. Knowledge, attitude and work performance were measured and compared before, after and four weeks after the intervention. The educational content was based on the Iranian Ministry of Health guidelines for the management of Covid-19 in pregnancy, childbirth and breastfeeding. Results: The results showed a significant difference between the mean score of knowledge, attitude, and work performance of the multimedia group and booklet group before and after the intervention (P<0.001), while there was no statistically significant difference between the mean score of knowledge, attitude, and work performance of the control group before and after the intervention (P<0.05). Conclusion: Multimedia teaching increases the knowledge, attitude and work performance of healthcare providers in community health centers regarding COVID.

Background: Gastric cancer is the fifth most common cancer worldwide. Objectives: This study investigated the risk factors associated with mediastinal lymph node metastases due to proximal gastric cancer. Methods: The study included patients with curative surgical resection and transcural lymphadenectomy for proximal gastric tumors between January 2012 and January 2020. The patients (n=88) were divided into Group 1 (n=54, negative) and Group 2 (n=34, positive) according to the positivity of mediastinal lymph nodes. The diagnostic value of composite immunonutritional and inflammatory indices in predicting lymph node positivity was examined. Results: It was found that only C-reactive protein (CRP) (P=0.044), the rate of postoperative respiratory complications (P=0.002), tumor size (P=0.0001), the total number of lymph nodes, and the number of metastatic lymph nodes were higher in Group 2. Moreover, pT stage (P=0.008) and pN stage (P<0.001) were more advanced in Group 2. Among the composite indices, only the neutrophil-to-lymphocyte ratio (NLR) had a diagnostic value, with a sensitivity of 67.65% and a specificity of 55.56% at a cut-off point of > 2.19. According to the multivariate analysis, a tumor size of > 3 cm, a CRP value of > 7, and tumor localization were independent risk factors. Conclusion: Our study found that mediastinal lymph node positivity was associated with elevated CRP and that these patients had more advanced tumors and poor histopathological characteristics. Mediastinal lymph node positivity was also associated with increased postoperative respiratory complications. We established the diagnostic value of the NLR in predicting lymph node positivity. It is helpful to establish the relationship between clinicopathological characteristics and mediastinal lymph node positivity in proximal gastric tumors since it can be useful in determining the surgical strategy for esophagogastric junction tumors.

Background: The development of data mining techniques and the adaptive neuro-fuzzy inference system (ANFIS) in the last few decades has made it possible to achieve accurate predictions in medical fields. Objectives: The present study aimed to use the ANFIS model, artificial neural network (ANN), and logistic regression to predict thyroid patients. Methods: This study aimed to predict thyroid disease using the UCI database, ANFIS and ANN models, and logistic regression. We only used four of its features as the input of the model and considered thyroid as a binary response (occurrence=1, non-occurrence=0) as the output of the model. Finally, three models were compared based on the accuracy and the area under the curve (AUC). Results: In this study, out of the extensive UCI database, which includes 3,772 samples and over 20 features, only five specific features were utilized. Data include 1,144 males and 2,485 females. The results of multiple logistic regression analysis demonstrated that free T4 index (FTI) and thyroid stimulating hormone (TSH) had a significant effect on thyroid. The ANFIS model had a higher accuracy (99%) compared to ANN (96%) and the logistic regression model (94%) in the prediction of thyroid. Conclusion: As evidenced by the obtained results, the forecasting performance of ANFIS is more efficient than other models. Moreover, the use of combined methods, such as ANFIS, to diagnose and predict diseases increases the accuracy of the model. Therefore, the results of this study can be used for screening programs to identify people at risk of thyroid disease.

Background & Aim: Health volunteers are the main members of the healthcare system in dealing with critical situations. The present study aimed to design and validate the behavioral skills promotion of health volunteers’ questionnaires in disasters in Iran. Materials & Methods: A five-point Likert (totally agree 5, totally disagree 1) was used to score the questionnaire. The questionnaire’s items were reviewed by 14 experts, and after content validity with Lawshe's formula, four items were removed and the number of items was reduced to 43 items. In this stage, 500 Red Crescent volunteers completed the questionnaire availability. Then, by examining the factor analysis, five items did not factor loads and were discarded. Finally, 38 items remained. Confirmatory factor analysis indicated that the behavioral skills promotion of health volunteer’s questionnaire model was fitted Results: The findings of this study indicated that this questionnaire has good validity for the whole questionnaire and factors with Cronbach's alpha coefficient method. Moreover, the factor analysis results indicated that there were seven factors, which explained 60.52% of the total variance. Conclusion: According to the obtained results, the questionnaire on behavioral skills promotion of health volunteers in disasters is a valid and reliable instrument in the case of critical situations in Iran.

Background: Pain control is one of the most important issues in femoral fractures. One of the most effective methods is the fascia iliaca compartment block. Objectives: The aim of this study was to compare the efficacy of the addition of dexmedetomidine to bupivacaine on the quality of ultrasound guided blockade of the fascia iliaca compartment in adults undergoing femoral shaft fracture surgery. Methods: This study was a double-blind clinical trial. We studied 60 adults who were hospitalized for a femoral shaft fracture. The patients were divided into two equal groups receiving either bupivacaine alone or bupivacaine and dexmedetomidine for compartment blockade of the iliac fascia. Group allocation was based on the method of randomization from concealed envelopes. Primary outcomes were pain intensity, sedation and analgesic consumption assessed at 1, 2, 6 and 24 hours after surgery in two groups. Data were analyzed using SPSS software. Results: Pain intensity was lower in the dexmedetomidine group 1, 2, 6 and 24 hours after surgery (p<0.05). The sedation score was also higher in the dexmedetomidine group 6 and 24 hours after surgery (p<0.05). The dose of analgesics used by the dexmedetomidine group was significantly lower 6 and 24 h after treatment. No hypotension, respiratory depressionand bradycardia occurred in the patients participating in this study. Conclusion: The addition of dexmedetomidine to bupivacaine during ultrasound-guided blockade of the fascia-iliac compartment is associated with reduced pain intensity and improved sedation in patients undergoing femoral fracture surgery.