Hafez Hospital

Over the past three decades, metabolic and bariatric surgery (MBS) has undergone significant changes in Iran, mirroring global trends and incorporating regional innovations. This study aims to investigate MBS trends in Iran over 15 years (2009-2024), with a focus on demographic patterns and procedural distribution. Data from the Iranian National Obesity Surgery Database (INOSD) provided the basis for a retrospective study. The study encompassed all patients with MBS between 2009 and 2024. The demographic traits, body mass index (BMI), obesity-associated medical disease, surgical operation type, and trends over time were analyzed. In total, 55,936 patients were included, most of whom were female (80%). The majority (62%) were aged 25-45 years. With a declining number of patients with BMI > 50kg/m² over time, most patients fell in the range of 40-50kg/m². The most common obesity-associated medical problems were hypertension (15%), severe obstructive sleep apnea (12%), type 2 diabetes mellitus (11%), and dyslipidemia (11%). Rising from 2.6% in 2009 to 56% in 2024, sleeve gastrectomy (SG) surpassed Roux-en-Y gastric bypass (RYGB), which decreased from 92% in 2009 to 13% in 2024. Especially in higher BMI patients, one anastomosis gastric bypass (OAGB) demonstrated a consistent rise. Rates of revisional and conversional surgery rose over time, specifically in OAGB. With an increasing inclination for SG and OAGB, MBS trends in Iran mirror a worldwide movement toward safer and more effective treatments.

Background: Brain abscess is a serious infection within the cranial space characterized by an encapsulated accumulation of purulent exudates. This report presents a case of a 14-day-old neonate with a brain abscess caused by Klebsiella pneumoniae. Case Report: The neonate, who had been treated with a traditional remedy involving bread dough and spices on the umbilical cord, presented with fever, poor feeding, and lethargy and later experienced seizures. Laboratory investigations confirmed the presence of K. pneumoniae in the blood and cerebrospinal fluid (CSF). Brain magnetic resonance imaging (MRI) demonstrated multiple ring-enhancing lesions in the bilateral frontal and left parietal regions, suggestive of brain abscesses. After treatment, the patient’s condition improved, and he was referred to another equipped center for further treatment. Discussion: Previous cases were linked to idiopathic or maternal causes, such as urinary tract infections. There was no evidence that the causes of these abscesses were community-acquired. This case, the first reported outside of India, may indicate a communityacquired brain abscess. Conclusion: This case report highlights the need for awareness and appropriate management of brain abscess caused by K. pneumoniae.

Self-image, conceived as one's mental blueprint and a composite of thoughts, is among the hotly debated topics in psychology. Exploring the brain's structure, functionality, and physiology has also proven crucial in understanding one's self-image. In this vein, the current study aimed to examine the relationship between quantitative electroencephalography (QEEG) findings and medical students' self-image. To measure self-image, the Offer Self-Image Questionnaire and, for the QEEG findings, a Mitsar EEG-202 device were used. To analyze the QEEG findings, the FDA-approved Neuroguide software was utilized. In the first phase, out of the 93 questionnaires returned, the maximum score, on a scale of 1 to 6, was 5.52 and the minimum was 2.36. Hence, it could be argued that the medical students who took part in this study had relatively high self-images. Results, however, showed no significant difference between the two genders regarding either their overall self-image score or any of its subcategories. In the second phase, the QEEG analyses of high- and low-self-image students suggested a statistically significant difference in their θ signal of the frontal lobes. Further analysis indicated that the difference was not localized to any single lead or lobe, but pertained to the overall function of the prefrontal cortices. The relationship observed between medical students' self-image and their brain θ waves could contribute to a better understanding of people's cognitive functions.

Introduction: Liver transplantation is the first line treatment for hepatocellular carcinoma (HCC) in the setting of liver cirrhosis. This study aimed to investigate the impact of loco-regional therapy (LRT) including trans-arterial chemoembolization and radiofrequency ablation during waiting time on post-transplant outcomes of patients with HCC. Methods: Liver transplant recipients who had undergone liver transplantation for HCC between 2010 and 2019 were included in the study. Patients’ characteristics including LRT before transplant were recorded. Kaplan-Meier estimation was used for survival analysis with log-rank test and Cox regression analysis was used to assess independent factors for overall survival. Results: Totally, 139 liver transplant recipients with mean age of 50.59 ± 13.46 were included. Eighty seven patients were within Milan criteria. Seventy eight patients (56.1 %) received LRT before liver transplantation. One year survival was 84.6 ± 4.1 % in patients who received LRT compared to 80.3 ± 5.1 % in those who did not receive LRT. In univariate analysis, LRT was associated with lower mortality after liver transplant (HR: 0.52; 95 % CI: 0.296- 0.944; P= 0.031) while microvascular tumor invasion (HR: 2.87; 95 % CI: 1.543- 5.359; P= 0.001) and tumor capsular invasion (HR: 3.06; 95 % CI: 1.291- 7.285; P= 0.011) were associated with increased mortality after liver transplantation. In multivariable COX regression analysis, LRT (HR: 0.51; 95 % CI: 0.276- 0.963; P= 0.038) and microvascular tumor invasion (HR: 2.54; 95 % CI: 1.298- 4.997; P= 0.007) were associated with lower and higher mortality after liver transplantation, respectively (Table). In a subgroup of patients within Milan criteria, LRT was an independent factor for decreased mortality after liver transplantation (HR: 0.43; 95 % CI: 0.188- 0.986; P= 0.046). Conclusion: LRT and micro vascular invasion were independent factors associated with survival of liver transplant recipients.

Abstract The objective of this article is to develop an effective method for material discrimination, distinguishing specifically between light metallic materials and heavy ones at low X-ray energies. In this research, Monte Carlo simulations are employed to investigate the influential factors affecting material discrimination. Initially, for result validation, the experimental setup is fully simulated based on the Monte Carlo method. The X-ray spectrum of 160 keV is simulated, and then it is registered after interacting with step wedges made of iron, aluminum, graphite, and ABS at specific thicknesses, capturing the radiation flux at each step. The results are compared with the experimental findings obtained from a dual-layer detector, demonstrating excellent agreement. In practice, the dual-layer detector comprises a low-energy GOS detector, a copper filter, and a high-energy CsI(Tl) detector. The energy spectra of the registered X-rays on each layer of detectors are obtained using the Monte Carlo method. Materials with low, medium, and high atomic numbers are chosen for analysis. These materials are categorized into three groups: organic materials (comprising both light and heavy organic and biological substances), light metals, and heavy metals. Discrimination between materials is achieved independently of their thickness by utilizing a material classification map (MCM) derived from a graph depicting the transmission ratio of low-energy X-ray photons versus the linear attenuation coefficient ratio for various materials with different atomic numbers. The results have been successfully validated through testing with various materials and thicknesses using both the experimental setup and Monte Carlo simulations.

The disease burden associated with Type-2 Diabetes Mellitus (T2DM) on a daily basis, which makes it necessary to develop new diagnostic modalities for T2DM. The recently emerging molecular biomarkers have high predictive potential, enhanced diagnostic efficacy, therapeutic efficacy, and ability to assess progression to complications. In recent times we have some epigenetic biomarkers like miRNAs which have shown some promise in various diseases including T2DM. There are recent reports that some epigenetic biomarkers, including miRNA have the predicting the onset of various diseases including T2DM. Recent data highlight the diagnostic potential of miRNAs in the diagnosis, associated pharmacogenomics, and assessment of various microvascular and macrovascular complications in T2DM. The existing literature was reviewed as per a defined methodology, and the studies on the miRNAs in the blood samples of patients with diabetes were finally included herein. The review identified the miRNAs that are upregulated and downregulated across various stages of T2DM. A T2DM miRNA signature was finally identified, which needs to be further validated by replicative data obtained from high-quality trials or advanced sequencing techniques for confirmation or annulment.

Breast cancer is the second leading cause of death after lung cancer. The only possible way to save patients' lives is early diagnosis of the disease; Because if this disease is diagnosed in the early stages and with a high level of accuracy, the chance of survival increases. Different fuzzy-based soft computing techniques have been proposed. In this research, the proposed fuzzy hybrid algorithm - particle swarm has been used to detect the type of breast tumors based on the analysis of features in mammography images. The proposed method in this study, the fuzzy hybrid algorithm - the proposed particle swarm algorithm, has a remarkable performance of 94.58% in breast cancer diagnosis. The results obtained from this study can be used for timely diagnosis and providing effective treatments for breast cancer

Estimation of liver fat among living donor candidates is necessary before living donor liver transplant. This study aimed to investigate the usefulness of the controlled attenuation parameter compared with liver biopsy for pretransplant estimation of hepatic steatosis in living liver donors. In this retrospective study, we included all individuals who underwent transient elastography with controlled attenuation parameter and ultrasonography-guided liver biopsy as a part of donor evaluations before living donor liver transplant. Clinical and laboratory data of living donor candidates were reviewed and collected. Of 49 donor candidates included in this study, 21 (42.9%) had different degrees of hepatic macrosteatosis. Of the 21 donor candidates who had hepatic steatosis in liver biopsy, 13 individuals were diagnosed to have steatosis in transient elastography. Of the 28 donor candidates without hepatic steatosis in liver biopsy, 26 individuals showed no steatosis in transient elastography (odds ratio: 21.12; 95% CI, 3.91- 114.08; P < .001). Controlled attenuation parameter was useful in discriminating presence (P = .001) and grade of hepatic steatosis (P = .009) compared with liver biopsy with good sensitivity and specificity. The controlled attenuation parameter is a noninvasive method for detection of hepatic steatosis in living donor candidates and can be used as an adjunct to liver biopsy for screening of living donor candidates before liver transplant.