Imam Reza Hospital

To summarize the evidence on the associations between 25-hydroxyvitamin D (25(OH)D) and risk of mortality in patients with chronic kidney disease (CKD). A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar for relevant papers published up to November 2025 that assessed the association between serum vitamin D levels and the risk of all-cause, cardiovascular disease (CVD), non-CVD, and cancer mortality was conducted. The lowest-versus-highest analysis and the linear and non-linear dose-response analyses were performed using a random-effects model. Overall, 36 publications (35 studies) with a total sample size of 129,135 participants, aged between 18 and 90 years, were included in the current meta-analysis. During the follow-up periods ranging between 3 months and 18 years, 117,403 cases of all-cause mortality, 2,568 cases of CVD mortality, 886 cases of non-CVD mortality, and 289 cases of cancer mortality were identified. The summary relative risk (RR) and 95% confidence intervals (CIs) comparing lowest versus highest levels of 25(OH)D was 1.61 (95% CI: 1.41–1.84, I2 = 89%, n = 28 studies, very low certainty) for all-cause mortality, 1.68 (95% CI: 1.41-2.00, I2 = 20%, n = 9, very low certainty) for CVD mortality, 1.33 (95% CI: 0.94–1.89, I2 = 26%, n = 3, very low certainty) for non-CVD mortality, and 1.51 (95% CI: 1.09–2.09, I2 = 26%, n = 1, very low certainty) for cancer mortality. There was evidence of non-linearity in the analysis of all-cause and CVD mortality, with a greater reduction in risk from serum levels of 12.5 nmol/L up to 60 nmol/L compared to higher levels, but with slight further reductions in risk with serum levels up to 110 nmol/L. This meta-analysis provides further evidence that lower levels of 25(OH)D are associated with a higher risk of all-cause, CVD, and cancer mortality in CKD patients. However, all outcomes were graded as very low certainty, and the observed associations may be influenced by confounding, small-study effects, and wide prediction intervals that include the null. Observed low-risk range around ~ 60 nmol/L in the non-linear dose-response analyses, should be interpreted cautiously and requires validation in randomized controlled trials. The protocol for this review was registered in PROSPERO (2025 CRD42025105350).

COVID-19 infection can cause significant long-term health problems for patients. While there is no universally accepted definition for long COVID, it is usually identified by persistent symptoms that extend past 4 weeks after the initial SARS-CoV-2 infection with no other explanation. The cardiovascular system is one of the most important systems involved in long COVID, and even asymptomatic patients have evidence of cardiovascular injury after COVID-19. This study aims to determine the long-term risk of developing cardiac arrhythmias after SARS-CoV-2 infection. A comprehensive systematic search on Scopus, PubMed, Science Direct, and Web of Science databases was performed on August 24th, 2025. Cohort articles consisting of a healthy control group with no history of COVID-19 infection and individuals who recovered from COVID-19 for at least 30 days were included. Hazard Ratio (HR) and 95% confidence intervals (CI) were estimated using random-effect models. Fourteen studies were eligible for the meta-analysis. The overall arrhythmia risk was higher in patients with long COVID (HR: 1.74, 95% CI [1.39, 2.10], I 2 = 99.65%). Specific arrhythmias examined included atrial fibrillation (HR: 1.49, 95% CI [1.24, 1.73], I 2 = 98.57%), sinus tachycardia (HR: 1.69, 95% CI [1.21, 2.18], I 2 = 99.51%), sinus bradycardia (HR: 1.58, 95% CI [1.50, 1.66], I 2 = 65.80%), and ventricular arrhythmias (HR: 1.72, 95% CI [1.48, 1.95], I 2 = 96.89%). Patients with a more severe initial infection were at a higher risk of developing arrhythmias. The risk of developing cardiac arrhythmias is increased after COVID-19 infection in the long term.

Women with a prior cesarean section frequently face challenges in choosing the mode of delivery, and limited knowledge, negative attitudes toward vaginal birth, and lack of tailored guidance often led to elective repeat cesarean sections. The main objective of this study is to design, develop, and evaluate a web-based counseling system to support and empower pregnant women in making informed decisions regarding vaginal birth after cesarean (VBAC). A sequential exploratory mixed-methods study will be conducted in Mashhad, Iran. Phase 1 (qualitative) will use conventional content analysis of semi-structured interviews with 25 pregnant women and healthcare providers to identify needs, expectations, and preferences for a web-based VBAC counseling system. Phase 2 will involve iterative prototype development following the prototyping model, guided by qualitative findings, expert validation, and a systematic review. Phase 3 will evaluate system usability (System Usability Scale) and effectiveness via a two-arm randomized controlled trial with 80 eligible women. Districts will be randomized; intervention participants will access the web-based system, while controls receive routine care. Primary outcomes are VBAC intention, choices, and VBAC actual rates. Secondary outcomes include knowledge, satisfaction, and breastfeeding success. Data will be analyzed using SPSS. This study examines the impact of a web-based VBAC counseling system on empowering pregnant women by enhancing their knowledge of delivery options and reducing decisional conflict. The system is designed to support informed decision-making, promote shared decision-making with healthcare providers, and facilitate safer, evidence-based choices regarding vaginal birth after cesarean. This trial is registered with the Iranian Registry of Clinical Trials under registration number IRCT20170607034378N3, with the registration date 2025-11-15.

Context: Endocrine therapy remains the standard of care for hormone receptor-positive (HR+) and human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (BC), but its efficacy is limited in patients with prior endocrine exposure. Cyclin-dependent kinase 4/6 inhibitors (CDK4/6i), such as palbociclib, have emerged as a promising strategy to enhance treatment outcomes. Objectives: This systematic review and meta-analysis aimed to evaluate the efficacy of palbociclib combined with endocrine therapy (ET) versus endocrine therapy alone in improving survival outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science up to November 9, 2025, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials (RCTs) comparing palbociclib plus ET with ET alone or placebo plus ET in HR+/HER2– advanced or metastatic BC patients were included. Outcomes assessed were progression-free survival (PFS) and overall survival (OS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were pooled. Results: Seven RCTs, including 1,758 patients, met inclusion criteria. Pooled analysis demonstrated that palbociclib combined with ET significantly improved PFS compared with ET alone (HR = 0.492; P < 0.001). A trend toward improved OS was observed (HR = 0.883; P = 0.075), though this did not reach statistical significance. Subgroup analyses and bias assessments confirmed consistent efficacy across populations and low risk of methodological bias, with no evidence of publication bias. Conclusions: Palbociclib combined with ET provides substantial improvements in PFS and demonstrates a favorable trend in OS for patients with HR+/HER2– advanced BC.

Adherence to an appropriate diet is among the most effective strategies for managing patients with non-alcoholic fatty liver disease (NAFLD). The Diet Quality Index-International (DQI-I) was developed to provide a comprehensive assessment of dietary quality on a global scale. The present study aimed to investigate the association between the DQI-I and non-invasive markers of liver function in adults. This cross-sectional study was conducted on 6,484 adults who participated in Ravansar Non-Communicable Diseases (RaNCD) cohort study in western Iran. The Diet Quality Index-International (DQI-I) score was calculated based on participants' dietary data obtained from a Food Frequency Questionnaire (FFQ). NAFLD predictor indices including Hepatic Steatosis Index (HSI), Fatty Liver Index (FLI), fibrosis-4 index (FIB-4), and Aspartate Aminotransferase to Platelet Ratio Index (APRI), were calculated using established formulas. The association between DQI-I score and its subgroups with NAFLD predictor indices was assessed using linear regression models adjusted for potential confounders. The findings of this study indicated that in the adjusted model (Model 2), SGPT (β = 0.0020, P = 0.003), HSI (β = 0.0014, P < 0.001), and FLI (β = 0.006, P < 0.001) levels showed a significant positive association with the total DQI-I score. Although these positive associations may appear counterintuitive, they could be influenced by confounding factors such as higher BMI in participants with higher DQI-I scores. Additionally, a one-unit increase in total DQI-I score was associated with a decrease in FIB-4 (β = -0.0018, P = 0.004), AST/ALT ratio (β = -0.0020, P < 0.001), and no significant change in APRI (β = -0.0007, P = 0.222). Among the DQI-I subgroups, a one-unit increase in both the variety and adequacy components was associated with a significant increase in SGPT, HSI, and FLI, whereas FIB-4, APRI, and AST/ALT ratio decreased on average. In the moderation subgroup, a one-unit increase was associated with a non-significant change in FIB-4 (β = -0.0008, P = 0.374). According to our results, there was a statistically significant inverse association between DQI-I scores and fibrosis-related indices, while paradoxically showing a positive association with steatosis-related markers.

Cancer surgery is undergoing transformative integration of precision medicine, artificial intelligence (AI), robotics, advanced imaging, and molecular technologies. These innovations promise enhanced surgical precision, improved patient outcomes, and personalized treatment approaches through data-driven decision-making. A comprehensive systematic literature review was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases from January 2020 to November 2025. Studies were analyzed for clinical applications, therapeutic outcomes, cost-effectiveness, and implementation challenges. Primary endpoints included surgical accuracy, margin status, survival outcomes, complication rates, and technology adoption metrics. Precision medicine utilizing genomic profiling and circulating tumor DNA demonstrated 94.9% sensitivity and 88.8% specificity in multi-cancer detection. The CIRCULATE-Japan GALAXY study showed ctDNA positivity during the molecular residual disease window predicted significantly inferior disease-free survival (HR 11.99; P < 0.0001) and overall survival (HR 9.68; P < 0.0001). AI-assisted surgical systems achieved area under the curve values of 0.76-0.85 in outcome prediction and reduced surgical complications by 25-30%. The da Vinci 5 robotic system demonstrated 43% reduction in tissue damage through force feedback technology. Meta-analysis of 15,137 patients showed robotic pancreatoduodenectomy reduced hospital stays and conversion rates compared to laparoscopy. Fluorescence-guided surgery achieved improved 5-year overall survival (80.6% vs. 66.7%, P = 0.018) in gastric cancer. Mass spectrometry techniques achieved 93.4-97.1% diagnostic accuracy. Perioperative immunotherapy in non-small cell lung cancer reduced recurrence risk by 43% (HR 0.57) and improved pathological complete response rates over 5-fold (RR 5.58). Nanotechnology-based delivery systems reduced cardiac toxicity (6% vs. 21%) while maintaining therapeutic efficacy. The convergence of precision medicine, AI, robotics, and molecular technologies is revolutionizing cancer surgery toward personalized, data-driven interventions with substantial clinical outcome improvements. Implementation challenges including cost, standardization, and healthcare disparities require systematic addressing for widespread adoption.

BackgroundTraumatic brain injury (TBI) poses a significant challenge within pediatric healthcare, being one of the leading causes of illness and death among children worldwide. Comprehending the clinical implications of pediatric TBI is essential for healthcare providers aiming to improve treatment methodologies and rehabilitation strategies. This study seeks to investigate the relationship between glucose-to-lymphocyte ratio (GLR) levels and clinical outcomes in pediatric patients who have experienced moderate to severe TBI.MethodsIn this investigation, we conducted a retrospective analysis of clinical, radiographic, and laboratory data for all pediatric patients diagnosed with moderate to severe traumatic brain injury (TBI) treated at our institution from July 2017 to May 2024. All patients were managed according to the Advanced Trauma Life Support (ATLS) guidelines specifically designed for critically injured individuals with head trauma. Clinical outcomes were assessed at the time of hospital discharge using the Glasgow Outcome Scale (GOS). Based on these results, patients were categorized into two distinct groups: those who achieved favorable outcomes (GOS scores of 4 and 5) and those with unfavorable outcomes (GOS scores of 1, 2, and 3). We compared various factors that could potentially influence clinical outcomes in pediatric TBI patients, including GLR levels, between these two groups.ResultsAmong the 424 pediatric patients with moderate to severe traumatic brain injury (TBI) included in this analysis, 166 patients (39.2%) were classified into the high glucose-lymphocyte ratio (GLR) group, defined as those with a GLR exceeding 93.4. In contrast, 258 patients (60.8%) fell into the low GLR category, with a ratio at or below 93.4. The mean GLR across the cohort was noted to be 98.2 ± 29.73. The results of the binary logistic regression analyses identified several independent risk factors for poor prognosis: GCS (OR: 3.41; 95% CI 1.67 – 4.83; p < 0.001), Rotterdam score (OR: 2.55; 95% CI 1.60 – 4.21; p = 0.015), pupillary light reflex (OR: 1.91; 95% CI 1.23 – 2.98; p = 0.027), and GLR level (OR: 1.63; 95% CI 1.18 – 2.78; p = 0.033).ConclusionThe results of this study indicate that GLR levels could act as a valuable indicator of poor clinical outcomes for pediatric patients with moderate to severe TBI. This easily obtainable and cost-effective biomarker may provide significant predictive value for assessing the clinical prognosis of these patients.