Background: Non-alcoholic fatty liver disease (NAFLD) is a common cause of elevated liver enzyme levels and is increasing in parallel with the global obesity epidemic in adults and children. Objectives: This study examined the association between liver stiffness and serum uric acid, high-density lipoprotein cholesterol (HDL), and the uric acid-to-HDL ratio (UHR) in patients with NAFLD-related fibrosis. Methods: This cross-sectional study was conducted using hospital and clinic data after ethical approval was obtained from Ahvaz Jundishapur University of Medical Sciences. Patients referred to a specialized liver center for liver fibrosis assessment who met the inclusion criteria, including liver steatosis and abnormal liver function tests, were enrolled. Data were analyzed using SPSS version 26.0. Univariable analyses were performed first. Subsequently, two generalized linear models were developed to evaluate the associations of uric acid, HDL, and UHR with elastography values after adjustment for age and sex. Results: A total of 44 participants were included in the final analysis; 23 (52.3%) were male, and the mean age was 43.97 +/- 7.65 years. The mean elastography value was 8.21 +/- 2.55 kPa, the mean HDL level was 39.45 +/- 11.34 mg/dL, and the mean uric acid level was 5.25 +/- 1.54 mg/dL. In univariable analyses, aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST/ALT ratio, uric acid, and UHR were positively associated with elastography values, whereas HDL showed an inverse association. The UHR was higher in males (P 5 0.01). In generalized linear models adjusted for age and sex, UHR (B =15.71, P = 0.001) and uric acid (B = 0.608, P = 0.028) remained significantly associated with elastography values, whereas HDL showed a non-significant inverse trend. However, after additional adjustment for AST, ALT, and platelet count, these associations were attenuated and were no longer statitically significant. Conclusions: Elastography values were significantly associated with uric acid and HDL levels, indicating that liver stiffness is related to metabolic factors. The inverse association between uric acid and HDL emphasizes the pro-inflammatory role of uric acid and the protective effects of HDL in the liver.
Background: Medical errors in cardiac surgery remain a major challenge for patient safety. These errors often arise from the interaction of individual fatigue, team communication problems, and organizational constraints. Exploring these factors qualitatively provides a deeper understanding for designing effective interventions. Objectives: The primary objective of this study is to identify and analyze the underlying factors of medical errors in cardiac surgery and to propose practical solutions for their reduction. Methods: This qualitative study was conducted in cardiac surgery departments of selected hospitals in Iran between March and September 2025. Semi-structured interviews were performed with cardiac surgeons only. Data were analyzed using thematic analysis, resulting in four main themes: individual factors, team-related factors, organizational factors, and consequences and solutions. A circular conceptual model was developed to illustrate the dynamic relationships among these domains. Results: Errors were found to be embedded within team dynamics and organizational structures rather than being solely individual. Participants emphasized fatigue, communication gaps, and restrictive policies as key contributors. The conceptual model demonstrated how these domains converge toward consequences and solutions, highlighting the systemic nature of medical errors. Conclusions: Preventing errors in cardiac surgery requires a multidimensional approach that integrates personal training, team communication, and organizational reforms. Sustainable improvement depends on systemic and cultural transformation within hospitals.
Context: Coronary angiography is a crucial diagnostic procedure, yet it often induces significant anxiety in patients. Various non-pharmacological interventions have been proposed to alleviate anxiety in patients undergoing coronary angiography. Despite existing methods, comprehensive comparative reviews on their effectiveness are lacking. Objectives: This systematic review aimed to evaluate the effectiveness of various non-pharmacological interventions in reducing anxiety for patients preparing for coronary angiography. Evidence Acquisition: In this systematic review, articles published in both Persian and English were collected from various databases, including Web of Science, PubMed, Scopus, Medlib, Magiran, SID, Iranmedex, and Google Scholar. The search used keywords related to coronary angiography, cardiac catheterization, anxiety, and non-pharmacological methods. The search was limited to studies published between 2009 and 2024. Articles that met the inclusion criteria were then selected for review. Out of the 1,457 articles retrieved, 33 were thoroughly examined and analyzed. To ensure data accuracy, two experienced researchers simultaneously reviewed the articles while the research team's faculty members independently assessed each article's quality. This collaborative approach was implemented to enhance the validity and reliability of the study. Results: Thirty-three articles were reviewed, revealing several effective interventions for reducing anxiety before angiography. These interventions included educational programs such as video-based education, virtual networks, and familiarization tours, as well as complementary medicine approaches like aromatherapy, herbal medicine, massage therapy, relaxation techniques, and emotional expression. Each of these methods showed promise in reducing anxiety levels among patients scheduled for coronary angiography. Conclusions: This review concludes that educational programs and orientation tours are the most practical, cost-effective, and side-effect-free approach for reducing anxiety before coronary angiography. Aromatherapy was noted as the second most effective intervention. Additionally, acupressure and muscle relaxation are also commonly used. Limited studies exist on guided imagery and emotional expression, highlighting the need for future research to standardize methodologies and further assess the effectiveness of these interventions in reducing pre-angiography anxiety.
Context: Post-operative fever in pediatric congenital heart surgery is a common and challenging complication that can affect recovery, hospitalization duration, and healthcare costs. Objectives: This systematic review aimed to investigate the prevalence, associated factors, and management approaches of this condition. Data Sources: A comprehensive search was conducted across Persian (SID, Magiran, IranMedex) and English (PubMed, Scopus, Web of Science) databases. Search keywords included "Post-operative fever", "Congenital heart surgery", and their Persian equivalents. Study Selection: Out of 860 identified articles, 25 studies were selected for the final analysis after screening. The quality of the articles was assessed using the Critical Appraisal Skills Programme (CASP) and AMSTAR tools. Data Extraction: Data were analyzed using RevMan software. Results: The prevalence of post-operative fever in pediatric congenital heart surgeries ranged from 10% to 25%, influenced by factors such as surgery duration, the complexity of congenital defects, patients' nutritional status, and quality of care. More complex and prolonged surgeries showed higher rates of fever. Additionally, biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) were identified as predictive tools for fever risk. Effective management through the use of prophylactic antibiotics, proper nutrition, and close monitoring of patient conditions helped reduce the incidence of this complication. Fever-related outcomes, such as prolonged hospital stays and elevated healthcare costs, were frequently observed. Conclusions: This study highlights the need for multifaceted management of post-operative fever in pediatric congenital heart surgeries. Reducing surgery duration, standardizing management protocols, and improving care quality can help decrease its prevalence. Furthermore, developing comprehensive research in resource-limited areas is recommended to enhance treatment quality and mitigate the negative outcomes of fever.
Introduction: Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is exceedingly rare and represents one of the most demanding percutaneous coronary interventions (PCIs) due to the large ischemic territory involved. This report describes two unique LMCA CTO cases successfully treated via distinct retrograde collateral routes, one through the conus branch artery (CBA) and another through septal collaterals, highlighting the technical feasibility of individualized pathway selection in situations where antegrade wiring is not possible. Patient Information and Clinical Findings: Case 1: A 65-year-old woman with Canadian Cardiovascular Society (CCS) class III stable angina and isolated ostial LMCA CTO supplied by the CBA from the right coronary artery (RCA). Case 2: A 68-year-old man with hypertension and diabetes presented with CCS III angina; angiography revealed LMCA CTO perfused via septal collaterals from the left anterior descending artery. Both patients declined coronary artery bypass grafting (CABG). Diagnostic Assessment, Intervention, and Outcomes: In both cases, diagnostic angiography precisely mapped collateral pathways enabling retrograde revascularization. Contemporary guidewires, microcatheters, and drug-eluting stents (DES) were used to restore distal flow Successful retrograde PCI was achieved with final TIMI 3 perfusion and complete resolution of angina. On scheduled follow-up (1 week, 1 month, 3 months), both patients remained asymptomatic with normal electrocardiogram (ECG) and preserved left ventricular function [left ventricular ejection fraction (LVEF) case 1: Fifty-five percent, LVEF case 2: Fiftyfive percent]. Conclusions: These cases demonstrate that careful identification and utilization of collateral anatomy, particularly the conus branch and septal channels, can allow safe and effective retrograde revascularization of LMCA CTO when standard antegrade PCI is unfeasible. Understanding distinct collateral patterns expands treatment options for high-risk, CABG-refusing patients and supports the role of tailored retrograde strategies in complex coronary interventions.
