Behzad Imani

Background and Aims: Despite routine prophylactic antibiotics, post‐cesarean infectious morbidity remains a major challenge. Preoperative vaginal preparation can reduce vaginal microbial load, but direct comparisons are scarce. This study compared metronidazole gel versus povidone‐iodine for preventing post‐cesarean infection‑related complications. Methods: This three‑arm randomized controlled trial was conducted at Fatemieh Hospital, Hamadan, Iran, from December 2025 to May 2026. A total of 201 women scheduled for elective cesarean delivery were randomized to metronidazole gel 0.75%, povidone‐iodine 10%, and control ( n = 67 each). Primary outcomes were endometritis, postoperative fever, and surgical site infection (SSI). Secondary outcomes included need for additional antibiotics, length of hospital stay, readmission, and adverse events. Data were analyzed in Stata v.17 using ANOVA and chi‐square tests ( p < 0.05). Results: The composite infectious morbidity was significantly lower in the metronidazole group (6/67, 8.96%) compared to controls (21/67, 31.34%) (risk difference: 22.4%; 95% CI: 9.5%–35.3%; p = 0.002). Endometritis rates were 1/67 (1.49%), 3/67 (4.48%), and 8/67 (11.94%) in the metronidazole, povidone‐iodine, and control groups, respectively ( p = 0.03). Fever rates were 2/67 (2.99%), 5/67 (7.46%), and 10/67 (14.93%) ( p = 0.04). Need for additional antibiotics was lower in the metronidazole group (7/67, 10.45%) versus controls (18/67, 26.87%) ( p = 0.04). Only the composite outcome remained significant after Bonferroni correction; individual outcomes did not. No significant differences were observed for SSI, readmission, or length of stay. Conclusions: Metronidazole gel significantly reduced composite infectious morbidity compared with no vaginal preparation, an effect that remained significant after adjustment for multiple comparisons. While individual outcomes showed clinically meaningful reductions, statistical significance was not maintained after Bonferroni correction. Metronidazole gel may be a promising option for vaginal preparation, particularly in high‐risk settings. Trial Registration: IRCT20251227068466N1.

Introduction: Brain tumors, as a life-threatening diagnosis, often lead to profound psychological and existential crises. Understanding the lived experiences of these patients is crucial for providing holistic care. This study explored the lived experiences of patients with brain tumors following a positive diagnosis. Methods: This qualitative study employed a descriptive phenomenological approach. Participants were purposefully selected based on their experiences, and data were collected through in-depth, semi-structured interviews with 12 patients at Besat Educational Hospital in Hamadan, Iran. Data analysis was conducted using Colaizzi’s seven-step method to ensure a rigorous and systematic exploration of participants’ experiences. Results: The analysis revealed four main themes: (1) Emotional Storm (shock, anger, anxiety, sorrow, and depression), (2) Psychophysical Transformations (physical deterioration, identity crisis, and personality changes), (3) Social Disintegration (self-imposed isolation, shifting roles, and social stigma), and (4) Adaptation to the Illness (hope-fear confrontation, seeking life’s meaning, gradual acceptance, and coping strategies). Conclusion: The findings highlight the severe psychological and social challenges faced by patients with brain tumors following a positive diagnosis. These experiences underscore the need for comprehensive, culturally sensitive interventions that address emotional, psychological, and social dimensions. Healthcare systems should prioritize patient-centered care, including counseling, support groups, and public education to reduce stigma.

Background and Aims: Prostate cancer affects many people around the world and is fatal. Today, artificial intelligence‐based techniques are widely used to predict and diagnose diseases. This study aimed to use machine learning‐based techniques to predict and identify the most significant risk factors of prostate cancer. Methods: This retrospective study was conducted at the Shahid Beheshti Hospital, Hamadan Province, Iran, in five steps, including the identification of risk factors, data collection, preprocessing, modeling, and evaluation. The Web of Science, Scopus, Medline, and PubMed Central databases were searched from the beginning of 2000 to 2024. Different prediction algorithms, including Logistic Regression, Gradient Boosting, Random Forest, XGBoost, Support Vector Machine, and Neural Networks algorithms developed based on 49 confirmed factors. 597 medical records were reviewed. 342 patients (57.29%) had prostate cancer, and 255 patients (42.71%) had benign prostate hyperplasia. The algorithm's performance was evaluated using accuracy, precision, recall, F1‐score, and support metrics. Results: The results of this study showed the XG Boosting model performed best in predicting the effective factors, with an accuracy of 77.5% a sensitivity of 74.5%, and a specificity of 79.7%. Key predictors included total and free prostate‐specific antigen (PSA) levels, hemoglobin, BMI, and fish consumption. Conclusion: Machine learning can enhance and personalize the identification of potential risks of PCa, but more research is necessary to refine these algorithms and address data biases.

Background and Aim: Nowadays, coronary artery bypass graft (CABG) surgery has become a common method for treating coronary artery diseases. This surgery requires a long post‐operative length of stay (PLOS) in the hospital. The purpose of this study was to systematically review the factors affecting PLOS in patients undergoing CABG surgery using machine learning methods. Method: A comprehensive search was conducted on PubMed, Scopus, IEEE Xplore, and Web of Science, from inception until September 25, 2023. This review was performed according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. All studies that investigated the factors affecting PLOS using machine learning methods in patients undergoing CABG surgery were included in the study. Result: In total, 9715 articles were identified after the removal of the duplicates. After the systematic screening, 20 studies met the inclusion criteria. The result showed there are 56 effective factors in predicting PLOS in patients undergoing CABG surgery. Of which 15 factors: age, gender, left ventricular ejection fraction, infection, Perceived Control (PC) levels, BMI, angina class, diabetes, Logistic Euro‐score, smoking, fluid balance, inotropes, low cardiac output, atrial fibrillation, and history of cerebrovascular accident are mentioned in more than one article as an affecting factors. Conclusion: This systematic review highlights the multifactorial nature of PLOS, showing that patients' postoperative length of stay is influenced by factors across pre‐, intra‐, and postoperative care.

Background: There are many reports about incomplete ligation of veins and inadvertent injury to the spermatic artery and lymphatic vessels during varicocelectomy, regardless of the surgical approach or advanced devices utilized. Objectives: Given that varicocelectomy risks arterial injury and vascular spasm, which compromise surgical success, this study aims to evaluate papaverine and hydrodissection as a means to enhance vessel exposure and ultimately improve sperm parameters. Methods: A randomized clinical trial was performed from April to July 2023 at Shahid Beheshti Specialty Hospital and Ofogh Clinic in Hamadan, Iran. Using convenience sampling, 114 patients eligible for varicocelectomy were recruited and randomized into three groups (A, B, and C) through a block randomization method with an equal allocation ratio (1:1:1). Group A underwent varicocelectomy only, Group B was administered papaverine, and Group C received papaverine combined with hydrodissection. The primary outcomes — sperm parameters and arterial preservation — were evaluated three months after surgery, whereas the secondary outcomes, namely operating time and surgical difficulty, were also assessed. Statistical analysis was performed using SPSS version 16, applying ANOVA, chi-square, Fisher’s exact test, and linear regression. Results: Three months after surgery, the mean score of motile sperm in the hydrodissection plus papaverine group was significantly higher compared to the other groups [69.34 (60.00) vs 62.70 (5.39) and 54.77 (14.48), P < 0.001]. Also, the three groups showed significant differences in the mean count of sperm. The highest count of sperm was observed in the papaverine plus hydrodissection group. This difference was statistically significant [65.96 (56.20) vs 39.25 (30.52) and 26.83 (21.65), P = 0.0001]. No significant difference was observed between the groups (P = 0.07) regarding sperm morphology. The mean arterial pressure in the papaverine plus hydrodissection group was superior to the other groups [0.59 (0.04) vs 0.46 (0.14) and 0.50 (0.02), P < 0.001). Conclusions: Papaverine plus hydrodissection provides benefits for semen parameters and preservation of the artery; this method is superior to the standard varicocelectomy procedure and allows for easier differentiation of vessels from each other.

BACKGROUND: Clinical education is a crucial component of the medical education system, providing essential opportunities to enhance students’ clinical competence and skills. In light of the numerous challenges in the clinical environment of the operating room, this study was conducted to compare the impact of team-based and mastery-based learning methods on the student’s clinical competence and their evaluation. MATERIALS AND METHODS: This quasi-experimental study was conducted on 6 ^th -semester operating room technology students at Hamadan University of Medical Sciences in 2023. In this study, students were selected by the convenience sampling method and were placed in two educational groups (team-based and mastery-based) of 31 people by the matching method. After implementing the training process in the operating room environment, the data related to the study were collected from Liu et al .’s clinical competence questionnaire and clinical assessment checklist of operating room nursing students. RESULTS: Findings showed that implementing the team-based learning method significantly affected students’ clinical competence ( P value = 0.012). Also, utilizing a mastery-based learning method compared to a team-based one had a significantly greater impact on the level of clinical skills and evaluation of students ( P value = 0.007). CONCLUSION: The results of this study have practical implications for clinical instructors and higher education institutions. Clinical instructors are advised to adopt a team-based learning method to enhance the student’s clinical competence in the operating room. Furthermore, higher education institutions are encouraged to provide adequate resources and make essential efforts to modernize educational methods in clinical environments, thereby empowering students and improving the quality of healthcare.

Patient Safety in the Operating Room: A Collective Commitment

Background: Migration among operating theatre nurses can adversely affect both the healthcare system and the quality of services provided. Therefore, researching this area is essential to gain a deeper understanding of the underlying causes. Methods: This study employed a qualitative design with a content analysis approach. Data were collected from March 2024 to July 2024. Operating theatre nurses were selected for inclusion through purposive sampling. Semi-structured interviews were conducted with the participants, continuing until data saturation was achieved. Data were analyzed using conventional content analysis, and the validity and reliability of the findings were assessed using the Lincoln and Guba criteria. Results: One key theme was identified: systemic dilemmas. This was further divided into three categories: economic issues, burnout, and unethical behaviors. Conclusion: Operating room nurse migration is a complex issue for healthcare organizations, driven by economic issues, burnout, and unethical behaviors. To address this, organizations should implement strategies focused on fair financial practices, workload support, and ethical standards. This holistic approach can enhance nurse retention, improve patient care, and strengthen the healthcare system. Supporting nurses fosters a positive work environment and reduces turnover.

Obesity is now recognized as a major global health challenge, associated with various comorbidities. Sleeve gastrectomy, a minimally invasive surgery, is accompanied by short-term complications such as postoperative pain, which undermines the advantages of this technique. Therefore, this study aims to compare the efficacy of intraperitoneal instillation with bupivacaine versus magnesium sulfate on early postoperative outcomes in patients undergoing sleeve gastrectomy. This study was conducted in Iran as a randomized controlled trial. A total of 105 patients candidates for laparoscopic sleeve gastrectomy were divided into three groups of 35 patients each: Group A(bupivacaine), Group B (magnesium sulfate), and Group C (normal saline). The VAS was used to assess postoperative pain in the first 24 h after surgery. Data were analyzed using SPSS version 16. Based on the results of the Kruskal–Wallis test, there was a significant difference in abdominal pain levels among the study groups at 1, 2, 4, and 6 h post-surgery (P-value < 0.05). Abdominal pain levels in both the bupivacaine and magnesium sulfate groups were significantly lower than those in the control group during the initial postoperative hours; however, no significant difference was observed between the bupivacaine and magnesium sulfate groups. Total rescue analgesic requests in the bupivacaine group was significantly lower than that in the control group (P-value = 0.010), with no significant difference observed between the bupivacaine and magnesium sulfate groups. Neither drug caused a significant difference in postoperative shoulder pain levels or the incidence of postoperative nausea and vomiting (P-value = 0.562). This study revealed that intraperitoneal administration of bupivacaine at 1, 2, and 4 h postoperatively, and magnesium sulfate at 2, 4, and 6 h postoperatively, significantly reduced pain in patients undergoing sleeve gastrectomy compared to those who didn't receive these analgesics. The lack of efficacy of both interventions in alleviating shoulder pain underscores the necessity of investigating alternative approaches to achieve comprehensive pain management in this patient population. Clinical Trial Registration https://www.irct.ir/ , identifier (IRCT20230129057271N2).