Background: Axillary dissection in breast cancer provides useful information on the degree of axillary nodule involvement, which serves as a reliable indicator for the prognosis and staging of breast cancer in patients. The aim of this study was to develop and validate the nomogram model by combining prognostic factors and clinical features to predict the node status of preoperative breast guard positive node cancer. Materials and Methods: Subjects consisted of patients referring to hospitals with the diagnosis of breast cancer. Patients were allowed to substitute molecular subtypes with data on breast cancer diagnosis and prognosis as well as sentinel node status. The bootstrap review was used for internal validation. The predicted performance was evaluated based on the area under the receiver operating characteristic curve. According to the logistic regression analysis, the nomograms reported material strength between predictors and final status reliability. Results: 1172 patients participated in the study, of whom only 539 patients had axillary lymph node involvement. The subtype, family history, calcification, and necrosis were not significantly related to axillary lymph node involvement. Tumor size, histological type, and lymphovascular invasion in multivariate logistic regression were significantly and directly correlated with axillary lymph node involvement. Conclusion: Nomograms, depending on the population, help make decisions to prevent axillary surgery. It seems that the prediction model presented in this study, based on the results of the neuromography, can help surgeons make a more informed decision on underarm surgery. Moreover, in some cases, their surgical program will be informed by accurate medical care and preclusion of major surgeries such as ALND.

Background: Complications or death risk factors is necessary for better monitoring and treatment. The aim of this study was to define the relative risk of toxico-clinical parameters with regard to poisoning severity and outcomes in patients with acute poisoning. Materials and Methods: This cross-sectional study entailed of patients with acute poisoning admitted to the poisoning emergency center of khorshid hospital, Isfahan, Iran from December 2018 until March 2019. Patients (n = 300) were categorized into four groups (minor, moderate, severe, and fatal poisoning) based on severity. Multivariate logistic regression analysis was employed to calculate the odds ratio (OR) as the estimate of the relative risk of the different variables for the poisoning severity and outcomes prediction. Results: In the minor group, opioids/opiates, alcohols, and benzodiazepines (14.7%) were the most prevalent poisoning, multidrug (23.3%) was in the moderate and severe groups and finally, pesticides poisoning (23%) was most common in the fatal group. The predictive factors for poisoning severity were pre-hospital antidote administration [OR, (95%CI); P value) [7.08 (1.77-28.34); 0.006]; loss of consciousness [4.38 (1.84-10.42), 0.001]; abnormal ECG [4.56 (1.65-12.56); 0.003]; and time interval of poisoning to admission in the hospital [1.15 (1.02-1.28); 0.01). Patients without complications was observed in 49.7% of subjects. Patients with the loss of consciousness [66.06 (2.41-180.07); 0.01); underlying disease [3.65 (1.09-12.24); 0.03]; abnormal respiration [1.14 (1.02-1.27); 0.02); have had a greater risk of complications and death. Conclusion: Important factors for poisoning severity and/or outcome were loss of consciousness, pre-hospital antidote administration, abnormal ECG or respiration, underlying disease, and delay to presentation to hospital.

Background: Although it is currently recommended that patients avoid solid food for 6–8 h and liquid for 2 h before cesarean section, longer restrictions still apply in many centers. Since studies on the duration of fasting before cesarean section is scarce, we aimed to investigate the effect of different fasting times before cesarean section on maternal and neonatal complications. Materials and methods: This descriptive study was performed on 405 candidates for cesarean section. These women were divided into five groups due to the length of time they did not consume clear liquid and solid food. Then, maternal and neonatal outcomes were compared using Kruskal–Wallis and Chi-square tests. Results: The rate of nausea during surgery was lower in the groups who ate solid food between 2 and 8 h and clear liquid <2 h before surgery (P = 0.04). Also, abdominal distension in the first 6 h after surgery in the group that did not eat solid food for <6–8 h and clear liquid for <2 h was more than in the other groups (P < 0.05). The prevalence of hypoglycemia was significantly lower in women who ate solid food for <6 h and drank clear liquid for <2 h (P < 0.05). Conclusion: Prolonged fasting time before cesarean section not only reduce complications but also may have undesirable consequences. The results of this study showed that it is better to use less strict measures in patients who are candidates for cesarean section and in patients with labor pains who are likely to have a cesarean section.

Background: As the prevalence of the coronavirus increases, there is now more emphasis on reducing “face-to-face” patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods: From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2^nd, 6^th, and 12^th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results: The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion: Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.

Background: Environmental factors play a key role in the occurrence of pediatric supracondylar humerus (SH) fracture which has been widely affected by the COVID-19 pandemic and the measures taken to curb its spread. In this study, we aim to investigate the ultimate impact coronavirus pandemic has had on SH fractures in children. Materials and Methods: This retrospective cohort study compares SH fractures which occurred during the pandemic with their prepandemic counterpart in a pediatric trauma public hospital. Patient's data, submitted from February to July 2020 and 2019, were collected and divided into two groups based on fractures' time of occurrence, i.e., during or before the pandemic. Results: There was no significant difference in terms of gender, type of fracture, injury location, and time of admission during a day between the aforementioned groups. However, in the pandemic group, patients were transferred to the operating room significantly quicker (odds ratio; 2.13 vs. 0.607, P = 0.01) and the surgery duration was shorter (40.17 ± 12.28 min vs. 49.11 ± 15.48 min, P = 0.011). It was found that the location of injury (home, school, etc.) varied between the two groups (P = 0.01) and the proportion of domestic injuries during the pandemic grew significantly (53.6% vs. 19.8%). Conclusion: Although the incidence of pediatric SH fractures has decreased due to the closure of schools and sports clubs during the pandemic, domestic occurrence of the same fracture type has grown disproportionately. To prevent this trend, pediatric centers should educate parents on child safety measures and fracture risks during the lockdown.

Background: This study aimed to compare respiratorily, arterial blood gas (ABG), and hemodynamics parameters among patients undergoing surgery who were admitted to intensive care unit (ICU), using three ventilation modes, including volume-assured pressure support (VAPS), volume support (VS), and spontaneous modes. Materials and Methods: One hundred and thirty-two patients were randomly assigned into three groups of VAPS, VS, and spontaneous modes utilizing randomized block procedure. Patients were followed between 12 and 30 h until extubation. Respiratory parameters including; peak inspiratory pressure (PIP), static compliance, resistance, rapid shallow breathing index (RSBI), and P 0.1(P0.1 correlates with respiratory drive and is defined as the negative pressure measured at the airway opening 100 ms after the initiation of an inspiratory effort), along with ABG parameters including; pH level, PaCO₂, HCO₃, PaO₂/FiO₂ ratio, extra hydrogen ion, and hemodynamics parameters including; mean arterial blood pressure and heart rate were measured every 3 h and compared among groups. Results: All studied parameters in three groups improved during the study. PIP, Resistance, PH, HCO₃, extra hydrogen ion, PCo₂, PaO₂/FiO₂ ratio, mean arterial blood pressure were similar among the three groups in most of the time points (P > 0.05). In most of the time points, RSBI (from 92.7 to 55.4), P 0.1 (from 6.8 to 1.7) in the VAPS group, static compliance (from 55.3 to 55.7) in the VS group, and heart rate (from 108.5 to 90.1) in spontaneous groups were significantly better than other modes (P < 0.05). Changes in RSBI, P 0.1, PCo₂, HCO₃, and heart rate during the study were significantly different among studied groups (P < 0.05). The length of stay in the ICU in patients who underwent VAPS was significantly shorter than the other modes. Conclusions: VAPS mode with better effects or at least as effective as VS and spontaneous modes could be select as the best mode of ventilation in postoperative early extubated patients admitted to ICU.

Background: Congenital infections are among the most important conditions threatening human fetal health, the majority of which are caused by viral agents. Screening pregnant women for viral infections is essential because such infections can cause serious consequences for both the mother and the infant. So, this study aimed to serologically investigate sexually transmitted viral infections in pregnant women and also find the association between the prevalence of viral infections and epidemiological parameters in pregnant women of Sari, Iran. Materials and Methods: This descriptive, observational study was performed in pregnant women referring to Sari Birth Cohort Center between 2018 and 2020. A total of 1092 blood samples were investigated for hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), human T-lymphotropic virus (HTLV), and cytomegalovirus (CMV) serological markers by enzyme-linked immunosorbent assay (ELISA). Results: The prevalence of HBsAg positivity, HCV, HIV, and HTLV was 0.2%, 0.09%, 0.09%, and 0.2%, respectively. The percentage of participants with CMV-IgM and -IgG antibody titers above normal was 0.2% and 91.8%, respectively. Pregnant women whose educational level was bachelor's degree or lower, those who did not use a male condom before pregnancy, or those with a family history of infectious disease were found to be more likely to have HBV, HCV, HIV, HTLV, and CMV infections. Conclusion: Family history, maternal age, pregnancy stage, and not using a male condom are among the risk factors for sexually transmitted viral infections in pregnant women in Sari.