https://ijs.ir/ Iranian Journal of Surgery en daily 1 Fri, 22 May 2026 00:00:00 +0330 Fri, 22 May 2026 00:00:00 +0330 https://ijs.ir/article_736405.html This paper explores the impact of the microbiome on breast cancer (BC), one of the most prevalent and dangerous types of cancer in women. While factors such as obesity and family history are recognized as risk factors, the microbiome has emerged as a novel and potential contributor to the onset and prevention of BC. The microbiomes of the breast, gut, and oral cavity can influence estrogen metabolism and inflammation, potentially facilitating the development of cancer. Additionally, research indicates that probiotics may play a role in inhibiting BC development. Given that the microbiome can affect treatment response and its side effects, monitoring microbiome composition and developing new therapeutic strategies could aid in the prevention and improvement of BC treatment outcomes. Due to the sensitivity and complexity of this topic, further research is necessary to gain a more precise understanding of the microbiome's role in BC. https://ijs.ir/article_736407.html Background and Objective: Meningiomas are the most common primary brain tumors, accounting for 15 to 20% of all primary brain tumors. Differentiating between malignant and benign meningiomas before surgery is essential for treatment planning and prognostic assessment. One proposed method for differentiating malignant from benign meningiomasis magnetic resonance perfusion (MR perfusion), but limited studies have been conducted in this respect. Therefore, this study aimed to determine the relationship between molecular subtypes and MR perfusion in patients with meningiomas. Materials & Methods: In this cross-sectional study, all patients with brainmeningiomas referred to Sina Hospital in Tehran between 2021 and 2024 were evaluated prospectively. MR perfusion was done for patients. After brain surgery, pathological samples were obtained from the patients, and in addition to determining the conventional tumor grade, molecular studies including Ki-67, EGFR amplification, and S100 were performed by the pathologist, and the results were recorded. The relationship between MR perfusion parameters (relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), and mean transit time) with tumor-related data was assessed. The significance level was considered less than 0.05.Results: Twenty-five patients were studied. The mean age was 55.08±12.07 years, and 17 patients (68%) were female. The most common presentation (76%) was headache. The findings showed that rCBV and rCBF were statistically significantly different between low-grade and high-grade tumors (P-values < 0.05). Although the calculated cut-offs for rCBV and rCBF (7.55 and 6.94, respectively) were useful for differentiating the different grades of disease, neither was statistically significant (P-value: 0.05 and P-value: 0.1, respectively). Also, patients with higher Ki67 levels had higher rCBV and rCBF (P-value < 0.05 for both).Conclusion: MR perfusion values (rCBV and rCBF) have statistically significant differences between different grades of meningioma. https://ijs.ir/article_736409.html Background and Objective: Traumatic hip fractures in elderly patients with rheumatoid arthritis are associated with significant postoperative pain that adversely impacts recovery and overall quality of life. Identification of reliable biomarkers, such as the systemic inflammatory-immunity index, may enhance the prediction of pain severity and refine pain management strategies. This study aims to investigate the role of the systemic inflammatory-immunity index in predicting postoperative pain outcomes, ultimately improving care for this vulnerable population through personalized, evidence-based approaches. Materials & Methods: This descriptive cross-sectional study was conducted in the winter of 2024 at Shahid and Imam Reza Hospitals, affiliated with Tabriz University of Medical Sciences. A total of 112 elderly patients with rheumatoid arthritis were recruited via convenience sampling. Demographic characteristics, clinical factors, and biomarkers (neutrophil, lymphocyte, and platelet counts) were collected to compute the systemic inflammatory-immunity index. Postoperative pain severity, opioid consumption, and hemodynamic parameters were assessed for their correlation with the systemic inflammatory-immunity index using Pearson correlation coefficients.Results: Correlation analyses demonstrated a significant positive relationship between the systemic inflammatory-immunity index during hospitalization and acute postoperative pain severity, as measured by the pain intensity scale, within the first four hours post-surgery. The strongest correlation with the Visual Analog Scale (VAS) score was recorded at the second postoperative hour (R=0.658, P=0.009). Additionally, significant correlations were found at the first hour (R=0.596, P=0.014), third hour (R=0.488, P=0.026), and fourth hour (R=0.452, P=0.036); however, these correlations progressively diminished and were non-significant in subsequent hours.Conclusion: The systemic inflammatory-immunity index is a valuable predictor of postoperative pain severity, hemodynamic instability, and extended hospital stays among elderly patients with rheumatoid arthritis. https://ijs.ir/article_736413.html Background and Objective: After ostomy surgery, patients experience many changes in their appearance and body function which they have to accept these changes and adjust with an ostomy and a new lifestyle.Religion and spirituality play an important role in people's well-being, adaptation, acceptance of treatment and lifestyle afterwards. The present study was conducted to evaluating the relationship between spiritual well-being and psychosocial adjustment with ostomy. Materials & Methods: This descriptive–analytical study was conducted in four surgical outpatient clinics affiliated with Isfahan University of Medical Sciences. A total of 130 patients were recruited using convenience sampling. Data were collected using a researcher-developed demographic–clinical questionnaire, Paloutzian and Ellison (1982) Spiritual Well-being (SWB) questionnaire, and Ostomy Adjustment Inventory (OAI-23) developed by Simmons et al. (2009). Data analysis was performed using SPSS software (version 17) and included both descriptive and inferential statistics(independent t-tests, ANOVA, regression analysis, Mann–Whitney and Kruskal–Wallis). The level of statistical significance was set at p<0.05.Results: The mean score of the spiritual well-being and Psychosocial adjustment were 97.40 ± 14.819 and 47.83 ± 17.211 respectively.The multiple linear regression model showed that the dimensions of spiritual well-being explained approximately 59.5% of the variance in ostomy adjustment (R = 0.772, R² = 0.595, adjusted R² = 0.586). Within this model, religious well-being had the strongest contribution to ostomy adjustment (β = 0.772, p = 0.018).Conclusion: Based on these findings, nurses as the main providers of health care, need to pay more attention to patient’s spiritual needs and try to improve their spiritual wellbeing, as a source for psychosocial adjustment with ostomy, by providing appropriate nursing support, training and counseling. https://ijs.ir/article_736414.html Background and Objective: The rapid advancement of information and communication technology has revolutionized higher education, particularly within the medical and dental fields. Virtual education serves as a critical component of the learning process, providing students with enhanced access and flexibility, while also presenting challenges that warrant careful consideration. This study aims to evaluate the satisfaction levels of clinical dental students at Tabriz University of Medical Sciences with respect to virtual education and to identify the key factors influencing their learning experience. Materials & Methods: A cross-sectional analytical study was conducted involving 165 clinical dental students who had completed at least one theoretical course through virtual education. Data were collected using a structured questionnaire developed by Houri et al. in 2022, which assessed various dimensions of online learning, including content delivery, professor-student interaction, technical support, and evaluation methods. The data were analyzed using SPSS software version 26, applying descriptive statistics, independent t-tests, and one-way ANOVA to explore differences in satisfaction based on gender, academic semester, and year of entry. The Pearson correlation coefficient was employed to examine the relationships between satisfaction scores and demographic factors, with a significance threshold set at a P-value of less than 0.05.Results: Overall satisfaction scores ranged from 27 to 78, yielding a mean of 47.05 ± 8.6, indicating a moderate to high level of satisfaction with virtual education. Statistically significant differences in satisfaction levels were not observed between female (47.36 ± 8.41) and male students (46.84 ± 8.7) (P = 0.620), across academic semesters (seventh semester 46.18 ± 9.53, ninth semester 47.9 ± 3.8, and eleventh semester 46.18 ± 9.53) (P = 0.600), or between years of entry (2018 47.08 ± 13.8, 2019 47.3 ± 3.8, and 2020 46.18 ± 9.53) (P = 0.600).Conclusion: The findings of this research suggest that virtual education is an effective means for delivering theoretical knowledge in the field of dental education. Nonetheless, it is essential to enhance interactive elements, adopt blended learning models, and strengthen technical support to increase student engagement and improve learning outcomes. This study underscores the necessity for ongoing assessment and refinement of virtual education strategies to better align with the educational needs of students. https://ijs.ir/article_736416.html Background and Objective: Distal tibial fractures, particularly those involving the diaphysis-metaphysis junction, represent a significant challenge in orthopedic trauma management, typically resulting from high-energy axial and rotational forces. Intramedullary nailing (IMN) has gained prominence as a standard treatment modality due to its associated benefits, including lower rates of wound complications, reduced operative duration, and accelerated postoperative rehabilitation. While the utilization of two or more distal interlocking screws is the conventional standard for achieving adequate construct stability, this is frequently precluded in distal fractures by restricted bone stock. This report evaluates the clinical feasibility and efficacy of IMN fixation utilizing a solitary distal interlocking screw in cases where additional screw placement is anatomically limited. Materials & Methods: We present the case of a 38-year-old male who sustained a spiral fracture of the distal tibia accompanied by an associated proximal fibular fracture. The patient underwent surgical stabilization via an intramedullary nail secured by a single distal interlocking screw. Clinical and radiographic outcomes were assessed throughout a 6-month follow-up period to evaluate fracture healing and functional recovery.Results: Clinical and radiographic assessments during the 6-month follow-up revealed no evidence of implant failure, fracture displacement, malunion, nonunion, or limb-length discrepancy. The patient achieved excellent functional outcomes, evidenced by an American Orthopaedic Foot & Ankle Society (AOFAS) score of 85 and a Visual Analog Scale (VAS) pain score of 1–2.Conclusion: In simple, non-comminuted distal tibial fractures, the use of an intramedullary nail with a single distal interlocking screw constitutes a viable and safe therapeutic strategy when anatomical constraints preclude standard multi-screw fixation. While this approach benefits from the inherent advantages of intramedullary nailing, these findings should be corroborated by further prospective, comparative studies to establish definitive clinical guidelines for such complex scenarios. https://ijs.ir/article_736431.html Background and Objective: Skin loss may occur due to various causes, including genetic disorders, acute trauma, chronic wounds, or even surgical interventions. Dressings can accelerate wound healing by protecting the wound from bacterial contamination and providing a favorable environment for tissue repair. Moist wound dressings are particularly effective in preventing dressing-related injuries, managing exudates, and minimizing discomfort and pain. In this study, a polyurethane-based film incorporated with walnut leaf extract was developed and evaluated. Materials & Methods: To prepare the polyurethane biofilm, a 12% polyurethane solution was formulated using tetrahydrofuran and dimethylformamide (50:50). Walnut leaf extract was then added at concentrations of 1%, 2%, and 4% (w/w), followed by casting into Teflon molds. Physicochemical and mechanical properties were assessed using Fourier-transform infrared spectroscopy (FTIR), light transmittance, swelling behavior in phosphate-buffered saline (PBS), degradation analysis, and cytotoxicity testing. The tensile strength of the films decreased with increasing extract content, while flexibility improved.Results: Due to the diverse chemical constituents of the extract, elongation at break increased from 38.4 ± 4.7% to 68.24 ± 11.3%. Swelling capacity in PBS rose from 76% for pure polyurethane to 96% for films containing 4% extract. MTT assay results indicated no cytotoxicity for films containing 1% and 2% extract, whereas the 4% extract film exhibited cytotoxic effects.Conclusion: Based on the analytical data and SEM observations of L929 fibroblast cells cultured on the films, it can be concluded that polyurethane films containing 2% walnut leaf extract provide optimal mechanical, chemical, physical, and biological properties, making them suitable candidates for skin tissue applications in surgical wound healing. https://ijs.ir/article_736433.html Background and Objective: The rapid advancement of science and technology in medicine has led to an escalating public demand for effective treatments for previously deemed incurable conditions. In many instances, organ transplantation emerges as the sole viable treatment option, necessitating the identification of suitable organ donors who meet specific criteria for donation and transplantation. Given the constraints on the availability of transplantable organs from living donors, the procurement of organs from deceased patients and individuals declared brain-dead has become increasingly significant. In 1379, the Iranian legislative body took notable steps to address these concerns by enacting a law comprised of a single article and three notes, subsequently followed by the approval of executive regulations in 1381. This legislation aims to establish a systematic framework for organ removal and transplantation processes. Materials & Methods: This study employs a descriptive-analytical methodology, supplemented by comprehensive library research and documentary analysis. Data were systematically gathered from relevant scholarly publications, including peer-reviewed articles and academic texts, and subjected to comparative analysis to derive informed conclusions.Results: The organ transplantation law addressing deceased patients and confirmed brain-dead individuals raises various legal questions concerning organ removal. However, it is fraught with significant ambiguities, particularly regarding the role of beneficiaries and the basis for their rights to grant consent for organ removal.Conclusion: Findings indicate that obtaining consent from beneficiaries of deceased patients is imperative for organ removal under the 1379 organ transplant law. There exists considerable divergence in the interpretation of these rights' nature and foundation. Some viewpoints argue that such authority derives from the ownership representation of the deceased, while others contend that it stems from beneficiaries’ ability to act in the deceased's best interests. The executive regulations classify beneficiaries as legal heirs, requiring consent solely from primary heirs, rather than from all heirs. Additionally, when the need to save another Muslim's life is substantiated, the law allows for organ removal without the universal consent of all heirs. Therefore, it can be inferred that the rights of heirs do not arise from ownership or inheritance laws, but instead reflect a respect-oriented approach, suggesting that the role of beneficiaries may be predominantly ceremonial. https://ijs.ir/article_736435.html No https://ijs.ir/article_736429.html Risk is defined as the probability of a specific health outcome occurring within a specified population over a defined period. Absolute risk quantifies the incidence of an outcome within a group, while relative risk provides a comparative measure between two distinct populations, such as exposed and unexposed groups. These metrics are fundamental in clinical research for assessing disease prevalence and determining the efficacy of interventions.