Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 13 257 264 EN Soraya Emamgholizadeh minaei Department of Medical Physics and Imaging, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia, Iran. Mahshid Mohammadian Department of Clinical Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Omid Esnaashari Department of Radiation Oncology, Omid Research and Treatment Center, Urmia, Iran Kamal Mostafanezhad Department of Radiation Oncology, Omid Research and Treatment Center, Urmia, Iran 2025 01 08 2025 11 04 Colorectal cancer (CRC) is diagnosed as one of the most prevalent cancers in the world. The application of radiotherapy in cancer treatment might be limited due to its radio resistance. Specific radiosensitizers are important factors in increasing the radiation therapy (RT) efficiency. In this study, Fe3O4@CuS-PEG nanoparticles in combination with the RT were evaluated for the treatment of CRC cells (HT-29 cells). HT-29 cells were treated with 2, 4, and 6 Gy of X-ray irradiation and/or a minimal toxic concentration of Fe3O4@CuS-PEG nanoparticles. The cytotoxic effect of various treatments was evaluated by MTT assay. Moreover, the malondialdehyde (MDA) level, superoxide dismutase (SOD) activity, and lactic acid level were assessed in single and combined treatments. Furthermore, the epidermal growth factor receptor (EGFR) gene expression level was measured by Quantitative Real-time PCR. Based on our results, cytotoxicity of Fe3O4@CuS-PEG nanoparticles was increased in a dose dependent manner. The nanoparticles were less cytotoxic in the concentration of 5 mg/mL compared to other examined concentrations. According to the results of MTT assay, the viability in the combined treatment groups was significantly lower than that of the single treatment groups. EGFR mRNA expression level was downregulated in radiation+nanoparticles groups in all examined doses of radiation. The level of MDA increased in the combined treatments compared to the alone treatments. Moreover, lactic acid level and SOD activity decreased in double agent combination treatments versus radiation alone. Based on our study, Fe3O4@CuS-PEG nanoparticles can be introduced as an effective radiosensitizer agent for targeted treatment of CRC cells. Moreover, combination treatment could efficiently treat cancerous cells and inhibit tumor growth in vitro. https://acta.tums.ac.ir/index.php/acta/article/view/11473 https://acta.tums.ac.ir/index.php/acta/article/download/11473/6047

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 12 11772 11772 EN Alireza Hoseinzadeh Fumeshi Department of General Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Seyed Amir Miratashi Yazdi Department of General Surgery, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Hoda Asefi Department of Radiology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2025 08 17 2026 02 14 Pneumothorax is one of the most common consequences of chest trauma, typically managed with chest tube insertion. However, the optimal timing for chest tube removal remains controversial. This study aimed to compare the incidence of clinical complications following chest tube removal at 48 hours versus 72 hours after insertion in trauma patients admitted to Sina Hospital. This prospective, single-center, parallel-group randomized controlled trial enrolled 194 trauma patients requiring tube thoracostomy. Participants were randomized in a 1:1 ratio using computer-generated block randomization with allocation concealment into two groups: removal at 48 hours (n=97) and removal at 72 hours (n=97). The primary endpoint was post-removal complications, defined as recurrent pneumothorax or incomplete lung re-expansion confirmed radiographically. Absolute risk differences (ARD) with 95% confidence intervals (CI) were calculated. Logistic regression analysis was performed to evaluate potential predictors of complications. Statistical significance was defined as P<0.05. The mean age of patients was 43.27±13.05 years. The 72-hour group had slightly higher mean oxygen saturation than the 48-hour group (94.89% vs. 94.76%, P=0.690), and higher mean heart rate (84.04 vs. 83.11, P=0.507) and respiratory rate (13.44 vs. 13.38, P=0.822). In contrast, mean pain intensity was higher in the 48-hour group (4.03 vs. 3.98, P=0.673). Recurrent pneumothorax occurred in 12 patients (12.4%) in the 48-hour group and 10 patients (10.3%) in the 72-hour group (ARD: 2.1%; 95% CI: −6.8% to 11.0%; P=0.651). Incomplete lung re-expansion occurred in 2 patients (2.1%) and 4 patients (4.1%), respectively (ARD: −2.0%; 95% CI: −6.7% to 2.7%; P=0.407). No statistically significant differences were detected between groups. Logistic regression analysis did not identify independent predictors of post-removal complications. Chest tube removal at 48 hours was not associated with a statistically significant increase in post-removal complications compared with removal at 72 hours. However, confidence intervals were wide, and the findings should be interpreted cautiously pending confirmation in larger adequately powered studies. https://acta.tums.ac.ir/index.php/acta/article/view/11772 https://acta.tums.ac.ir/index.php/acta/article/download/11772/6048

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 271 280 Elham Maleki Department of Pediatrics, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran Mina Sepehran Department of Pediatrics, Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran Sa’adat Barkhori Mehni Department of Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Kerman, Iran. 2025 10 26 2026 02 24 Several factors have been reported to affect glycemic control, the significance of most of which is still a topic of discussion. Therefore, we aimed to investigate such effects in more detail. We conducted our cross-sectional analysis on 163 children and adolescents 2 to 18 with T1DM. Moreover, we obtained their demographic and clinical information in addition to glycated hemoglobin (HbA1C) levels and performed a multivariate regression analysis to determine their effects. Among the investigated factors parents living together (P<0.001), higher parental education (P<0.001), level of monthly income (P<0.001), and residing in urban areas (P<0.001), positive history of hospitalization due to ketoacidosis (P=0.001), injection site lipodystrophy (P=0.005), physical activity (P<0.001), regular endocrinology clinic visits (P<0.01), physician long distance access (P<0.001), social media usage (P<0.001), nutritionist supervision (P<0.001), regular visits by a mental health expert (P=0.02), body mass index (P=0.449, P<0.001), daily insulin units (r=0.447, P<0.001), height Z score (r= -0.177, P=0.024), and duration of Diabetes (r= -0.199, P=0.011) significantly affected HbA1C levels. Furthermore, the regression model significantly predicted 56.4% of the changes in HbA1C. With environmental and family-related factors proving pivotal, educational interventions and implementing relevant policies are crucial. Financial aid to those affected by facilitating access to healthcare-related technologies and state-of-the-art care centers can also pay substantial dividends. https://acta.tums.ac.ir/index.php/acta/article/view/11861 https://acta.tums.ac.ir/index.php/acta/article/download/11861/6049

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 11958 11958 Qasim Kadhim Ashour Department Pediatric Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq . Mohammed Kadhim Saadoon Department Pediatric Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. Hasan Saud Abdul Hussein Department Pediatric Nursing, College of Nursing, University of Kerbala, Kerbala, Iraq. Enas Ahmed abdel Karim Department of Pediatric Nursing, College of Nursing, University of Al-Qadisiyah, Al-Diwaniyah, Iraq 2025 12 25 2026 02 24 Diarrheal disease: It is frequently unknown how often bacteria cause diarrhea when assessed in ambulatory settings. We attempted to develop criteria for bacterial culture and identify the microbiological causes of diarrhea in a clinic that primarily serves immigrant children and in a private pediatric practice. Diarrhea is often caused by infections, food intolerance, digestive disorders, or contaminated water and food. It can lead to dehydration, especially in young children and the elderly, making proper hydration and medical attention crucial in severe cases. A descriptive cross-sectional design was utilized. The study was conducted from 15 June 2024 to 13 August 2024. A non-probability (convenience) sample of 100 mothers of children under five years of age was selected. Data were collected via a questionnaire assessing mothers’ knowledge. The data were described statistically and analyzed using descriptive and inferential statistical procedures. The findings of the present study indicate that mothers demonstrated a moderate level of knowledge and practice related to diarrhea prevention, with 47.5% of participants falling within the moderate range. The level of mothers’ knowledge and practice showed a significant association with their educational level. However, the results section should include additional statistical details—such as mean scores, standard deviations, and P—to fully support the reported associations. The study concludes that mothers’ responses across the assessed domains were significantly associated with both their educational level and their children’s sociodemographic characteristics. Based on these findings, it is recommended that community-based diarrhea prevention programs adopt a mother’s self-efficacy assessment scale to identify perceived risks and to design targeted interventions aimed at strengthening and sustaining diarrhea prevention behaviors at the household level. https://acta.tums.ac.ir/index.php/acta/article/view/11958 https://acta.tums.ac.ir/index.php/acta/article/download/11958/6050

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 286 293 Reza valizadeh Department of Medicine, Ilam University of Medical Sciences, Ilam, Iran. Maryam Zinivand School of Medicine, Ilam University of Medical Sciences, Ilam, Iran. Aliashraf Mozafari Department of Epidemiology, School of Health, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran. Sehat Aibod Department of Psychology, Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran. Sajad Sohrabnejad Department of Clinical Psychology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran 2025 10 18 2026 05 31 Medical students face multiple academic and clinical stressors that can compromise their psychological well-being. Identifying protective psychological factors is crucial for developing effective mental health promotion and prevention strategies in university settings. This study examined the relationships between personality traits, self-compassion, and psychological well-being among medical students, focusing on their potential preventive roles. A cross-sectional correlational study was conducted with 162 medical students. Participants completed the NEO Five-Factor Inventory (NEO-FFI), the Self-Compassion Scale (SCS), and the Psychological Well-Being Scale (PWB). Data were analyzed using descriptive statistics, Pearson’s correlations, and multiple regression analyses (α<0.05). Mean scores were Neuroticism 22.96±4.87, Extraversion 26.15±5.02, Openness 27.78±4.65, Agreeableness 29.89±5.41, Conscientiousness 30.23±5.12, Self-Compassion 41.13±5.94, and Psychological Well-Being 67.52±8.91. Psychological well-being correlated positively with Openness to Experience (r=0.21, P=0.02) and Conscientiousness (r=0.25, P=0.01). Gender differences were significant for Extraversion, Openness, and the “Common Humanity” dimension of self-compassion (P<0.05). Regression analysis indicated that personality traits significantly predicted psychological well-being (β=0.19, P=0.04), whereas self-compassion was not a direct predictor (β=0.03, P=0.93). Conscientiousness and Openness to Experience play pivotal roles in medical students’ psychological well-being. Notably, this study found no direct predictive relationship between self-compassion and well-being. Rather than a lack of relevance, this finding suggests that in the rigorous context of medical education, self-compassion may function through indirect mechanisms or act as a moderating factor. These findings underscore the importance of interventions that enhance adaptive personality traits, while highlighting the need for a more nuanced understanding of how self-compassion contributes to resilience and sustainable mental health in high-pressure academic settings. Conscientiousness and Openness to Experience play pivotal roles in medical students’ psychological well-being. Notably, this study found no direct predictive relationship between self-compassion and well-being. Rather than a lack of relevance, this finding suggests that in the rigorous context of medical education, self-compassion may function through indirect mechanisms or act as a moderating factor. These findings underscore the importance of interventions that enhance adaptive personality traits, while highlighting the need for a more nuanced understanding of how self-compassion contributes to resilience and sustainable mental health in high-pressure academic settings. https://acta.tums.ac.ir/index.php/acta/article/view/11848 https://acta.tums.ac.ir/index.php/acta/article/download/11848/6053

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 294 299 Seyedeh Noushin Ghalandarpoor-Attar Department of Obstetrics and Gynecology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran Seyedeh Mojgan Ghalandarpoor-Attar Department of Obstetrics and Gynecology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran Seyed Morteza Hosseini Spiritual Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran Zahra Soleimani Department of Obstetrics and Gynecology, Baqiyatallah Hospital, Baqiyatallah University of Medical Sciences, Tehran, Iran. AND Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran. 2025 01 31 2025 07 07 Iron deficiency is the most prevalent nutritional deficiency worldwide ,affecting populations in both developing and developed .despite the absence of anemia, pregnant women may still experience depleted iron stores, which can have significant health implication for both mother and fetus This study aimed  to assess the prevalence of iron deficiency among non-anemic pregnant women in their  second trimester by analyzing serum  ferritin concentrations and identifying related clinical and demographic factors. This cross-sectional study included 246 non-anemic pregnant women at 24-28 weeks’ gestation visiting Baqiatallah Hospital in Tehran for routine diabetes screening in 2022. Blood samples were analyzed for complete blood count, ferritin, iron, and total iron binding capacity. Demographic data and supplement use were recorded. Participants were divided into low ferritin (<30 ng/mL) and normal ferritin (≥30 ng/mL) groups. Demographic characteristics, clinical parameters, and laboratory findings were compared between these two groups using Student's t-test, Mann-Whitney U, and Chi-square tests, Mann-Whitney U, and Chi square tests. Of the participants, 64.4% had low ferritin levels despite 94.3% reporting regular iron supplement use. There were no significant differences in demographic characteristics or supplement use between low and normal ferritin groups (P>0.05). Women with low ferritin had significantly lower platelet counts (213.1±43.4 vs 231.0±59.1 thousand/μL, P=0.04) and serum iron levels (97.5±41.9 vs 105.8±34.9 μg/dL, P=0.018) compared to those with normal ferritin. No significant differences were found in hemoglobin, hematocrit, or other red blood cell indices between groups (P>0.05). A high prevalence of iron deficiency was observed among non-anemic pregnant women despite regular supplement use. Current iron supplementation strategies may be inadequate in addressing iron deficiency during pregnancy. Regular monitoring of serum iron profiles is recommended to identify at-risk women and allow for timely interventions. https://acta.tums.ac.ir/index.php/acta/article/view/11513 https://acta.tums.ac.ir/index.php/acta/article/download/11513/6054

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 12098 12098 Mohammed Abd Al-Hussein Khalil Department of Chemistry and Biochemistry, Faculty of Medicine, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq. Qabas Abdulsamad Thanoon Department of Basic Sciences, Faculty of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq. Ammar Yasir Abdulrahman Department of Basic Sciences, Faculty of Dentistry, Ibn Sina University of Medical and Pharmaceutical Sciences, Baghdad, Iraq 2026 04 27 2026 05 14 Rheumatoid arthritis (RA) defined as a chronic inflammatory disease characterized by painull inflammation of small joints additionally to cardiac disease, probably due to shared pathophysiological pathways and dyslipidemia. The main goal of the presented study is to evaluate the role of the ApoE polymorphisms in Iraqi RA patients and their association with lipid profiles, total ApoE levels, and disease severity markers, including galectin-3 and anti-CCP. A case-control study included 90 RA patients and 90 gender- and healthy controls aged 21 to 70 years with BMI ranging from 18 to 27 kg/m². Fasting serum lipid profiles were analyzed colorimetrically. Total ApoE, ApoE isoforms, anti-CCP, and galectin-3 were quantified by ELISA. Genomic DNA was used to perform ApoE genotyping for the ε2, ε3, and ε4 alleles. RA patients had significantly lower total ApoE levels and markedly higher levels of total cholesterol, LDL, galectin-3, and anti-CCP than controls (P<0.001). The ApoE ε2 allele correlated with reduced cholesterol and LDL-c levels and higher total ApoE levels. In contrast, the ApoE ε4 allele was associated with more severe dyslipidemia, including higher cholesterol and LDL-c levels, as well as increased inflammatory markers, including galectin-3 and anti-CCP, compared with carriers of either ε2 or ε3. ApoE polymorphisms, specifically the ε4 allele, together with elevated galectin-3 levels, are associated with exacerbated dyslipidemia and systemic inflammation in RA, suggesting their potential utility as combined biomarkers for identifying patients with a heightened atherogenic profile who may warrant cardiovascular risk assessment. https://acta.tums.ac.ir/index.php/acta/article/view/12098 https://acta.tums.ac.ir/index.php/acta/article/download/12098/6059

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 309 316 Atessa Pakfetrat Department of Oral and Maxillofacial Diseases, Oral and Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Mahdi Talebi Department of Family Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Taghi Shakeri Department of Epidemiology and Biostatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Reza Shakiba Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Mohammad Mahdi Rivandi Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran Ala Ghazi Oral and Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 01 25 2025 11 10 This study was conducted with the aim of investigating the pattern of smoking and its relationship with chronic pain in patients with atypical facial pain (AFP). This descriptive cross-sectional study was conducted on patients with AFP referred to the Oral and Maxillofacial Medicine department of Mashhad Dental faculty. Patients whose disease was confirmed through clinical and psychiatric examinations, and standard diagnostic criteria were included in the study. The information based on the designed checklist includes demographic characteristics, pain characteristics, and information related to tobacco use was extracted and recorded. Out of 77 patients included in the study, 23 were smokers and 54 were non-smokers. The most common site of pain in the smoking group was the face and, in the non-smoking group was the mandible. The most reported pain type was sharp pain in both groups. In non-smokers, a history of mental stress at the same time as the onset of pain was reported in 56% of people, and in the population of smokers, it was reported in 73% of people. In both groups, most people reported that pain does not affect sleep patterns. No significant difference was observed between the smoking and non-smoking groups in terms of pain intensity. According to the findings of present study, Smoking does not play a role in the pain intensity and sleep pattern of people with AFP, and other factors such as economic status, stress, anxiety, and smoking compounds may be effective, which should be investigated in future studies. https://acta.tums.ac.ir/index.php/acta/article/view/11500 https://acta.tums.ac.ir/index.php/acta/article/download/11500/6058

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 317 328 Ali Najeh Al-Awwady Department of Surgery, College of Medicine, Jabir ibn Hayyan University for Medical and Pharmaceutical Sciences, Al-Najaf, Iraq 2026 04 26 2026 05 16 Septoplasty is a common otolaryngological procedure in which a bloodless surgical field is critical for safe and accurate surgery. Deliberate hypotension is widely used to minimise intra-operative bleeding and optimise visibility, but the relative haemodynamic stability, blood-conservation efficacy, and postoperative nausea and vomiting (PONV) profile of total intravenous anaesthesia (TIVA) compared with combined intravenous–inhalational techniques in septoplasty are not fully established. This study aimed to compare propofol–remifentanil TIVA with a combined intravenous–inhalational technique (isoflurane plus metoprolol and glyceryl trinitrate) in patients undergoing septoplasty, with regard to haemodynamic stability, intra-operative blood loss, and PONV. A prospective, single-centre, parallel-arm, open-label randomised clinical trial was conducted at Al-Najaf Teaching Hospital, Iraq, between December 2022 and October 2023, and is reported in accordance with the CONSORT 2010 statement. Forty patients aged 16–50 years (ASA physical status I–II) were randomly allocated 1:1 by an independent biostatistician using a computer-generated block-randomisation sequence (block size 4). Allocation was concealed in sequentially numbered, opaque, sealed envelopes, which were opened only after enrolment and immediately before induction. Patients were assigned to combined intravenous–inhalational anaesthesia (Group A, n=20) or TIVA with propofol and remifentanil (Group B, n=20). The pre-specified primary endpoint was the proportion of patients achieving and maintaining the deliberate-hypotension target (MAP 50-65 mmHg) for ≥90% of the intra-operative period. Secondary endpoints were intra-operative blood loss, PONV incidence within 24 h, operative time, and recovery profile. Heart rate, systolic and diastolic blood pressure, MAP, intra-operative blood loss, and PONV up to 24 h after surgery were recorded. Both groups achieved the deliberate-hypotension target within five minutes of induction and maintained stable haemodynamics throughout surgery. Intra-operative blood loss did not differ significantly between groups (TIVA 119.0±14.10 mL vs combined 121.5±14.60 mL; P=0.548). PONV occurred in 25% of TIVA patients and 35% of combined-anaesthesia patients (P=0.503); no episodes of vomiting were recorded in either group within 24 h. Female sex was significantly associated with PONV (P=0.014). Operative time and recovery profiles were similar between the two groups. Both TIVA and combined intravenous–inhalational anaesthesia, when titrated to identical haemodynamic targets, showed no statistically significant differences in haemodynamic stability, intra-operative blood loss, or PONV outcomes during septoplasty. Because the study was not designed or powered as a formal equivalence or non-inferiority trial, these findings should be interpreted as hypothesis-generating rather than as proof of clinical equivalence. Either technique may be selected on the basis of patient-specific factors, drug availability, and clinician preference. https://acta.tums.ac.ir/index.php/acta/article/view/12097 https://acta.tums.ac.ir/index.php/acta/article/download/12097/6057

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 65 5 2026 07 06 11416 11416 Amir Mir Mohammad Sadeghi Cardiovascular Surgery Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Mohaddeseh Behjati Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Bashir Najafabadian Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran Keyvan Shirneshan Pathology Research Center, Dr. Ali Shariati Hospital, Isfahan, Iran Mohsen Mir Mohammad Sadeghi Cardiovascular Surgery Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 2024 12 15 2025 07 26 This case report details the remarkable long-term survival of a 73-year-old female who underwent bicaval heart transplantation 13 years ago due to severe heart failure caused by dilated cardiomyopathy (DCM) with an ejection fraction of 10%. Simultaneously, she was diagnosed with papillary thyroid carcinoma (PTC). Despite the potential complications, her case highlights the feasibility of heart transplantation in patients with concurrent, non-aggressive cancers. Post-transplant, she underwent successful total thyroidectomy and cervical lymph node dissection three months after heart transplantation to address her PTC. Over the 13 years following the transplantation, she maintained stable cardiac health, evidenced by consistent left ventricular ejection fraction improvements, peaking at 55%. However, she developed severe osteoporosis and experienced vertebral fractures due to significant hypocalcemia in the setting of hyperparathyroidism, which was managed with vertebroplasty. This case underscores the importance of a multidisciplinary approach in managing complex cases involving both severe cardiac and oncological conditions and emphasizes the potential for positive outcomes with comprehensive medical and surgical interventions. https://acta.tums.ac.ir/index.php/acta/article/view/11416 https://acta.tums.ac.ir/index.php/acta/article/download/11416/6055