Translational Health Reports

Abstract Background: Hyponatremia, a frequent yet potentially life-threatening electrolyte 
imbalance, poses heightened risks in intensive care contexts. This investigation sought to 
explore contributory factors linked to hyponatremia following linezolid administration in 
critically ill (CI) individuals and to formulate a robust predictive framework. 
Methods: A retrospective evaluation was conducted on clinical records and follow-up data 
from 200 CI patients who received linezolid therapy. To isolate key determinants, logistic 
regression modeling was utilized, followed by validation using Receiver Operating 
Characteristic (ROC) curve analysis. A nomogram-based risk assessment tool was then 
constructed, with calibration tested via the Hosmer-Lemeshow goodness-of-fit approach. 
Findings: Adverse reactions were recorded in 23.5% of the cohort. Statistically significant 
disparities (P < 0.05) emerged between CI and non-CI patients across several variables, 
including linezolid serum levels, therapy duration (DOM), baseline sodium values (BSS), 
estimated glomerular filtration rate (eGFR), white blood cell (WBC) count, total bilirubin 
(TBIL), albumin (ALB), and key biomarkers (NGAL, suPAR, Cystatin C), as well as concurrent 
spironolactone usage. The Z-score presented the highest diagnostic efficacy for 
hyponatremia, with a threshold of -3.24. The model demonstrated an 85.5% predictive 
accuracy, and the nomogram—based on multivariate regression and fit assessment—
 exhibited excellent alignment with actual outcomes. 
Interpretation: Independent predictors of hyponatremia included DOM, drug 
concentration, BSS, eGFR, and TBIL. Incorporation of novel biomarker profiles modestly 
improved model precision, suggesting added value in patient risk stratification. The 
developed tool offers promise for early detection and intervention in vulnerable ICU 
populations. 

Abstract  Background: This investigation explored the clinical utility of the Gugging Swallowing 
Screen (GUSS) in identifying swallowing dysfunction following stroke and examined its 
application in designing individualized nutritional interventions. The study also assessed a 
set of physiological markers—brain-derived neurotrophic factor (BDNF), salivary cortisol, 
leptin, and growth differentiation factor-15 (GDF-15)—to determine their relationship with 
dysphagia severity, neural recovery, and clinical prognosis. 
Methods: A cohort of 174 individuals recovering from stroke underwent swallowing 
assessments using both the GUSS protocol and the traditional water swallow test (WST). 
Participants diagnosed with swallowing impairments were randomized into a control group 
(CG), which received standard medical care, and an observation group (OG), which received 
additional GUSS-guided stratified feeding regimens. Comparative analyses focused on 
changes in swallowing ability, emotional well-being, serum and salivary biomarker profiles, 
and occurrence of medical complications. 
Findings: GUSS outperformed WST in sensitivity and responsiveness (P < 0.05), as shown 
by significantly higher effect size (ES) and standardized response mean (SRM). Patients in 
the OG exhibited notably greater improvement in deglutition function and fewer adverse 
outcomes than those in the CG (P < 0.05). Post-treatment nutritional markers—albumin 
(Alb), prealbumin (PA), and transferrin (TNF)—were also more favorable in the OG. BDNF 
and leptin levels showed strong alignment with dysphagia grading, while elevated salivary 
cortisol was associated with stress-related swallowing issues. GDF-15 levels correlated 
significantly with dysphagia-related complications. Moreover, quality of life indicators—
 including mental, physical, and social dimensions—were significantly enhanced in the OG (P 
< 0.05). 
Conclusion: GUSS proves to be a robust tool for early detection of post-stroke swallowing 
disorders and offers added clinical value when used to guide dietary intervention. The 
inclusion of stress, neuroplasticity, and inflammatory biomarkers—particularly salivary 
cortisol and GDF-15—adds depth to severity assessment and supports the development of 
personalized rehabilitation pathways.

Abstract Introduction: The length of stay in the emergency department (ED) starts from entering the unit and does not end until the patient is discharged home, admitted to the hospital or until transferred to another department or other treatment center. This period of time indicates the optimal management of beds in the ED. It is used as a performance index to evaluate the quality of care in the ED and the evidence shows that a stay in the ED of more than 6 hours is associated with an increase in mortality and morbidity. Therefore, the present study aims to investigate the causes of long-term stay (more than 12 hours) patients in the ED of Ayatollah Rouhani Babol educational and treatment center is designed.
Research method: This research was cross-sectional-retrospective. The study population consisted of all patients who referred to the ED of Rohani Babol Hospital in 2022. Sampling was done in the form of the entire census of the studied community. Data was collected using a checklist from Rouhani Hospital in Babol city. The collection tool was a pre-made checklist that included basic and demographic information of the patients. If a file did not have the desired information, or was incomplete, it was excluded from the study.
Results: This study was conducted on 400 patients who referred to the ED of Ayatollah Rouhani and Shahid Beheshti hospitals, who stayed in the emergency ward for more than 12 hours. In this study, the average duration of hospitalization until the assignment of the patient by the emergency medicine specialist was 57.8±82.6 minutes. The average time from entering to leaving the ED was 31.8 ± 21.8 hours for men and 33.8 ± 24.4 hours for women. The average time from entering to leaving the ED in patients with a history of hypertension was 38.9 ± 27.1 hours, with a history of diabetes 37.6 ± 27.3 hours, and with a history of heart disease 36.5 ± 24.3 hours. It was statistically significant (p=0.001), (p=0.007) and (p=0.040) respectively). The difference between the average time of entering and leaving the ED with the way the patient left the emergency ward was not statistically significant (p=0.636). However, a statistically significant difference was observed between the average time of entering and exiting the ED with the level of triage (p=0.004) and the type of disease (p=0.001). The results of the one-way analysis of variance test showed that the difference in the average duration of hospitalization in the emergency medicine service until leaving the emergency medicine service, the difference in the average duration of assignment by emergency medicine to the visit of the specialist assistant (p=0.814) and the difference in the average duration of required tests From the request to the answer to the test (p=0.454), no significant statistical difference was observed in the age groups. However, the difference in the average time between entering and leaving the ED in the age groups was found to be statistically significant (p=0.001).
Conclusion: The length of stay is influenced by various demographic and clinical factors. Therefore, it is possible to predict the length of stay by applying data mining techniques on hospital admission data. This work can be a suitable tool for planning and optimal allocation of hospital resources.

Abstract Background: The optimal radiation dose for stage III non-small cell lung cancer (NSCLC) remains unclear. This study aimed to investigate the radiation dose-response relationship in patients with stage III NSCLC treated with definitive radiation therapy.

Methods: This retrospective cohort study analyzed 376 patients with stage III NSCLC treated with definitive radiation therapy between 2010 and 2019. The study population had a median age of 68 years, with 64.9% being male and 89.4% having a performance status of ECOG 0-1. The median radiation dose was 66 Gy, with 74.5% of patients receiving conventional fractionation and 25.5% receiving hypofractionated radiation.

Results: The median overall survival (OS) was 24.5 months, with a 95% confidence interval (CI) of 13.1-32.9 months. For every 1 Gy increase in radiation dose, the hazard of death decreases by 6% (HR = 0.94, p < 0.001). Older age is associated with a higher hazard of death (HR = 1.02, p = 0.002). Poorer performance status (ECOG 2-3) is associated with a higher hazard of death compared to good performance status (ECOG 0-1) (HR = 1.63, p = 0.009). Histology other than adenocarcinoma is associated with a higher hazard of death (HR = 1.55, p = 0.02). The results of the PCA suggest that the 15 dosimetric variables can be reduced to 5 components that explain 88.4% of the variance in the data suggesting that higher doses to smaller tumor volumes may be associated with better treatment outcomes.

Conclusion: Higher radiation doses may be associated with improved OS, but in patients with smaller tumor size. Further studies are needed to confirm these findings and to determine the optimal radiation dose for this patient population.

Abstract Background and purpose: Pressure ulcers are common postoperative complications that increase morbidity, mortality, and healthcare costs. Operating room (OR) technologists play a critical role in preventing pressure ulcers through proper skin care. This study aimed to assess the knowledge, attitude, and performance of OR technologists regarding skin care and pressure ulcer prevention.
Materials and methods: This descriptive-analytical, cross-sectional study was conducted from September to December 2022. Using a census sampling method, we included 58 operating room technologists from the educational hospitals affiliated with Zahedan University of Medical Sciences. Data were collected using a researcher-made questionnaire assessing knowledge, attitude, and performance. The data were analyzed using SPSS version 21, employing descriptive statistics, independent t-tests, and ANOVA.
Results: The mean and standard deviation of knowledge, attitude, and performance scores were 38.00 ± 15.00, 33.00 ± 6.00, and 23.00 ± 4.00, respectively. Most operating room technologists demonstrated a positive attitude, relatively good knowledge, and average performance toward pressure ulcer prevention. There was a significant relationship between knowledge scores and the age of operating room technologists (p < 0.0001).
Conclusion: The results of this study highlight the importance of knowledge, attitude, and performance among operating room professionals in reducing the risk of pressure ulcers in patients surgical candidates.. It can be suggested that in the field of skincare and prevention of pressure ulcers in the operating room, basic pressure ulcer training should be included at the beginning of the operating room courses and in the in-service training of operating room experts.

Abstract Background: Oligometastatic lung cancer is a clinical entity characterized by a limited number of metastases, and stereotactic body radiation therapy (SBRT) has emerged as a promising treatment option for this condition. However, the relationship between SBRT dose and adverse events in this population is not well understood.


Objectives: To evaluate the treatment outcomes and adverse events associated with SBRT in patients with oligometastatic lung cancer, and to investigate the relationship between radiation dose and adverse events.


Methods: This retrospective chart review included 81 patients with oligometastatic lung cancer who underwent SBRT at a single institution between 2015 and 2023. Patients received SBRT with a dose of 30-60 Gy in 3-10 fractions. Data on patient demographics, tumor characteristics, treatment details, and adverse events were collected and analyzed.


Results: The study found that 37% of patients experienced adverse events of grade ≥2, with fatigue, dermatitis, and cough being the most common. Multivariate analysis revealed that higher radiation dose was significantly associated with increased risk of adverse events (OR 1.05, 95% CI 1.01-1.09, p=0.01). Other factors, including age, sex, ECOG performance status, and previous chemotherapy, were not significantly associated with adverse events.


Conclusion: This study demonstrates that SBRT higher radiation doses are associated with increased risk of adverse events with no other risk factor predicting adverse event occurrence. These findings highlight the importance of careful treatment planning and dose optimization to minimize toxicity while maintaining treatment efficacy.

Abstract Background: Early-stage laryngeal squamous cell carcinoma (T1-T2) can be treated with either radiation therapy or surgery, but the cost-effectiveness of these treatments is unclear.

Methods: This study is a cost-effectiveness analysis comparing radiation therapy and surgery as treatments for early-stage laryngeal squamous cell carcinoma (T1-T2) at a university hospital's tertiary care center. A consecutive sampling method was used to select 86 patients (43 per group) diagnosed with early-stage laryngeal squamous cell carcinoma (T1-T2) between January 2018 and December 2020. Demographic, clinical, and cost data were collected, and quality of life data were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30).

Results: The mean total cost for patients treated with radiation therapy was ¥123,419, which was significantly lower than the mean total cost for patients treated with surgery (¥153,219, p=0.012). The mean QALYs for patients treated with radiation therapy was 4.21 (± 1.23), which was slightly higher than the mean QALYs for patients treated with surgery (3.92 ± 1.35), but the difference was not statistically significant (p=0.142). The incremental cost-effectiveness ratio (ICER) was ¥24,011 per QALY gained, indicating that radiation therapy was associated with a lower cost per QALY gained compared to surgery. At a willingness-to-pay (WTP) threshold of ¥50,000 per QALY, the probability that radiation therapy is cost-effective is 72.1%.

Conclusion: Radiation therapy is a cost-effective treatment option for early-stage laryngeal squamous cell carcinoma (T1-T2) compared to surgery, with a lower ICER and a higher probability of cost-effectiveness at various WTP thresholds. These findings can inform treatment decisions and resource allocation in the management of early-stage laryngeal squamous cell carcinoma.

Abstract Background: In the context of modern healthcare, surgical interventions are essential yet pose inherent risks, including postoperative infections. Antibiotic prophylaxis plays a pivotal role in mitigating these risks, aiming to prevent surgical site infections (SSIs) and associated complications. This study focuses on the consumption patterns of antibiotic prophylaxis regimens among patients admitted to the surgical wards at Bu Ali Sina Medical and Educational Services Center in Sari, Iran.
Methods: This retrospective cross-sectional study involved 970 participants undergoing clean or clean-contaminated surgical procedures. The research employed a researcher-made questionnaire covering demographic information, antibiotic details, side effects, duration of administration post-operation, adherence to guidelines, and compliance with ASHP 2013 antibiotic prophylaxis guidelines. Statistical analyses included central tendency and dispersion indicators, Chi-squared test, Fisher's exact test, one-sample Kolmogorov-Smirnov, Mann-Whitney U test, and T-test.
Results: The predominant antibiotic categories were cephalosporins, with ceftriaxone and cefazolin accounting for 65.2% and 61.8% of prescriptions, respectively. Comparison between orthopedic and ENT surgery groups did not reveal significant differences in antibiotic regimens (P=0.085). However, a noteworthy difference emerged in the duration of antibiotic prophylaxis, with a significant distinction between orthopedic and ENT surgery groups (P=0.650). Compliance with ASHP 2013 guidelines was observed in 84% of cases regarding the timing and type of prescribed antibiotic prophylaxis regimen.
Conclusion: This study provides crucial insights into the consumption patterns of antibiotic prophylaxis among surgical patients, emphasizing the prevalence of cephalosporins and revealing distinctions in duration between orthopedic and ENT surgery groups. The findings contribute to optimizing patient outcomes and addressing antimicrobial resistance challenges. As the healthcare community navigates the delicate balance between prophylactic benefits and resistance concerns, these results offer valuable information for policy-making and clinical practices.

Abstract Background: Neoadjuvant chemotherapy is a common treatment approach for breast cancer, but its impact on disease-free survival, quality of life, and recurrence rates is not well understood.

Objectives: To evaluate the association between neoadjuvant chemotherapy and disease-free survival, quality of life, and recurrence rates in patients with breast cancer.

Methods: This retrospective cohort study included 350 patients with breast cancer who underwent surgery at a university clinic between 2015 and 2022. Patients were divided into two groups: those who received neoadjuvant chemotherapy (n=105) and those who did not (n=245). Demographic, tumor, and treatment characteristics were compared between groups. Disease-free survival, quality of life, and recurrence rates were analyzed using Cox proportional hazards models, multivariate analysis of variance, and logistic regression models. 1 year follow ups were made.

Results: Patients who received neoadjuvant chemotherapy had a significant reduction in the risk of disease recurrence (HR=0.65, p=0.02) and local recurrence (OR=0.42, p=0.01). However, they had lower physical and social functioning scores compared to those who did not receive neoadjuvant chemotherapy (p=0.04 and p=0.02, respectively). Neoadjuvant chemotherapy was also associated with a higher survival rate at 12 months (92.5% vs. 85.1%, p=0.03).

Conclusions: Neoadjuvant chemotherapy is associated with improved disease-free survival and reduced local recurrence rates in patients with breast cancer. However, it may have a negative impact on quality of life, particularly physical and social functioning. These findings have implications for the management of breast cancer and highlight the need for further research on the optimal use of neoadjuvant chemotherapy.

Abstract This forward-looking clinical investigation explored the prognostic utility of four distinct 
biomarkers—high-sensitivity cardiac troponin T (hs-cTnT), N-terminal pro b-type 
natriuretic peptide (NT-proBNP), Copeptin, and Mid-regional pro-Adrenomedullin (MR
proADM)—in forecasting significant cardiovascular complications among 120 individuals 
presenting with symptoms suggestive of acute coronary syndrome (ACS) in an emergency 
care setting. Across a 12-month observation window, occurrences of major adverse 
cardiovascular events (MACE)—encompassing myocardial infarction, stroke, and 
cardiovascular mortality—were systematically tracked and correlated with both initial and 
serial biomarker measurements. 
Multivariate analysis using Cox proportional hazards modeling, adjusted for demographic 
and behavioral risk factors such as age, sex, and smoking, revealed a robust association 
between elevated biomarker levels and MACE incidence. Diagnostic accuracy for each 
marker—individually and collectively—was assessed through ROC curve analysis, 
demonstrating favorable area under the curve (AUC) values indicative of strong predictive 
performance. Survival outcomes stratified by median biomarker thresholds were estimated 
using Kaplan-Meier methodology, showing pronounced differences in MACE-free survival 
between high- and low-risk groups. 
The findings affirm the clinical value of hs-cTnT, NT-proBNP, Copeptin, and MR-proADM in 
early cardiovascular risk stratification. Moreover, the integrative use of these markers was 
shown to outperform any single biomarker alone, emphasizing their combined role in 
refining diagnostic precision and guiding therapeutic decisions. These results support 
incorporating such biomarker panels into routine evaluation protocols for patients 
undergoing assessment for suspected ACS.

Abstract Background: Glioblastoma multiforme (GBM) is a highly aggressive brain tumor with a poor prognosis. Radiation therapy (RT) and temozolomide (TMZ) are standard treatments, but their impact on cognitive function is not well understood.

Objective: To investigate the effects of radiation dose and TMZ dose on cognitive function in patients with GBM treated with RT and TMZ.

Methods: This retrospective study included 162 patients with GBM treated with RT and TMZ between 2018 and 2023. Cognitive function was assessed using a comprehensive battery of neuropsychological tests, and MRI-based measures of cognitive function were obtained. Patients were categorized into three groups based on radiation dose received: low dose (< 50 Gy), moderate dose (50-60 Gy), and high dose (> 60 Gy). Follow ups were made up to 8 to 12 months after chemoradiotherapy.

Results: Patients in the high dose group performed significantly worse on executive function and memory tests, and had reduced white matter integrity and increased white matter hyperintensity volume compared to the low dose group. Higher TMZ doses were associated with poorer cognitive outcomes in executive function, memory, and reduced hippocampal volume. Linear regression analysis showed that higher radiation doses were associated with poorer cognitive outcomes in memory, and higher TMZ doses were associated with poorer cognitive outcomes in executive function, memory, and reduced hippocampal volume.

Conclusion: This study suggests that higher radiation doses and TMZ doses are associated with poorer cognitive outcomes in patients with GBM. These findings have important implications for the management of GBM, highlighting the need to minimize radiation dose and TMZ dose to prevent cognitive decline. Future studies are needed to confirm these findings and to explore strategies to mitigate the cognitive effects of RT and TMZ in patients with GBM.

Abstract Background: Renal colic is a common and severely painful emergency condition often caused by ureteral stones. Rapid pain management is critical. This study evaluates the efficacy of inhaled salbutamol, a β2-agonist with smooth muscle relaxant properties, as an adjunct therapy in reducing pain severity in patients with acute renal colic.

Methods: In this double-blind randomized controlled trial, 204 patients with moderate renal colic pain (based on the Visual Analog Scale, VAS) referred to the emergency department of Imam Khomeini Hospital in Sari, Iran, were randomly assigned to two groups. The intervention group received 30 mg intravenous ketorolac and inhaled salbutamol (5 puffs), while the control group received ketorolac and a placebo inhalation. Pain intensity, vital signs, and symptoms such as nausea and vomiting were recorded at baseline and at intervals of 10, 20, 30, 45, 60, and 120 minutes after treatment.

Results: Pain intensity significantly decreased over time in both groups (p

Abstract Brain tumor-related epilepsy (BTRE) is a prevalent complication, affecting 25-60% of patients with primary or metastatic brain tumors, significantly impacting quality of life and complicating oncologic management. This narrative review examines factors influencing the effectiveness of levetiracetam (LEV), lamotrigine (LTG), and lacosamide (LCS) in BTRE. By analyzing epidemiological data, pathophysiological mechanisms, pharmacological profiles, and clinical evidence, we study how tumor characteristics (type, location, molecular profile), patient-specific factors (age, comorbidities), drug interactions, and pharmacodynamic properties modulate seizure control. LEV is often the first-line choice due to its favorable tolerability and minimal drug interactions, achieving seizure freedom in 65-80% of patients in some studies. LTG and LCS, effective as monotherapy or add-on therapies with response rates of 50-70%, vary in efficacy based on tumor histology and peritumoral microenvironment. Challenges include drug resistance linked to glutamate excitotoxicity, sodium channel dysregulation, and tumor-driven molecular changes. Research gaps, such as long-term comparative trials and personalized dosing strategies, highlight the need for further investigation. Optimizing AED selection in BTRE requires a multidisciplinary approach to balance seizure control, antitumor therapy efficacy, and adverse effect minimization, emphasizing personalized medicine.

Abstract Background: Spinal injuries are a significant cause of morbidity and mortality globally. Trauma-related spinal fractures contribute to the burden on healthcare systems and significantly affect the quality of life. Although substantial progress has been made in trauma care, spinal fractures, particularly those associated with spinal cord injuries (SCI), remain a leading cause of long-term disability. The epidemiology of spinal fractures varies regionally due to demographic, trauma mechanisms, and healthcare factors. In Iran, motor vehicle accidents and falls from heights are prominent causes of spinal injuries, but regional data on the epidemiology of these injuries, particularly from smaller cities, is scarce.


Materials and Methods: This retrospective cohort study was conducted at Imam Khomeini Hospital in Sari, Mazandaran province, Iran, reviewing the records of 288 patients with spinal fractures treated between March 2014 and March 2018. Data collected included demographic characteristics (age and gender), injury mechanisms, fracture locations, fracture types, presence of spinal cord injuries, and clinical outcomes. The analysis also included the association between injury mechanisms and fracture types using statistical tests.


Results: The study included 288 patients, with 75% being male and a mean age of 39.21 years. The most common mechanisms of injury were motor vehicle accidents (47.2%) and falls from height (35.4%). Cervical spine fractures were the most common, accounting for 49% of cases. Burst fractures were the most prevalent type of fracture (40.5%). Spinal cord injuries were present in 21.2% of the patients, with a higher incidence in those injured by vehicle accidents. The mortality rate was 3.1%, and 42.4% of patients underwent surgical intervention. The average hospital stay was 7.53 days.


Conclusion: This study provides a comprehensive epidemiological profile of spinal fractures in a regional Iranian hospital. It highlights the high incidence of spinal fractures due to motor vehicle accidents and falls from height, with cervical spine fractures and burst fractures being the most common. The presence of spinal cord injury is significant and underscores the need for early diagnosis and effective treatment. . Further studies, particularly prospective ones, are needed to better understand the long-term outcomes of spinal injuries and SCI in Iran.