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In Iran, Health Sector Evolution Plan, the most significant reform in the healthcare system in recent decades, has been launched since 2014 with the objective of achieving universal health coverage, decreasing out-of-pocket health expenditures and improving access to health services in hospitals and clinics affiliated to the Ministry of Health and Medical Education (MOHME). This study aimed to estimate the hospitalization costs of lung cancer and the impact of HSEP on hospitalization costs of lung cancer and patients' contribution in Iran between 2010 and 2017. This was a prevalence-based cost of illness study with a bottom-up costing approach. The sample size included 1778 lung cancer patients hospitalized in the Imam Reza hospital in Tabriz, Iran, between May 5, 2010, to May 5, 2014, and four years after the implementation of Health Sector Evolution Plan: from May 5, 2014, to May 5, 2017. The analysis was conducted from a societal perspective. Data were extracted from the electronic medical records of patients and were analyzed using SPSS V22.0, STATA V13.0 and Microsoft Excel 2016. The Interrupted Time-Series design was applied to estimate the impact of the implementation of HSEP on hospitalization costs and patient contribution rate for reimbursement of costs. The mean hospitalization costs of lung cancer before and after the implementation of Health Sector Evolution Plan was estimated at 2860 ± 4575 and 5300 ± 8880 PPP (Current International $), respectively. Moreover, the amount of out-of-pocket payments reduced from 705 PPP (Current International$) (22.16%) before the implementation of Health Sector Evolution Plan to 480 PPP (Current International $) (10.5%) after its implementation. the hospitalization costs went up moderately before the HSEP (increased from 2320 $ in 2010 to 3025 $ in 2013). After the HSEP, it continued to rise, but with a more significant increase until 2016. Then, in 2016, it reached a peak (6395 $) before dropping in 2017 (5005 $). Regarding patient contribution, before the HSEP, the percentage of patient contributions increased from 19.45 in 2010 to 24.28 in 2013. With HSEP's implementation, this fell dramatically to 14.47 and continued to decline, reaching 7.99% in 2016. In 2017, patient contribution increased again and reached 9.58%. Overall, hospitalization costs experienced an upward trend over the course of study, but this trend considerably intensified further after the HSEP. The patient contribution demonstrated an upward trend before HSEP, followed by a significant decline post-HESP, and the percentage of out-of-pocket payments reduced after implementation of HSEP. Therefor this plan has been successful in achieving the goal of financial protection of patients.

Background Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. Methods A scoping review of the literature was conducted based on the Arkesy and O’Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. Results In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). Conclusion Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.

Background and objectives Human cystic echinococcosis (CE), is a common health problem in low- and middle-income countries. Cardiac involvement is a relatively rare manifestation of Echinococcus infection. This study aims to summarize the evidence regarding the features of cardiac CE. Methods Case series of the patients with cardiac CE, were included in this study. Non-English papers, case reports, reviews, letters, , commentaries, and conference abstracts were not included. A systematic search was conducted in PubMed and EMBASE databases and the risk of bias in the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Results Out of 3985 results of the searches, finally 37 studies were included in this systematic review. Based on available evidence, cardiac involvement is an uncommon but serious presentation of CE which presents with some non-specific signs and symptoms. Dyspnea, chest pain, and palpitation are the most common symptoms of the disease and normal sinus rhythm is the most common Electrocardiogram (ECG) feature. The disease is not associated with high mortality in case of timely diagnosis and appropriate management. Discussion Consecutive and complete inclusion of participants, statistical analysis, and appropriate reporting of the demographics were the sources of bias in the included studies. The exclusion of non-English papers was a limitation during the review process. Funding The research protocol was approved and supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 69380). Registration This study was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42022381204).

Screening and early detection of cardiovascular disease (CVD) are crucial for managing progress and preventing related morbidity. In recent years, several studies have reported the important role of Artificial intelligence (AI) technology and its integration into various medical sectors. AI applications are able to deal with the massive amounts of data (medical records, ultrasounds, medications, and experimental results) generated in medicine and identify novel details that would otherwise be forgotten in the mass of healthcare data sets. Nowadays, AI algorithms are currently used to improve diagnosis of some CVDs including heart failure, atrial fibrillation, hypertrophic cardiomyopathy and pulmonary hypertension. This review summarized some AI concepts, critical execution requirements, obstacles, and new applications for CVDs.

Background:Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by disorganized atrial activity and subsequent mechanical atrial failure. Postoperative AF is a frequent complication of coronary artery bypass grafting (CABG). Although there is evidence of decreased AF after CABG with statin usage, information is scarce regarding a direct comparison between atorvastatin and rosuvastatin. The present study was conducted to compare the efficacy of rosuvastatin and atorvastatin in preventing post-CABG AF.Methods:The present double-blind randomized comparative clinical trial selected CABG candidates with stable ischemic heart disease or acute coronary syndromes. Atorvastatin (40 mg per day) or rosuvastatin (20 mg per day) was prescribed 1 week before surgery, and the outcomes were compared.Results:Two-hundred patients, 100 cases in each group, completed the study. Twenty-five patients in each group were female, and the mean age was 59.30±8.42 years in the rosuvastatin group and 60.13±9.40 years in the atorvastatin group (P=0.513).The frequency of AFwas 31%inthe atorvastatin group and 27% in the rosuvastatin group (P=0.534). No significant differences existed between the groups concerning the length of hospital and ICU stay (P=0.333 andP=0.161) and in-hospital and 3-month mortality (P=0.315 andP=0.648). A subgroup analysis of only patients with stable ischemic heart disease could not detect a significant difference between the study groups in any of the investigated outcomes. Ourlogistic regression analysis showed an association only between age and the incidence of AF after CABG (OR, 1.12; 95% CI, 1.05 to 1.20; P<0.01).Conclusion:Rosuvastatin and atorvastatin are similar concerning the prevention of post-CABG AF, but there is a need for future well-designed multicenter studies on this topic.

Background and Aims Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self‐care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self‐care barriers. Methods This was a cross‐sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ2 test was used to examine the association between the socioeconomic and disease‐related variables and the prevalence of diabetes complications. T‐test was used to examine the association between diet knowledge and skills, self‐care barriers, and the incidence of diabetes complications. Results In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self‐reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44). Conclusion This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self‐care. In light of these findings, taking appropriate measures to reduce barriers to self‐care can prevent or delay the onset of diabetes complications.

Introduction: Acute pulmonary thromboembolism (PTE) is one of the leading causes of death and severe disability. Considering the impact of inflammation and lipid profile on prevalence and prognosis of deep vein thrombosis and PTE, this study was conducted to assess the predictive value of lipid-to-neutrophil count ratios for the short-term survival of PTE patients. Methods: This study is an analytical cross-sectional study. Data regarding the demographics, past medical history, vital signs, laboratory variables, and the outcomes of hospitalization were gathered from the Tabriz PTE registry. The receiver operating characteristics (ROC) curve and area under curve (AUC) were utilized for assessing the prognostic values. SPSS 26 was used for all of the statistical analysis. Results: The population of this analytical cross-sectional study consists of 547 PTE patients of which 41 patients (7.5%) died during hospitalization. There was a significant difference between death and survived groups regarding cholesterol (146.00[60.50] vs. 165.50[59.75]; p-value<0.01), LDL (80.00[48.00] vs. 102.00[52.00]; p-value<0.01), HDL (31.00[19.00] vs. 35.00[14.00]; p-value=0.04). Cholesterol/neutrophil*1000 with a cut-off value of 22.014 (sensitivity: 56.7%; specificity: 61.3%), LDL/neutrophil*1000 with a cut-off value of 10.909 (sensitivity: 69.3%; specificity: 51.9%) and HDL/neutrophile *1000 with a cut-off value of 4.150 (sensitivity: 61.9%; specificity: 58.1%) can predict short-term survival in patients with acute PTE. Conclusion: Based on our findings, patients with higher cholesterol/neutrophil, LDL/neutrophil, and HDL/neutrophil ratios have a better in-hospital prognosis and measurement of lipid-to-neutrophil ratio in the first 24 hours of hospitalization may be a valuable marker for determining the early prognosis of PTE. However, additional clinical studies are suggested for a more definitive conclusion.

An accessory mitral valve (AMV) is a rare anomaly of the mitral valve (MV) that often causes left ventricular outflow tract (LVOT) obstruction. We describe a young woman presenting with infrequent palpitations to our outpatient clinic. She was evaluated for mid-systolic murmur at the left sternal border. At the initial transthoracic echocardiography, vegetation on the MV was suspected. The patient was referred to our advanced echocardiography lab, where transesophageal echocardiography revealed an AMV with mild LVOT obstruction. The findings, along with extensive laboratory tests, ruled out vegetation. Additionally, she had a bicuspid aortic valve. At follow-up after 1 year, the patient was asymptomatic regarding the AMV with LVOT obstruction, and the repeat echocardiography depicted no changes compared with the previous echocardiography. Distinguishing AMVs from other MV masses, including vegetation, sometimes poses a challenge and can lead to unnecessary diagnostic and therapeutic measures. This rare MV anomaly is associated with bicuspid aortic valves.