1 Lifestyle and Socioeconomic Determinants of Coronary Artery Disease Recurrence: A Cross-Sectional Study https://brieflands.com/journals/ircrj/articles/167127 10.69107/icrj-167127 1 Background :Although the primary prevention of coronary artery disease (CAD) has been widely studied, data on factors influencing CAD recurrence, particularly in Middle Eastern populations, remain scarce. Identifying modifiable risk factors for recurrence is essential for improving secondary prevention strategies. Objectives :This study aimed to investigate the associations between demographic, clinical, and lifestyle factors and CAD recurrence in a cohort of Iranian patients. Methods :In this hospital-based, cross-sectional study, data from 300 patients with a confirmed diagnosis of CAD who had more than one hospitalization for CAD at Heshmatieh Hospital in Sabzevar, Iran, between March 2017 and March 2020 were analyzed. Data on demographics, clinical history, lifestyle behaviors (including smoking, opium use, physical activity, and diet), and medication adherence were collected using a structured checklist. Associations between these variables and the number of recurrent CAD events were evaluated using independent t-tests, chi-square tests, and Fisher exact tests. Results :The mean age of the participants was 58.7 years, and the sex distribution was nearly equal, with 49.7% being male. Lower educational level (P = 0.019), urban residence (P = 0.021), and lack of regular physical activity (P = 0.007) were significantly associated with a higher number of recurrent CAD events. Paradoxically, a higher number of follow-up visits was associated with more recurrences (P = 0.035), likely reflecting a sicker cohort. No significant associations were identified for sex, occupational stress, or traditional risk factors such as hypertension and diabetes in these analyses. Conclusions :This cross-sectional study identified associations suggesting that modifiable socioeconomic and lifestyle factors, specifically low education, urban residence, and physical inactivity, may be important determinants of CAD recurrence in this Iranian population. These findings highlight potential targets for secondary prevention but require confirmation in prospective studies. Secondary prevention programs should consider moving beyond traditional risk factor management to include interventions addressing these broader determinants of health. 1 6 Mahboubeh Neamatshahi Department of Medicine, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Iran mahneamatshahi@yahoo.com Mohammad Neamatshahi Department of Anesthesiology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Iran 9151737407@gmail.com Hamidreza Salimi Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Iran hamidsalimikavir@gmail.com Aghil Keykhosravi Department of Pediatric Nephrology, Faculty of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran Iran drakeykhosravi@yahoo.com No Keyword 1.pdf [0]Di Cesare M, Perel P, Taylor S, Kabudula C, Bixby H, Gaziano TA, et al.The heart of the world. Global Heart. 2024;19(1). 11. [PubMed ID: 38273998]. 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1 Association Between the Severity of Non-alcoholic Fatty Liver Disease and the Uric Acid-to-HDL Ratio https://brieflands.com/journals/ircrj/articles/169166 10.5812/icrj-169166 1 Background :Non-alcoholic fatty liver disease (NAFLD) is a common cause of elevated liver enzyme levels and is increasing in parallel with the global obesity epidemic in adults and children. Objectives :This study examined the association between liver stiffness and serum uric acid, high-density lipoprotein cholesterol (HDL), and the uric acid-to-HDL ratio (UHR) in patients with NAFLD-related fibrosis. Methods :This cross-sectional study was conducted using hospital and clinic data after ethical approval was obtained from Ahvaz Jundishapur University of Medical Sciences. Patients referred to a specialized liver center for liver fibrosis assessment who met the inclusion criteria, including liver steatosis and abnormal liver function tests, were enrolled. Data were analyzed using SPSS version 26.0. Univariable analyses were performed first. Subsequently, two generalized linear models were developed to evaluate the associations of uric acid, HDL, and UHR with elastography values after adjustment for age and sex. Results :A total of 44 participants were included in the final analysis; 23 (52.3%) were male, and the mean age was 43.97 ± 7.65 years. The mean elastography value was 8.21 ± 2.55 kPa, the mean HDL level was 39.45 ± 11.34 mg/dL, and the mean uric acid level was 5.25 ± 1.54 mg/dL. In univariable analyses, aspartate aminotransferase (AST), alanine aminotransferase (ALT), the AST/ALT ratio, uric acid, and UHR were positively associated with elastography values, whereas HDL showed an inverse association. The UHR was higher in males (P ≤ 0.01). In generalized linear models adjusted for age and sex, UHR (B = 15.71, P = 0.001) and uric acid (B = 0.608, P = 0.028) remained significantly associated with elastography values, whereas HDL showed a non-significant inverse trend. However, after additional adjustment for AST, ALT, and platelet count, these associations were attenuated and were no longer statistically significant. Conclusions :Elastography values were significantly associated with uric acid and HDL levels, indicating that liver stiffness is related to metabolic factors. The inverse association between uric acid and HDL emphasizes the pro-inflammatory role of uric acid and the protective effects of HDL in the liver. 1 9 Abazar Parsi Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran dr_abazar_parsi@yahoo.com Bahram Nasiri Department Faculty of Medicine, Alimentary Tract Research Center, Institute of Clinical Sciences, Ahvaz Jundishapur University of Medical Sciences (AJUMS), Ahvaz, Iran Iran na.bahram.90@gmail.com Eskandar Hajiani Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran hajiani-e@ajums.ac.ir Ahmad Nejadisalami Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran nejadisalami-a@ajums.ac.ir Arman Shahriari Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran shahriari-a@ajums.ac.ir Mehdi Bazrafshan Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Iran mehdi.bazrafshan9695@gmail.com No Keyword 2.pdf [0]F Zhou, J Zhou, W Wang, XJ Zhang, YX Ji, P Zhang, et al.Unexpected rapid increase in the burden of NAFLD in China from 2008 to 2018: a systematic review and meta-analysis. Hepatology. 2019;70(4):1119-33. [PubMed ID: 31070259]. doi: 10.1002/hep.30702.##[1]N Stefan, K Kantartzis, H-U Häring.Causes and metabolic consequences of fatty liver. Endocrine Reviews. 2008;29(7):939-60. [PubMed ID: 18723451]. doi: 10.1210/er.2008-0009.##[2]CA Matteoni, ZM Younossi, T Gramlich, N Boparai, YC Liu, AJ McCullough.Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413-9. [PubMed ID: 10348825]. doi: 10.1016/S0016-5085(99)70506-8.##[3]C Griffin, R Bahirwani.The diagnosis and management of nonalcoholic fatty liver disease: a patient-friendly summary of the 2018 AASLD guidelines. Clinical Liver Disease. 2022;19(6):222-6. [PubMed ID: 35795618]. [PubMed Central ID: PMC9248926]. doi: 10.1002/cld.1216.##[4]M Bazrafshan, S Nematollahi, M Kamali, A Farrokhian, N Moeinvaziri, H Bazrafshan, et al.Bariatric surgery mitigated electrocardiographic abnormalities in patients with morbid obesity. Scientific Reports. 2024;14(1):6710. doi: 10.1038/s41598-024-57155-2.##[5]N Katsiki, DP Mikhailidis, CS Mantzoros.Non-alcoholic fatty liver disease and dyslipidemia: an update. Metabolism. 2016;65(8):1109-23. [PubMed ID: 27237577]. doi: 10.1016/j.metabol.2016.05.003.##[6]M Shimada, E Hashimoto, H Kaneda, S Noguchi, N Hayashi.Nonalcoholic steatohepatitis: risk factors for liver fibrosis. Hepatology Research. 2002;24(4):429-38. [PubMed ID: 12479942]. doi: 10.1016/S1386-6346(02)00246-2.##[7]ZM Younossi.Non-alcoholic fatty liver disease: a global public health perspective. Journal of Hepatology. 2019;70(3):531-44. [PubMed ID: 30414863]. [PubMed Central ID: PMC12683257]. doi: 10.1016/j.jhep.2018.10.033.##[8]Y Li, C Xu, C Yu, L Xu, M Miao.Association of serum uric acid level with non-alcoholic fatty liver disease: a cross-sectional study. Journal of Hepatology. 2009;50(5):1029-34. [PubMed ID: 19299029]. doi: 10.1016/j.jhep.2008.11.021.##[9]X Zheng, L Gong, R Luo, H Chen, B Peng, W Ren, et al.Serum uric acid and non-alcoholic fatty liver disease in non-obesity Chinese adults. Lipids in Health and Disease. 2017;16:1-7. [PubMed ID: 29037239]. [PubMed Central ID: PMC5644248]. doi: 10.1186/s12944-017-0531-5.##[10]J Fan, D Wang.Serum uric acid and nonalcoholic fatty liver disease. Frontiers in Endocrinology. 2024;15. 1455132. [PubMed ID: 39669496]. [PubMed Central ID: PMC11635646]. doi: 10.3389/fendo.2024.1455132.##[11]TA Wynn, TR Ramalingam.Mechanisms of fibrosis: therapeutic translation for fibrotic disease. Nature Medicine. 2012;18(7):1028-40. [PubMed ID: 22772564]. [PubMed Central ID: PMC3405917]. doi: 10.1038/nm.2807.##[12]LJ Heyens, D Busschots, GH Koek, G Robaeys, S Francque.Liver fibrosis in non-alcoholic fatty liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment. Frontiers in Medicine. 2021;8. 615978. [PubMed ID: 33937277]. [PubMed Central ID: PMC8079659]. doi: 10.3389/fmed.2021.615978.##[13]DH Kaswala, M Lai, NH Afdhal.Fibrosis assessment in nonalcoholic fatty liver disease (NAFLD) in 2016. Digestive Diseases and Sciences. 2016;61(5):1356-64. [PubMed ID: 27017224]. doi: 10.1007/s10620-016-4079-4.##[14]Liver EuropeanAssociationfortheStudyofthe, Diabetes EuropeanAssociationfortheStudyof, Obesity EuropeanAssociationfortheStudyof.EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. Obesity Facts. 2016;9(2):65-90. [PubMed ID: 27055256]. [PubMed Central ID: PMC5644799]. doi: 10.1159/000443344.##[15]JC Sirota, K McFann, G Targher, RJ Johnson, M Chonchol, DI Jalal.Elevated serum uric acid levels are associated with non-alcoholic fatty liver disease independently of metabolic syndrome features in the United States: liver ultrasound data from the National Health and Nutrition Examination Survey. Metabolism. 2013;62(3):392-9. [PubMed ID: 23036645]. [PubMed Central ID: PMC3565047]. doi: 10.1016/j.metabol.2012.08.013.##[16]D Sari, A Soetoko, M Romi, U Tranggono, W Setyaningsih, N Arfian.Uric acid induces liver fibrosis through activation of inflammatory mediators and proliferating hepatic stellate cell in mice. The Medical Journal of Malaysia. 2020;75(Suppl 1):14-8.##[17]SM Francque, D VanDerGraaff, WJ Kwanten.Non-alcoholic fatty liver disease and cardiovascular risk: pathophysiological mechanisms and implications. Journal of Hepatology. 2016;65(2):425-43. [PubMed ID: 27091791]. doi: 10.1016/j.jhep.2016.04.005.##[18]AD Mooradian.Dyslipidemia in type 2 diabetes mellitus. Nature Reviews Endocrinology. 2009;5(3):150-9. [PubMed ID: 19229235]. doi: 10.1038/ncpendmet1066.##[19]ES Ford, C Li, N Sattar.Metabolic syndrome and incident diabetes: current state of the evidence. Diabetes Care. 2008;31(9):1898-904. [PubMed ID: 18591398]. 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1 Emergent Surgical Intervention for a Right Ventricular Stab Wound in a Young Man: A Case Report https://brieflands.com/journals/ircrj/articles/167339 10.5812/icrj-167339 1 Introduction :Penetrating cardiac injuries (PCIs) require prompt diagnosis because of the risk of hemodynamic instability. Diagnostic clues include abnormalities on chest radiography and pericardial effusion on ultrasound. Although sometimes necessary, emergency department thoracotomy is associated with a higher mortality risk. Case Presentation :A 25-year-old male presented with a chest stab wound and dyspnea but stable vital signs. The initial assessment revealed a small pericardial effusion and complete opacification of the left hemithorax on chest radiography, consistent with a massive hemothorax. Despite initial stability, the patient deteriorated, with decreasing blood pressure and an increasing heart rate. An emergency left anterolateral thoracotomy revealed a 1-cm right ventricular laceration, which was successfully repaired. Postoperative echocardiography showed preserved left ventricular function. General surgeons repaired the right ventricular laceration without cardiopulmonary bypass. The patient was transferred for further cardiac care, recovered, and was discharged on the sixth postoperative day. Conclusions :PCIs vary in presentation and severity and are associated with high prehospital mortality rates. Most cases can be managed by general surgeons, with specialized care required only for severe cases. 1 5 Roozbeh Shadidi Asil Department of General Surgery, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran dr.roozbehshadidiasil@gmail.com Arshia Zardoui Department of General Surgery, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran Iran Iran arshiazardoui@gmail.com Leila Vatuizade Department of General Surgery, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran leilavatuizade@gmail.com Amir Zamani Department of General Surgery, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran amir.zamani.66@gmail.com Kasra Hatampour Geraviani Department of General Surgery, Loghman Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Iran drkasrahatampour@gmail.com No Keyword 3.pdf [0]Hromalik Jr LR, Wall Jr MJ, Mattox KL, Tsai PI.Penetrating cardiac injury: a narrative review. Mediastinum. 2023;7:15-15. [PubMed ID: 37261091]. [PubMed Central ID: PMC10226890]. doi: 10.21037/med-22-18.##[1]Molina EJ, P. Gaughan J, Kulp H, B. McClurken J, J. Goldberg A, J. Seamon M.Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective. Interactive Cardiovascular and Thoracic Surgery. 2008;7(5):845-848. [PubMed ID: 18653499]. doi: 10.1510/icvts.2008.183293.##[2]Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N.Survival after emergency department thoracotomy: review of published data from the past 25 years. Journal of the American College of Surgeons. 2000;190(3):288-298. [PubMed ID: 10703853]. doi: 10.1016/S1072-7515(99)00233-1.##[3]Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D.The CARE guidelines: consensus-based clinical case reporting guideline development. Global Advances in Health and Medicine. 2013;2(5):38-43. [PubMed ID: 24416692]. 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1 A Qualitative Study of Factors Contributing to Medical Errors in Cardiac Surgery: Perspectives of Iranian Specialists https://brieflands.com/journals/ircrj/articles/168426 10.69107/icrj-168426 1 Background :Medical errors in cardiac surgery remain a major challenge for patient safety. These errors often arise from the interaction of individual fatigue, team communication problems, and organizational constraints. Exploring these factors qualitatively provides a deeper understanding for designing effective interventions. Objectives :The primary objective of this study is to identify and analyze the underlying factors of medical errors in cardiac surgery and to propose practical solutions for their reduction. Methods :This qualitative study was conducted in cardiac surgery departments of selected hospitals in Iran between March and September 2025. Semi-structured interviews were performed with cardiac surgeons only. Data were analyzed using thematic analysis, resulting in four main themes: individual factors, team-related factors, organizational factors, and consequences and solutions. A circular conceptual model was developed to illustrate the dynamic relationships among these domains. Results :Errors were found to be embedded within team dynamics and organizational structures rather than being solely individual. Participants emphasized fatigue, communication gaps, and restrictive policies as key contributors. The conceptual model demonstrated how these domains converge toward consequences and solutions, highlighting the systemic nature of medical errors. Conclusions :Preventing errors in cardiac surgery requires a multidimensional approach that integrates personal training, team communication, and organizational reforms. Sustainable improvement depends on systemic and cultural transformation within hospitals. 1 9 Seyed Mohammad Salehi Behbahani Ayatollah Taleghani Hospital, Shahid Beheshti Hospital, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran Iran salehi.m.1985.ms@gmail.com Ehsan Moradi-Joo Department of Public Health, School of Health, Abadan University of Medical Sciences, Abadan, Iran Iran ehsanmoradijoo@yahoo.com Hoda Hamedpour Department of Nursing-Midwifery, Islamic Azad University of Ahvaz, Ahvaz, Iran Iran hoda.hamedpour@gmail.com Seyed Mohammad Mohammadi Department of Orthopedics, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran mohammadi-sm@ajums.ac.ir Farzad Faraji Khiavi Department of Healthcare Services Management, Social Determinants of Health Research Center, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran faraji-f@ajums.ac.ir Saeed Bagheri Faradonbeh Department of Healthcare Services Management, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran bagheri-sa@ajums.ac.ir Seyed Salaheddin Nabavi Department of General Surgery, Imam Khomeini Hospital, Golestan Hospital, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran nabavi-ss@ajums.ac.ir Behnam Gholizadeh Department of Cardiac Surgery, Atherosclerosis Research Center, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Iran gholizadeh-b@ajums.ac.ir No Keyword 4.pdf [0]Makary MA, Daniel M.Medical error-the third leading cause of death in the US. BMJ. 2016;353. i2139. [PubMed ID: 27143499]. doi: 10.1136/bmj.i2139.##[1]Gawande AA, Zinner MJ, Studdert DM, Brennan TA.Analysis of errors reported by surgeons at three teaching hospitals. Surgery. 2003;133(6):614-21. [PubMed ID: 12796727]. doi: 10.1067/msy.2003.169.##[2]Nabavi SS, Salehi Behbahani SM, Jalili Shahandashti F, Toloueitabar Y, Hamedpour H, Gholizadeh B, et al.Prevalence and Associated Factors of Postoperative Fever in Pediatric Congenital Heart Surgery: A Systematic Review. Int Cardiovasc Res J. 2025;19(1). doi: 10.5812/icrj-161516.##[3]Alexander AP.Lincoln and Guba’s quality criteria for trustworthiness. IDC Int J. 2019;6(4):1-6.##[4]Lincoln YS, Guba EG, Pilotta JJ.Naturalistic inquiry. Int J Intercult Relat. 1985;9(4):438-9. doi: 10.1016/0147-1767(85)90062-8.##[5]Nowell LS, Norris JM, White DE, Moules NJ.Thematic Analysis. Intl J Qual Methods. 2017;16(1). doi: 10.1177/1609406917733847.##[6]Magaldi D, Berler M.Semi-structured Interviews. 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