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We report the case of a 63-year-old female patient who was urgently admitted from electrophysiology laboratory (EP Lab) to operating room (OR) with hemodynamic instability and hemothorax. The dual-chamber pacemaker had been implanted 15 years ago. After median sternotomy she was evaluated for perforations and raptures of cardiac chambers and status of right ventricle (RV) lead of permanent pacemaker (PPM) by the surgeon. Evaluations revealed that RV and right atrium (RA) have been ruptured and tricuspid valve has been damaged as a result of dislodgment of RV PPM lead secondary to manipulations in electrophysiology (EP) lab. This lead was withdrawn through SVC and ruptures were repaired and tricuspid valve was replaced. The epicardial pacemaker was placed by the surgeon. After surgery, the patient was transferred to ICU, after three days she was discharged to ward and after 5 days from surgery she was discharged from hospital in good condition.

Background Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. Methods This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran’s national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. Results The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country’s Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. Conclusions TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.

Background and purpose: Breast cancer is one of the most common cancers in women all over the world. The death rate of this cancer is also increasing. It seems that medication is related to this cancer. The present study aimed at estimating the risk of this cancer using Gail Model and its relationship with medication in women. Materials and Methods: In this cross-sectional study, 260 35-year-old women were selected from healthcare centers in Zahedan. The data were collected using interview and questionnaire. The risk of breast cancer was estimated by Gail Model. The medication conditions were estimated by interviewing the employees in healthcare center. The data were analyzed using independent sample t-test and linear regression. Results: The average age of women was 49.3±8.3 years old with five-year risk, and the lifetime of breast cancer were 0.37±0.24 and 5.5±0.79 percent, respectively. Self-medication (P=0.043) and medication (p=0.035) had a significant relationship with estimated risk of breast cancer. Conclusion: The risk of breast cancer in women can be influenced by medication along with socioeconomic and menstrual-reproductive factors and variables, such as ethnicity, body mass index, education, age, marriage age, nursing period, and menstrual age. The final analysis showed that consuming contraceptive pills, painkillers, and anti-inflammatory pills are the most important predictive factors in 5-year risk with cancer based on Gail Model. On the other hand, consuming painkillers and contraceptive pills were found to be the most important predictive factors in lifetime risk with cancer based on Gail Model.

Background: Personality is associated with health behaviors, such as smoking and substance abuse, yet there is little information about the relationship between optimism and tobacco smoking or substance abuse among high school students. Objectives: The aim of the present study was to determine the association between optimism or pessimism in predicting tobacco smoking and substance abuse among high school students in southeast of Iran. Methods: In this study, 1094 students of high schools in Zahedan city, southeast of Iran, were selected using proportionally multi-stage sampling. Cigarette and hookah smoking status, substance abuse, optimism, and other potential confounders were measured using a self-administered questionnaire. The data were analyzed using chi-square, analysis of variance (ANOVA) tests and ordinal logistic regression in Stata.14 software. Results: According to the results of present study, the prevalence of cigarette smoking and ever hookah smoking was 32.7% and 36.1%, respectively. About 11.2% of students had used at least one illicit drug. After controlling potential confounders, optimism score was negatively related to cigarette smoking stages (OR = 0.90, 95% CI: 0.79 to 0.97) and illicit drugs use (OR = 0.91, 95% CI: 0.70 to 0.96) yet was not associated with hookah smoking (OR = 0.98, 95% CI: 0.82 to 1.31). Conclusions: Optimism and pessimism have an important role in tendency of students to tobacco smoking and substance abuse. On the other hand, the co-occurrence of smoking and substance abuse is high among students with low optimism scores. Therefore, educating and consulting students regarding positivism and promising could prevent from smoking and substance abuse and probably transition to higher stages.