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Abstract Background A cesarean scar defect (CSD) is incomplete healing of the myometrium at the site of a prior cesarean section (CS), complicating more than half of all cesarean sections. While transvaginal ultrasound (TVU) is the most common modality for diagnosing this defect, hysteroscopy remains the gold standard. We aimed to develop an efficient diagnostic tool for CSD among women with abnormal uterine bleeding (AUB) by integrating TVU findings and participants’ demographic features. Methods A single-center cross-sectional study was conducted on 100 premenopausal and non-pregnant women with a history of CS complaining of AUB without a known systemic or structural etiology. Each participant underwent a hysteroscopy followed by a TVU the next day. The defect dimensions in TVU, patients’ age, and the number of previous CSs were integrated into a binary logistic regression model to evaluate their predictive ability for a hysteroscopy-confirmed CSD. Results Hysteroscopy identified 74 (74%) participants with CSD. The variables age, the number of CSs, defect length, and defect width significantly contributed to the logistic regression model to diagnose CSD with odds ratios of 9.7, 0.7, 2.6, and 1.7, respectively. The developed model exhibited accuracy, sensitivity, and specificity of 88.00%, 91.89%, and 76.92%, respectively. The area under the receiver operating curve was 0.955 (P-value

Background: Many people worldwide have developed a combination of natural and vaccine-induced immunity to COVID-19. This study investigated whether exposure to SARS-CoV-2 before full vaccination promotes protection against a breakthrough infection. Methods: We studied a total of 2,902,545 people in the Isfahan COVID-19 Registry. All the participants had received two doses of either Sinopharm BIBP, ChAdOx1-nCoV-19, Gam-COVID-Vac, or BIV1-CovIran vaccines. A cohort study examined the association between prior COVID-19 infection and the risk of a breakthrough infection for each vaccine. Cohorts in each pair were matched by gender, age group, calendar week of the first dose, the interval between the first and second doses, and the proportion of healthcare workers. The probable virus variant for the previous infections was also considered. Each individual’s follow-up started 14 days after their second vaccine dose until either the end of the study censoring date, occurrence of a COVID-19 infection, or death. The breakthrough infection risk was compared between each cohort pair by using the hazard ratio (HR) and incidence rate ratio (IRR). Results: Total breakthrough HRs (95% confidence interval) (previously infected over infection-naïve matched cohort) were 0.36 (0.23–0.55), 0.35 (0.32–0.40), 0.37 (0.30–0.46), and 0.43 (0.32–0.56) for the BIV1-CovIran, Sinopharm BIBP, Gam-COVID-Vac, and ChAdOx1-nCoV-19 vaccine groups, respectively. The breakthrough infection IRRs were approximately similar to the total HRs mentioned above. Conclusion: Prior SARS-CoV-2 infection conferred additive immunity against breakthrough after vaccination, no matter which vaccine brand was injected. Such a result could guide health authorities to codify low-cost high-benefit vaccination protocols and protect the community’s well-being.

Background: Tuberous breast disorder (TBD), is manifested usually in small or asymmetric breasts after puberty, which makes patients candidates for breast augmentation surgery. Yet, its diagnosis may be difficult due to a wide variety of diagnostic criteria and severity of the disorder. So, the aim of this study -which to our knowledge stands as the first epidemiologic study about TBD in Iran, is estimation of the relative frequency of TBD among candidates for breast augmentation surgery.Methods: In a descriptive cross-sectional study, profiles and real-size photograms of anteroposterior and lateral views of 732 referral candidates for breast augmentation surgery aged 18 years or older to clinics of two plastic surgeons in the city of [Isfahan] over a period of 9 years were enrolled. Relative frequency of TBD and its subtypes from I to III based on Grolleau et al. criteria, patients fulfilling at least one of the described features of the TBD, and breast asymmetry were estimated among the study population.Findings: Among the study population 78% experienced asymmetry and 28.9% were diagnosed with TBD with a distribution of 50.9%, 39.1%, and 9.9% in the groups I to III respectively. 73.9% of patients fulfilled at least one of the TBD features.Conclusion: Relative frequencies of 28.9% and 73.9% for TBD and its criteria respectively, show considerable prevalence among candidates for breast augmentation surgery.

Background: This study aimed to investigate reference Doppler velocimetry indices (DVIs) of the fetal ductus venosus (DV) during 11–13 + 6 gestational weeks. Materials and Methods: In a prospective observation over referrals to a single tertiary care center in a 2-year interval, normal singleton pregnancies with fetal crown-rump lengths (CRLs) of 43–80 mm were examined by a single experienced sonographer for their DV pulsatility index (DVPI), DV resistance index (DVRI), and S-wave maximum velocity/A-wave minimum velocity (S/A ratio). Multinomial and quantile regression functions were used to analyze the effect of gestational age (estimated by CRL) on reference values (5th and 95th percentiles of the distribution in each gestational day/week). P < 0.05 was considered significant. Results: Over a sample of 415 participants with a mean/median gestational age of 12 + 1 weeks, no significant correlations were found between the CRL and DVIs using multinomial regression functions (linear model best fitted for all [DVPI: B coefficient = 0.001, P = 0.235] [DVRI: B coefficient = 0.001, P = 0.287] [DV S/A: B coefficient = 0.010, P = 283]). Quantile regression analyses of DVIs' reference values were nonsignificant across the CRL range except for the DVRI ([5th regression line: coefficient = −0.004, P = 0.018] [95th regression line: coefficient = −0.001, P = 0.030]). Conclusion: Reference values for DVPI, DVRI, and DV S/A ratios were established as 0.80–1.39, 0.62–0.88, and 2.57–6.70, respectively. Future meta-analyses and multicenter studies are required to incorporate DV DVIs into an updated universal version of the practice.