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Mendelian randomization, a method for inferring causal relationships in observational studies and an alternative to clinical trial studies: a brief report
Mahdi Akbarzadeh, Danial Habibi , Goodarz Kolifarhood , Mohammad Bidkhori, Fereidoun Azizi , Maryam S. Daneshpour,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Mendelian randomization (MR) is a new generation in the statistical method that uses genetic variants as instrumental variables in data from non-experimental studies to evaluate and estimate the causal effects of risk factors.
Methods: The weakness of observational studies to detect causality, the difficulties of conducting clinical trials, the dramatic advancement of Genome-Wide Association Studies (GWAS) have led to the emergence of a new type of study called MR. It is increasingly being used to determine causality MR is an approach based on meta-analysis methods. The main idea of the MR is based on using the instrument variable (IV) to find the causality between exposure and outcome. This variable does not need to adjust the confounding effects found in observational studies.
Results: Data for this study were collected from the beginning of January 2003 to October 2020 in PubMed. Our results showed that MR has an increasing trend. The data used in MR includes summarized statistical data, individual-level data, and meta-analysis. Choosing the suitable IV is essential to successfully conduct an MR. For an unbiased estimate, three main hypotheses should be considered: 1) The IV has a strong relationship with the desired exposure (i.e., potential risk factor), 2) The IV is not related to the confounding variable, and 3) The IV is not directly related to the outcome and should only relate to the outcome through exposure. If these conditions are not met, one solution is to use robust methods. Besides, this research introduced the study designs, estimation methods, limitations, software packages, and some applications of MR in medical research.
Conclusion: When we seek to find a causal relationship, but it is not possible to use a clinical trial as a standard method, the MR design can be used in observational studies. Therefore, it is possible to obtain causal relationships between exposure and outcome using the MR.

Atrophy of hippocampal subfields as a diagnostic biomarker in alzheimer's disease patients and its differentiation from mild cognitive impairment disorders
Yunus Soleymani, Amir Reza Jahanshahi, Davood Khezerloo ,
Volume 80, Issue 11 (2-2023)
Abstract
Background: Atrophy of hippocampal subfields is one of the diagnostic biomarkers of Alzheimer's disease, which has also been observed in many patients with mild cognitive impairment. There is still no clear understanding of the atrophy pattern of hippocampal subfields in Alzheimer's disease and its differentiation from mild cognitive impairment. In this cross-sectional study, hippocampal subfield atrophy in Alzheimer's patients were compared with patients with early (EMCI) and late (LMCI) cognitive impairment and the control group.
Methods: This was a cross-sectional study conducted from September 2021 to September 2022 in the radiology department of Tabriz Paramedical Faculty. MRI images of Alzheimer's patients, EMCI patients, LMCI patients, and normal controls (NCs) were obtained from the ADNI database. Different hippocampus subfields of hippocampal fissure, dentate gyrus head, dentate gyrus body, first cornu ammonis body, cornu ammonis head, subiculum body, and subiculum head were isolated using the hippocampus segmentation tool in FreeSurfer 7.0 software. The volume of all subfields was calculated bilaterally and normalized. The volume difference of each hippocampus subfield between the groups participating in the study and the pair volume difference between the groups was analyzed using the Kruskal-Wallis H Test and post-hoc Dunn's test. The P<0.05 was considered as the significance level.
Results: The most significant volume difference between the four groups participating in the study was related to the whole hippocampus, DG body, subiculum body, and subiculum head subfields (P<0.0001). Also, when examining pairs, the most significant difference was observed between the NC/AD pair (P<0.0001) and the least significant difference between the pair of LMCI/AD group (P<0.05) and in the subfield subiculum body showing the progressive course of hippocampal subfield atrophy with cognitive progress towards Alzheimer's disease.
Conclusion: In most subfields of the hippocampus, a significant difference in atrophy can be seen, increasing the severity of atrophy as the disorder progresses toward Alzheimer's. Such findings can help guide future studies to improve diagnostic performance to identify individuals at high risk of Alzheimer's disease.

The success of simultaneous balloon dacryoplasty and stenting in failed congenital nasolacrimal duct intubations and its indications
Mansooreh Jamshidian Tehrani , Haniyeh Zeidabadinejad, Fereshteh Tayebi, Mohammad Reza Khalili, Bita Momenaei ,
Volume 80, Issue 12 (3-2023)
Abstract
Background: Congenital nasolacrimal duct obstruction (CNLDO) is one of the most prevalent orbital diseases in children and treatment of recalcitrant cases is always challenging. The purpose of this study is to identify the effectiveness of balloon dacryoplasty and stenting in persistent congenital nasolacrimal duct obstruction following previous intubation of nasolacrimal duct.
Methods: Our study was an interventional study from January 2015 to January 2018 on 16 lacrimal systems of 11 patients (5 males and 6 females) with congenital obstruction of the lacrimal duct (CNLDO) and a history of unsuccessful probing and stenting, in Farabi Hospital of Tehran (affiliated to Tehran University of Medical Sciences). Children who presented to our hospital and had previously been probed with or without intubation by another surgeon first underwent reprobing and re-intubation with a Crawford tube. Endoscopy of the nasolacrimal system was performed in suspected cases of false stent passage or in the presence of a history indicating nasal pathology. Crawford's Monoka tube was removed after two months. Balloon dacryoplasty with intubation was performed as the third surgery in cases who did not respond to probing and stenting after 3-6 months. The success after six months was evaluated using fluorescein dye disappearance test (FDDT) and also the resolution of the patients' symptoms.

Results: The age of the patients was 67±35.01 months (range: 26-121). The site of the canalicular stenosis in our patients was in the common canaliculi or within 2-3 mm from it. After 6 months, surgery was successfully performed in 13 lacrimal systems (81.25%). One patient with congenital lacrimal duct obstruction and Down syndrome and two other patients did not respond to balloon dacryoplasty and stenting and subsequently underwent dacryocystorhinostomy (DCR).
Conclusion: Balloon dacryoplasty combined with Monocrawford intubation is an effective surgical procedure that should be considered in cases of congenital nasolacrimal duct obstruction who have not responded to the probing and stenting of the lacrimal system.

 

Efficacy of treatment in children and adolescents with vasovagal syncope in the long term: an 8-year follow-up study
Mohammad Reza Sabri, Bahar Dehghan, Mahsa Rafiee Alhossaini ,
Volume 81, Issue 1 (4-2023)
Abstract
Background: Syncope is a temporary loss of consciousness with a loss of postural tone. Medicinal treatment of reflex syncope has shown to have no significant effect in reducing the recurrence of syncope. A 36-month follow-up of our pilot cohort showed that non-pharmacological treatments alone were effective in reducing relapse rates. The purpose of this study is to investigate long-term results and 8-year follow-up of previous patients.
Methods: The current study is a continuation of a prospective pilot cohort which was done between August 2013 and 2014 in two academic hospitals in Isfahan (Dr. Chamran heart center and Imam Hossein children hospitals). This current study examines the 8-year follow-up results of children with reflex syncope who were treated with non-pharmacological treatments alone or with drugs. Therefore, the patients who participated in the pilot study were enrolled (30 patients in the pharmacologic group and 40 patients non-pharmacological group). Finally, on 26 patients in the pharmacologic group and 31 patients in the non-pharmacological group (after applying the exclusion criteria), the incidence of syncope and pre-syncope attacks was compared between these two groups of patients using the Chi-square test.
Results: Our study showed that within 5 years after the last follow-up, the incidence of syncope and pre-syncope in patients with a history of vasovagal syncope who did not continue the diet or tilt exercises was different between the two groups of patients (without medication and drug recipient) was not significantly different, even the incidence of presyncope increased significantly again in both groups. The incidence of syncope in the period of 5 years after the last follow-up from the previous study was slightly increased in the group of patients without medication compared to the previous periods, but in the group of patients receiving medication, this incidence decreased slightly.
Conclusion: In order to prevent recurrence, the use of non-pharmacological methods is effective, but for the stability of this recovery, follow-up and continuation of these methods is necessary.

Presenting a model for assessing general medical students: a brief report
Neda Negahban Jouzan , Hossein Karimi Moonaghi , Hoorak Poorzand, Mohammad Khajedaluee,
Volume 81, Issue 1 (4-2023)
Abstract
Background: By examining the comprehensive system for evaluating the academic progress of general medical students, often the objectives of the cognitive domain and the form of cumulative evaluation were used, and the tests were not used much for feedback to the students. The aim of the study is to develop a model that fits the levels of Miller's evaluation pyramid in formative-cumulative forms.
Methods: The search was started in Iranian and international databases, magazines, curriculum of prestigious universities in the world. To find out about the latest events in the field of assessment, AMEE international virtual conferences in August 2021 and the summary booklet of medical education articles of Shahid Motahari 1400 (the 22nd national conference of medical education) were reviewed. Data analysis was done by Beredy's adaptive model. The search and analysis lasted for 11 months. Finally, a model was developed according to Miller's evaluation pyramid. Its validation was done in the focus group meeting in two ways, in person at Mashhad Medical School and virtual.
Results: According to the extracted data, the approach of assessment is towards formative assessment format and improvement of traditional methods along with modern methods, which was clearly observed in the study of the curriculum of Harvard-Stanford University in America and Oxford University in England. Integrating the results with Miller's evaluation levels, and the formative and cumulative evaluation format, led to the formulation of a model with the most favorable opinions of experts. In addition, the majority of opinions and suggestions of experts were related to the change in the way of executive policies of universities and providing a context for the emergence of new idea.
Conclusion: A model including measurement methods according to the levels of Miller's evaluation pyramid was developed in formative-cumulative. It is suggested that the model be reviewed by the relevant experts and notified by taking into account the implementation conditions for the correct evaluation process.

Risk assessment of carcinogenic and non-carcinogenic effets of exposure to heavy metals in hookah smoke using the monte carlo simulation technique
Taibe Ruenifard, Ali Oghazyan, Mohammad Hossien Saghi , Mahdi Ghorbanian , Ayoob Rastegar, Shahram Nazari ,
Volume 81, Issue 4 (7-2023)
Abstract
Background: This study aimed to evaluate the carcinogenic and non-carcinogenic health risks of heavy metals in seven types of tobacco widely consumed in the east of the country through inhalation exposure.
Methods: This descriptive-analytical study was conducted from April 2022 to October 2022 in the city of Bojnord, Iran on sook of seven popular tobacco brands. Metal concentrations in sook of tobacco were determined using inductively coupled plasma-optical emission spectroscopy. In order to analyze the data and ensure the accuracy of the results, the amount of metals in the samples was repeated three times, and their average was analyzed. Monte Carlo software was used to assess possible risks.
Results: The results of this study showed heavy metal concentrations in sook tobaccos were, respectively, Fe>Zn>Mn>Ba>Pb>Ni>Cu>Mo>Cr>As>Cd. The concentration of heavy metals such as arsenic, cadmium and molybdenum in Alrah brand tobacco was higher than other types of tobacco. So that the amounts of heavy metals including arsenic, cadmium and molybdenum for this brand were 14.2±0.05, 10.4±0.06 and 11.6±0.04 micrograms per gram, respectively. The hazard index (HI) values for different types of tobacco, including Al-Rah, Amordadsub, Al-Fakher, Al-Rubi, Mazaya, traditional flavorless, and Nakhle, were 2.64, 2.41, 2.05, 1.7, 1.49, 1.46, and 1.44, respectively. The lifetime cancer risk (ILCR) for Amordadsub, Al-Rah, Nakhla, Mazaya, Al-Rubi, Al-Fakher, and traditional flavorless tobaccos was 2.8×10-3, 2.43×10-3, 1.72×10-3, 1.58×10-3, 1.43×10-3, 9.58×10-4, and 8.08×10-4, respectively. Lead in Alrah tobacco sook had the highest non-carcinogenic risk value with a value of 1.59.
Conclusion: According to the obtained results, Alrah tobacco sook has a higher cancer and non-cancer risk than regular tobacco and can cause non-carcinogenic and carcinogenic risks for consumers. Thus, it is necessary to regularly monitor the quality of prevalent tobacco to reduce delete human health risks.

Frequency of causes of otalgia in patients referred to the ENT clinic: a brief report
Mohamad Ali Damghani , Ayeh Shamsadini , Elham Abbaszade,
Volume 81, Issue 6 (9-2023)
Abstract
Background: Otalgia is defined as pain localizing in the ear that can be primary or referred. By careful history and physical examination, all causes in this extensive differential diagnosis can be excluded. Given that otalgia is one of the most common causes for patients to visit the clinic and has a wide variety of differential diagnosis, the purpose of this study is to investigate the frequency of different etiologies of ear pain in patients referred to referral clinic.
Methods: This cross-sectional study was performed on patients presenting with otalgia. After entering the study, the patient underwent a thorough examination of the ear, nose, throat, head and neck, teeth and salivary glands by a resident under the supervision of a senior otologist, and based on the findings, relevant para clinical procedures such as x-ray, CT scan or stroboscopy were performed. Data collection was done based on a data log check list. Samples were collected during six months. SPSS software version 20 was used for analyses.
Results: The most common causes of otalgia were acute otitis media 29%, external otitis 17% and chronic otitis media 15%. Cerumen and referral ear pain were next in line (13.5%). There was significant relationship between otalgia with age groups (The age between 13 and 30 years were the most referred due to otalgia). There was no significant relationship between otalgia and gender, underlying disease, economic status, smoking and opium use.
Conclusion: Given that otalgia is a common complaint in patients referred to the clinic, knowing its causes and origin is useful in diagnosing, proper treating it and avoiding unnecessary para clinical procedures and empirical treatment. The most common causes of otalgia in this study were acute otitis media, otitis externa and chronic otitis media, respectively. Referral otalgia and cerumen impaction were the next causes. Among the age groups, the age between 13 and 30 years were the most referred due to otalgia, but there was no significant relationship with any of the variables of gender, economic status and smoking and opium use.

Efficacy of filgrastim and Lenograstim drug treatment in patients with neutropenia: a systematic review
Sogol Shirzad, Zeinab Karimi, Mehdi Mohsen Zadeh , Masoud Mohammadi,
Volume 81, Issue 7 (10-2023)
Abstract
Background: Neutropenia refers to a decrease in the absolute number of neutrophils in the blood circulation, certain drugs are used in connection with the treatment of neutropenia. Therefore, the aim of this study is to investigate and compare the efficacy of filgrastim and lenograstim drug treatment in patients with neutropenia in a systematic review.
Methods: This study is a systematic review study conducted in connection with the comparison of the effectiveness of filgrastim and lenograstim in neutropenic patients based on the search in Google scholar, PubMed, ScienceDirect, Irandoc, SID, Magiran databases in the time range of January 2000 to August 2023. This systematic review was based on the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, including systematic search of databases, organization of documents for review, selection of studies, information extraction and finally presentation of the final report. The keywords used for searching in this study were selected based on published primary studies and MESH, and after a detailed examination of the study questions, they were selected according to the PECO criteria.
Results: 1099 articles were identified in the review of the investigated databases, and after removing duplicate articles, unrelated articles, as well as articles that did not have access to their full text or did not have the required information, eight studies were the final phase, and were checked. Out of the eight selected articles, three articles declared the effectiveness of lenograstim more than filgrastim. Two articles mentioned the greater effect of filgrastim and three articles published in recent years declared the effect of two drugs to be the same. Among these articles, the studies that considered the drug dosage to be the same in the investigated groups and the studies that had a larger statistical population in order to generalize to the society are more important.
Conclusion: According to studies conducted in recent years, both filgrastim and lenograstim recombinant drugs have the same effectiveness in the treatment of neutropenia.

Investigating the relationship between types of breast tumors and menopause in women
Ahmad Kachoei, Monireh Mirzaei , Amrolah Salimi, Mostafa Vahidian, Shima Rahimi, Ali Ghalehnoie,
Volume 81, Issue 7 (10-2023)
Abstract
Background: Considering the high prevalence of breast masses and the importance of screening and follow-up for malignancies in women, and since age and hormonal changes during menopause play a role in determining the type of pathology and prognosis of the masses, the purpose of this study is to determine the relationship between menopause and mass pathology.
Methods: This was a cross-sectional-analytical study that was conducted in order to investigate the types of pathology of breast masses and their relationship with the age of menopause in women referred to Shahid Beheshti Hospital in Qom between April 2013 and April 2019. The inclusion criteria include: having sufficient file information and having a contact number to complete personal information, no history of cancer in other parts of the body and simultaneous malignancies, and the exclusion criteria also include: samples that were taken by cellular aspiration sampling, There were women who had a history of first-degree breast malignancy and were previously diagnosed with breast cancer and there was a possibility that the new mass under study was metastatic. Finally, the patients' information was extracted from the files and recorded in pre-prepared checklists. And the supplementary information of the incomplete files was asked and completed using the contact information of the patients. After collecting the information, using SPSS software version 26 and with chi-square and t-test statistical tests and considering the significance level of 0.05 the data was analyzed.
Results: He prevalence of malignancy in postmenopausal women was higher than in premenopausal women. Also, a significant difference was found between tumor size, the presence or absence of metastasis, and menopause (P<0.05), but no significant difference was found between tumor location and menopause (P>0.05).
Conclusion: Breast malignancies (invasive ductal carcinoma, invasive mixed carcinoma, mucinous, medullary, and papillary carcinoma) were more common in postmenopausal women than non-menopausal women. In both groups, ductal dilatation and chronic inflammation were the most benign findings, and fibroadenoma was found at a much lower rate in menopausal women than in non-menopausal.

Comparison of the effect of sequential use of metronidazole and probiotics with probiotics alone on functional bloating
Maryam Soheilipour, Aliakbar Gorjipour , Mojtaba Mohammadpour, Elham Tabesh, Mohammad Javad Tarrahi ,
Volume 81, Issue 8 (11-2023)
Abstract
Background: Most people often complain of abdominal bloating. The present study was designed and conducted with the purpose of examining the effect of sequential treatment of Metronidazole and Probiotics, and Probiotics alone in reducing the severity of symptoms of functional bloating.
Methods: The present study was a randomized clinical trial that was carried out from March 2022 until June 2023 in Isfahan and Khurshid Hospital. The studied population were suffering from flatulence and were diagnosed with functional bloating by a gastroenterologist based on Rome III criteria. Then they entered one of the two study groups in a double-blind manner. The first group was treated with Metronidazole for two weeks and then with Probiotic for two weeks. The second group was treated with Probiotic for four weeks. The severity of patients' bloating was measured by a 4-question questionnaire in five stages: before the start of the study, two weeks after, four weeks after, six weeks after, eight weeks after and 12 weeks after the start of the study.  Finally, the obtained information was entered into SPSS software version 24 Repeated measures ANOVA was used to investigate the relationship between variables.
Results: After collecting the data, 43 patients in the first group and 44 patients in the second group were examined. 72.1% of the first group were women and 27.9% were men. In group two, this ratio was 72.7% for women and 27.3% for men. In this intervention, it was seen that in the 1st group, the average severity of bloating decreased until the end of the eighth week and after the second week of drug treatment, and then increased. In the second group, the average intensity of bloating decreased until the end of the fourth week and at the same time as the end of drug treatment, and then increased.
Conclusion: It was shown that in the study, the effect of this combined treatment had a greater effect in reducing the severity of functional bloating among patients with functional bloating.

A systematic review on the effect of brachytherapy in the treatment of prostate cancer
Mostafa Kazemi , Mohammad Hossain Dadkhah Tehrani , Ali Asghar Khaleghi, Masoud Mohammadi ,
Volume 81, Issue 9 (12-2023)
Abstract
Background: Prostate cancer is one of the most common cancers in the world, which is associated with a high prevalence, especially in the elderly male population. Treatment options for non-metastatic prostate cancer usually include active surveillance, radiotherapy and surgery, so the aim of the present study is a systematic review of brachytherapy in the treatment of prostate cancer.
Methods: The study conducted is a systematic review article in which a review of the treatment of prostate cancer with brachytherapy has been done. The information used is taken from articles published in Persian and English in Google scholar, SID and PubMed databases from 2000 to 2022. The selected keywords in this article included Brachy therapy, Prostate cancer, Radio therapy, Prostate neoplasms, High dose rate, Low dose rate and External beam radio therapy. Selection of studies was done according to PRISMA guidelines.
Results: Brachytherapy can be classified into 2 types of permanent implantation and temporary implantation based on the length of the treatment period. In permanent brachytherapy implants for prostate cancer, iodine (125I) or palladium (103Pd) are used as radioactive sources for low dose rate cases and for high dose rate brachytherapy. Iridium (192Ir) is used. Brachytherapy is usually used in two ways, either as a monotherapy in which LDR and HDR are used to treat some low-risk patients, or as a booster treatment after other treatments such as EBRT, which here may be part of the treatment process before, after, or during treatment. In contrast to brachytherapy alone, brachytherapy plus EBRT is an appropriate approach in patients with intermediate-risk and high-risk disease. In high-risk patients, the combined use of EBRT and HDR-BT can lead to better results than EBRT alone. Brachytherapy treatment is not suitable for every disease.
Conclusion: One of the main advantages of this treatment method is the ability to administer a high dose of radiation while minimizing radiation exposure to adjacent healthy organs. Since optimal dose distribution occurs in the treatment, quality treatment can be ensured. The results obtained from both forms of brachytherapy are generally suitable and comparable to other treatment methods with fewer side effects.

Evaluating the role of brain MRI in predicting clinical outcome of global developmental delay in children
Alireza Dehghan, Mahbube Abshirini, Hamid Nemati, Mahdi Saeedi-Moghadam ,
Volume 81, Issue 11 (1-2024)
Abstract
Background: Developmental disorders in children include a group of problems and limitations in learning and acquiring specific skills of each age group. The term global developmental delay is used to describe developmental disability in children under five years of age, which is in at least two areas of major development. Neuroradiological imaging such as brain MRI provides important information for physicians. The purpose of this study is to determine the role of brain MRI in predicting the clinical outcome of global developmental delay in children.
Methods: In this cross-sectional study, from 79 - from September 2013 to September 2018 at Motahari Clinic of Shiraz University of Medical Sciences, Shiraz Iran - eligible children with developmental disabilities, 37 patient who had brain MRI were selected as a sample and children scores in five ASQ clinical areas and MRI findings were reviewed and compared. Patients suffering from metabolic, genetic, trauma, infection and neoplasms problems and diseases were excluded from the study.
Results: Out of 37 patients studied, 23 were female and 14 were male with a dispersion of three 3 to 60 months of age. 31 of these children had at least one abnormal finding in brain MRI images and the other six were completely normal. In relation to the imaging findings, the highest frequency is related to abnormal head circumference with a prevalence of 54% and the lowest frequency is related to abnormal myelinization with a prevalence of 10.8%. Results of MRI findings correlation with developmental domains demonstrated that Children with white matter disorder on MRI show severe gross motor abnormality (P<0.049) and who had MRI finding of cortical problems suffer from developmental delay in fine motor area. (P<0.001).
Conclusion: Considering the mentioned findings; brain MRI can be a useful diagnostic tool in children with developmental delay and also focusing on the developmental area that is more likely to be affected, MRI can help with treatment and rehabilitation process of these children in the future.

Application of bone cements based on ceramic and polymer in orthopedic surgeries: a review article
Naeemeh Kalali, Sogand Mirshah, Mohammad Hossein Ebrahimzadeh , Bibi Fatemeh Kalalinia, Ali Moradi, Azar Gharib, Nafiseh Jirofti ,
Volume 81, Issue 12 (2-2024)
Abstract
For over 50 years, bone cement has been used to strengthen artificial joints like hip, knee, shoulder, and elbow joints. The main purpose of bone cement is to fill the space between the prosthesis and the bone. This absorbs the forces on the joint by creating an elastic area. Besides ensuring the long-term stability of the artificial implant, it also improves the damaged bone. Polymeric bone cement consists of a polymer matrix known as polymethyl methacrylate (PMMA) and a liquid monomer called methyl methacrylate (MMA). When these two components are mixed, a free radical polymerization reaction occurs, leading to the cement's hardening at the place of use. The properties of bone cement, such as mechanical strength, biocompatibility, and handling characteristics, can be adjusted by combining the effective polymerization parameters. However, there are some challenges, such as heat generation during polymerization.
Ceramic bone cement is a composite material of ceramic particles dispersed in a polymer matrix, including calcium phosphate and calcium sulfate. The ceramic particles provide strength and bioactivity, while the polymer matrix enhances the transport properties of the cement. This combination results in a mechanically stable, bone-conductive, and biocompatible cement. Moreover, ceramic bone cement can be engineered to release therapeutic agents, such as antibiotics or growth factors, to prevent infection and foster bone regeneration. Ceramic bone cement is a promising alternative material for bone cement in joint replacement. However, more research and development are required to optimize the properties of bone cement and overcome the challenges associated with its use. With continued advancements in biomaterials, ceramic and polymer bone cement could revolutionize the field of orthopedic surgery and improve patient outcomes. Recent research has focused on developing new bone cement with improved properties like bioactivity, antibacterial activity, and drug delivery capabilities. These developments aim to enhance the performance of bone cement and remove the current limitations in orthopedic applications. In this review study, we will focus on the types of bone cement, their mechanical, biological, and structural properties, and how to optimize them.

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