دکتر محمود یوسفی فرد

Transfusion of packed red blood cells (PRBCs) following severe bleeding from multiple trauma can reduce mortality. The present study aimed to compare the accuracy of eight different scoring systems for predicting the need for blood transfusion in such patients. The present diagnostic accuracy study was conducted at the emergency department of Shohadaye Tajrish Hospital in Tehran, From March to September 2023. Medical records of multiple trauma patients admitted to the emergency department were reviewed. The predictive performances of eight scoring systems including Glasgow coma scale (GCS), revised trauma score (RTS), trauma associated severe hemorrhage (TASH), Prince of Wales hospital score (PWH), emergency transfusion score (ETS), base deficit, assessment of blood consumption (ABC), and the Shock index in predicting the need for PRBC transfusion were assessed. The area under the ROC curve of TASH in predicting PRBC transfusion was calculated 0.959, significantly higher than the area under the ROC curves for PWH, GCS, Shock index, Base deficit, ETS, RTS, and ABC (0.902, 0.899, 0.882, 0.857, 0.846, 0.824, and 0.810 respectively; p < 0.001). Sensitivity and specificity of TASH at the optimal cut-off were 98.72% and 51.56% respectively. A new score, the MTTP (Multiple Trauma Transfusion Predictor), developed by evaluating the association of clinical and laboratory variables with PRBC transfusion in the ED, showed an AUC of 0.964, not significantly higher than the AUC of TASH (p=0.804). The sensitivity and specificity of MTTP at the optimal cut-off were 93.59% and 91.84%, respectively. Among the evaluated scores, TASH was the most accurate for predicting PRBC transfusion in multiple trauma patients in the ED. Furthermore, among the pre-hospital scores, the Shock index was identified as the most accurate predictor for PRBC transfusion. This score is recommended for use in the ED due to its simplicity, rapid calculation and high prediction accuracy. The MTTP, the newly developed scoring system in this study, outperformed all the other scores.

The present systematic review and meta-analysis was designed to investigate platelet-rich plasma (PRP) as an effective treatment for spinal cord injury in animal models.

An extensive literature search was conducted using electronic databases. The included studies were summarized based on the investigated outcomes, including functional recovery and cavity size. Data were recorded as Mean±SD. The relationships between variables and the outcomes were investigated based on the “meta” command in the STATA 17.0 statistical program.

In total, 9 articles were included in the present meta-analysis. Pooled data analysis showed that administrating PRP significantly improved the motor function of animals (standardized mean differences [SMD]=1.5; 95% CI, 0.9%, 2.1%; P<0.0001). In subgroup analysis based on the severity of the injury, PRP administration significantly improved the motor function of animals in both moderate (SMD=2.59; 95% CI, 1.59%, 3.59%; P<0.0001; I2=30.22%) and severe injuries (SMD=1.22; 95% CI, 0.64%, 1.79%; P<0.0001; I2=56.35%). However, the recovery of function was significantly more in animals with moderate spinal cord injury (meta-regression coefficient=-1.36; 95% CI, -2.68%, -0.09%; P=0.035). In assessing cavity size, pooled data analysis showed that PRP administration significantly reduces cavity size (SMD=-2.2; 95% CI, -3.44%, -0.95%; P<0.0001).

This meta-analysis shows that PRP can significantly improve motor function and reduce the cavity size in animals with moderate to severe spinal cord injuries.

The available evidence suggests that urinary calprotectin may be a potential biomarker in distinguishing between intrinsic acute kidney injury (AKI) and prerenal AKI. 

The aim of this study was to determine the diagnostic value of calprotectin in identifying pediatric acute renal impairment. 

A search of the Medline, Embase, Scopus and Web of Science electronic databases was conducted on April 27, 2024. Diagnostic studies conducted on the value of urinary calprotectin in AKI were included. Two independent reviewers assessed the search records and any disagreements were resolved by discussion. The risk of bias was assessed using quality assessment of diagnostic accuracy studies (QUADAS-2) guidelines. The performance of urinary calprotectin in diagnosing AKI and its discriminatory ability between intrinsic and prerenal AKI were evaluated by calculating the pooled standardized mean difference (SMD) and 95% confidence interval (CI), as well as sensitivity, specificity and area under the curve (AUC). 

Seven studies were included. The mean urinary levels of calprotectin in AKI were significantly higher than those in the non-AKI group (SMD=0.73; 95% CI, 0.50%, 0.97%; I2=0.00%). The mean urinary levels of calprotectin in pediatrics with intrinsic AKI were significantly higher than in those with prerenal AKI (SMD=0.76; 95% CI, 0.48%, 1.05%; 95% CI, 0%). Urinary calprotectin exhibited a sensitivity of 0.937 (95% CI, 0.829%, 0.978%) and a specificity of 0.252 (95% CI, 0.126%, 0.442%) for distinguishing intrinsic AKI from prerenal AKI. Additionally, the AUC of urinary calprotectin in differentiating intrinsic AKI from prerenal AKI was 0.691 (95% CI, 0.541%, 0.809%). 

Urinary calprotectin demonstrates fair screening performance characteristics for differentiating intrinsic from prerenal AKI in children. However, the low specificity necessitates additional diagnostic testing in cases with positive results.

The current registry system aims to design a database that can be used for future research as a tool to produce and update new protocols for the diagnosis, treatment, management, and prevention of heart diseases.  

In this hospital-based registry system, established on 27 July 2021, all the adult patients (age ≥18 years old) with signs and symptoms of cardiac diseases under coronary angiography or angioplasty in the cardiac ward of Imam Hossein Hospital of Tehran, Iran were recruited and followed-up until 30 days after discharge in the pilot phase. All data were collected using a researcher-made checklist from face-to-face interviews with patients and their medical records. The data were registered electronically in web-based software. Quality Control (QC) is conducted monthly by the QC team to ensure the documented data's quality.  

among 1265 patients under coronary angiography or angioplasty over a year, 97% (n=1198) of them were Iranian, and 991 (73.33%) patients lived in the country's capital, Tehran. About 55% (n=706) of patients were male. The mean age of the total patients was 60.48 ± 12.01 years. 764 (60.39%) patients were diagnosed with Coronary Artery Disease (CAD). Of all CAD patients, 32.72% (n=250) and 1.18% (n=9) were premature and very early CAD, respectively. During one year, 22.54% (n=279) and 7.02% (n=87) of patients were under PCI and CABG, respectively.  

Since CVDs, especially CADs, are one of the most common and priority diseases in Iran's health system, establishing a coronary angiography and angioplasty registration system is an opportunity to study the epidemiological and clinical process of CVDs in the shape of an accurate registration system.

 In light of the potential of enhanced functional and neurological recovery in traumatic brain injury (TBI) with the administration of rapamycin, this systematic review and meta-analysis aimed to investigate the efficacy of rapamycin treatment in animal models of TBI.

 An extensive search was conducted in the electronic databases of Medline, Embase, Scopus, and Web of Science by July 1st, 2023. Two independent researchers performed the screening process by reviewing the titles and abstracts and the full texts of the relevant articles, including those meeting the inclusion criteria. Apoptosis rate, inflammation, locomotion, and neurological status were assessed as outcomes. A standardized mean difference (SMD) with a 95% confidence interval (95%CI) was calculated for each experiment, and a pooled effect size was reported. Statistical analyses were performed using STATA 17.0 software.

 Twelve articles were deemed eligible for inclusion in this meta-analysis. Pooled data analysis indicated notable reductions in the number of apoptotic cells (SMD for Tunnel-positive cells = -1.60; 95%CI: -2.21, -0.99, p<0.001), p-mTOR (SMD=-1.41; 95%CI: -2.03, -0.80, p<0.001), and p-S6 (SMD=-2.27; 95%CI: -3.03, -1.50, p<0.001) in TBI post-treatment. Our analysis also indicated substantial IL-1β reductions after rapamycin administration (SMD= -1.91; 95%CI: -2.61, -1.21, p<0.001). Moreover, pooled data analysis found significant neurological severity score (NSS) improvements at 24 hours (SMD= -1.16; 95%CI: -1.69, -0.62, p<0.001; I²=0.00%), 72 hours (SMD= -1.44; 95%CI: -2.00, -0.88, p<0.001; I²=0.00%), and 168 hours post-TBI (SMD= -1.56; 95%CI: -2.44, -0.68, p<0.001; I²=63.37%). No such improvement was observed in the grip test.

 Low to moderate-level evidence demonstrated a significant decrease in apoptotic and inflammatory markers and improved neurological status in rodents with TBI. However, no such improvements were observed in locomotion recovery.

A comprehensive analysis of the epidemiological features of aortic dissections in Azerbaijan Province, Iran, and their influence on patient survival remains unexplored. This study aimed to determine the incidence of aortic dissection and identify the associated factors of mortality in these patients.

A retrospective longitudinal study was conducted using hospital records of patients diagnosed with aortic dissection in Tabriz, Iran, between 2017 and 2021. The 3-month mortality was followed up via telephone calls using the contact numbers provided in the patients’ records. Then, independently associated factors of mortality were identified using a multivariate stepwise logistic regression analysis.

Among the 150 cases of aortic dissection identified, 74% (n = 111) were classified as type A, and 26% (n = 39) were classified as type B. The overall incidence proportion of aortic dissections was 2.35 per 100000 population. In type A dissections, 64% (71 out of 111) of patients received surgical treatment, while 21.6% (24 out of 111) received medical treatment. Among type B dissections, only 23.1% (9 out of 39) underwent surgery. The all-cause mortality rate at 3 months was 52.5% (73 out of 139 patients with complete follow-up), 47 male (54%) and 26 female (50%). Multivariate analysis showed that higher age was independently associated with increased mortality (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.00-1.06, p = 0.027). In contrast, patients with DeBakey Type III classification (OR = 0.29; 95% CI: 0.01-0.87, p = 0.027), hypothyroidism (OR = 0.12; 95% CI: 0.01-0.99, p = 0.049), and those who received either surgical treatment (OR = 0.19; 95% CI: 0.05-0.76, p = 0.019) or medical treatment (OR = 0.18; 95% CI: 0.04-0.80, p = 0.024) had a lower chance of mortality. Gender was not found to be associated with the outcome.

The study revealed an annual incidence rate of aortic dissection as 2.35 per 100000 population. Aortic dissection, regardless of type, remains a highly fatal condition, with over half of patients dying within 3 months of the initial event. To reduce the high mortality rates associated with aortic dissections, it is crucial to implement specific measures for the early identification of patients and ensure prompt and appropriate care. 

The Corticosteroid Randomization After Significant Head injury (CRASH) and the International Missionfor Prognosis and Analysis of Clinical Trials (IMPACT) are two prognostic models frequently used in predicting the out-come of patients with traumatic brain injury. There are ongoing debates about which of the two models has a betterprognostic value. This study aims to compare the CRASH and IMPACT in predicting mortality and unfavorable outcomeof patients with traumatic brain injury.

We performed a literature search using Medline (via PubMed), Embase,Scopus, and Web of Science databases until August 17, 2022. After two independent researchers screened the articles,we included all the original articles comparing the prognostic value of IMPACT and CRASH models in patients with trau-matic brain injury. The outcomes evaluated were mortality and unfavorable outcome. The data of the included articleswere analyzed using STATA 17.0 statistical program, and we reported an odds ratio (OR) with a 95% confidence interval(95% CI) for comparison.

We included the data from 16 studies. The analysis showed that the areas under thecurve of the IMPACT core model and CRASH basic model do not differ in predicting the mortality of patients (OR=0.99;p=0.905) and their six-month unfavorable outcome (OR=1.01; p=0.719). Additionally, the CRASH CT model showed nodifference from the IMPACT extended (OR=0.98; p=0.507) and IMPACT Lab (OR=1.00; p=0.298) models in predicting themortality of patients with traumatic brain injury. We also observed similar findings in the six-month unfavorable out-come, showing that the CRASH CT model does not differ from the IMPACT extended (OR=1.00; p=0.990) and IMPACTLab (OR=1.00; p=0.570) in predicting the unfavorable outcome in head trauma patients.

Low to very lowlevel of evidence shows that IMPACT and CRASH models have similar values in predicting mortality and unfavorableoutcome in patients with traumatic brain injury. Since the discriminative power of the IMPACT Core and CRASH basicmodels is not different from the IMPACT extended, IMPACT Lab, and CRASH CT models, it may be possible to only usethe core and basic models in examining the prognosis of patients with traumatic injuries to the brain.

In this study, we investigate the diagnostic value of the field assessment stroke triage for emergency destination (FAST-ED) tool in the diagnosis of large vessels occlusion (LVO) in a systematic review and metaanalysis.

We conducted a search in Medline (PubMed), Embase, Scopus, and Web of Science databases until the 21s t of September 2022, as well as a manual search in Google ,and Google scholar to find related articles. Studies of diagnostic value in adult population were included. Screening, data collection and quality control of articles were done by two independent researchers. The data were entered and analyzed in STATA 17.0 statistical program.

The data from 30 articles were entered. The best cut-off points for FAST-ED were 3 or 4. The sensitivity and specificity of FAST-ED at cut-off points 3 were 0.77 (95% CI:0.73,0.80) and 0.76 (95% CI:0.72,0.80), respectively. These values for cut-off point 4 were 0.72 (95% CI:0.65,0.78) and 0.79 (95% CI:0.75,0.82), respectively. Meta-regression showed that the sensitivity and specificity of FAST-ED performed by a neurologist wasmore accurate compared to emergency physician (P for sensitivity=0.01; P for specificity<0.001) and emergency medical technicians (P for sensitivity=0.03; P for specificity<0.001). Finally, it was found that the sensitivity of FAST-ED performed by the emergency physician and the emergency medical technician has no statistically significant difference (P=0.76). However, the specificity of FAST-ED reported by the emergency physician is significantly higher (P<0.001). The false negative rate of this tool at cut-off points 3 and 4 is 22.5% and 28.8%, respectively.

Although FAST-ED has an acceptable sensitivity in identifying LVO, its false negative rate varies between 22.5% and 28.8%. A percentage this high is unacceptable for a screening tool to aid in the diagnosis of strokes considering it has a high rate or morbidity and mortality. Therefore, it is recommended to use another diagnostic tool for the stroke screening.

There is no consensus on the performance of decision rules in predicting the prognosis of traumapatients. Therefore, the present study aimed to compare the value of Glasgow coma scale (GCS) and physiologicscoring systems in predicting mortality and poor outcome of trauma patients.

This diagnostic accu-racy study was conducted on multiple trauma patients admitted to the intensive care units of two hospitals inTehran, Iran, from 21 November 2020 to 22 May 2021. The patients’ demographic characteristics, length of stayin the intensive care unit (ICU), the vital signs, and the GCS on admission were recorded. Finally, the mortal-ity, disability, and complete recovery of patients at the time of discharge were evaluated and receiver operatingcharacteristics (ROC) curve analysis was used to compare the performance of physiologic scoring systems withGCS.

200 trauma patients with the mean age of 43.53±19.84 years were evaluated (74% male). The areaunder the ROC curve for New Trauma Score (NTS), Revised Trauma Score (RTS), Worthing Physiological Scor-ing System (WPSS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), ModifiedEarly Warning Score (MEWS), National Early Warning Score (NEWS), Glasgow Coma Scale, Age, and SystolicBlood Pressure score (GAPS) ,Glasgow coma scale (GCS) in prediction of mortality were 0.95, 0.95, 0.83, 0.89,0.91, 0.84, 0.77, 0.97, and 0.98 respectively. The performance of GCS was statistically superior to RTS (P=0.005),WPSS (P=0.0001), RAPS (P=0.0002), REMS (P=0.002), MEWS (P<0.0001), and NEWS (P<0.0001). However, theperformance of GCS, NTS (P=0.146), and GAPS (P=0.513) were not significantly different. Also, in predictionof poor outcomes, the AUC of GCS (0.98) was significantly higher than RTS (0.95), RAPS (0.85), REMS (0.85),MEWS (0.84), NEWS (0.77), and WPSS (0.75).

The GCS score seems to be a better instrument topredict mortality and poor outcome in trauma patients compared to other tools due to its high accuracy, wideapplication, and easy calculation.

ntroduction:Outcome prediction of intensive care unit (ICU)-admitted patients is one of the important is-sues for physicians. This study aimed to compare the accuracy of Quick Sequential Organ Failure Assessment(qSOFA), Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), andSystemic Inflammatory Response Syndrome (SIRS) scores in predicting the in-hospital mortality of COVID-19patients.

This prognostic accuracy study was performed on 225 ICU-admitted patients with a defini-tive diagnosis of COVID-19 from July to December 2021 in Tehran, Iran. The patients’ clinical characteristicswere evaluated at the time of ICU admission, and they were followed up until discharge from ICU. The screeningperformance characteristics of CURB-65, qSOFA, and SIRS in predicting their mortality was compared.

225 patients with the mean age of 63.27±14.89 years were studied (56.89% male). The in-hospital mortality rateof this series of patients was 39.10%. The area under the curve (AUC) of SIRS, CURB-65, and qSOFA were 0.62(95% CI: 0.55 - 0.69), 0.66 (95% CI: 0.59 - 0.73), and 0.61(95% CI: 0.54 - 0.67), respectively (p = 0.508). In cut-off≥1, the estimated sensitivity values of SIRS, CURB-65, and qSOFA were 85.23%, 96.59%, and 78.41%, respectively.The estimated specificity of scores were 34.31%, 6.57%, and 38.69%, respectively. In cut-off≥2, the sensitivityvalues of SIRS, CURB-65, and qSOFA were evaluated as 39.77%, 87.50%, and 15.91%, respectively. Meanwhile,the specificity of scores were 72.99%, 34.31%, and 92.70%.

It seems that the performance of SIRS,CURB-65, and qSOFA is similar in predicting the ICU mortality of COVID-19 patients. However, the sensitivityof CURB-65 is higher than qSOFA and SIRS.

Anal fistula refers to a clinical condition with local pain and inflammation associated with purulent discharge that affects the quality of life. Due to the lack of studies, the presence of bias, and high heterogeneity in the studies, the present systematic review is the first to be performed on the population-based database in this field. The present systematic review and meta-analysis was performed according to MOOSE guidelines. After systematic searching in electronic databases, only four articles met the inclusion criteria. After preparing a checklist and extracting data from the relevant articles, a meta-analysis was performed. All studies on the prevalence of anal fistula are related to Europe, and so far, no study has been conducted on other continents. The overall prevalence of anal fistula in European countries was 18.37 (95% CI: 18.20-18.55%) per 100,000 individuals, and the highest prevalence was reported for Italy (23.20 (95% CI: 22.82 to 23.59) per 100,000 people). From the present population-based (224,097,362) study results, it can be concluded that there is a prominent knowledge gap in this context. Because all the studies included in the current study relate only to Europe, the need for further research in this field in other countries is inevitably sensible.

The coronavirus disease 2019 (COVID-19) was first emerged from Wuhan, China, in late 2019, and has since been spreading progressively all around the world. Its prevalence is climbing increasingly and almost all countries worldwide are confronting this pandemic. As of April 11, 2020, reports obtained about the management of COVID-19 patients indicate that the mortality rate of the disease is around 5% with consideration of the active cases and 21% of the closed cases

The present systematic review and meta-analysis aims to investigate the role of Posterior Tibial Nerve Stimulation (PTNS) in the control of fecal incontinence (FI).

Two independent reviewers extensively searched in the electronic databases of Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, CINAHL, and Scopus for the studies published until the end of 2016. Only randomized clinical trials were included. The studied outcomes included FI episodes, FI score, resting pressure, squeezing pressure, and maximum tolerable pressure. The data were reported as Standardized Mean Differences (SMD) with 95% confidence interval.

Five articles were included in the present study (249 patients under treatment with PTNS and 239 in the sham group). Analyses showed that PTNS led to a significant decrease in the number of FI episodes (SMD=-0.38; 95% CI: -0.67-0.10; P=0.009). Yet, it did not have an effect on FI score (SMD=0.13; 95% CI: -0.49-0.75; P=0.68), resting pressure (SMD=0.12; 95% CI: -0.14-0.37; P=0.67), squeezing pressure (SMD=-0.27; 95% CI: -1.03-0.50; P=0.50), and maximum tolerable pressure (SMD=-0.10; 95% CI: -0.40-0.24; P=0.52).

Based on the results, it seems that the prescription of PTNS alone cannot significantly improve FI.