فهرست مطالب mahmoud yousefifard

To determine the optimum volume of intravenous fluid administration in traumatic rhabdomyolysis patients to prevent acute kidney injury (AKI) and the need for dialysis. Systematic search was done via the electronic databases Medline, Embase, Scopus, and Web of Science on January 21, 2024 using the query formed for keywords rhabdomyolysis, fluid therapy, and AKI. No filter was used. Citation searching was done, as well. Trials and observational studies reporting data on fluid therapy and AKI in traumatic rhabdomyolysis patients were included. Animal studies, case reports, reviews, and studies on non-traumatic causes were excluded. Risk of bias assessment was done using NHLBI tool for observational and cohort studies. The quality of evidence was assessed using the GRADE score. Analyses were carried out using STATA v.18 for outcomes AKI and dialysis by categorizing studies into three treatment volumes of ≤3 L/day, >3 L/day, and Better et al. protocols. Eight studies were included in the final analysis. The estimated prevalence of AKI and the need for dialysis in traumatic rhabdomyolysis patients were lowest when administering 3-8 L of IV fluid per 24 hours (AKI: 0.02 (95% CI: 0.00, 0.11) compared with 0.48 (95% CI: 0.0, 1.0), and 0.16 (95% CI: 0.01, 0.38) in studies administering ≤3 L/day, and those following Better et al. protocol, respectively; Dialysis: 0.01 (95% CI: 0.00, 0.03) compared with 0.05 (95% CI: 0.00, 0.18) in ≤3, and 0.16 (95% CI: 0.01, 0.38) in Better protocol.). All studies were of non-low risk of bias and the quality of evidence is very low. There is paucity of high quality data on fluid therapy in traumatic rhabdomyolysis, which warrants further studies. The scarce evidence is in favor of administering a volume of 3-8 L/day to prevent AKI and the need for dialysis in traumatic rhabdomyolysis patients, albeit with very low quality.

Identifying affecting and predictive factors of steroid-sensitive nephrotic syndrome’s (SSNS's) outcome may greatly benefit the proper management of SSNS patients. 

The current systematic review comprehensively reviews all available evidence on the risk factors of SSNS relapse in children and adolescents. 

An extensive search was conducted on the electronic databases of Medline, Embase, Web of Science, and Scopus until February 18, 2024. Studies investigating the risk factors of relapse were included in this systematic review.

A total of 11 articles were included. Age, gender, and laboratory variables, such as serum creatinine and serum protein are not risk factors for relapse in these studies. Possible associations were reported for risk factors, such as the number of relapses and response time. Overall, the studies reported conflicting results on the value of relapse risk factors.

Although factors, such as hematuria, hypertension, time from treatment to response, and number of relapses have been proposed as possible risk factors for relapse, no conclusion can be reached due to the heterogeneity of studies. Future studies should have more conforming designs to make comparisons more reliable.

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.

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. 

 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.

Large vessel occlusion (LVO) strokes are associated with worse functional outcomes and higher mortality rates. In the present systematic review and meta-analysis, we evaluated the diagnostic yield of the Cincinnati Prehospital Stroke Scale (CPSS) in detecting LVO.

We performed an extensive systematic search among online databases including Medline, Embase, Web of Science, and Scopus, until July 31st, 2023. We also conducted a manual search on Google and Google scholar, along with citation tracking to supplement the systematic search in retrieving all studies that evaluated the diagnostic accuracy of the CPSS in detecting LVO among patients suspected to stroke.

Fourteen studies were included in the present meta-analysis. CPSS showed the sensitivity of 97% (95% CI: 87%–99%) and the specificity of 17% (95% CI: 4%–54%) at the cut-off point of ≥1. The optimal threshold was determined to be ≥2, with a sensitivity of 82% (95% CI: 74%–88%) and specificity of 62% (95% CI: 48%–74%) in detecting LVO. At the highest cut-off point of ≥3, the CPSS had the lowest sensitivity of 60% (95% CI: 51%–69%) and the highest specificity of 81% (95% CI: 71%–88%). Sensitivity analyses showed the robustness of the results regardless of study population, inclusion of hemorrhagic stroke patients, pre-hospital or in-hospital settings, and the definition of LVO.

A very low level of evidence demonstrated that CPSS, with a threshold set at ≥2, is a useful tool for identifying LVO stroke and directing patients to CSCs, both in prehospital and in-hospital settings.

Traumatic brain injury (TBI) represents a significant global health burden. This systematic review delves into the comparison of S100B and Neuron-Specific Enolase (NSE) regarding their diagnostic and prognostic accuracy in TBI within the adult population.

Conducted on October 21, 2023, the search identified 24 studies encompassing 6454 adult patients. QUADAS-2 and QUAPAS tools were employed to assess the risk of bias. The analyses aimed to evaluate the diagnostic and prognostic performance of S100B and NSE based on sensitivity, specificity, and area under the curve (AUC). The outcomes were detecting intracranial injury, mortality, and unfavorable outcome.

Pooled data analysis tended towards favoring S100B for diagnostic and prognostic purposes. S100B exhibited a diagnostic AUC of 0.74 (95% confidence interval (CI): 0.70-0.78), sensitivity of 80% (95% CI: 63%-90%), and specificity of 59% (95% CI: 45%-72%), outperforming NSE with an AUC of 0.66 (95% CI: 0.61–0.70), sensitivity of 74% (95% CI: 53%-88%), and specificity of 46% (95% CI: 24%-69%). Notably, both biomarkers demonstrated enhanced diagnostic value when blood samples were collected within 12 hours post-injury. The analyses also revealed the excellent diagnostic ability of S100B with a sensitivity of 99% (95% CI: 4%-100%) and a specificity of 76% (95% CI: 51%-91%) in mild TBI patients (AUC = 0.89 [0.86–0.91]). In predicting mortality, S100B showed a sensitivity of 90% (95% CI: 65%-98%) and specificity of 61% (95% CI: 39%-79%), slightly surpassing NSE's performance with a sensitivity of 88% (95% CI: 76%-95%) and specificity of 56% (95% CI: 47%-65%). For predicting unfavorable outcomes, S100B exhibited a sensitivity of 83% (95% CI: 74%-90%) and specificity of 51% (95% CI: 30%-72%), while NSE had a sensitivity of 80% (95% CI: 64%-90%) and specificity of 59% (95% CI: 46%-71%).

Although neither biomarker has shown promising diagnostic performance in detecting abnormal computed tomography (CT) findings, they have displayed acceptable outcome prediction capabilities, particularly with regard to mortality.

Coronary computed tomographic angiography (CCTA) reporting has traditionally been operator-dependent, and no precise classification is broadly used for reporting Coronary Artery Disease (CAD) severity. TheCoronary Artery Disease Reporting and Data Systems (CAD-RADS) was introduced to address the inconsistent CCTA re-ports. This systematic review with meta-analysis aimed to comprehensively appraise all available studies and draw con-clusions on the prognostic value of the CAD-RADS classification system in CAD patients.

Online databasesof PubMed, Embase, Scopus, and Web of Science were searched until September 19th, 2022, for studies on the value ofCAD-RADS categorization for outcome prediction of CAD patients.

16 articles were included in this system-atic review, 14 of which had assessed the value of CAD-RADS in the prediction of major adverse cardiovascular events(MACE) and 3 articles investigated the outcome of all-cause mortality. Our analysis demonstrated that all original CAD-RADS categories can be a predictor of MACE [Hazard ratios (HR) ranged from 3.39 to 8.63] and all categories, exceptCAD-RADS 1, can be a predictor of all-cause mortality (HRs ranged from 1.50 to 3.09). Moreover, higher CAD-RADScategories were associated with an increased hazard ratio for unfavorable outcomes among CAD patients (p for MACE= 0.007 and p for all-cause mortality = 0.018).

The evidence demonstrated that the CAD-RADS classifica-tion system can be used to predict incidence of MACE and all-cause mortality. This indicates that the implementationof CAD-RADS into clinical practice, besides enhancing the communication between physicians and improving patientcare, can also guide physicians in risk assessment of the patients and predicting their prognosis.

Introduction:

A comprehensive conclusion has yet to be made about the predictive value of serum N-terminalpro-brain natriuretic peptide (NT-proBNP) for stroke/systemic embolic events (SEE) in patients with atrial fib-rillation (AF). This study aims to review the evidence for evaluating the value of NT-proBNP in predicting the riskof stroke/SEE in patients with AF through a systematic review and meta-analysis.

Two independentreviewers screened all relevant studies that were retrieved from the database of Medline, Embase, Scopus, andWeb of Science until December 7th, 2021. The predictive value of NT-proBNP in the prediction of stroke/SEEwas recorded as hazard ratio (HR) and 95% confidence interval (95% CI).

Nine articles (38,093 patients,3.10% stroke/SEE) were included in our analysis. There was no publication bias in these studies (P=0.320). Ouranalysis showed that NT-proBNP can be a good predictor of stroke/SEE risk in AF patients, even at differentcut-off values (HR=1.76; 95% CI: 1.51, 2.02; P < 0.001). Subgroup analysis showed that diabetes could have apossible effect on the predictive value of NT-proBNP (meta-regression coefficient = 0.042; P = 0.037).Conclu-sion:Measurement of NT-proBNP during the first admission could be used to assess the short- or long-termrisk of stroke/SEE in patients with AF. Further studies are needed to evaluate the possible applicability of serumNT-proBNP measurement in the settings in which stroke is the sole outcome of the investigation.

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.

Developing novel diagnostic and screening tools for exploring intracranial injuries following mi-nor head trauma is a necessity. This study aimed to evaluate the diagnostic value of serum glial fibrillary acidicprotein (GFAP) in detecting intracranial injuries following minor head trauma.

An extensive searchwas performed in Medline, Embase, Scopus, and Web of Science databases up to the end of April 2022. Hu-man observational studies were chosen, regardless of sex and ethnicity of their participants. Pediatrics studies,report of diagnostic value of GFAP combined with other biomarkers (without reporting the GFAP alone), arti-cles including patients with all trauma severity, defining minor head trauma without intracranial lesions as theoutcome of the study, not reporting sensitivity/specificity or any other values essential for computation of truepositive, true negative, false positive and false-negative, being performed in the prehospital setting, assessingthe prognostic value of GFAP, duplicated reports, preclinical studies, retracted articles, and review papers wereexcluded. The result was provided as pooled sensitivity, specificity, diagnostic score and diagnostic odds ratio,and area under the summary receiver operating characteristic (SROC) curve with a 95% confidence interval (95%CI).

Eventually, 11 related articles were introduced into the meta-analysis. The pooled analysis impliesthat the area under the SROC curve for serum GFAP level in minor traumatic brain injuries (TBI) was 0.75 (95%CI: 0.71 to 0.78). Sensitivity and specificity of this biomarker in below 100 pg/ml cut-off were 0.83 (95% CI: 0.78to 0.89) and 0.39 (95% CI: 0.24 to 0.53), respectively. The diagnostic score and diagnostic odds ratio of GFAP indetection of minor TBI were 1.13 (95% CI: 0.53 to 1.74) and 3.11 (95% CI: 1.69 to 5.72), respectively. The level ofevidence for the presented results were moderate.

The present study’s findings demonstrate thatserum GFAP can detect intracranial lesions in mild TBI patients. The optimum cut-off of GFAP in detection ofTBI was below 100 pg/ml. As a result, implementing serum GFAP may be beneficial in mild TBI diagnosis forpreventing unnecessary computed tomography (CT) scans and their related side effects.

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.

Los AngelesMotor Scale (LAMS) is a validated prehospital scoring tool to identify stroke patients with large vessel occlusions (LVOs). While some studies have reported conflicting data in regards to the diagnostic value of LAMS, this systematic review and meta-analysis aims to provide a more concrete evidence for the value of this clinical decision tool in the diagnosis of LVO in suspected stroke patients.

Online databases of PubMed, Embase, Scopus, and Web of Science were searched until the end of October 2022, for studies evaluating the diagnostic performance of LAMS in the detection of LVOs in suspected stroke patients.

The results of our analysis demonstrated an AUC of 0.83 (95% CI: 0.79, 0.86), sensitivity of 0.65 (95% CI: 0.54, 0.74), and specificity of 0.83 (95% CI: 0.79, 0.86) for the diagnostic value of LAMS score with a cut-off value of ¸ 4. The diagnostic odds ratio of LAMS score was 8.81 (95% CI: 6.24, 12.45). Sensitivity analyses reveled that diagnostic performance of LAMS improves when utilized for detection of occlusion in the more proximal segments of large vessels, with a sensitivity of 0.75 and specificity of 0.83.

A high level of evidence showed that LAMS scale does not have a promising diagnostic value in the identification of LVOs in suspected stroke patients. The sensitivity of 0.65 for this tool makes it obsolete as a proper triaging tool. As a suggestion, LAMS could be utilized in conjunction with other additional factors to increase its diagnostic performance.

Evidence indicates the protective role of Irisin on nervous tissue following ischemic events, bypreventing the cascades of secondary damage. We conducted this scoping review to summarize what has beendiscovered so far on the neuroprotective effects of Irisin, with a focus on ischemic stroke.

Searchstrategies were designed based on the keywords related to ischemic stroke and Irisin. Next, an extensive searchin Medline, Embase, Scopus, and Web of Science was conducted by the end of April 2022. Two researchers inde-pendently reviewed the articles and performed the screening of the selected papers according to the inclusioncriteria. Finally, the required data were extracted to a checklist designed based on the PRISMA guideline. The“meta” package was used for the meta-analysis, and heterogeneity between studies was assessed using the I2test.

Pooled data analysis showed that the Irisin administration significantly improved the neurologicalfunction following cerebral ischemia / reperfusion injuries (SMD = 3.08; 95% CI: 1.10, 5.06; p<0.0001). Addi-tionally, meta-regression demonstrated that the improvement in neurological function was directly related tothe dose of administered Irisin (meta-regression coefficient = 0.03; p = 0.02). Moreover, Irisin administrationsignificantly reduced the volume of infarcted lesions (SMD= -3.14; 95% CI: -4.23, -2.04; p<0.0001), the amountof edema in the brain (SMD= -2.30; 95% CI: -4.07, -0.53; p<0.0001), and the extend of neuronal-cell apoptosisrate (SMD= -4.67; 95% CI: -8.15, -1.19; p<0.0001).

The present study demonstrates that the admin-istration of Irisin in animal models of cerebral ischemia / reperfusion injuries is associated with a significantdose-dependent improvement in neurological function. Due to the limited number of articles, more researchon the aim of finding the optimum Irisin dosage is in high demand.

In 2017, the American Academy of Pediatrics (AAP) updated clinical practice guidelines for the diagnosis and management of hypertension in children. The present study aimed to assess the prevalence of hypertension in Iranian children based on the latest guidelines.

Data on 7301 student participants (3589 boys and 3712 girls) aged between 7-12 yr were assessed. The data were extracted from the fifth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN V) school-based study conducted in the 30 provinces of Iran in 2015. Blood pressure (BP) was classified as normal, elevated BP, and stage 1 and 2 hypertension using weighted analysis and the 2017 AAP guidelines. All analyses were performed in STATA 14.0 statistical software, with findings presented in terms of prevalence.

The overall prevalence of high BP in Iranian children was 14.7%. In addition, 15.1% of boys had high BP, with 9.4% and 1.7% of them with stage 1 and 2 hypertension, respectively. Moreover, 14.3% of girls had high BP, of which 10% had stage 1 and 1.3% with stage 2 hypertension. For elevated hypertension, it was observed in 4% of boys and 3% of girls.

Using the 2017 AAP guidelines demonstrated a higher prevalence of hypertension in children (14.7%) in Iran. The prevalence of hypertension in boys was slightly higher compared to girls.

The present systematic review and meta-analysis aims to conduct a comprehensive and complete search of electronic resources to investigate the role of administrating Chondroitinase ABC (ChABC) in improving complications following Spinal Cord Injuries (SCI).

MEDLINE, Embase, Scopus, and Web of Sciences databases were searched until the end of 2019. Two independent reviewers assessed the studies conducted on rats and mice and summarized the data. Using the STATA 14.0 software, the findings were reported as pooled standardized mean differences (SMD) with 95% confidence intervals (CI). 

A total of 34 preclinical studies were included. ChABC administration improves locomotion recovery after SCI (SMD=0.90; 95% CI: 0.61 to 1.20; P<0.001). The subgroup analysis showed that the differences in the SCI model (P=0.732), the severity of the injury (P=0.821), the number of ChABC administrations (P=0.092), the blinding status (P=0.294), the use of different locomotor score (P=0.567), and the follow-up duration (P=0.750) have no effect on the efficacy of ChABC treatment.

The findings of the present study showed that prescribing ChABC has a moderate effect in improving locomotion after SCI in mice and rats. However, this moderate effect introduces ChABC as adjuvant therapy and not as primary therapy.

Currently, there is lack of evidence regarding the long-term follow-up of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to present a 6-month follow-up of COVID-19 patients who were discharged from hospital after their recovery.

This retrospective cohort study was performed to assess the six-month follow-up of COVID-19 patients who were discharged from the hospital between February 18 and July 20, 2020. The primary outcome was 6-month all-cause mortality.

Data related to 614 patients were included to this study. Of these 614 patients, 48 patients died (7.8%). The cause of death in 26 patients (54.2%) was the relapse of COVID-19. Also, 44.2% of deaths happened in the first week after discharge and 74.4% in the first month. Risk factors of all-cause mortality included increase in age (odds ratio [OR]=1.09; P<0.001), increase in neutrophil percentage (OR=1.05; P=0.009) and increase in heart rate (OR=1.06; P=0.002) on the first admission. However, the risk of all-cause death was lower in patients who had higher levels of hematocrit (OR=0.93; P=0.021), oxygen saturation (OR=0.90; P=0.001) and mean arterial pressure (OR=0.93; P=0.001). In addition, increase in age (OR=1.11; P<0.001) was an independent risk factor for COVID-19-related death, while higher levels of lymphocyte percentage (OR=0.96; P=0.048), mean arterial pressure (OR=0.93; P=0.006) and arterial oxygen saturation (OR=0.91; P=0.009) were protective factors against COVID-19-related deaths during the 6-month period after discharge.

Death is relatively common in COVID-19 patients after their discharge from hospital. In light of our findings, we suggest that elderly patients who experience a decrease in their mean arterial pressure, oxygen saturation and lymphocyte count during their hospitalization, should be discharged cautiously. In addition, we recommend that one-month follow-up of discharged patients should be take place, and urgent return to hospital should be advised when the first signs of COVID-19 relapse are observed.

Although various predictive instruments have been introduced for early stroke diagnosis, there is no consensus on their performance. Therefore, we decided to assess the value of predictive instruments in the detection of stroke by conducting an umbrella review. 

A search was performed in the Medline, Embase, Scopus and Web of Science databases by the end of August 2021 for systematic reviews and meta-analyses. Original articles included in the systematic reviews were retrieved, summarized and pooled sensitivity, specificity and diagnostic odds ratio were calculated. The level of evidence was divided into five groups: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant. 

The value of 33 predictive instruments was evaluated. The sample size included in these scoring systems’ assessments varied between 182 and 47072 patients. The level of evidence was class I in one tool, class II in 18 tools, class III in 2 tools, class IV in 11 tools, and non-significant in one tool. Apart from Med PACS, which had a low diagnostic value, other tools appeared to be able to detect a stroke. The optimum performance for diagnosis of stroke was for ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS. 

Convincing to suggestive evidence shows that ROSIER, NIHSS, PASS, FAST, LAMS, RACE and CPSS have the optimum performance in identifying stroke. Since ROSIER’s calculation is simple and has the highest sensitivity and specificity among those predictive instruments, it is recommended for stroke diagnosis in pre-hospital and in-hospital settings.

In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. 

This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. 

Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; p=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; p=0.018), history of cardiovascular diseases (RR=1.16; p=0.017), history of cancer (RR=1.40; p=0.004) and QT prolongation on ECG (RR=1.18; p=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, from the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI; 1.49-2.35; p<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. no significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. 

The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and Kaletra (Lopinavir-Ritonavir) had no association with the development cardiac dysrhythmias during hospitalization.

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.

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.

Interleukins (ILs) can act as a predictive indicator of Premature Coronary Artery Disease (pCAD) and may be useful in screening of high-risk patients. However, there is no consensus on the relationship of serum levels of ILs and pCAD, yet. As a result, this study has been conducted in order to review the literature on the relationship between serum levels of different ILs and pCAD.

Medline, Scopus, Embase, and Web of Science databases were searched until December 7th 2020. Two reviewers independently screened and summarized eligible articles. A meta-analysis was performed to assess the relationship of ILs and pCAD.

12 case-control articles were included. IL-6 plasma changes do happen in pCAD patients with a standardized mean difference (SMD) of 0.51 (95% CI: 0.12-0.90; p=0.010) compared with the control group. This difference was also observed when evaluating the plasma levels of IL-1 and IL-17, with an SMD of 1.42 (95% CI: 1.11-1.73; p<0.001) and 0.59 (95% CI: 0.14-1.04; p=0.011), respectively. Meanwhile, no significant difference existed in plasma levels of IL-10 (SMD=0.26; 95% CI: -0.17-0.70; p=0.236), and IL-18 (SMD=1.44; 95% CI: -0.19-3.07; p=0.083) between pCAD patients and those in the control group.

Low level of evidence showed that there may be a significant relationship between increased plasma levels of ILs and the occurrence of pCAD. As a result, prospective cohort studies with serial assessments of serum ILs during follow up period, focusing on controlling classical risk factors of pCAD and increase in level of ILs, should be conducted.

The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings.

In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed.

614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients.

Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.

Early decompression within the first 24 hours after spinal cord injury (SCI) is proposed in currentguidelines. However, the possible benefits of earlier decompression are unclear. Thus, the present meta-analysisaims to investigate the existing evidence regarding the efficacy of ultra-early decompression surgery (within 12hours after SCI) in improving patients’ neurological status.

A search was performed in Medline, Em-base, Scopus and Web of Science electronic databases, until the end of August 2021. Cohort studies and clinicaltrials were included in the present study. Exclusion criteria were absence of an early or late surgery group, fail-ure to report neurological status based on the American spinal injury association impairment scale (AIS) grade,failure to perform the surgery within the first 12 hours after SCI, and duplicate reports and review articles. Twoindependent reviewers performed data collection, and risk of bias and certainty of evidence assessments. Theoutcome was reported as odds ratio (OR) and 95% confidence interval (CI).

Data from 16 articles, whichstudied 868 patients, were included. Compared to early or late decompression surgery, ultra-early decompres-sion surgery significantly improves patients’ neurological status (OR = 2.25; 95% CI: 1.41 to 3.58). However,ultra-early surgery in thoracolumbar injuries is not significantly more effective than early to late surgery. More-over, ultra-early surgery in patients with a baseline AIS A increases the chance of neurologic resolvent up to 3.86folds (OR=3.86; 95% CI: 1.50 to 9.91). Contrastingly, ultra-early surgery does not result in significant improve-ment compared to early to late surgery in patients with AIS B (OR = 1.32; 95% CI: 0.51 to 3.45), AIS C (OR = 1.83;95% CI: 0.72 to 4.64), and AIS D (OR = 0.99; 95% CI: 0.31 to 3.17).

Current guidelines emphasizethat spinal decompression should be performed within 24 hours after SCI, regardless of injury severity and loca-tion. However, results of the present study demonstrated that certain considerations may be taken into accountwhen performing decompression surgery: 1) in patients with AIS A injury, decompression surgery should beperformed as soon as possible, since its efficacy in neurological improvement is 3.86 folds higher in the first 12hours after injury. 2) ultra-early decompression surgery in patients with cervical injury is more effective than inpatients with thoracic or lumbar injuries. 3) postponing decompression surgery to 24 hours in SCI patients withAIS B to D does not significantly affect the neurological outcome.