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Re-evaluating Risk Factors, Incidence, and Outcome of Aneurysmal and Non-aneurysmal Subarachnoid Hemorrhage: A Population-based Registry Study from Isfahan Province, Iran, 2016-2020
No full textINTRODUCTION: Subarachnoid hemorrhage (SAH) is one of the world's most life-threatening types of stroke. SAH can be classified into two main categories, aneurysmal (aSAH) and non-aneurysmal SAH (naSAH). In the present study, we aimed to prospectively evaluate SAH and its subcategories incidences, risk factors (RF), complications and outcomes in central Iran. METHODS: All SAH patients diagnosed between 2016-2020 were included in Isfahan SAH Registry (ISR). Demographic, clinical characteristics, incidence rates (based on age categories), and laboratory/imaging findings were collected and compared between aSAH and naSAH subgroups. Complications during hospital stay and outcomes were also analyzed. Binary logistic regression analysis was performed to investigate the predictors of aSAH versus naSAH. Kaplan-Meier curves and Cox regression were used to evaluate the survival probability. RESULTS: A total of 461 SAH patients were included through ISR. The SAH annual incidence rate was 3.11 per 100,000 person-years. aSAH had higher incidence rate than naSAH (2.08/100,000 versus 0.9/100,00 person-years). In-hospital mortality was 18.2 with no significant difference between aSAH and naSAH subgroups. Hypertension (p=0.003) and smoking (p=0.03) were significantly associated with aSAH, whereas DM (p<0.001) was more associated with naSAH. After Cox regression analysis, there were higher hazard ratios for reduced in-hospital survival in conditions including altered mental status, Glasgow coma scale </=13, rebleeding and seizures. CONCLUSION: This study provided an updated estimation of SAH and its subgroups incidences in central Iran. Risk factors for aSAH are comparable to the ones reported in the literature. It is noteworthy that DM was associated with a higher incidence of naSAH in our cohort
Factors affecting decision-making for knee arthroplasty in patients with osteoarthritis
No full textOBJECTIVE: Identifying factors affecting decision-making for knee arthroplasty in patients with knee osteoarthritis is critically important for pain relief, improving in knee function and reaching an optimal outcome. When decision-making is hurried or delayed, surgery may not occur in time, which complicates the surgery and increases its complications. This study was conducted to investigate the factors influencing decision-making for knee arthroplasty. METHODS: This study is a qualitative study and inductive content analysis method. This study enrolled 22 patients undergoing knee arthroplasty selected through purposive sampling. Data were collected through semi-structured in-depth interviews and analyzed using inductive content analysis. RESULTS: Data analysis yielded three categories: hope to return to normal life, encouragement and recommendations, and trust and assurance. CONCLUSION: To make better treatment-related decisions and achieve better outcomes based on the patient's values and wishes, it is necessary for the treatment team to increase its interactions and establish stronger communication with patients to make their expectations more realistic and help them understand the risks. They should also make efforts to increase patients' knowledge about the advantages and disadvantages of surgery and clarify what is important to them in decision-making
Phytotherapy in Burn Wound Healing: A Review of Native Iranian Medicinal Plants
No full textStudies have shown that burn wounds are one of the most severe forms of trauma which may cause disability, morbidity and mortality, stupendous hospital costs, and emotional disturbance. In spite of the therapeutic effects of synthetic drugs, due to their unwanted side effects, the tendency of people to use these drugs has been decreasing, contrary to the use of natural origin drugs. Medicinal plants that can be formulated to treat and repair the wound should be identified. Therefore, in this article a number of native Iranian medicinal plants that have been studied and their healing effects on burn wounds have been reported are discussed. In this review article, the keywords medicinal plants, burn, burn wound repair, burn wound and Iran were used to search for relevant articles indexed in databases such as IranMedex, Scientific Information Database, Google Scholar, Scopus, Institute for Scientific Information, Web of Science and PubMed. Based on the results, the medicinal plants Aloe vera (L.) Burm.f., Matricaria chamomilla L, Quercus brantii Lindl., Cydonia oblonga Mill., Scrophularia striata, Camellia sinensis (L.) Kuntze, Portulaca oleracea L, Cinnamomum zeylanicum Blume, Achillea talagonica Boiss., Olea europaea L., Hypericum perforatum L., Cucurbita pepo L., Teucrium polium L., Myrtus communis, Brassica oleracea L., Plantago major L., Malva sylvestris L., Arnebia euchroma (Royle) I.M.Johnst., Cucurbita moschata Duchesne, Achillea millefolium L., Lythrum salicaria L., Crocus sativus L. and Allium sativum L. are some of the most important herbal remedies to repair burn wounds. According to the various researches on the medicinal plants, the anti-inflammatory, antimicrobial and antimicrobial effects of these plants have been scientifically demonstrated, which has led to information that can be used to produce antimicrobial drugs for infectious and burn wounds. © 2023, Islamic Azad University. All rights reserved
Standard Triple Therapy as a Remedy for Treatment of Helicobacter pylo-ri Infection: A Systematic Review and Meta-analysis of Randomized Clinical Trials
No full textBackground: H. pylori infection, one of the most prevalent infectious diseases, can cause severe health problems. Therefore, it seems to be crucial to effectively counter the H. pylori infection with a well-tolerated eradication regimen. However, since the discovery of H. pylori, the optimal treatment for this disease is still unclear and remains controversial. Objectives: The present study aims to estimate the efficacy of standard triple therapy for eradicating H. pylori by systematic review and meta-analysis. Methods: We identified randomized clinical trials RCTs involving triple therapy PPIAC/M Omeprazole, Amoxicillin, and Clarithromycin/Metronidazole in the first-line treatment of H. pylori infection and reported eradication rate through electronic and manual searches in PubMed, ISI, EM-BASE, the Cochrane Central Register, and Scopus databases. Data were analyzed using the random effect model, and the Cochrane Q test and I2 statistics were used to assess heterogeneity. Statistical analyses were performed using STATA version 12. Results: Forty-seven RCTs PPIAC: 40 RCTs and PPIAM: 7 RCTs with 4,938 patients selected as el-igible for the final analysis. Per-protocol eradication rate was 80% 95% CI: 74-84 and 80% 95% CI: 73-87 for PPIAC and PPIAM regimens, respectively. The eradication rate for PPIAC and PPIAM regimens was 83% 95% CI: 70%-95% and 83% 95% CI: 75%-90% and also 77% 95% CI: 68%-88% and 78% 95% CI: 69%-88%, respectively. Based on different treatment durations, the pooled estimates of PP per-protocol analysis treatment outcomes were found the highest in 14-day treatment in both regimens. Conclusion: Standard triple therapy PPIAC/M is recommended to be an effective and safe regimen, although adequate data are not available to suggest PPIAC/M as the first-line therapy for H. Pylori in-fection. Interestingly, our analysis demonstrated that PPIAC/M regimens were more effective in Asian than European populations. © 2023 Bentham Science Publishers
Prognostic significance of chest CT severity score in mortality prediction of COVID-19 patients, a machine learning study
No full textBackgroundThe high mortality rate of COVID-19 makes it necessary to seek early identification of high-risk patients with poor prognoses. Although the association between CT-SS and mortality of COVID-19 patients was reported, its prognosis significance in combination with other prognostic parameters was not evaluated yet.MethodsThis retrospective single-center study reviewed a total of 6854 suspected patients referred to Imam Khomeini hospital, Ilam city, west of Iran, from February 9, 2020 to December 20, 2020. The prognostic performances of k-Nearest Neighbors (kNN), Multilayer Perceptron (MLP), Support Vector Machine (SVM), and J48 decision tree algorithms were evaluated based on the most important and relevant predictors. The metrics derived from the confusion matrix were used to determine the performance of the ML models.ResultsAfter applying exclusion criteria, 815 hospitalized cases were entered into the study. Of these, 447(54.85) were male and the mean (+/- SD) age of participants was 57.22(+/- 16.76) years. The results showed that the performances of the ML algorithms were improved when they are fed by the dataset with CT-SS data. The kNN model with an accuracy of 94.1, sensitivity of 100. 0, precision of 89.5, specificity of 88.3, and AUC around 97.2 had the best performance among the other three ML techniques.ConclusionsThe integration of CT-SS data with demographics, risk factors, clinical manifestations, and laboratory parameters improved the prognostic performances of the ML algorithms. An ML model with a comprehensive collection of predictors could identify high-risk patients more efficiently and lead to the optimal use of hospital resources
Bosentan for high-risk outpatients with COVID-19 infection: a randomized, double blind, placebo-controlled trial
No full textBackground The endothelium is supposedly activated and damaged in COVID-19 because of endothelin-1 over secretion. This study evaluates the effect of bosentan as an endothelin receptor blocker on the progression of disease in high-risk outpatients with COVID-19 infection.Methods From 15 December 2021 to 15 May 2022, high-risk outpatients were randomly assigned to receive bosentan, 62.5 mg or placebo twice daily from enrollment for 30 days. Both groups received standard medical treatment too. On day 30 of the trial, the patients underwent complete doppler ultrasound of the lower extremities to detect asymptomatic thromboembolic events. The primary outcome in this study was hospitalization or death from any cause within the first 15 days. Secondary outcomes included thromboembolic events, hospital-free days and death from any cause within 30 days after randomization (IRCT.ir, IRCT20211203053263N1). Findings Basal characteristics of the two groups were similar. Primary outcomes occurred in 3 (2.3) of the 129 patients in the bosentan group versus 15 (11.5) of the 130 patients in the placebo group risk difference: -9.2% (95% CI: -15.3 to -3.1), P = 0.006. Median hospital-free days was significantly higher in the bosentan group (P = 0.004). A total of three deaths occurred and all were in the control group. Bosentan was associated with a nonsignificant reduction in mortality compared with placebo (P = 0.24). Thromboembolic events occurred in one (1%) of 97 patients in the bosentan group versus nine (8.7%) of 104 patients in the placebo group within 30 days after randomization risk difference: -8.3% (95% CI: -14.4 to -2.2), P = 0.008. Interpretation Early administration of bosentan may prevent disease progression and thromboembolic events in high risk outpatients with COVID-19
Occult hepatitis B in Iranian blood donors, an overview of the challenges: A narrative review
No full textBackgroundOccult hepatitis B infection (OBI) is a transfusion-transmitted infection. Although, screening the hepatitis B virus among blood donors can play an important role in increasing the health of blood products, OBI screening in blood transfusion centers is still a challenge. This review study aimed to appraise the challenges of OBI screening and its associated do's and don'ts in blood transfusion centers. MethodsIn this review study, a search was conducted on the electronic databases of PubMed, Web of Science, Scopus, Ovid, Irandoc, and Magiran from January 1996 to December 2020. Also, cross-sectional studies that determined the prevalence of OBI or anti-HBc were included in the study. In addition, studies with incomplete data on the prevalence of OBI were excluded. ResultsThe prevalence of OBI varies among Iranian blood donors. The rates reported by blood transfusion centers of Mashhad, Ahvaz, and Tehran were 0, and Isfahan, Shiraz, and Kerman were 0.9, 0.08, and 2.36, respectively. In areas with high prevalence of hepatitis B virus, OBI screening only by anti-HBc test led to the exemption of blood donors from donating blood. Avoiding OBI screening also effected the risk of virus transmission to blood recipients. Plasma products had a higher risk (85) of virus transmission. ConclusionsDetermining an appropriate screening strategy based on prevalence status, the cost-effectiveness of screening tests, and the policies of each blood transfusion center is essential
Long non-coding RNAs and gastric cancer: An update of potential biomarkers and therapeutic applications
No full textThe frequent metastasis of gastric cancer (GC) complicates the cure and therefore the development of effective diagnostic and therapeutic approaches is urgently necessary. In recent years, lncRNA has emerged as a drug target in the treatment of GC, particularly in the areas of cancer immunity, cancer metabolism, and cancer metastasis. This has led to the demonstration of the importance of these RNAs as prognostic, diagnostic and therapeutic agents. In this review, we provide an overview of the biological activities of lncRNAs in GC devel-opment and update the latest pathological activities, prognostic and diagnostic strategies, and therapeutic op-tions for GC-related lncRNAs
Post-traumatic stress disorder among COVID-19-affected high-risk cardiac patients
No full textBackground During the first coronavirus disease 2019 (COVID-19) wave there was a high prevalence of mental health impairments and post-traumatic stress disorder (PTSD), particularly in patients with comorbid cardiac diseases. Methods During waves 2-5, all hospitalized patients with cardiac problems and suspected COVID-19 were eligible to participate in this study. Results The prevalence of PTSD was 31.4 (n=48) in 153 participants. No age- and gender-related differences for PTSD were found. Conclusions The prevalence is lower than during the first wave but higher than in patients reported in other studies who were isolated at home. Routine mental health assessments are strongly recommended for patients at risk
Antileishmanial effects and drugability characteristics of a heterocyclic copper complex: An in silico, in vitro and molecular study
No full textLeishmaniasis caused by the protozoan Leishmania presents a severe illness, principally in tropical and subtropical areas. Antileishmanial metal complexes, like Glucantime (R) with proven activity, are routinely studied to probe their potency. We investigated the effects of a Cu (II) homoleptic complex coordinated by two dimethylbipyridine ligands against Leishmania major stages in silico and in vitro. The affinity of this heterocyclic Cu (II) complex (CuDMBP) towards a parasitic metacaspase was studied by molecular docking. Key pharmacokinetic and pharmacodynamic properties of the complex were predicted using three web-based tools. CuDMBP was tested for in vitro antileishmanial activities using MTT assay, model murine macrophages, flow cytometry, and quantitative real-time polymerase chain reaction (qPCR). Molecular docking confirmed the tendency between the target macromolecule and the complex. ADMET evaluations highlighted CuDMBP's key pharmacological features, including P-glycoprotein-associated GI absorption and lack of trans-BBB permeability. MTT showed significant inhibitory effects against promastigotes. CuDMBP significantly increased the level of cellular IL-12 expression (p 0.05). It decreased the expression of IL-10 significantly (p < 0.05). Findings demonstrated that CuDMBP deserves to be introduced as a leishmanicidal candidate provided further studies are carried out