Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis.

BACKGROUND: This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers. METHODS: A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots. RESULTS: Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA's performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation. CONCLUSION: This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.

COVID-19-associated encephalitis or Creutzfeldt-Jakob disease: a case report.

Background: Accurate diagnosis and management of patients with rapidly progressive dementia may be challenging during the COVID-19 pandemic, which has negatively influenced the diagnostic performances, medical resource allocation and routine care for all non-COVID-19 diseases. Case presentation: We herein present a case of a 57-year-old male with rapidly progressive cognitive decline, headache, diplopia, myalgia, unsteady gait, aggression, depression, insomnia, hallucinations and delusions of persecution. COVID-19-associated encephalitis was briefly considered as a differential diagnosis. However, this hypothesis was rejected upon further investigation. A final diagnosis of sporadic Creutzfeldt-Jakob disease was made. Conclusion: A timely and accurate diagnosis of Creutzfeldt-Jakob disease gives patients and their families the chance to receive a good standard of healthcare and avoid extensive evaluations for other conditions.

Extensive Acute Lower Extremity Arterial Thrombosis: A Major Thrombus Formation Caused by COVID-19.

Acute thromboembolic events have been frequently reported in patients with coronavirus disease 2019 (COVID-19) due to an increase in the coagulation system activity and endothelial dysfunction. This report describes a patient with COVID-19 who initially reported respiratory symptoms and developed acute lower limb ischemia secondary to extensive macrovascular arterial thrombosis, which was treated with thrombectomy. The development of such extensive arterial thrombosis with anticoagulants at therapeutic doses is a new sign of increased viral pathogenicity, and it is necessary to develop and apply updated prophylaxis protocols for thrombosis in these patients.

Efficacy of different doses of ketamine as a bolus in major depressive disorder.

BACKGROUND: Major depressive disorder is a severe, heterogeneous, common medical illness and a leading cause of disability throughout the world that poses a significant public health issue. Previous studies have shown rapid antidepressant effects following a single administration of ketamine. This study aimed to assess the impact of route of administration and dose of ketamine for the reduction of depressive symptoms and compare the effects of different doses and methods. METHODS: A double-blind clinical controlled trial was done on 100 patients with a primary diagnosis of major depressive disorder who were assigned into two groups of 50 subjects at a dose of 0.5 mg/kg and 0.75 mg/kg ketamine and each group was divided into two groups of 25 subjects following a single dose of intravenous bolus and infusion of ketamine. The patient's severity of depression was evaluated with Hamillton Depression Rating Scale and Beck Depression Inventory scores after 2 days, 7 days, 30 days and 60 days of ketamine administration, then the results were compared between groups. RESULTS: According to Hamilton and Beck score, the treatment response in investigated patients was 64% and 60%, respectively. CONCLUSIONS: These data suggest that ketamine effect is related to drug dose and type of administration. The dose of 0.75 mg/kg of ketamine is more effective than 0.5 mg/kg and a bolus injection of low-dose ketamine (0.5 mg/kg) is more effective than infusion and in high-dose ketamine (0.75 mg/kg), there was no difference between the methods of drug administration.