Evaluation of early complications, outcome, and mortality in Coronavirus Disease 2019 (COVID-19) infection in patients who underwent orthopedic surgery.

BACKGROUND: A higher mortality and morbidity rate has been reported in COVID-19 patients undergoing surgery. To reduce the morbidity and mortality rate in COVID-19 patients undergoing orthopedic procedures, we aimed to increase the threshold for surgical planning. METHODS: In a prospective cohort study, COVID-19 patients who underwent elective or emergent orthopedic surgery in three orthopedic surgery centers from February 2020 to September 2020 were included. In this period, 6751 patients were scheduled for orthopedic surgery. To increase surgical threshold planning, all patients with grade 5 of the American Society of Anesthesiologists (ASA) classification and patients with COVID-19 related moderate to severe pulmonary involvement were identified as high-risk patients and were excluded. RESULTS: 35 deaths occurred during the study. The frequency of deaths was significantly higher in patients with COVID-19, 6 (9.4%) than patients without COVID-19, 29 (0. 43%). The average hospitalization stay was 12.8 ± 12.1 days. The odds ratio (OR) for death was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 8.13, Confidence interval 95% (CI95%) (5.02-11.25), P: 0.001]. Four (6.3%) COVID-19-associated complications were recorded in this series that all were respiratory failure requiring unexpected postoperative ventilation. Twenty surgical complications (31.3%) were recorded. The odds ratio for ICU admission was significantly higher in patients with COVID-19 than patients without COVID-19. [OR: 5.46, CI 95% (2.68-8.68), P: 0.001]. CONCLUSIONS: An increased threshold for orthopedic surgery is suggested for COVID-19 patients with a mortality rate of 9.3%, which is less than the mortality rate in other studies. Level of evidence III.

Five-Year Recurrence Rate and the Predictors Following Stroke in the Mashhad Stroke Incidence Study: A Population-Based Cohort Study of Stroke in the Middle East.

BACKGROUND: Little is known about the risk of recurrent stroke in low- and middle-income countries. This study was designed to identify the long-term risk of stroke recurrence and its associated factors. METHODS: From November 21, 2006 for a period of 1 year, 624 patients with first-ever stroke (FES) were registered from the residents of 3 neighborhoods in Mashhad, Iran. Patients were followed up for the next 5 years after the index event for any stroke recurrence or death. We used competing risk analysis and cause-specific Cox proportional hazard models to estimate the cumulative incidence of stroke recurrence and its associated variables. RESULTS: The cumulative incidence of stroke recurrence was 14.5% by the end of 5 years, with the largest rate during the first year after FES (5.6%). Only advanced age (adjusted hazard ratio [HR] 1.02; 95% CI 1.01-1.04) and severe stroke (National Institutes of Health Stroke Scale score >20; HR 2.23; 95% CI 1.05-4.74) were independently associated with an increased risk of 5-year recurrence. Case fatality at 30 days after first recurrent stroke was 43.2%, which was significantly greater than the case fatality at 30 days after FES of 24.7% (p = 0.001). CONCLUSION: A substantial number of our patients either died or had stroke recurrences during the study period. Advanced age and the severity of the index stroke significantly increased the risk of recurrence. This is an important finding for health policy makers and for designing preventive strategies in people surviving their stroke.

Five-Year Case Fatality Following First-Ever Stroke in the Mashhad Stroke Incidence Study: A Population-Based Study of Stroke in the Middle East.

BACKGROUND AND PURPOSE: Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors. METHODS: During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model. RESULTS: The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality. CONCLUSIONS: Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.

Diagnostic Accuracy of Multiple MRI Parameters in Dealing with Incidental Thyroid Nodules.

Background: Different MRI parameters have been studied for evaluating thyroid nodules. Diffusion-weighted imaging (DWI) and T2 imaging sequences with considerable efficacy in evaluating soft tissue tumors merit further assessment for thyroid nodule investigation. Method: We evaluated incidental thyroid nodules (ITNs) reported on head and neck MRI studies. The T2 signal intensity (SI), T2 signal intensity ratio (SIR), Z value, and apparent diffusion coefficient (ADC) values of the thyroid nodule were obtained for every patient. The patients were referred to the radiology department for the thyroid nodule ultrasound study. Finally, 33 participants (37 thyroid nodules) who were scheduled for fine needle aspiration and cytology (FNAC) were enrolled. Regarding the FNAC results, the nodules were divided into malignant and benign groups. The two groups' MRI parameters were compared using a two samples independent t test, and the cutoff values were estimated by analyzing the receiver operating characteristics plot. Results: The T2 signal intensities, SIR, Z values, and ADC values were significantly higher in the benign group than malignant. The cutoff points of 230 (AUC = 0.759), 3.38 (AUC = 0.754), 37 (AUC = 0.759), and 1.73 (AUC = .690) were obtained for T2 values, SIR, Z values, and ADC values, respectively. Conclusion: T2, SIR, Z, and ADC values are reliable for discriminating benign from malignant ITNs. However, further studies with a larger sample size are needed to provide more accurate mean values, identify outliers, and reduce confounding factors and bias.

Prediction of thyroid nodule malignancy using thyroid imaging reporting and data system (TIRADS) and nodule size.

OBJECTIVES: Thyroid imaging reporting and data system (TIRADS) is a combination of ultrasonographic features developed to help physicians in predicting the malignancy risk of thyroid nodules based on sonographic characteristics. Thyroid nodule size is another factor in determining whether a nodule is malignant. The aim of this study was detecting the predictive value of TIRADS and nodule size based on Bethesda classification in prognostication of malignancy. METHODS: This was a cross-sectional study of 239 patients with thyroid nodules. The patients underwent ultrasonography using TIRADS classification and FNA biopsy based on Bethesda categorization. The results were analyzed using SPSS with the cut off points and predictive values measured. RESULTS: TIRADS ≥4 could detect malignant nodules with a sensitivity of 91.67% and specificity of 52.8%. An inverse relationship was observed between nodule size and malignancy risk and cutoff point of 12 mm was found for detecting malignant nodules. CONCLUSIONS: Thyroid nodules with TIRADS 4 and 5 and diameter lower than 12 mm, are highly suspicious for malignancy and should be considered as indications for fine needle aspiration biopsy. ADVANCES IN KNOWLEDGE: The study suggests TIRADS and thyroid nodule size as sensitive predictors of malignancy.

One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: a population-based study of stroke in Iran.

BACKGROUND: In developing countries, there are few comprehensive studies of mortality following stroke. AIMS AND/OR HYPOTHESIS: We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran. METHODS: Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin. RESULTS: A total of 226 (34·3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30·6% following ischemic stroke and 53·0% following hemorrhagic stroke (55·8% after intracerebral hemorrhage and 35·7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17·7% with ischemic and 43·0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3·99; 95% confidence interval 1·90-8·37], age (HR 1·05; 95% confidence interval 1·03-1·08), previous transient ischemic attack (HR 2·45; 95% confidence interval 1·00-5·99), and National Institutes of Health Stroke Scale on admission (HR 1·14; 95% confidence interval 1·10-1·17). CONCLUSION: Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.

Characterization of a novel nanobiomaterial fabricated from HA, TiO2 and Al2O3 powders: an in vitro study.

For the purposes of this study, hydroxyapatite (HA)-Al2O3-TiO2 nanobiomaterial with significant surface properties and biocompatibility capable of forming surface apatite was fabricated by cold-press and sintering method. Samples were examined for hardness and porosity. The results showed that in terms of hardness and porosity, sample A (50 wt% TiO2-30 wt% HA-20 wt% Al2O3) was superior to sample B (30 wt% TiO2-50 wt% HA-20 wt% Al2O3), and also the density of nanobiomaterial was close to natural bone density. Bioactivity of the samples in a simulated body fluid (SBF) was investigated. Then, after immersing the samples in SBF solution for a period of 7 days, sample B exhibited greater ability to form calcium phosphate compounds on the surface as compared to sample A. In addition, in vitro studies showed that MG-67 osteoblast-like cells attached and spread on the samples surface. The results showed that cells proliferated in greater numbers on the sample B as compared to the sample A. Finally, X-ray diffraction, scanning electron microscopy, and energy-dispersive X-ray analysis were performed to identify phases, study microstructure, and determine percentage of elements, respectively. The results revealed that considering their different properties, both nanobiomaterials can be used in medical applications.

Clinical features of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) in northeast Iran.

This study aimed to introduce clinical manifestations of patients in northeast Iran with HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and describe the epidemiological features, as well as risk factors for HTLV-1 infection. This is a cross-sectional study of HTLV-1 infected cases and HAM/TSP patients referred by outpatient neurology clinics as well as Mashhad Blood Transfusion Center from 2005 to 2010. The study comprises 513 cases, including 358 healthy carriers (HCs) and 145 HAM/TSP patients. The majority of carriers were male (73.5%), whereas 67.6% of HAM/TSP sufferers were female (P < 0.001). The mean age of HAM/TSP patients and HCs was 45.9 ± 13.6 and 39.5 ± 11.58 years, respectively (P < 0.001). The history of transfusion, surgery, hospitalization and cupping was observed in a significant greater number of HAM/TSP patients than the HCs (P < 0.001, P < 0.001, P < 0.001 and P = 0.029, respectively). Gait disturbance was the most common complaint in HAM/TSP patients (72.4%). This research develops an HTLV-1 data registry in an endemic area such as Mashhad which can serve useful purposes, including evaluation of clinical and laboratory characteristics of HAM/TSP patients and epidemiological data of HTLV-1-infected cases.

The impact of interferon-alpha treatment on clinical and immunovirological aspects of HTLV-1-associated myelopathy in northeast of Iran.

Human T-lymphotropic virus type 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a chronic inflammatory myelopathy. The pathophysiology of HAM/TSP is not yet fully understood; therefore, effective therapy remains a challenging issue. This study was designed to evaluate the efficacy of interferon-alpha (IFN-α) in HAM/TSP patients in the Northeast of Iran. Forty-nine patients with a definite diagnosis of HAM/TSP were enrolled in this clinical trial. For six months, the patients received three million international units of subcutaneous IFN-α-2b per each injection. The dose regimen was daily injection for the first month, three times administration per week for the months 2 and 3, twice weekly injection for the months 4 and 5 and weekly injection for the sixth month. The clinical and laboratory responses were evaluated based on neurologic examinations and immunovirological markers. IFN-α had significant but temporary effect on the motor and urinary functions of the patients. Comparing to the baseline values, proviral load was significantly decreased one month after treatment in responders (495.20±306.87 to 262.69±219.24 p=0.02) and non-responders (624.86±261.90 to 428.28±259.88 p=0.03). Anti-HTLV-1 antibody titers were significantly decreased among responders (1152.1±200.5 to 511.6±98.2 p=0.009) and non-responders (1280.1±368.1 to 537.6±187 p=0.007). Flow cytometry showed no significant changes in CD4, CD8, CD4CD25 and CD16CD56 counts with IFN-α. The positive impact of IFN-α was observed during the treatment period with significant effects on some clinical aspects of HAM/TSP.