Exploring the efficacy and safety of cannabidiol in individuals with epilepsy: an umbrella review of meta-analyses and systematic reviews.

BACKGROUND: Epilepsy ranks among the most prevalent neurological conditions worldwide. Cannabidiol (CBD) has received authorization for epilepsy treatment, yet utilizing CBD is linked to a variety of adverse events (AEs). This umbrella review aims to explore risk and frequency of AEs in epilepsy patients undergoing treatment with CBD. METHODS: International electronic databases comprising Scopus, PubMed, and Web of Science were extensively searched from the most ancient data accessible until May 2024. In line with fundamental principle of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), this umbrella review was executed. RStudio software version 2023.03.1 along with R software 4.3.2 was used for our statistical analyses. RESULTS: Thirteen meta-analyses and systematic reviews were included. CBD use in epileptic patients compared to controls can be meaningfully linked with 10.87% becoming seizure-free (RD: 10.87%, 95%CI: 2.39%, 19.34%; I2 = 80%). Compared to controls, a meaningful 73% increase in 50% or greater reduction in seizure frequency was observed (RR: 1.73, 95%CI: 1.47, 2.03; I2 = 0%). In epileptic individuals who using CBD with the dosage of 20 mg/kg/d, a higher incidence of treatment withdrawal was detected (RR: 4.39, 95%CI: 2.46, 7.83; I2 = 0%). CONCLUSION: In this umbrella review of meta-analyses and systematic reviews, CBD use in epileptic patients was linked to an increased risk of ample AEs. Further research, specifically targeting various epilepsy categories, is essential to fully understand the effectiveness and potential side effects of CBD across different epilepsy forms.

Effects of Coffee and Tea Consumption on Glioma Risk: An Umbrella Review of Systematic Reviews and Meta-analyses.

BACKGROUND: Coffee and tea are considered to have some effects on glioma as one of the most prevalent intracranial malignant tumors in adults. However, the precise effect of coffee and tea consumption on glioma is not obvious. This umbrella review aimed to evaluate the impact of tea and coffee consumption on glioma risk. METHODS: Three online databases containing Scopus, Web of Science, and PubMed were thoroughly searched from the beginning to February 23, 2024 with no language constraints. Relying on I2 and Q statistics, a random-effect model or a fixed-effect model was applied. The PICO structure was followed as Population (Patients with glioma), Intervention (Coffee and tea consumption), Comparison (Standard treatment or placebo), and Outcome (Risk of glioma). RESULTS: Totally, seven meta-analyses and systematic reviews contain 23591 patients were included in this umbrella review. Coffee and tea consumption led to significant 15% and 16% reductions in glioma risk, respectively (RR= 0.85; 95% CI: 0.74, 0.98; RR= 0.84; 95% CI: 0.79, 0.89). The results did not change after subgroup analyses. CONCLUSION: This umbrella review revealed that the coffee and tea consumption may decrease the glioma risk. Consumption of tea and coffee may be considered as dietary strategies against glioma. PROSPERO REGISTRATION CODE: CRD42024521525.

Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study.

BACKGROUND: Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. METHODS: This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. RESULTS: 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. CONCLUSIONS: It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Screw Stimulation Thresholds for Neuromonitoring in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion (OLLIF): A Correlational Study.

INTRODUCTION: This study presents findings from an investigation into the correlation of neuromonitoring techniques in minimally invasive lumbar fusions and their open counterparts regarding acceptable thresholds for screw stimulation. The threshold for acceptable stimulation value for open surgery has been established. The study compared acceptable thresholds for open pedicle screws where there is more connection between the screw and the soft tissue. METHODS: The neuromonitoring data of 17 patients who underwent oblique lateral lumbar interbody fusion (OLLIF) procedures between September 2023 to May 2024 were reviewed. Neuromonitoring was conducted throughout surgeries, recording stimulation thresholds for pedicle screws insulated and uninsulated, to simulate the environment of a screw during open and minimally invasive surgery respectively. Patients' BMI was also collected for potential correlation analysis. RESULTS: Results indicate a discernible correlation between stimulation thresholds in open and minimally invasive surgeries, but no definitive correlation with BMI due to sample size limitations. Though a significant correlation between the two stimulating styles is apparent, there is a good correlation to suggest what threshold should determine a standard stimulation threshold for minimally invasive surgeries. CONCLUSION: The study emphasizes the need for refined neuromonitoring strategies in minimally invasive spinal fusion (MISF) surgeries to ensure patient safety and surgical effectiveness. Further research with larger cohorts is recommended to establish optimized protocols that have a clearly defined amplitude for MISF thresholds.

The Link Between Vitamin D and the Risk of Aneurysmal Subarachnoid Hemorrhage: A Systematic Review.

BACKGROUND: Vitamin D (VD) is one of the fat-soluble vitamins proposed to be associated with aSAH. According to the clinical evidence, this investigation explores the link between VD concentrations and clinical outcomes in aSAH patients. METHODS: This systematic review was executed based on the PRISMA 2020 statement. Observational studies that evaluated the serum VD concentrations in aSAH patients were considered as included articles. Review articles, case reports, letters, commentaries, non-English papers, and conference abstracts were excluded. Five online databases-Scopus, PubMed, Web of Science, Embase, and Ovid-were searched up to November 23, 2023, and based on the Newcastle-Ottawa Scale, the risk of bias was assessed. RESULTS: Out of 383 articles initially identified, eventually 7 studies were included in the systematic review. These studies were conducted between 2016 and 2023 and included a total of 333,907 patients. The varying results suggest that VD may impact clinical outcomes in aSAH patients. CONCLUSIONS: This study highlights the complex association between VD concentration and the risk of aSAH. The observed inconsistencies in study outcomes suggest that the relationship between VD and aSAH is multifaceted and may be influenced by various factors, including study population, geographical location, and methodological approach.

Shining a Light on Trace Elements: A Systematic Review and Meta-analysis of Serum Concentrations in Febrile seizure.

Febrile seizures (FS) are a common occurrence in pediatric patients and are typically triggered by high fevers above 100.4°F (38°C), often associated with viral or bacterial infections such as respiratory or gastrointestinal infections. Recent research suggests that the serum concentration of trace elements may play a role in the occurrence of FS. This study aimed to assess the association between serum levels of trace elements and FS in pediatric patients. A comprehensive search of four databases, including Scopus, Web of Science, PubMed, and Google Scholar, was conducted up to February 2024. The study followed the PICO structure, focusing on the Population (pediatric patients with FS), Intervention (serum concentrations of selenium, zinc, magnesium, and copper), Comparison (with or without controls), and Outcome (occurrence of FS). The methodological quality of the included observational studies was assessed using the Newcastle-Ottawa Scale (NOS) tool. Out of a total of 168 papers, 37 met the inclusion criteria for this meta-analysis, covering studies published between 2018 and 2023. Lower serum zinc levels were observed in pediatric patients with FS compared to control groups (SMD: -1.25, 95% CI: -1.47, -1.03). Conversely, higher serum copper levels were found in control groups compared to those with FS (SMD: 0.43, 95% CI: 0.04, 0.82). Additionally, lower serum magnesium levels were detected in the FS group compared to controls (SMD: -0.76, 95% CI: -1.57, 0.05), while serum selenium levels were approximately two times lower in the FS group than in controls (SMD: -2.23, 95% CI: -2.76, -1.70). Our meta-analysis suggests that pediatric patients with FS have lower serum concentrations of trace elements compared to controls. Further research is warranted to elucidate the potential role of trace elements in the pathogenesis of FS. This meta-analysis and systematic review was registered in the International prospective register of systematic reviews (PROSPERO ID: CRD42024519163). Registry URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024519163 registry number: CRD42024519163.

Deep Learning for Generalized EEG Seizure Detection after Hypoxia-Ischemia-Preclinical Validation.

Brain maturity and many clinical treatments such as therapeutic hypothermia (TH) can significantly influence the morphology of neonatal EEG seizures after hypoxia-ischemia (HI), and so there is a need for generalized automatic seizure identification. This study validates efficacy of advanced deep-learning pattern classifiers based on a convolutional neural network (CNN) for seizure detection after HI in fetal sheep and determines the effects of maturation and brain cooling on their accuracy. The cohorts included HI-normothermia term (n = 7), HI-hypothermia term (n = 14), sham-normothermia term (n = 5), and HI-normothermia preterm (n = 14) groups, with a total of >17,300 h of recordings. Algorithms were trained and tested using leave-one-out cross-validation and k-fold cross-validation approaches. The accuracy of the term-trained seizure detectors was consistently excellent for HI-normothermia preterm data (accuracy = 99.5%, area under curve (AUC) = 99.2%). Conversely, when the HI-normothermia preterm data were used in training, the performance on HI-normothermia term and HI-hypothermia term data fell (accuracy = 98.6%, AUC = 96.5% and accuracy = 96.9%, AUC = 89.6%, respectively). Findings suggest that HI-normothermia preterm seizures do not contain all the spectral features seen at term. Nevertheless, an average 5-fold cross-validated accuracy of 99.7% (AUC = 99.4%) was achieved from all seizure detectors. This significant advancement highlights the reliability of the proposed deep-learning algorithms in identifying clinically translatable post-HI stereotypic seizures in 256Hz recordings, regardless of maturity and with minimal impact from hypothermia.

2D Wavelet-Scalogram Deep-Learning for Seizures Pattern Identification in the Post-Hypoxic-Ischemic EEG of Preterm Fetal Sheep.

Neonatal seizures after an hypoxic-ischemic (HI) event in preterm newborns can contribute to neural injury and cause impaired brain development. Preterm neonatal seizures are often not detected or their occurrence underestimated. Therefore, there is a need to improve knowledge about preterm seizures that can help establish diagnostic tools for accurate identification of seizures and for determining morphological differences. We have previously shown the superior utility of deep-learning algorithms for the accurate identification and quantification of post-HI microscale epileptiform transients (e.g., gamma spikes and sharp waves) in preterm fetal sheep models; before the irreversible secondary phase of cerebral energy failure starts by the bursts of high-amplitude stereotypic evolving seizures (HAS) in the signal. We have previously developed successful deep-learning algorithms that accurately identify and quantify the micro-scale transients, during the latent phase. Building up on our deep-learning strategies, this work introduces a real-time deep-learning-based pattern fusion approach to identify HAS in the 256Hz sampled post-HI data from our preterm fetuses. Here, for the first time, we propose a 17-layer deep convolutional neural network (CNN) classifier fed with 2D wavelet-scalogram (WS) images of the EEG patterns for accurate seizure identification. The WS-CNN classifier was cross-validated over 1812 manually annotated EEG segments during ~6 to 48 hours post-HI recordings. The classifier accurately recognized HAS patterns with 97.19% overall accuracy (AUC = 0.96).Clinical relevance-The promising results from this preliminary work indicate the ability of the proposed WS-CNN pattern classifier to identify HI-related seizures in the neonatal preterm brain using 256Hz EEG; the frequency commonly used clinically for data collection.

Atlas-Free Automatic Segmentation of Sheep Brain MRI.

Automated 3D brain segmentation methods have been shown to produce fast, reliable, and reproducible segmentations from magnetic resonance imaging (MRI) sequences for the anatomical structures of the human brain. Despite the extensive experimental research utility of large animal species such as the sheep, there is limited literature on the segmentation of their brains relative to that of humans. The availability of automatic segmentation algorithms for animal brain models can have significant impact for experimental explorations, such as treatment planning and studying brain injuries. The neuroanatomical similarities in size and structure between sheep and humans, plus their long lifespan and docility, make them an ideal animal model for investigating automatic segmentation methods.This work, for the first time, proposes an atlas-free fully automatic sheep brain segmentation tool that only requires structural MR images (T1-MPRAGE images) to segment the entire sheep brain in less than one minute. We trained a convolutional neural network (CNN) model - namely a four-layer U-Net - on data from eleven adult sheep brains (training and validation: 8 sheep, testing: 3 sheep), with a high overall Dice overlap score of 93.7%.Clinical relevance- Upon future validation on larger datasets, our atlas-free automatic segmentation tool can have clinical utility and contribute towards developing robust and fully automatic segmentation tools which could compete with atlas-based tools currently available.

Deep-Learning Markerless Tracking of Infant General Movements using Standard Video Recordings.

Monitoring spontaneous General Movements (GM) of infants 6-20 weeks post-term age is a reliable tool to assess the quality of neurodevelopment in early infancy. Abnormal or absent GMs are reliable prognostic indicators of whether an infant is at risk of developing neurological impairments and disorders such as cerebral palsy (CP). Therapeutic interventions are most effective at improving neuromuscular outcomes if administered in early infancy. Current clinical protocols require trained assessors to rate videos of infant movements, a time-intensive task. This work proposes a simple, inexpensive, and broadly applicable markerless pose-estimation approach for automatic infant movement tracking using conventional video recordings from handheld devices (e.g., tablets and mobile phones). We leverage the enhanced capabilities of deep-learning technology in image processing to identify 12 anatomical locations (3 per limb) in each video frame, tracking a baby's natural movement throughout the recordings. We validate the capability of resnet152 and a mobile-net-v2-1 to identify body-parts in unseen frames from a full-term male infant, using a novel automatic unsupervised approach that fuses likelihood outputs of a Kalman filter and the deep-nets. Both deep-net models were found to perform very well in the identification of anatomical locations in the unseen data with high average Percentage of Correct Keypoints (aPCK) performances of >99.65% across all locations.Clinical relevance-Results of this research confirm the feasibility of a low-cost and publicly accessible technology to automatically track infants' GMs and diagnose those at higher risk of developing neurological conditions early, when clinical interventions are most effective.

Simultaneous acute portal vein thrombosis and ST elevation myocardial infarction in a Covid-19 patient - Case report.

Background: Covid-19 infected patients without any risk factors and family history of a thrombotic event can be still at risks of developing thrombotic and/or other Covid-19-related complications, and therefore, there is a substantial need to study such cases. Case presentation: In this study, we present a 60-years-old Covid-19 patient with mild symptoms who was admitted to the hospital with simultaneous arterial and venous thrombotic event, with chief complaint of chest pain and vague abdominal pain. The patient was diagnosed with Covid-19 two weeks before admission to the ICU. A 12-lead electrocardiogram revealed pathologic Q-wave ST-segment elevation and T-wave inversion in II, III, aVF, and T inversion in V5 and V6. Quantitative troponin was elevated which confirmed inferior ST-elevation MI. Abdominal color Doppler sonography and CT scan with contrast demonstrated an absent flow in the portal vein and thrombosis. A chest CT scan illustrated a normal pattern. We started IV unfractionated heparin (UFH), dual antiplatelet, beta-blocker, statin, intravenous nitrate, and angiotensin-converting enzyme inhibitor. Coronary angiography showed the right coronary artery was totally cut off at the proximal part.Here we report three main un-common characteristics associated with our patient compared to other similar studies. First, the thrombotic event in our case occurred without pulmonary involvement and the patient only had a flu-like symptom two weeks before admission. The second main difference is that the patient's arterial and venous thrombotic events had simultaneously happened, which is not common in most cases. Patient presented simultaneous portal vein thrombosis and recent ST-segment elevation Myocardial Infarction (MI). Finally, both MI and portal vein thrombosis symptoms were subtle and confusing, which could cause misdiagnosis. A post two-weeks color Doppler sonography follow-up showed portal vein thrombosis recanalization and myocardial perfusion scan had no viability and reversible ischemia in RCA territory. Conclusions: This report addresses that a cautious diagnosis of Covid-19 at the time of admission can play a vital role in preventing cardiovascular events; where even asymptomatic to mildly infected patients could be still at higher risks of developing clinical complications (e.g., thrombotic events).

Visual transformer and deep CNN prediction of high-risk COVID-19 infected patients using fusion of CT images and clinical data.

BACKGROUND: Despite the globally reducing hospitalization rates and the much lower risks of Covid-19 mortality, accurate diagnosis of the infection stage and prediction of outcomes are clinically of interest. Advanced current technology can facilitate automating the process and help identifying those who are at higher risks of developing severe illness. This work explores and represents deep-learning-based schemes for predicting clinical outcomes in Covid-19 infected patients, using Visual Transformer and Convolutional Neural Networks (CNNs), fed with 3D data fusion of CT scan images and patients' clinical data. METHODS: We report on the efficiency of Video Swin Transformers and several CNN models fed with fusion datasets and CT scans only vs. a set of conventional classifiers fed with patients' clinical data only. A relatively large clinical dataset from 380 Covid-19 diagnosed patients was used to train/test the models. RESULTS: Results show that the 3D Video Swin Transformers fed with the fusion datasets of 64 sectional CT scans + 67 clinical labels outperformed all other approaches for predicting outcomes in Covid-19-infected patients amongst all techniques (i.e., TPR = 0.95, FPR = 0.40, F0.5 score = 0.82, AUC = 0.77, Kappa = 0.6). CONCLUSIONS: We demonstrate how the utility of our proposed novel 3D data fusion approach through concatenating CT scan images with patients' clinical data can remarkably improve the performance of the models in predicting Covid-19 infection outcomes. SIGNIFICANCE: Findings indicate possibilities of predicting the severity of outcome using patients' CT images and clinical data collected at the time of admission to hospital.

Emergency medical services preparedness in mass casualty incidents: A systematic review.

OBJECTIVE: The role of emergency medical services (EMS) preparedness in mass casualty incidents (MCIs) is crucial. MCIs are increasing worldwide, and EMS must enhance preparedness for them. For this purpose, the main components of EMS preparedness should be identified. This study aimed to describe the components of EMS preparedness in response to MCIs. DESIGN AND SETTING: This systematic review was conducted based on the Preferred Reporting Item for Systematic Reviews and Meta-analyses guideline. The articles published from January 1970 to February 2022 were searched to discover the main components of EMS preparedness in MCIs. The electronic databases including PubMed, Cochrane Library, Scopus, Science Direct, and ProQuest were searched using predetermined keywords. Ten articles were selected and included in this review. RESULTS: After reviewing the articles, we identified the components of EMS preparedness in MCIs. Accordingly, 16 main components were extracted and classified into four categories, ie, individual improvement, group improvement, resources, and operations. CONCLUSION: MCIs are so complicated that they require adequate prehospital preparedness. This study described the components of EMS preparedness in MCIs. The authorities in EMS will benefit from this framework in planning and responding to MCIs.

Emergency medical services preparedness in mass casualty incidents: A qualitative study.

Background and Aims: The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. Methods: A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid-March 2023), using in-depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face-to-face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Results: Thirty-six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including "Strengthening management and organization," "individual and group empowerment," "capacity expansion," "technology and infrastructure development," and "operational response measures." Conclusion: Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Household Food Insecurity and Associated Factors among Iranian Patients with Esophageal and Gastric Cancers.

Background: Household food insecurity (HFI) which has still been one of the major global public health issues is related to adverse health outcomes in individuals. Therefore, this study aimed to determine the prevalence of HFI and its associated factors in Iranian patients with esophageal and gastric cancers. Methods: The data of this cross-sectional study was obtained from 315 patients with esophageal and gastric cancers who were selected from a gastrointestinal cancer-based cohort study conducted in Firoozgar hospital, in Tehran. Food insecurity (FI) was measured using the Iranian version of the HFI questionnaire that was completed by a trained interviewer. The multivariable logistic regression model was used to determine the independent association of each factor with HFI. A P value lower than 0.05 was considered statistically significant. Results: The mean±SD of participants' age was 63.2±12.6 years and 65.4% were men. Most of the patients (75.8%) suffered from gastric cancer and 24.2% from esophageal cancer. The overall prevalence of FI among participants' households was 35.2%. There was an independent significant association between wealth index (WI) and HFI after the use of the multivariable logistic regression model, in such a way that the odds of FI in the poorest, poor, moderate, and rich patients' households were respectively, 6.41, 5.05, 2.74 and 2.04 times higher compared with the richest households. Conclusion: More than a third of participants' households struggled with FI, which was found to have a higher prevalence in loweconomic households. Therefore, health policymakers should intervene in food-insecure households by developing, establishing, and implementing strategies and control programs to improve affordable food access.

Efficacy and Clinical Outcomes of Minimally Invasive Direct Thoracic Interbody Fusion: A Retrospective Analysis.

INTRODUCTION: A unique surgical approach - the minimally invasive direct interbody fusion (MIS-DTIF) - was previously introduced in our proof-of-concept study, which included four patients who underwent thoracic interbody fusion below the scapula at the T6/7 vertebral level. However, due to the novelty of this method, a report of associated operative parameters such as pain, function, and clinical outcomes from an expanded patient cohort was needed to assess the validity of our results. MATERIALS AND METHODS: Following IRB approval, data were analyzed retrospectively from electronic health records between 2014 and 2021. Inclusion criteria were patients ≥18 years old who underwent minimally invasive thoracic interbody fusion using the MIS-DTIF technique for at least one vertebral level. The primary outcomes included demographic/radiographic features (e.g., age). Secondary outcomes included perioperative clinical features (e.g., preoperative and ≥1-year final follow-up (FFU)). Tertiary outcomes included perioperative complications. Both preoperative and FFU patient-reported pain and functional outcomes (ODI scores) were analyzed using t-tests to establish significance.  Results: A total of 13 patients who underwent MIS-DTIF surgery were observed, with eight male patients and five female patients. The average age was 49.2 years, with an average BMI of 30.5 kg/m2. Of the surgeries included, the majority (69.23%) were 1-level thoracic vertebrae fusions - with 2-level fusions and ≥ 3-level fusions accounting for 15.38% and 15.38% of cases, respectively. The mean operative time was 58.9 ± 19.9 minutes, with an average fluoroscopy time of 285.7 ± 126.8 seconds and an average actual blood loss volume of 109.0 ± 79.0 mL. The average hospital length of stay was 1.1 (±1.7) days, and no clinically significant perioperative complications were observed in this patient cohort. The average follow-up period was 12.1 ± 9.6 months, with preoperative and FFU back pain visual analog scale (VAS) scores showing highly significant improvement (p<0.001). In addition to pain reduction, quality of life improvements was noted, with significant differences in some of the ODI domains between preoperative and FFU scores (p<0.05), as well as the overall total score between preoperative and FFU ODI assessment (p<0.001) - both of which reflect increased patient function and decreased disability. CONCLUSION: This study provides further evidence for the safety and efficacy of the MIS-DTIF approach for surgical management of symptomatically refractory patients with thoracic disc herniation or stenosis owing to degenerative disc disease or compression fractures. Additionally, the data gathered suggests that this minimally invasive procedure offers many clinical benefits, including less tissue damage, decreased intraoperative blood loss, shortened surgery time, and shortened hospital length of stay. Finally, in addition to significant pain intensity improvement, this study showed that treated patients highly benefited from 'sleeping' and 'return-to-work' domains and other ODI functional domains in activities of daily living (ADLs). More clinical studies are recommended in larger patient cohorts to ascertain the findings reported in this study.

Effectiveness of online practical education on vaccination training in the students of bachelor programs during the Covid-19 pandemic.

BACKGROUND: The importance of immunization and the necessity of achieving the goals of the immunization expansion plan and the critical role of undergraduate public health students in attaining these goals in the Covid-19 pandemic is evident. The present study aimed at investigating the effectiveness of using online educational videos on practical learning of vaccination in the apprenticeship stage during covid-19 pandemic: a randomized controlled trial. MATERIAL AND METHODS: This experimental study was conducted on 120 students (60 interventions and 60 control groups) at Hamadan University of Medical Sciences during 2019-2020. The intervention included training vaccination skills through educational videos based on self-efficacy theory, which was conducted for two weeks each week in two sessions of two hours for the intervention group using an educational video. A researcher-made questionnaire and a performance checklist were used to collect data. Data were analyzed using SPSS-16 software. Paired t-test, independent t-test, and Chi-square. RESULTS: The mean age of the subjects was 22.41 years, and most of the participants were female students (80%). There were statistically significant differences between the intervention and control groups regarding knowledge (19.17±0.92 vs. 16.03±3.00; P<0.001), self-efficacy (40.84±3.71 vs 33.45±4.83; P = 0.01), attitude (22.56±2.95vs 20.28±3.25; P = 0.01) and performance (27.92±6.00 vs 22.38±5.40; P = 0.01) after the intervention. CONCLUSION: According to the findings of this study, the use of educational videos for undergraduate students of public health during the apprenticeship period has a positive effect on the practical learning of vaccination. However, it seems that in non-critical times, online education along with face-to-face education will be more effective for practical training.

Transfacet Oblique Lateral Lumbar Interbody Fusion: Technical Description and Early Results.

Introduction The oblique lateral lumbar interbody fusion (OLLIF) is a relatively new method of lumbar interbody fusion (LIF) that utilizes a trans-Kambin approach to the disc space. The OLLIF can be performed from T12-S1 in the majority of cases but is occasionally obstructed at the L5-S1 level by osteophytes, an overgrown facet joint and/or prominent sacral ala. Transfacet OLLIF (TF-OLLIF) is a novel method for LIF in which the disc space is accessed by drilling through hypertrophic facets with an OLLIF approach. We provide a proof-of-concept report on the TF-OLLIF surgical technique and report the clinical and perioperative outcomes for the first 29 patients who underwent this procedure. Methods This is a retrospective single surgeon cohort study of 29 patients with lumbar spinal stenosis (LSS) who underwent TF-OLLIF procedures between 8/2018 and 1/2021. The primary outcome was a change in the Oswestry Disability Index (ODI) one year after surgery. Secondary outcomes were surgery time, blood loss, hospital stay, and complications. The TF-OLLIF was performed using the approach and instrumentation of OLLIF. When osseous hypertrophy is reached during the approach, an 8 mm drill is used to drill through the obstructing bone with continuous neuromonitoring. Discectomy and interbody placement are performed with subsequent posterior pedicle screw fixation. Results ODI improved from 49% pre-op to 31% at one-year follow-up. Estimated blood loss ranged from 97.6±93.3 ml for one level TF-OLLIF to 146.2±60.3 ml for a 3+ level TF-OLLIF. Operative time ranged from 57.4±19.5 minutes for a one-level TF-OLLIF to 102.9±27.8 minutes for a 3+ level TF-OLLIF. The average length of hospital stay (LOS) was 0.4±0.8 days for one-level TF-OLLIF and 1.6±1.9 days for 3+ level TF-OLLIF. Complications included five cases of nerve root irritation immediately postoperatively, with three of these patients still reporting mild L5 distribution numbness at the last follow-up, which was not clinically limiting. Conclusion The first 29 cases of TF-OLLIF demonstrated that it is a safe method of interbody fusion that yields good clinical results. This is an important development for practitioners of OLLIF as it enables interbody placement with OLLIF instruments and approach even for challenging L5-S1 levels without compromising surgical outcomes.

Alternative Water Resources Selection to Supply Drinking Water in Flood Disasters by Multicriteria Decision-Making Techniques (DANP and VIKOR).

Background: Emergency is generally caused by natural disaster and infectious disease outbreaks, or it is man-made. Floods are natural phenomena that generally appear in multiple parts of the world. Flooding is one of the most destructive naturally occurring environmental hazards and can cause public, infrastructural, and environmental damage. The purpose of this study is to select alternative water resources for supplying Bandar Abbas in flood disasters by multicriteria decision-making techniques. Methods: Information required includes possible water resources alternative for flood, quantitative and qualitative characteristics of the water resources, climatic circumstances, and demographic information used in organizations data and previous studies. After selecting and proposing water resources alternative for Bandar Abbas in flood, the subcriteria were weighed applying DANP (DEMATEL-ANP) techniques and water resources were prioritized with the VIKOR technique. According to the network structure and internal and external dependence of the criteria and subcriteria, the advantages of DANP in calculating weights have been used to adapt to more real-world problems. The VIKOR technique was developed for multicriteria optimization of complex systems. Results: After reviewing and extracting the criteria from various studies, 9 main criteria and 44 subcriteria were defined to select water resources in disasters and emergencies. According to field studies and related organizations' information, the proposed water resources for Bandar Abbas to use in flood disasters include humidity, sea (Persian Gulf), Sarkhoon plain, and wastewater treatment plant of Bandar Abbas. Conclusion: Results showed that the optimal water resources for Bandar Abbas in flood disasters are the sea and wastewater treatment plant effluent (after advanced treatment). The study proposed appropriate model to select optimal water resources for various natural disasters in different geographical areas. This model can help officials and decision-makers to plan for drinking water supply from disaster-prone areas before disasters occur.