The association of in-utero exposure to air pollution and atherogenic index of plasma in newborns.

BACKGROUND: Prenatal exposure to particulate matter (PM) and traffic was associated with the programming of cardiovascular diseases (CVDs) in early life. However, the exact underlying mechanisms are not fully understood. Therefore, we aimed to evaluate the association between in-utero exposure to PMs and traffic indicators with the atherogenic index of plasma (AIP) in newborns, which is a precise index reflecting an enhancement of lipid risk factors for CVDs. METHODS: In this cross-sectional study, a total of 300 mother-newborn pairs were enrolled in Sabzevar, Iran. Spatiotemporal land-use regression models were used to estimate the level of PM1, PM2.5 and PM10 at the mother's residential address. The total length of streets in different buffers (100,300 and 500m) and proximity to major roads were calculated as indicators of traffic. The AIP of cord blood samples was calculated using an AIP calculator. Multiple linear regression models were used to examine the association of PM concentrations as well as traffic indicators with AIP controlled for relevant covariates. RESULTS: PM2.5 exposure was significantly associated with higher levels of AIP in newborns. Each interquartile range (IQR) increment of PM2.5 concentration at the mothers' residential addresses was associated with a 5.3% (95% confidence interval (CI): 0.0, 10.6%, P = 0.04) increase in the AIP. Associations between PM1, PM10 and traffic indicators with cord blood level of AIP were positive but not statistically significant. CONCLUSION: Our findings showed that in utero exposure to PM2.5 may be associated with CVDs programming through the increase of atherogenic lipids.

Investigating the association of acute kidney injury (AKI) with COVID-19 mortality using data-mining scheme.

COVID-19 has caused significant challenges in kidney research and disease management. Data mining techniques such as logistic regression (LR) and decision tree (DT) were used to model data. All analyses were performed using SPSS 25 and Python 3. The incidence of acute kidney injury (AKI) was 14.1% and the overall mortality risk was 13% among COVID-19 patients. The mortality was associated with, AKI, age, marital status, smoking status, heart failure, chronic obstructive pulmonary disease, malignancy, and SPO2 level using LR. The accuracy, sensitivity, specificity, and area under the curve of the DT (and LR) classifier were 70% (85%), 73% (75%), 78% (79%), and 77% (81%), respectively. Based on the DT model, the variable most significantly associated with COVID-19 mortality was AKI followed by age, high WBC count, BMI, and lymphocyte count. It was concluded that the incidence of AKI was high, and AKI was identified as one of the important factors that played an effective role in mortality due to COVID-19.

Evaluating the characteristics of patients with SARS-CoV-2 infection admitted during COVID-19 peaks: A single-center study.

Background: Nowadays, the world is facing a coronavirus disease (COVID-19) pandemic, elicited by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At the time of studying, five COVID-19 waves occurred in Iran. We aimed to evaluate the characteristics of patients with SARS-CoV-2 infection admitted to Vasei Hospital of Sabzevar, Iran during COVID-19 peaks. Methods: Clinical manifestations, laboratory findings, radiological findings, and underlying diseases of patients with COVID-19 were obtained from electronic medical records. Then, this information was compared in patients with SARS-CoV-2 infection to the peaks of COVID-19. Results: The highest and lowest respiratory involvements were observed in the third (74.6%) and fourth (38.8%) peaks, respectively. The most common radiological finding in all peaks was ground-glass opacity (28.98%), followed by consolidation, which was the highest (14.6%) in peak three. The lymphocyte count decreased in all peaks. Its highest reduction (16.12) occurred in the third peak. The SpO2 was lower than normal range in all peaks, except for the second (90.77%) and fifth (91.06%) peaks. Dyspnea (52.36%) was the most and dizziness (1.26%) and sore throat (0.6%) were the least frequent symptoms. The mortality rates were 14. 4%, 18.2%, 23%, 9.02%, and 9.4% in the first to fifth peaks, respectively. Conclusion: As different variants of the SARS-CoV-2 virus were predominant in each wave, COVID-19 patients had different features in various peaks. The fifth wave of COVID-19 had the highest number of hospitalized patients, while the first peak had the lowest number. Perhaps, the significant increase in testing capacity in the fifth wave and its long time period are the reasons for this growth. Most of the clinical symptoms were similar in all peaks, but the incidence was different. As patients hospitalized in the third peak had the highest rate of underlying disease, it can be a reason for the increase in the death rate of patients. We did not observe any significant differences in laboratory tests among the patients during different peaks. Thus, we should be vigilant in continuously studying the characteristics of the disease, and be able to modify treatments rapidly if necessary.

Antecedentes: Hoy en día, el mundo se enfrenta a una pandemia de enfermedad por coronavirus (COVID-19), provocada por el síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). En el momento del estudio, se produjeron cinco olas de COVID-19 en Irán. Nuestro objetivo fue evaluar las características de los pacientes con infección por SARS-CoV-2 ingresados en el Hospital Vasei de Sabzevar, Irán, durante los picos de COVID-19. Métodos: Las manifestaciones clínicas, los hallazgos de laboratorio, los hallazgos radiológicos y las enfermedades subyacentes de los pacientes con COVID-19 se obtuvieron de los registros médicos electrónicos. Luego, esta información se comparó en pacientes con infección por SARS-CoV-2 a los picos de COVID-19. Resultados: Las afectaciones respiratorias más altas y más bajas se observaron en el tercer (74,6%) y cuarto (38,8%) picos, respectivamente. El hallazgo radiológico más frecuente en todos los picos fue la opacidad en vidrio esmerilado (28,98%), seguida de la consolidación, que fue la más alta (14,6%) en el pico tres. El recuento de linfocitos disminuyó en todos los picos. Su mayor reducción (16,12) se produjo en el tercer pico. La SpO2 estuvo por debajo del rango normal en todos los picos, excepto en el segundo (90,77%) y quinto (91,06%) picos. La disnea (52,36%) fue el síntoma más frecuente y el mareo (1,26%) y el dolor de garganta (0,6%) los síntomas menos frecuentes. Las tasas de mortalidad fueron 14,4%, 18,2%, 23%, 9,02% y 9,4% en los picos primero a quinto, respectivamente. Conclusión: Como en cada oleada predominaban diferentes variantes del virus SARS-CoV-2, los pacientes con COVID-19 tenían características diferentes en varios picos. La quinta ola de COVID-19 tuvo el mayor número de pacientes hospitalizados, mientras que el primer pico tuvo el número más bajo. Quizás, el aumento significativo en la capacidad de prueba en la quinta ola y su largo período de tiempo sean las razones de este crecimiento. La mayoría de los síntomas clínicos fueron similares en todos los picos, pero la incidencia fue diferente. Dado que los pacientes hospitalizados en el tercer pico tenían la tasa más alta de enfermedad subyacente, puede ser una de las razones del aumento de la tasa de mortalidad de los pacientes. No observamos diferencias significativas en las pruebas de laboratorio entre los pacientes durante los diferentes picos. Por tanto, debemos estar atentos al estudio continuo de las características de la enfermedad, y ser capaces de modificar los tratamientos rápidamente si es necesario.

An 18-Month Epidemiologic Survey of 3364 Deceased COVID-19 Cases; a Retrospective Cross-sectional Study.

Introduction: The COVID-19 pandemic has been considered an international problem. This study aimed to survey the demographic and clinical characteristics of the deceased COVID-19 patients. Methods: The present cross-sectional study was performed on all deceased COVID-19 patients who died in Imam Reza Hospital, Mashhad, Iran, from March 20, 2020, to September 23, 2021. Their data, including age, gender, complaints, and clinical symptoms at the time of admission, as well as information at the time of death (hour, shift, holiday/non-holiday) were analyzed and reported. Results: 3364 deaths due to COVID-19 have been registered during the study period (60.46% male). The patients' mean age was 66.99±16.97 (range: 1-101) years (92.7% of them were Iranian). The mortality at night shifts was less than day shifts (1643 vs. 1721). The average amount of deaths/day on holidays and workdays was (5.63 vs. 6.24). The number of deaths varied during the various hours of the day and night. Diabetes and cardiovascular diseases were the most common confounding factors, which were observed in 22.44% and 15.36% of the cases, respectively. Conclusion: Based on the findings of this series, COVID-19 mortality was frequently observed in male patients, those with the mean age of 66.99 years, morning shifts, and workdays.

Effects of the Sufentanil and Dexmedetomidine Combination on Spinal Anesthesia in Patients Undergoing Lower Abdominal or Lower Extremity Surgery: A Double-Blind Randomized Controlled Trial.

Background: Intrathecal additive drugs are becoming increasingly common in anesthesia practice. We aimed to evaluate the additive effects of dexmedetomidine on spinal anesthesia with sufentanil in patients undergoing lower abdominal or lower limb surgery. Methods: This double-blind randomized controlled trial was performed in Mashhad, Iran, between 2017 and 2018. Sixty patients undergoing lower abdominal or lower limb surgery were randomly divided to receive 15 mg of bupivacaine and 3 µg of sufentanil (control group; n=30) or 15 mg of bupivacaine, 3 µg of sufentanil, and 10 µg of dexmedetomidine (intervention group; n=30). Outcomes, comprised of the onset and regression of sensory and motor blocks, the duration of analgesia, analgesic use, hemodynamic parameters, and side effects, were assessed. The data were analyzed in the SPSS software (version 22), using different statistical tests. A P value of less than 0.05 was considered significant. Results: The times of sensory and motor blocks reaching T10 and Bromage 3, respectively, were significantly shorter, while the times of sensory and motor regressions to S1 and Bromage 0, correspondingly, were significantly longer in the intervention group than in the control group (P<0.001). Both the frequency (P=0.006) and the dose (P<0.001) of postoperative analgesic use were significantly lower, and the duration of analgesia was significantly longer in the intervention group (P<0.001). The frequency of side effects and changes in hemodynamic parameters had no significant differences between the groups. Conclusion: The sufentanil and dexmedetomidine combination in spinal anesthesia caused the earlier onset and later regression of sensory and motor blocks, longer postoperative analgesia, and lower analgesic use without significant side effects or hemodynamic changes, which appears to be due to the combined effects of sufentanil and dexmedetomidine. Trial Registration Number: IRCT2017082833680N3.

Epidemiological characteristics and initial spatiotemporal visualisation of COVID-19 in a major city in the Middle East.

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged initially in China in December 2019 causing the COVID-19 disease, which quickly spread worldwide. Iran was one of the first countries outside China to be affected in a major way and is now under the spell of a fourth wave. This study aims to investigate the epidemiological characteristics of COVID-19 cases in north-eastern Iran through mapping the spatiotemporal trend of the disease. METHODS: The study comprises data of 4000 patients diagnosed by laboratory assays or clinical investigation from the beginning of the disease on Feb 14, 2020, until May 11, 2020. Epidemiological features and spatiotemporal trends of the disease in the study area were explored by classical statistical approaches and Geographic Information Systems. RESULTS: Most common symptoms were dyspnoea (69.4%), cough (59.4%), fever (54.4%) and weakness (19.5%). Approximately 82% of those who did not survive suffered from dyspnoea. The highest Case Fatality Rate (CFR) was related to those with cardiovascular disease (27.9%) and/or diabetes (18.1%). Old age (≥60 years) was associated with an almost five-fold increased CFR. Odds Ratio (OR) showed malignancy (3.8), nervous diseases (2.2), and respiratory diseases (2.2) to be significantly associated with increased CFR with developments, such as hospitalization at the ICU (2.9) and LOS (1.1) also having high correlations. Furthermore, spatial analyses revealed a geographical pattern in terms of both incidence and mortality rates, with COVID-19 first being observed in suburban areas from where the disease swiftly spread into downtown reaching a peak between 25 February to 06 March (4 incidences per km2). Mortality peaked 3 weeks later after which the infection gradually decreased. Out of patients investigated by the spatiotemporal approach (n = 727), 205 (28.2%) did not survive and 66.8% of them were men. CONCLUSIONS: Older adults and people with severe co-morbidities were at higher risk for developing serious complications due to COVID-19. Applying spatiotemporal methods to identify the transmission trends and high-risk areas can rapidly be documented, thereby assisting policymakers in designing and implementing tailored interventions to control and prevent not only COVID-19 but also other rapidly spreading epidemics/pandemics.

ACEP's Recommendations for Brain Computed Tomography Scan in Adult Minor Head Trauma Patients; a Diagnostic Accuracy Study.

INTRODUCTION: Some clinical decision rules have been developed to identify minor head trauma (MHT) patients in need of brain computed tomography (CT) scan for detection of possible traumatic brain injuries (TBIs). This study aimed to evaluate the performance of American College of Emergency Physicians (ACEP) recommendations in this regard. METHODS: This study is a cross-sectional study of MHT (GCS: 13-15) cases who referred to emergency department of a level one trauma center, Mashhad, Iran, from October 2017 to March 2018. The screening performance characteristics of ACEP recommendations for performing brain CT scan in these patients were calculated. RESULTS: 500 patients with a mean age of 37.97 ± 15.96 years were evaluated. Based on level one recommendations, 73 (14.6 %) patients had to be assessed by brain CT scan. 67 (91.8%) were assessed and 6 (8.2%) were not assessed based on decision of their in-charge physician. According to level two recommendations, 125 (25.0%) patients did not need brain CT scan, 85 (68%) of whom had been assessed (all normal). Performing brain CT scan according to the level one recommendation of ACEP's clinical policy showed 29.6% sensitivity (95% CI: 13.75 to 50.18) and 86.3% specificity (95% CI: 82.68 to 89.14). The overall ACEP's clinical policy for neuroimaging of adults with MTBI showed sensitivity and specificity of 92.59% (95% CI: 75.71 to 99.09) and 26.4% (95% CI: 22.51 to 30.65), respectively. CONCLUSION: ACEP's clinical policy has a high-level sensitivity for using brain CT scan in detection of probable TBI in patients with MHT.

Diagnostic Accuracy of Physical Examination and History Taking in Traumatic Rib Fracture; A Single Center Experience.

OBJECTIVE: To evaluate the diagnostic accuracy of history taking and physical examination in the patients with traumatic rib fractures. METHODS: In a cross-sectional study, all patients with multiple traumas who referred to the emergency department were evaluated for the mechanism of injury, chief complaints, vital signs and oxygen saturation. History taking and physical examination were performed according to Barbara Bates reference. Fracture was diagnosed based on chest x-ray results and CT scan, if needed. The results were analyzed by receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis. RESULTS: Isolated rib fractures of thoracic bones were found in 8 out of 99 subjects with mean age of 33.4±19.43 years. In the sensitivity analysis of history taking and physical exam tests, the highest sensitivity was chest tenderness and deformity with 100% sensitivity for each one and the lowest was for the dyspnea with 28.10%; however, the highest sensitivity was for dyspnea with 62.50% sensitivity; and pulmonary hearing aid and chest deformity were not specific (0%). For heart rate, AUC analysis was significant. Heart rate above 80/min was associated with 87.5% sensitivity and 62.5% specificity for rib fractures. CONCLUSION: Proper and physical examination and history taking can help to detect rib fractures with high sensitivity and specificity denoting to the importance of the issue; while, radiographic or surgical approval is required to diagnose rib fractures.