Prognostic Value of Qualitative and Quantitative Stress CMR in Patients With Known or Suspected CAD.

BACKGROUND: Recent studies suggest that quantitative cardiac magnetic resonance (CMR) may have more accuracy than qualitative CMR in coronary artery disease (CAD) diagnosis. However, the prognostic value of quantitative and qualitative CMR has not been compared systematically. OBJECTIVES: The objective was to conduct a systematic review and meta-analysis assessing the utility of qualitative and quantitative stress CMR in the prognosis of patients with known or suspected CAD. METHODS: A comprehensive search was performed through Embase, Scopus, Web of Science, and Medline. Studies that used qualitative vasodilator CMR or quantitative CMR assessments to compare the prognosis of patients with positive and negative CMR results were extracted. A meta-analysis was then performed to assess: 1) major adverse cardiovascular events (MACE) including cardiac death, nonfatal myocardial infarction (MI), unstable angina, and coronary revascularization; and 2) cardiac hard events defined as the composite of cardiac death and nonfatal MI. RESULTS: Forty-one studies with 38,030 patients were included in this systematic review. MACE occurred significantly more in patients with positive qualitative (HR: 3.86; 95% CI: 3.28-4.54) and quantitative (HR: 4.60; 95% CI: 1.60-13.21) CMR assessments. There was no significant difference between qualitative and quantitative CMR assessments in predicting MACE (P = 0.75). In studies with qualitative CMR assessment, cardiac hard events (OR: 7.21; 95% CI: 4.99-10.41), cardiac death (OR: 5.63; 95% CI: 2.46-12.92), nonfatal MI (OR: 7.46; 95% CI: 3.49-15.96), coronary revascularization (OR: 6.34; 95% CI: 3.42-1.75), and all-cause mortality (HR: 1.66; 95% CI: 1.12-2.47) were higher in patients with positive CMR. CONCLUSIONS: The presence of myocardial ischemia on CMR is associated with worse clinical outcomes in patients with known or suspected CAD. Both qualitative and quantitative stress CMR assessments are helpful tools for predicting clinical outcomes.

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

PURPOSE: In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. METHODS: The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. RESULTS: In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. CONCLUSION: The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria have higher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Early and mid-term outcomes of off-pump versus on-pump coronary artery bypass surgery in patients with triple-vessel coronary artery disease: a randomized controlled trial.

BACKGROUND AND AIM OF THE STUDY: Several studies have compared early and late outcomes of on-pump coronary artery bypass grafting (CABG) and off-pump CABG. However, there is still an ongoing debate on this matter, especially in patients with triple-vessel coronary artery disease (3VD). METHODS: We randomly assigned 274 consecutive patients with 3VD to two equal groups to undergo on-pump CABG or off-pump CABG. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, acute coronary syndrome, stroke or transient ischemic attack, and the need for repeat revascularization. The secondary outcomes were postoperative infection, ventilation time, ICU admission duration, hospital stay length, and renal failure after surgery. RESULTS: The median follow-up duration was 31.2 months (range 24.6-35.2 months). The mean age of patients was 61.4 ± 9.3 years (range: 38-86), and 207 (78.7%) were men. There were 15 (11.2%) and 9 (7.0%) MACCE occurrences in on-pump and off-pump groups, respectively (P value = 0.23). MACCE components including all-cause death, non-fatal MI, CVA, and revascularization did not significantly differ between on-pump and off-pump groups. We observed no difference in the occurrence of MACCE between off-pump and on-pump groups in multivariable regression analysis (HR = 0.57; 95% CI 0.24-1.32; P value = 0.192). There were no statistical differences in postoperative outcomes between the off-pump and on-pump CABG groups. CONCLUSIONS: Off-pump CABG is an equal option to on-pump CABG for 3VD patients with similar rates of MACCE and postoperative complications incidence when surgery is performed in the same setting by an expert surgeon in both methods. (IRCT20190120042428N1).

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis.

While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68-.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45-.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.

Increased Intracranial Pressure on a Patient with Neuromyelitis Optica Spectrum Disorder.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathic disease affecting central nervous system (CNS). CSF pressure in these patients is usually normal. CASE PRESENTATION: A 30-year-old woman was admitted with complaints of headache and lower limbs paresis. Lumbar puncture (LP) and magnetic resonance imaging were performed for the patient. Opening pressure was 42 cm H2O in the first LP. According to the clinical evidences, imaging, and the patient's positive aquaporin-4 antibody, the diagnosis of NMOSD was established. CONCLUSION: High intracranial pressure headache; however rare, may be the first sign of the onset of the acute exacerbation phase of NMOSD.

The Outcome of COVID-19 in Patients with a History of Taking Rituximab: A Narrative Review.

Coronavirus disease 2019 (COVID-19) is a recently emerging disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Notably, the safety of immunosuppressive medications is a major concern during an infectious disease pandemic. Rituximab (RTX), as a monoclonal antibody against CD20 molecule, is widely used for the treatment of various diseases, mostly autoimmune diseases and some malignancies. Previous studies indicated that RTX, as an immunosuppressive medication, may be associated with the increased risk of infections. Moreover, given the wide use of RTX, a necessity of determining the different aspects of RTX use in the COVID-19 era is strongly felt. We reviewed current studies on the clinical courses of patients with SARS-CoV-2 infection. It appears that the use of RTX does not increase morbidity and mortality in most patients. However, underlying diseases and other concomitant medications may play a role in the disease course, while the concerns of vaccine efficacy in patients receiving RTX still need to be addressed. Therefore, more controlled studies are needed for a better conclusion.

Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis.

BACKGROUND: One of the most concerning features that involves 40-70% of patients with multiple sclerosis (MS) is cognitive impairment. Moreover, it affects various aspects of patients' life. In this regard, this study was conducted to find independent predictors of cognitive function. METHOD: We performed a cross-sectional analysis on 92 patients chosen from MS clinic of Sina hospital, Iran. After completing a general questionnaire of demographic and various clinical features, the included participants (patients with RRMS) underwent neuropsychological assessment using Minimal Assessment of Cognitive function in Multiple Sclerosis (MACFIMS), Expanded disability Status Scale (EDSS), Beck Depression Inventory II (BDI-II), and National American Adult Reading Test (NAART). An un-weighted average of MACFIMS subscales z-scores was reported as cognitive index. In order to find the association between CI and different factors, each variable was entered in a simple regression model first. Then, a univariate multiple regression model was invoked to evaluate the predictors of cognitive index in patients. RESULTS: Simple regression for cognitive index of 92 patients (86% female) with a mean age of 33.4±7.6 years old suffering of RRMS for 6.8±4.8 years revealed patients with history of former smoking (p=0.001), sole visual symptoms as the presentation sign of the study (ß=-0.341, p=0.001), lower EDSS score (ß=-0.299, p=0.005), higher NAART score (ß=0.416, p≤0.0001), and college education (p=0.001), had better cognitive function in our study population. Such factors including age, educational status, BDI-II score, EDSS score, and disease duration were fixed and the other significant factors entered once separately and then simultaneously in the univariate multiple linear regression model. It was revealed that former smoking (ß=-0.372, p≤0.0001), NAART (ß=0.304, p=0.002), and EDSS (ß= -0.185, P=0.045) are associated significantly with the cognitive function of patients with multiple sclerosis. CONCLUSION: This study demonstrated NAART, as a proxy of premorbid intelligence, history of former smoking, and EDSS score may have effects on cognitive function in MS. Future studies need to be invoked for the evaluation of the causality relation of these factors.

Estimation of genetic variation in the Secretor and Lewis genes in Iranian hospitalized children.

BACKGROUND: The Secretor (FUT2) and lewis gene (FUT3) are in charge of the construction of histo-blood group antigens, which act as a receptor for some Pathogenes. This study aimed to estimate the prevalence of five significant single nucleotide polymorphisms (SNPs) in Iranian children. METHODS: In this cross-sectional study, 102 blood samples collected from hospitalized children. The FUT2 gene region was amplified and sequenced to explore rs1047781 and rs601338, and the FUT3 gene region was amplified to explore rs28362459, rs812936, rs778986 SNPs. RESULTS: In FUT2 gene, Se358,428 that produces Se phenotype with 63% (0.53 - 0.72) prevalence, was the most common genotype. For FUT3 gene Le59,202,314 with 80% prevalence was most common genotype (0.71 - 0.87). CONCLUSION: This study genotyped Secretor and Lewis genes and designated SNPs' distinct distribution in Iran, and clarified at-risk groups for certain diseases.

Evaluation of emotional intelligence (EI) in neuromyelitis optica spectrum disorder (NMOSD) patients compared to healthy individuals.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is known as an autoimmune astrocytopathic disorder involving central nervous system (CNS). The aim of this study was to compare Emotional Intelligence (EI) score between NMOSD patients and healthy individuals, and to find out the possible effect of this disease on EI. METHODS: A total of 45 NMOSD participants and 48 healthy individuals were enrolled in this study. Demographic information (e.g., gender and age) of all participants as well as their level of education, and data on the patients' duration of disease were collected. EI of each participant was assessed using Persian version of Emotional Quotient inventory (EQ-i) questionnaire. RESULTS: The mean total EI score was significantly different between the participants and controls (322±36.7 vs 338±31.5, p value<0.03). Compared to controls, patients had a poor performance in 4 of 15 EI subscales including emotional self-awareness (21.29±3.6 vs 22.85±3, p value<0.03), optimism (22.4±4 vs 24.1±3.1, p value<0.03), self-regard (22.7±4.6 vs 24.5±3.4, p value<0.04), and impulse control (16.9±6.5 vs 19.5±5.5, p value<0.05). No difference was found between anti-aquaporin-4 antibody (AQP4-IgG) positive and AQP4-IgG negative patients regarding EI score or its subscale scores, except for self-actualization (p value<0.05). CONCLUSION: Our study showed that EI could be regarded as a tool for understanding emotions, thoughts, and behavior of NMOSD patients. It was implied that taking therapeutic steps could improve the performance of NMOSD patients with EI impairment in social life.