Brain Natriuretic Peptides in Screening of Syncope with Cardiac Origin; a Commentary

Syncope is a serious problem with life-time prevalence of 35%. It is estimated that 1 -3% of referrals to emergency departments and in-patient admissions are due to syncope. The underlying conditions can be cardiac or neurologic. Considering the completely different circumstances ruling the encounters with cardiac and neurologic syncope, in recent years many attempts have beenmade to find the proper tool for differentiating cardiac and non-cardiac causes of syncope. The result of which is formation of some clinical decision rules including San Francisco Syncope Rule (SFSR), Osservatorio Epidemiologico sulla Sincope nel Lazio (OESIL),Evaluation of Guidelines in Syncope Study (EGSYS), risk stratification of syncope in the emergency department (Rose), and Boston Syncope Rules. The serum marker brain natriuretic peptide (BNP), which is becoming increasingly established in emergency departments for diagnosis of acute heart failure, can reflect thepresence of a structural heart disease. It seems that BNP could be considered as a screening tool in detection of syncope with cardiac origin. In a study by Wojtowicz J et al. who evaluated BNP in children and adolescents with syncope, there was no significant difference in terms of BNP level between the syncope andcontrol groups. In contrast, Zhang Q et al. concluded that serum BNP is helpful in differentiating cardiac (958.78 § 2443.41 pg/mL) and non-cardiac (31.05 § 22.64 pg/mL) syncope. Tanimoto K et al. considered the cut-off value of 40 pg/ml for BNP in differentiating cardiac and non-cardiac syncope and found that it had 82% sensitivity and 92% specificity. A significant difference was observed in BNP level of the cardiac group (514 pg/ml) compared to the non-cardiac ones (182 pg/ml) in Pfister et al. study. It seems that, more research is needed to clarify this relationship and the variables that might play the role of confounders in a causal inference.More studies on children are required because there is some controversy regarding this relationship. Running studies with accurate methodology, large sample sizes, and in a multicentric fashion could be helpful in this regard

Analysis of correlation between estradiol and fracture of femur neck

Osteoporosis is a major public health challenge all over the world. Estrogen hormone was cited amongst other hormones to be an efficient hormone for the production and maintenance of bone density. This study was designed with the purpose of evaluating and analyzing the estradiol effect on fractures of femur neck in the Iranian society. This study evaluated men over 50 years of age suffering with mild trauma (falling off the same level height or lower) and with a fracture on their femur neck. Also, their serum level of estradiol was measured with an ELISA method. Using this procedure, the patients were assigned into groups with either normal estradiol serum level (10pg/ml and higher) or with lower than normal level (lower than 10 pg/ml). A control group including 50-year-old and older men without hip fracture, or its history, was chosen to access their estradiol serum level. Data collected from these two groups were statistically compared. A total of 120 patients were evaluated (60 in the control and 60 in the test group). The mean age of patients in the control and test groups were 67.9±10.22 and 69.5±8.84 years, respectively (p=0.376). Smoker patients’ percentages in the control and test groups were 35% and 31.7%, respectively (p=0.699). On the basis of the serum estradiol level, patients’ percentages with low estradiol level in control and test groups were 10% and 16.7%, respectively (p=0.283). The only significant factor in predicting serum estradiol level was smoking. In conclusion, in this study it was observed that fractures of the femoral neck following a mild trauma were not correlated to low level of serum estradiol

Evaluation of sensitivity and the specificity of Canadian CT head rule and New Orleans criteria in patients with head injury

BackgroundMillions of people around the world are annually under emergency investigation due to severe head injuries. Computed tomography (CT) scans is a diagnostic procedure that can be done for most people. AimsThis study is aimed to evaluate the sensitivity and the specificity of Canadian and New Orleans criteria in determining the rate of head injury.Methods To obtain the relationship between clinical symptoms and CT scan results, the required information was obtained by filling out the records and physical examination in the emergency department and the results from the patients were statistically analysed. Data needed to complete the questionnaire was collected from patient, the patient, their concomitant examination, and the information in their medical records. The raw data from the questionnaire was analysed using SPSS version 17 software. In this study, after obtaining the CT scan results, the individuals were classified into two clinical criteria, New Orleans and Canadian, and their sensitivity and specificity were analysed using ROC curve analysis.Results ROC curve analysis data showed that the sensitivity and specificity of New Orleans criteria are 31 per cent and 69 per cent, respectively, and the sensitivity and specificity of Canadian criteria are 76 per cent and 74 per cent, respectively. Data shows that the Canadian curve has a significant difference compared to basic state (P-Value < 0.05).ConclusionDespite abnormal CT scan results in patients with head trauma, there is a significant relationship between headache and a combination of symptoms in patients. The results can be used in decision-making on involved in performing a CT scan. ROC curve analysis also showed that the Canadian criterion has higher sensitivity and specificity for the diagnosis of severe head trauma compared to New Orleans criteria

The Relationship between Clinical Findings of Shoulder Joint with Bone Damage of Shoulder Joint in Patients with Isolated Shoulder Blunt Trauma

BACKGROUND: Due to the prevalence of shoulder injuries among athletes and other people and the prevalence of radiography for these injuries, there are still no valid criteria for indication of doing shoulder radiography. AIM: This study aimed to examine the relationship between some signs and clinical examinations of the shoulder with shoulder bone injuries and the need for radiography. METHODS: This is a cross-sectional study. All patients aged 18-70 years who referred to the emergency ward of Imam Reza and Hasheminejad Hospital in the year 2014 due to blunt trauma and had criteria for entering the study and lacking exclusion criteria were included in the study process. Data on clinical symptoms, radiographic results, and final diagnosis were extracted from the patients' records through a questionnaire and analysed statistically. RESULTS: There was a significant relationship between the clinical signs of patients Existence of ecchymosis in the shoulder fractures with glenoid and humerus fractures (p = 0.029, p = 0.004 respectively). There was also a significant relationship between clavicle fracture and limitation in shoulder rotation and abduction (p = 0.000 and p = 0.001 respectively). Other clinical symptoms did not show any significant relationship with radiographs indicative of the problem requiring specific treatment. CONCLUSION: Although it is possible to define critters based on clinical symptoms that reduce the need for unnecessary radiographs that the does not reliably help inpatient treatment, but finding these critters to indicate the performance of the graphs in shoulder injuries requires further studies with the higher population and more clinical variables

Risk factors contributing to the incidence and mortality of acute childhood poisoning in emergency department patients in Iran: a hospital-based case-control study

OBJECTIVES Since poisoning is one of the most important preventable factors contributing to the hospitalization and death of children who present to emergency departments, this study was carried out to investigate the risk factors contributing to the incidence and mortality of acute childhood poisoning. METHODS This hospital-based case-control study included 243 cases and 489 controls, drawn from daily admissions to the emergency departments of the included hospitals according to the inclusion and exclusion criteria. RESULTS Gastrointestinal poisoning was the most common poisoning type, found in 87.7% of subjects, and medications were the most common cause of poisoning (49.8%). Multiple logistic regression analysis showed that a history of poisoning (odds ratio [OR], 10.44; 95% confidence interval [CI], 5.58 to 19.51; p<0.001) and the availability of poisonous substances (OR, 8.88; 95% CI, 5.41 to 14.56; p<0.001) were among the most important predictors of childhood poisoning. Respiratory poisoning (OR, 6.72; 95% CI, 1.40 to 32.07; p<0.05) and the presence of addiction in the family (OR, 4.54; 95% CI, 1.10 to 18.68; p<0.05) were the most important predictors of mortality among children with poisoning. CONCLUSIONS Addiction and the presence of physical or psychological disorders in family members, a history of poisoning, and the availability of poisonous substances were significantly associated with the incidence of childhood poisoning and resultant mortality

Early Effectiveness of Noninvasive Positive Pressure Ventilation on Right Ventricular Function in Chronic Obstructive Pulmonary Disease Subjects with Acute Hypercapnic Respiratory Failure

Introduction: Noninvasive positive pressure ventilation (NIPPV) has become an integral tool in the management of acute hypercapnic respiratory failure (AHRF) in chronic obstructive pulmonary disease (COPD). This study was performed to evaluate the early effects of NIPPV on pulmonary artery pressure (PAP), serum N-terminal pro BNP (NT-proBNP), and ventilatory parameters in the COPD patients with AHRF. Materials & Methods: This quasi-experimental study was conducted on 20 COPD patients with AHRF. The participants received the standard treatment in addition to NIPPV. There was no contraindication for NIPPV. Arterial blood gas analysis, Doppler echocardiography (for measuring PAP), and plasma NT-proBNP measurements were performed before and after NIPPV. Results: According to the results, the mean age of the participants was 54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide (PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After one week of NIPPV, there were statistically significant differences among the mean pH, PaCO2, PAP, and NT-proBNP (

Investigating the Effect of Inflammation on Atrial Fibrillation Occurrence by Measuring Highly Sensitive C-reactive Protein (hs-CRP)

Introduction: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmias that cardiologists and internists encounter. The goal of this article is to clarify an overview of the evidence linking inflammation to AF existence, which may highlight the effect of some pharmacological agents that have genuine potential to reduce the clinical burden of AF by modulating inflammatory pathways. Materials and Methods: In a case-control study, 50 patients with atrial fibrillation (AF) with different etiologies and 50 patients with sinus rhythm and similar bases were selected. Sampling for highly sensitive c-reactive (hs-CRP) was done on the patients presenting with AF to the Ghaem hospital between October 2006 and June 2007. Results: Mean age of the patients was 62 years with maximum of 90 and minimum of 36 and standard deviation of 13.80. The most frequent age group was 71-80years. Fifty-four percent of patients were male and 46% were female. Mean serum hs-CRP levels in AF patients with hypertension (HTN) ,Ischemic heart disease(IHD), Valvular heart disease (VHD), HTN+IHD and hyperthyroidism were 8.10, 9.40, 8.68, 10.16 and 5.98 mg/Lit; respectively. There was significant difference between hs-CRP levels in hypertensive patients in the two groups (P=0.010). Similar results were observed in IHD patients, VHD patients and HTN+IHD patients in two groups (P=0.015, P=0.037, P=0.000). Conclusion: In addition to some risk factors like baseline cardiac diseases, aging, thyrotoxicosis, pulmonary embolism, pneumonia and cardiac surgery, there also appears to be consistent links between hs-CRP, a marker of inflammation, and the pathogenesis of AF

Predicting outcomes 3 months after traumatic brain injury in patients admitted to emergency department

Background Traumatic brain injury (TBI) is among the leading causes of mortality and long-term disability. Prognosis assessment is a primary factor of clinical decision-making by emergency physicians. This study aimed to investigate the prognostic factors of TBI in the patients admitted to a typical emergency department. Methods This prospective cohort study was conducted involving 100 TBI patients. Baseline characteristics, including age, gender, Glasgow Coma Scale (GCS), and vital signs were recorded. Blood tests and brain CT scans were collected. The patients were followed-up three months after the date of admission. The observed outcomes were categorized as recovery without complication, recovery with complication, or death. Statistical analysis was performed using the simple and multivariate binary logistic regression in the software IBM SPSS version 19. Results The most common brain CT scan findings were subarachnoid hemorrhage (21.0%) and epidural hemorrhage (20.0%). In the follow-up performed three months after the admission, 47 patients (47.0%) had died, 39 (39.0%) were suffering from complications, and 14 patients (14.0%) were recovering without complications. Simple binary logistic regression showed that older age (OR=3.28, 95% C.I.=1.27-8.41), minor/moderate head trauma (OR=13.93, 95% C.I.=1.73-112.11), severe head trauma (OR=54.40, 95% C.I.=5.71-517.56) and presence of deep skull fracture (OR=8.92, 95% C.I.=1.04-75.53) were statistically significant predictors of mortality. Multivariate logistic regression showed that mortality chance was higher in elderly (OR=7.45, 95% C.I.=2.02-27.36), minor/moderate head trauma (OR=26.87, 95% C.I.=2.42-298.25) and severe head trauma (OR=127.97, 95% C.I.=9.11-1796.28). Conclusion This study demonstrated that severe head trauma was the most predicted risk factor of poorer clinical outcomes after TBI

The effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19:A systematic review and meta-analysis

BACKGROUND: Vaccination, one of the most important and effective ways of preventing infectious diseases, has recently been used to control the COVID-19 pandemic. The present meta-analysis study aimed to evaluate the effectiveness of COVID-19 vaccines in reducing the incidence, hospitalization, and mortality from COVID-19. METHODS: A systematic search was performed independently in Scopus, PubMed via Medline, ProQuest, and Google Scholar electronic databases as well as preprint servers using the keywords under study. We used random-effect models and the heterogeneity of the studies was assessed using I(2) and χ(2) statistics. In addition, the Pooled Vaccine Effectiveness (PVE) obtained from the studies was calculated by converting based on the type of outcome. RESULTS: A total of 54 studies were included in this meta-analysis. The PVE against SARS-COV 2 infection were 71% [odds ratio (OR) = 0.29, 95% confidence intervals (CI): 0.23–0.36] in the first dose and 87% (OR = 0.13, 95% CI: 0.08–0.21) in the second dose. The PVE for preventing hospitalization due to COVID-19 infection was 73% (OR = 0.27, 95% CI: 0.18–0.41) in the first dose and 89% (OR = 0.11, 95% CI: 0.07–0.17) in the second dose. With regard to the type of vaccine, mRNA-1273 and combined studies in the first dose and ChAdOx1 and mRNA-1273 in the second dose had the highest effectiveness in preventing infection. Regarding the COVID-19-related mortality, PVE was 68% (HR = 0.32, 95% CI: 0.23–0.45) in the first dose and 92% (HR = 0.08, 95% CI: 0.02–0.29) in the second dose. CONCLUSION: The results of this meta-analysis indicated that vaccination against COVID-19 with BNT162b2 mRNA, mRNA-1273, and ChAdOx1, and also their combination, was associated with a favorable effectiveness against SARS-CoV2 incidence rate, hospitalization, and mortality rate in the first and second doses in different populations. We suggest that to prevent the severe form of the disease in the future, and, in particular, in the coming epidemic picks, vaccination could be the best strategy to prevent the severe form of the disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42021289937]