Rationale and Design of a Registry in a Referral and Educational Medical Center in Tehran, Iran: Sina Hospital Covid-19 Registry (SHCo-19R)

Coronavirus disease 2019 (Covid-19) is caused by the novel coronavirus resulting in a highly contagious respiratory tract infection with an increased risk of acute respiratory distress syndrome (ARDS), which was first seen in Wuhan, China. Thus far, this virus has spread to many countries worldwide, including Iran. Multiple studies have assessed disease characteristics, viral genetics, and complications of Covid-19 in the Chinese population. However, there is limited data regarding patient characteristics and outcomes of infected cases outside of China. Besides, risk factors of adverse outcomes are poorly identified in different populations. Due to limited data in the Iranian population affected by the virus, we aimed to design a registry of patients with Covid-19 at Sina Hospital in Tehran, Iran [Sina Hospital Covid-19 Registry (SHCo-19R)] in this regard, to assess patient characteristics, imaging features, laboratory findings, management strategies, and adverse outcomes of Iranian patients with Covid-19 and their differences with other populations

Meta-analysis of neuron specific enolase in predicting pediatric brain injury outcomes

A reliable biomarker has not been identified to predict the outcome of traumatic brain injury (TBI) in children. Therefore, the present systematic review and meta-analysis aimed to assess the association between neuron specific enolase (NSE) and traumatic brain injury (TBI) in children. Two independent reviewers searched electronic databases of EMBASE, Cochrane library, Medline and Scopus and then they summarized the results and did a quality control check. At the end, standardized mean difference (SMD) with 95 % confidence interval (CI) and performance of NSE were assessed. 10 studies were included in the present meta-analysis. Average serum (SMD=1.3; 95 % CI: 0.5 to 2.1; p=0.001) and CSF levels (SMD=2.45; 95 % CI: 1.04 to 3.8; p<0.0001) of NSE biomarker were significantly higher in children with TBI with unfavorable outcome compared with other children. Serum NSE had an area under the curve, sensitivity and specificity of 0.75 (95 % CI: 0.72 to 0.79), 0.74 (95 % CI: 0.64 to 0.82) and 0.69 (95 % CI: 0.59 to 0.77), respectively in prediction outcome of TBI. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of serum NSE were 2.4 (95 % CI: 1.7 to 3.3), 0.38 (95 % CI: 0.26 to 0.55) and 6.0 (95 % CI: 3.0 to 12.0), respectively. The results show that the performance of NSE is in a moderate level in prediction of unfavorable outcome in children with TBI. However, data in this aspect is not sufficient and more studies are needed

Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI.&nbsp;Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI was further categorized.&nbsp;Results: 31 studies were included in the analysis. The limitations of ISNCSCI were classified into 6 domains: 1) lack of assessment of autonomic nervous system; 2) low value in assessing severity of SCI severity in children; 3) confounding factors which impact outcome are not accounted for by ISNCSCI; 4) lack of an established optimal cut off time point for administering the ISNCSCI; 5) low predictive and diagnostic value for assessing incomplete motor injuries; 6) poor classification and predictive value of the ISNCSCI.&nbsp;Conclusion: Although the ISNCSCI is a commonly used tool to assess the severity of SCI, there are several limitations

Severity assessment of impairment in spinal cord injury; a systematic review on challenging points about International Standards for Neurological Classification of Spinal Cord Injury

Objective: Assessment of spinal cord injuries (SCI) severity is usually done according to the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). However, a limitation of ISNCSCI has not been thoroughly evaluate; therefore, a systematic review was performed to gather current evidence on the limitations of the ISNCSCI for assessing SCI. Methods: An extensive literature search was performed using Medline, Embase, Web of Science, Cochrane library, and Scopus for all articles up until the end of 2017 and then was updated to the end of 2020. Data was summarized by two independent reviewers and limitations of the ISNCSCI was further categorized. Results: Thirty one studies were included in the analysis. The limitations of ISNCSCI were classified into 6 domains: 1) lack of assessment of autonomic nervous system; 2) low value in assessing severity of SCI severity in children; 3) confounding factors which impact outcome are not accounted for by ISNCSCI; 4) lack of an established optimal cut off time point for administering the ISNCSCI; 5) low predictive and diagnostic value for assessing incomplete motor injuries; 6) poor classification and predictive value of the ISNCSCI. Conclusion: Although the ISNCSCI is a commonly used tool to assess the severity of SCI, there are several limitations

Prevalence, Awareness, Treatment, and Control of Hypertension among Adult Residents of Tehran: The Tehran Cohort Study.

Background High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality. Objective We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran. Methods We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed. Results The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions. Conclusion Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men

Prevalence, awareness, treatment, and control of type 2 diabetes mellitus among the adult residents of tehran: Tehran Cohort Study.

BACKGROUND The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. METHODS We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control. RESULTS A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1-18.4) and 25.1% (95% CI: 23.1-27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m2: 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants. CONCLUSION There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled

Effect of Active and Passive Exposure to Cigarette Smoke on Lipid Profile of Children and Adolescents; A Systematic Review and Meta-Analysis

Background: The present systematic review and meta-analysis is designed in order to assess the association between passive and active smoking and lipid profile of children and adolescents. Materials and Methods:  An extensive search was done in databases of Medline, EMBASE, Web of Science, Scopus and CINAHL until October 2017. Two independent researchers screened articles and in the next step, full texts of probably relevant articles were read and summarized. At the end, results of mentioned studies were pooled and a standardized mean difference (SMD) with 95% confidence interval (95% CI) was reported. Results: Data from 17 studies (containing 41619 children and adolescents; age group between 4 and 18 years old; 51.72% boys) were entered. Comparing serum level of high density lipoprotein (HDL) in two groups of exposed and non-exposed to cigarette smoking showed that active exposure (SMD= -0.40, 95% CI: -0.59 to -0.21) and passive exposure to cigarette smoke (SMD= -0.18, 95% CI: -0.30 to -0.06) decreases the serum level of mentioned lipoprotein. Additionally, active exposure to cigarette smoke (SMD=0.16, 95% CI: 0.06 to 0.27) causes a modest increase in serum level of triglyceride. However, cigarette smoke exposure does not have any effect on the level of total cholesterol and low density lipoprotein (LDL). Conclusion: The present meta-analysis showed that exposure to cigarette smoke leads to a significant decrease in the level of HDL and triglyceride but, it does not have any effect of the level of total cholesterol and LDL in children and adolescents

The Primary Angioplasty Registry of Sina (PARS); A Brief Report of Design and Rationale

Cardiovascular diseases, especially ST-elevation myocardial infarction (STEMI), are among the major health concerns in Iran. Although primary percutaneous coronary intervention (pPCI) is performed as the treatment of choice in Iranian hospitals, there is limited data on its efficacy, safety, procedural variations, and clinical outcomes after implementation of the new Protocol-247, which transfers patients with STEMI directly to pPCI-capable hospitals. The Primary Angioplasty Registry of Sina (PARS) is an ongoing prospective hospital-based registry enrolling patient with STEMI undergoing pPCI in Sina Hospital, which is a high-volume referral PCI-capable general hospital in Tehran, Iran. This registry aims to gather high-quality data on patient characteristics, hospital-based quality of care, coronary interventions, and in-hospital as well as long-term clinical outcomes of patients undergoing pPCI due to STEMI. In addition, the findings will be used to identify independent predictors of mortality and adverse events and form the basis of future clinical trials and quality improvement strategies

Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

Background: Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007). In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2;