Comparative analysis of treatment options for chronic heart failure and depression: a systematic review and Bayesian network meta-analysis

Different interventions have been evaluated for the treatment of depression in heart failure (HF) patients. However, clear and established recommendations are lacking. PubMed, Scopus, and Web of Science databases were systematically searched for randomized controlled trials (RCT) evaluating the effect of various treatment options on depression scores in heart failure patients. The primary outcome was a change in depression scores presented as standardized mean difference (SMD). A Bayesian network for meta-analysis was constructed. Twenty-five RCTs were included, randomizing 6014 patients with confirmed heart failure and depression between 2003 and 2022. Compared to treatment as usual (TAU), only cognitive behavioral therapy (CBT) (SMD - 0.60, CI95% [- 1.0, - 0.17]) leads to a significant reduction in depression scores. Other interventions did not improve depression scores significantly. Our results show that for patients with HF and depression, CBT can significantly improve measures of depression, being the most efficacious treatment.

Prediabetes and major adverse cardiac events after acute coronary syndrome: An overestimated concept

BACKGROUND

Unlike diabetes, the effect of prediabetes on outcomes in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) is not much investigated. We investigated the association between fasting glycemic status and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with ACS undergoing PCI and had mid to long-term follow-up after coronary stenting.

METHODS

Registry-based retrospective cohort study included ACS patients who underwent PCI at the Tehran Heart Center from 2015 to 2021 with a median follow-up of 378 days. Patients were allocated into normoglycemic, prediabetic, and diabetic groups. The primary and secondary outcomes were MACCE and its components, respectively. Unadjusted and adjusted Cox models were used to evaluate the association between glycemic status and outcomes.

RESULTS

Among 13 682 patients, 3151 (23%) were prediabetic, and 5834 (42.6%) were diabetic. MACCE risk was significantly higher for diabetic versus normoglycemic (adjusted hazard ratio [aHR]: 1.22, 95% confidence interval [CI]: 1.06-1.41), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 0.95, 95% CI: 0.78-1.10). All-cause mortality risk was significantly higher in diabetic versus normoglycemic (aHR: 1.42, 95% CI: 1.08-1.86), but nonsignificantly higher for prediabetic versus normoglycemic (aHR: 1.15, 95% CI: 0.84-1.59). Among other components of MACCE, only coronary artery bypass grafting was significantly higher in diabetic patients, and not prediabetic, compared with normoglycemic.

CONCLUSIONS

Prediabetic ACS patients undergoing PCI, unlike diabetics, are not at increased risk of MACCE and all-cause mortality. While prediabetic patients could be regarded as having the same risk as nondiabetics, careful consideration to provide more intensive pre- and post-PCI care in diabetic patients is mandatory.

Ventricular Septal Defect and Mitral Regurgitation Due to Penetrating Cardiac Trauma; a Case Report and Review of Literature

Penetrating cardiac trauma is a fatal condition and can result in the injury of various parts of the heart. Ventricular Septal Defect (VSD) following these traumas occurs only in 1-5% of cases. The patients' conditions depend on location, size, and concomitant injuries. One of the uncommon coincidences with the VSD is Mitral Regurgitation (MR) due to injury to sub-valvular structures. In this study, we report a case of concomitant traumatic-induced VSD and MR in a 14-year-old boy following a stab wound to his chest. The patient was a teenage boy coming to the Rajaei Cardiology Hospital emergency room following a stab wound to the anterior and left part of his chest. Despite primary urgent surgery, his breathlessness had continued for three more months. Evaluations with Transthoracic Echocardiography (TTE) revealed VSD with concomitant MR, but there was no papillary muscle rupture. Cardiac Magnetic Resonance Imaging (MRI) and angiographic evaluation confirmed the provisional diagnosis. The Amplatzer VSD occluder repaired the VSD, and the patient was discharged following the resolution of his symptoms. Although the MR has been present in the follow-up echocardiography, the patient has been asymptomatic. Since the initial presenting symptoms and signs of VSD and MR might be subtle or delayed, imaging modalities such as TTE and Transesophageal Echocardiogram (TEE) are beneficial in determining the diagnosis and the optimal treatment.

Association of tramadol use with risk of hip fractures in patients with osteoarthritis: A systematic review and meta-analysis of observational studies

OBJECTIVE

Many studies have reported conflicting results for the use of tramadol with the risk of fractures, especially hip fractures. This systematic review and meta-analysis study aimed to evaluate the association of tramadol use versus codeine use with the risk of hip fracture for the first time.

METHODS

PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find studies that examined the association of tramadol use with hip fracture risk in patients with osteoarthritis up to May 2023. The risk of hip fracture secondary to tramadol versus codeine use was estimated based on age and sex. This systematic review was conducted based on the PRISMA checklist. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests. Egger's test was used to check publication bias. The Newcastle-Ottawa Checklist (NOS) was used to assess the quality of the studies.

FINDINGS

Ten studies with 1,939,293 participants were reviewed. The majority of participants were female. Based on the study evaluation checklist, most studies were of good quality. Tramadol use significantly increases the overall risk of hip fracture. (HR: 1.32, 95% CI: 1.14, 1.51, P: 0.001, I2:19.3%) Tramadol use significantly increases the risk of hip fracture in men (HR: 1.48, 95% CI: 1.24, 1.73, P: 0.001 I2:35%) and age ≤65 years (HR: 1.63, 95% CI: 1.45, 1.80, P: 0.001, I2:0%).

CONCLUSION

The use of tramadol significantly increases the risk of hip fracture. This increased risk of hip fracture was greater in males younger than 65 years.

An unusual presentation of metastatic prostate cancer in a 44-year-old man: A case report and review of the literature

Prostate cancer is one of the two most common non-cutaneous cancers in men. Its presentation might be with unusual symptoms and cause the wrong initial diagnosis. This case report discusses a rare neurologic manifestation of advanced metastatic cancer in a low-risk man. He had been receiving treatment for multiple sclerosis incorrectly due to unusual manifestations such as claudication and pelvic, leg, and shoulder pain. The patient underwent a whole-body bone scan and then a transrectal ultrasound-guided biopsy, which confirmed metastatic prostate cancer with a Gleason score between 7/10 and 10/10 in all samples. Following treatment with chemotherapeutic injections (docetaxel), luteinizing hormone-releasing hormone (LHRH) analogous (Zoladex), and testosterone-suppressing tablets (abiraterone), the disease has been under control and prostate-specific antigen (PSA) level has decreased significantly. The most common sites of metastasis are regional lymph nodes, bones, and lungs. However, there are reports about the spread of this type of cancer to other parts of the body. Although most patients are diagnosed when the tumor is localized to the prostate, in about 25% of patients, the disease is diagnosed when metastasis has occurred. Some markers can assist physicians in the diagnosis of this disease, such as the Prostate Health Index and the 4 K score.

Key Clinical Message

The diagnosis of prostate cancer should be considered in all age ranges of adult men. The long-distance metastasis might cause unusual presentations of the disease, such as neurologic, musculoskeletal, and dermatologic symptoms and signs far from the origin of the cancer, before genitourinary manifestations. It is crucial to keep the diagnosis of prostate cancer in mind for men with suggestive signs and symptoms that are not usually detected in this disease.

Effect of ABO blood group on postoperative overall survival and recurrence-free survival rate in patients with hepatocellular carcinoma after hepatectomy: a multi-center retrospective cohort study

BACKGROUND

Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide. The survival rate after hepatectomy as the first line of treatment for HCC depends on various factors. This study evaluated the association of the ABO blood group and Rh with overall survival (OS) and Recurrence-free survival (RFS) rate after hepatectomy.

METHODS

This multicenter retrospective cohort study reviewed the medical files of 639 HCC patients who underwent hepatectomy from 2010 to 2022 in three medical centers affiliated with the Iran University of Medical Sciences. Patient data, including demographic, clinical, tumor characteristics, and post-surgery outcomes, were collected by referring to the patient's medical profiles. The Cox proportional hazard investigated the relationship between ABO blood group type and OS and RFS rate after hepatectomy.

RESULTS

The five-year OS and RFS rates were 25.4% and 18.7%, respectively. The five-year OS (Lok rank:40.89, P:0.001) and RFS rate in patients with blood type A were significantly lower than in non-A patients. (Lok rank:10.8, P:0.001) The multivariate Cox analysis showed that blood type A, age < 45 years, tumor size > 5 cm, Poor tumor differentiation, presence of metastasis, The number of involved lymph nodes ≤ 2, and serum Alpha-Fetoprotein)AFP( level ≥ 400 were significantly related to the decreased survival rate of HCC patients after hepatectomy (P < 0.05) There was no significant association between Rh with OS and RFS (P > 0.05).

CONCLUSION

Blood group type A, compared to non-A, can be associated with decreased OS and RFS rates in patients with HCC after hepatectomy.

Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial

INTRODUCTION

Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery.

METHODS

This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS).

RESULTS

40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively).

CONCLUSION

Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial

BACKGROUND

Recovery of patients with traumatic brain injury largely depends on the reduction in secondary brain damage. The present study aims at investigating the effect of Tranexamic Acid (TXA) administration within the first hours of brain trauma in the emergency department (ED).

METHODS

This randomized, double-blind, placebo-controlled clinical trial was carried out in patients with subdural and epidural hemorrhage. Patients with any type of bleeding were assigned into two groups of TXA and 0.9% normal saline as placebo. The rate of intracranial hemorrhage after surgery was assessed by CT-scan and amount of hemoglobin (Hb) was measured immediately before surgery and after 6 hours of surgery.

RESULTS

A total of 80 participants were randomly assigned into four groups of 20 people. There was a significant difference in the mean of intraoperative bleeding during surgery in patients receiving TXA and placebo in both SDH (Subdural hematoma) and EDH (Epidural Hemorrhage) groups (P= 0.012). The Hb drop amount had no significant difference with placebo (P< 0.0001). No complications were observed in any of the intervention and control groups during the study as well.

CONCLUSION

The use of TXA may reduce bleeding, however, based on the results of this study, such effect was not statistically significant in controlling the epidural and subdural hemorrhage, but clinical trials with a higher sample size are suggested for further investigation in this regard.

Preliminary assessment of groundwater hydrogeochemistry within Gilan, a northern province of Iran

In four basins of Gilan province, groundwater samples were collected from 127 piezometric wells to investigate the hydrogeochemistry of groundwater, and additionally its suitability for drinking and irrigation purposes. The average concentrations of major cations and anions follow the order of Ca²⁺ > Na⁺ > Mg²⁺ > K⁺ and [Formula: see text], respectively. Using Piper diagram delineation, CaMgHCO₃ was determined as the main hydrogeochemical facies of groundwater. According to Piper diagrams, Gibbs plots, and ionic ratios, silicate weathering and ion exchange are the major processes regulating the groundwater hydrochemistry. Furthermore, saturation indices (SIs) revealed that carbonate precipitation also plays an important role in aquifers. Among the processes, weathering of silicate minerals seems to be the dominant process. Comparing the analyzed major ions and physicochemical parameters with the WHO guideline values indicates that the potability of most groundwater samples is generally acceptable. Electrical conductivity (EC) and total dissolved solid (TDS) measurements along with sodium percentage (SP), sodium adsorption ratio (SAR), Kelley's index (KI), and residual sodium carbonate (RSC) calculations suggest that groundwater in many areas is suitable for irrigation use. Nonetheless, total hardness (TH) values ranging as high as 650.0 mg/l reveal many groundwater samples to be classified as hard and very hard, indicating a requirement for long-term monitoring and further evaluation. The present study shows that the groundwater quality in Lahijan, Astaneh, and to a lesser extent Fouman drainage basins is lower than in Talesh. Therefore, intense monitoring programs towards enhanced water management practices are recommended before poorer quality groundwater is further utilized.

Hydrogeochemical investigations and groundwater quality assessment of Torbat-Zaveh plain, Khorasan Razavi, Iran

Hydrogeochemical investigations of groundwater in Torbat-Zaveh plain have been carried out to assess the water quality for drinking and irrigation purposes. In this study, 190 groundwater samples were collected and analyzed for physicochemical parameters and major ion concentrations. The abundance of major cations and anions was in the following order: Na(+) > Mg(2+) > Ca(2+) > K(+), and Cl(-) > [Formula: see text] > [Formula: see text] > [Formula: see text]. As a result, alkaline element (Na(+)) exceeds alkaline earth elements (Mg(2+) and Ca(2+)), and strong acids (Cl(-) and [Formula: see text]) dominate weak acids ([Formula: see text] and [Formula: see text]) in majority of the groundwater samples. Statistical analyses including Spearman correlation coefficients and factor analysis display good correlation between physicochemical parameters (EC, TDS and TH) and Na(+), Mg(2+), Ca(2+), Cl(-) and [Formula: see text]. The results display that rock-weathering interactions and ion-exchange processes play important role in controlling groundwater chemistry. Saturation index values also indicate that water chemistry is significantly affected by carbonate minerals such as calcite, aragonite and dolomite. US Salinity Laboratory(USSL) and Wilcox diagrams together with permeability index values reveal that most of the groundwater samples are suitable for irrigation purpose. However, in some regions, the water samples do not indicate required irrigational quality.

Peripheral venous pressure as a predictor of central venous pressure in continuous monitoring in children

BACKGROUND

Measurement of central venous pressure (CVP) is a reliable method for evaluating intravascular volume status and cardiac function; however it is an invasive and expensive method that may result in some complications such as arterial puncture, pneumothorax and development of infections. This study was performedto compare CVP measurements between central and peripheral catheters in infant and children with congenital heart disease.

METHODS

The CVP and peripheral venous pressure (PVP) were measured simultaneously in 30 patients within 10 consecutive hours.

RESULTS

The mean difference between CVP and PVP was 1.48±0.98 mmHg. The linear regression equation showed that CVP was 0.374+0.774 PVP (r(2) = 0.725).

CONCLUSION

PVP measured from a peripheral intravenous catheter in infants and children with congenital heart disease is an accurate estimation of CVP and its changes has good concordance with CVP over a long period of time.

Doxorubicin-loaded albumin nanoparticles: formulation and characterization

The purpose of the present study was to develop Doxorubicin (Dox) loaded albumin nanoparticles for regional drug release in solid tumours. Bovine serum albumin nanoparticles were prepared by coacervation method. The nanoparticles were characterized using various techniques: Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC), Dynamic Light Scattering (DLS) technique and Laser Doppler Electrophoresis (LDE) method. The entrapment of Dox in albumin nanoparticles also found out and in vitro release of drug was studied. The results show that the size of albumin nanoparticles increases from Z average of 67 nm to 98 and 106 nm for two different methods; A and B of drug loading, respectively. The SEM results confirm the spherical shape of nanoparticles which made at 4 degrees C. The results show that the size of nanoparticles decreases by decreasing temperature in their production process.

Poor physical activity in the elderly as assessed by a visual analogue scale is associated with dyslipidemia

The aim of the present study was to evaluate the association between a subjective measure of physical activity assessed by a Visual Analogue Scale (VAS) and dyslipidemia in an elderly population of Iran. A total of 74 elderly subjects (39 males) aged 65 years and older who referred to the Cardiovascular Department of the Hospital were studied. Physical activity was assessed on a 100 mm VAS according to which patients were then divided in to two groups active (activity score > or = 50; n = 31) and inactive (activity score < 50; n = 43). Body Mass Index (BMI), systolic and diastolic blood pressure, triglycerides, total cholesterol, Low-Density Lipoproteins (LDL) and High-Density Lipoproteins (HDL) were measured by standard methods. TG (p = 0.021) and LDL (p = 0.006) were significantly higher and HDL was significantly lower (p = 0.028) in the inactive group. No significant associations were found for other variables. As the first report from Iran, present results are important given the race differences that exist in response of plasma lipids to exercise training. Limitations of the present study include its cross-sectional, rather than prospective, structure and the relatively small sample size. It remains to be seen whether VAS can be used as a rapid screening tool for the presence of dyslipidemia in the elderly.

A 10-Gbit/s EML link using detuned narrowband optical filtering

In this paper, the effects of asymmetric narrowband optical filtering are investigated in a 10-Gbit/s optical communication link using integrated electro-absorption modulated lasers (EML). We investigate the effect of EML chirp on link performance as well as the optimal filter bandwidth and wavelength detuning. We show that both the phase response and the spectral narrowing of the filter will enable a longer distance transmission by interacting with the EML transient chirp and compensating for the fiber chromatic dispersion. Experimentally, an 8.75-GHz filter is shown to improve the link distance by 40 km from 65 to 105 km, when transmitting over standard single mode fiber.

Simultaneous optimization of resolution and analysis time in mixed micellar liquid chromatography of coumarins by use of a utility function

A chemometrics approach has been used to optimize the separation of eight coumarin compounds by mixed micellar liquid chromatography. A utility function, a multi-criterion decision-making (MCDM) method, was tested for evaluation of two different measures of chromatographic performance (resolution and analysis time). The effect of six experimental parameters on a chromatographic response function (CRF) was investigated. The factors studied were the concentrations of SDS and Brij-35, alkyl-chain length of the alcohol used as organic modifier, organic modifier concentration, mobile phase pH, and temperature. The experiments were performed according to a face-centered cube response-surface experimental design. For evaluation of the chromatograms a simple linear response function was used which expressed as a summation of two optimization criteria, resolution and analysis time. Then calculated CRF values were fitted to a polynomial model to correlate the CRF values with the variables and their interactions. The regression model obtained was characterized by both its descriptive and predictive ability (R=0.963 and R2cv=0.861) and used, by means of a grid-search algorithm, to optimize the chromatographic conditions. Experiments performed under the optimum conditions predicted by the model produced a chromatogram of high quality. The model was also verified by the good agreement observed between predicted and experimental values of the chromatographic response function under the optimum conditions.

Spectrophotometric determination of captopril with DTNB reagent in pharmaceutical formulation

A simple and sensitive spectrophotometeric method has been developed for the determination of captopril in its dosage form. The method is based on the reaction of the drug with DTNB reagent in pH 8 to produce a yellow coloured species measurable at 412 nm. The absorbance-concentration plot is linear over the range 1-10 x 10(-5) M with correlation coefficient of 0.997. The molar absorptivity and minimum delectability were 13553 and 3.2 x 10(-7) respectively. The proposed method was applied successfully for determination of captopril in its tablets form. The mean quantity and recovery were found to be 25.01+/-2% and 100.04+/-2% (each tablet contain 25 mg captopril). Quantification of the same tablets was determined by a standard method such as HPLC. The mean quantity of each tablet was found to be 25.07+/-1.22% by using HPLC method. It was not statistically, significant difference between Ellman's and HPLC method. This proposed method can be successfully applied to the determination of captopril in water and its dosage form and can use instead HPLC.