Relationship Between BMI and Disease Severity in COVID-19 Patients.

Background: Obesity and increased body mass index (BMI) are associated with coronavirus disease 2019 (COVID-19)-related complications and severity. They can exacerbate the cytokine storm and lead to severe symptoms or death in obese patients. Objectives: This cross-sectional descriptive study included patients with COVID-19 admitted to the Razi Hospital in Ahvaz, Iran, from January 2019 to December 2020. Methods: We evaluated the effect of BMI of patients admitted to the general ward and invasive unit care (ICU) on the length of hospitalization. Results: We included a total of 466 patients (male: 281 or 60.3% vs. female: 185 or 39.7%) with a mean age of 59.49 ± 14.5 years in the study. Also, 47 (10.1%) patients were admitted to the ICU, and 418 (89.7%) patients to the general ward. A higher BMI was associated with longer hospitalization (P < 0.001). Patients with BMI in the range of 18.5 - 24.9 experienced a longer hospitalization (10-20 days) (P < 0.001). BMI had no significant effect on ICU hospitalization (P = 0.36). Also, there was no significant difference between the two groups regarding the length of hospitalization (P = 0.49). Furthermore, non-diabetic patients were less likely to be admitted to the ICU (73.3% vs. 26.7%) (P < 0.001). The number of discharged patients was higher in patients admitted to the general ward compared to those admitted to the ICU (93.8% vs. 63.8%) (P < 0.001). Conclusions: According to our results, a higher BMI was a risk factor for COVID-19, especially in the early stage of infection.

Dexmedetomidine as an adjunctive treatment for acute asthma.

OBJECTIVE: This study aimed to compare the efficacy of using dexmedetomidine with salbutamol and salbutamol nebulization alone in patients with acute exacerbation of asthma presenting to the emergency department. METHODS: This clinical trial included 60 patients, in the age range of 18 to 55 years, with signs of bronchospasm presenting to the emergency department. In the intervention group, dexmedetomidine 0.5 µg/kg was injected intravenously and three doses of salbutamol nebulization were administered over 60 minutes. In the control group, salbutamol nebulization was administered for 60 minutes three times. The patient's clinical status, based on clinical symptoms, consciousness, speech, breathing rate, heart rate, and blood pressure were recorded before the intervention, and peak expiratory flow rate and forced expiratory volume in 1 second were measured at 20, 40, and 60 minutes after intervention. Patients who did not respond to the intervention were excluded from the study within 60 minutes. RESULTS: The increased mean forced expiratory volume in 1 second and mean peak expiratory flow rate were found to be similar in both groups during the treatment (P=0.304). The mean systolic and diastolic blood pressure recorded at 40 and 60 minutes were significantly lower in the intervention group. During this study, no patient was excluded before 60 minutes. CONCLUSION: Administration of dexmedetomidine in addition to standard salbutamol treatment has no beneficial effect in patients with acute asthma attacks and merely causes hypotension in patients.

The diagnostic accuracy of Artificial Intelligence-Assisted CT imaging in COVID-19 disease: A systematic review and meta-analysis.

Artificial intelligence (AI) systems have become critical in support of decision-making. This systematic review summarizes all the data currently available on the AI-assisted CT-Scan prediction accuracy for COVID-19. The ISI Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, Science Direct, PROSPERO, and EMBASE were systematically searched. We used the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess all included studies' quality and potential bias. A hierarchical receiver-operating characteristic summary (HSROC) curve and a summary receiver operating characteristic (SROC) curve have been implemented. The area under the curve (AUC) was computed to determine the diagnostic accuracy. Finally, 36 studies (a total of 39,246 image data) were selected for inclusion into the final meta-analysis. The pooled sensitivity for AI was 0.90 (95% CI, 0.90-0.91), specificity was 0.91 (95% CI, 0.90-0.92) and the AUC was 0.96 (95% CI, 0.91-0.98). For deep learning (DL) method, the pooled sensitivity was 0.90 (95% CI, 0.90-0.91), specificity was 0.88 (95% CI, 0.87-0.88) and the AUC was 0.96 (95% CI, 0.93-0.97). In case of machine learning (ML), the pooled sensitivity was 0.90 (95% CI, 0.90-0.91), specificity was 0.95 (95% CI, 0.94-0.95) and the AUC was 0.97 (95% CI, 0.96-0.99). AI in COVID-19 patients is useful in identifying symptoms of lung involvement. More prospective real-time trials are required to confirm AI's role for high and quick COVID-19 diagnosis due to the possible selection bias and retrospective existence of currently available studies.

Clinical Efficacy of Dexmedetomidine versus Ketamine in Shoulder Dislocation Reduction: A Randomized Clinical Trial Study.

Background :Shoulder joint dislocation and displacement is a common clinical condition. The present research aims to compare the clinical efficacy of ketamine versus dexmedetomidine during shoulder joint reduction. Methods : In this randomized clinical double-blind trial method, patients aged 18 to 65 years with shoulder dislocation referred to the Emergency Hospital of Imam Khomeini Hospital in Ahvaz, Iran, were enrolled. Patients were separated into two groups, patients in group A received 1mg/kg nebu-lized ketamine and patients in group B received 1 µg/kg nebulized dexmedetomidine. Pain score was recorded at 5 different time points: Zero (before intervention), 10 minutes, 20 minutes, 30 minutes, and 60 minutes after intervention., The pain score was evaluated using the visual analog scale (VAS) test. A linear regression test was carried out to compare the slopes. Also, ANOVA repeated measures test variables differences between groups. Then Tukey's multiple comparisons as post-hock were applied to compare the pains at different time points. Using IBM SPSS version 19.0 software, all analyzes were accomplished. Results : The pain score in both groups significantly decreased during different time points. The pain reduction slope in the group that received dexmedetomidine is meaningfully upper than that of ketamine (-0.08 vs. -0.06, p=0.012). The ketamine action onset time was 20 minutes after the in-tervention. In comparison, the effect of dexmedetomidine has an onset of 10 minutes after the in-tervention. Conclusion : Overall, the results of current research demonstrated that although nebulized dexme-detomidine and nebulized ketamine produce a significant decrease in pain score, dexmedetomidine provides a faster effect. Therefore, nebulized dexmedetomidine seems to be used as an appropriate choice to induce sedation during shoulder joint reduction in emergency departments.

Diagnostic Accuracy of Serum and Urine S100A8/A9 and Serum Amyloid A in Probable Acute Abdominal Pain at Emergency Department.

STUDY DESIGN: This study was performed to investigate the diagnostic values of some inflammatory biomarkers in abdominal pain. METHODS: Patients over 18 years of age with acute recent abdominal pain who presented to the Emergency Department were evaluated. Serum and urinary samples were taken and evaluated for serum and urine S100A8/A9 and serum amyloid A. All patients were referred to a surgeon and were followed up until the final diagnosis. In the end, the final diagnosis was compared with the levels of biomarkers. RESULTS: Of a total of 181 patients, 71 underwent surgery and 110 patients did not need surgery after they were clinically diagnosed. Mean levels of serum and urine S100A8/A9 had a significant difference between two groups, but serum amyloid A did not show. The diagnostic accuracy of serum S100A8/A9, urine S100A8/A9, and serum amyloid A was 86%, 79%, and 50%, respectively, in anticipation of the need or no need for surgery in acute abdominal pain. CONCLUSIONS: Our study showed that in acute abdominal pain, serum and urine S100A8/A9 can be useful indicators of the need for surgery, but serum amyloid A had a low and nonsignificant diagnostic accuracy.

A Comparison of the Effects and Side Effects of Oral Betahistine with Injectable Promethazine in the Treatment of Acute Peripheral Vertigo in Emergency.

BACKGROUND: Vertigo is an illusion of rotation that is caused by the asymmetry of neurological function of the right and left vestibular nuclei. The aim of this study was to compare the efficacy and side effects of oral betahistine with injectable promethazine in treatment of acute peripheral vertigo. METHODS: In this double-blind clinical trial study, the patients with acute peripheral vertigo were assigned in the two groups: receiving promethazine intramuscularly at a dose of 25 mg (group A) and receiving 8 mg betahistine tablets (group B) and the severity of their vertigo was evaluated on the visual analog scale (VAS) scoring system. In addition, adverse events in both groups of patients were compared and evaluated. RESULTS: A total of 162 patients (82 subjects in group A) participated in this study. The mean age, gender distribution, intensity and symptoms of vertigo were similar in both groups before the intervention. At 2 and 3 h after the intervention, the score of VAS in patients taking betahistine was significantly higher than promethazine. In addition, the clinical symptoms after taking betahistine were significantly less. Side effects seen in patients taking the promethazine include mainly drowsiness. After taking betahistine, the most common complication was abdominal problems (nausea and vomiting). CONCLUSION: The results of this study show that betahistine is a safe and effective drug in controlling patients with acute vertigo and its impact is more than promethazine.