Investigating the diagnostic and prognostic value of anti-SARS-CoV-2 Spike IgG/IgM ELISA tests in patients infected with coronavirus Delta variant.

Aim: This study aimed to investigate the diagnostic and prognostic value of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike IgG/IgM antibodies in patients infected with coronavirus Delta variant. Methods: This analytical observational study included 270 unvaccinated patients (aged ≥18 years) diagnosed with coronavirus disease 2019 (COVID-19) Delta variant who referred to Emergency Department of our hospital. The serum levels of anti-SARS-CoV-2 Spike IgG and IgM were measured by indirect ELISA. Main measured outcomes included anti-SARS-CoV-2 Spike IgG and IgM, chest computed tomography (CT) severity score, clinical and laboratory findings which were prospectively evaluated throughout the study period. Results: The IgM levels in critical patients were significantly higher than non-critical patients (p<0.05). But the mean level of IgG in critical patients was not significantly different from its level in non-critical patients (p>0.05). However, a significant positive correlation was observed between the levels of both antibodies and chest CT severity score (p<0.0001); this implies that their levels may reflect the degree of lung involvement. The IgM level on 15th-16th days after symptoms onset was significantly associated with the hazard of death even after adjusting for all other factors (adjusted HR (95%CI):1.28(1.014_1.63), p=0.03), whereas IgG was not (p>0.05). The survival probability among patients with IgM level ≥8.67 RU/ml (34.2%) was significantly lower than those with IgM level <8.67 RU/ml (99.5%, p=0.0001). Conclusions: Anti-SARS-CoV-2 Spike IgM antibody was significantly associated with the disease severity and risk of death in unvaccinated patients infected with coronavirus Delta variant. However, further large-scale investigations on diverse infected populations are required to precisely determine the diagnostic/prognostic value of these antibodies.

Diagnostic Competence of Creatine Kinase BB, in Mild Traumatic Brain Injury and its Prognostic Value.

Background: Due to the very high and increasing prevalence, essential complications, and risk factors for psychiatric disorders, it is necessary to introduce screening tests for diagnosing and predicting mild traumatic brain injury (mTBI) prognosis. Materials and Methods: After completing the consent form and recording information and examination findings of patients with mild trauma, venous blood samples were taken from these patients. The samples were measured by observing the cold chain. After 3 months from mTBI, the post concussion symptoms questionnaire (PCSQ) and the short form 36 (SF-36) questionnaire for physical and mental evaluations were performed. Statistical tests analyzed the relationship between different variables and serum Creatine kinase BB (CKBB) levels. Results: Statistic analyses showed no relation between CKBB level of serum and age, gender, level of consciousness, PCSQ, and SF 36 scale, and the interval between trauma and arrival to the hospital. Further, there is a significant correlation between CK-BB levels and intracranial damage based on Fisher's exact test. Conclusion: This study and following more significant considerations can introduce a serum-based biomarker panel that can accurately differentiate patients with complicated mTBI from those with uncomplicated.

Comparative Study on Clinical Characteristics of COVID-19 Patients with or without Digestive Symptoms in Razi Hospital, Ahvaz, Khuzestan.

BACKGROUND: Most commonly reported clinical manifestations are fever, fatigue and dry cough. Interestingly, a small percentage of patients experience GI symptoms, with the most common being anorexia, diarrhea, nausea and vomiting. We aimed to conduct a comparative study on COVID-19 patients with or without gastrointestinal patients (GI). AIMS: The pandemic of coronavirus disease 2019 (COVID-19) has emerged as a dire health problem, causing a massive crisis for global health. METHODS: Collective data of clinical manifestations and laboratory reports of patients admitted to Razi Hospital, Ahvaz, Khuzestan, Iran, for two weeks were analyzed. RESULTS: Our results showed that GI symptoms are not statistically significant criteria to be predictive or prognostic factors in COVID-19 patients, although they are probably related to the acute or non-acute phase of the disease. Moreover, non-specific GI symptoms seem to result from cytokine storm that occurred during the disease. CONCLUSION: Therefore, our results did not support GI tract involvement as a common route of COVID- 19 infection. Maybe future research will shed light on why and how the gastrointestinal system becomes infected by COVID-19.

Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis

Objective: The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). Methods: We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. Results: Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). Conclusion: The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.

Assessment of the diagnostic performance of two new tools versus routine screening instruments for bipolar disorder: a meta-analysis.

OBJECTIVE: The present meta-analysis was conducted to determine the diagnostic accuracy of the bipolarity index (BI) and Rapid Mode Screener (RMS) as compared with the Bipolar Spectrum Diagnostic Scale (BSDS), the Hypomania Checklist (HCL-32), and the Mood Disorder Questionnaire (MDQ) in people with bipolar disorder (BD). METHODS: We systematically searched five databases using standard search terms, and relevant articles published between May 1990 and November 30, 2021 were collected and reviewed. RESULTS: Ninety-three original studies were included (n=62,291). At the recommended cutoffs for the BI, HCL-32, BSDS, MDQ, and RMS, the pooled sensitivities were 0.82, 0.75, 0.71, 0.71, and 0.78, respectively, while the corresponding pooled specificities were 0.73, 0.63, 0.73, 0.77, and 0.72, respectively. However, there was evidence that the accuracy of the BI was superior to that of the other tests, with a relative diagnostic odds ratio (RDOR) of 1.22 (0.98-1.52, p < 0.0001). The RMS was significantly more accurate than the other tests, with an RDOR (95%CI) of 0.79 (0.67-0.92, p < 0.0001) for the detection of BD type I (BD-I). However, there was evidence that the accuracy of the MDQ was superior to that of the other tests, with an RDOR of 1.93 (0.89-2.79, p = 0.0019), for the detection of BD type II (BD-II). CONCLUSION: The psychometric properties of two new instruments, the BI and RMS, in people with BD were consistent with considerably higher diagnostic accuracy than the HCL-32, BSDS, and MDQ. However, a positive screening should be confirmed by a clinical diagnostic evaluation for BD.

The Diagnostic Competence of Glial Fibrillary Acidic Protein in Mild Traumatic Brain Injury and Its Prognostic Value in Patient Recovery.

AIM: To show whether the glial fibrillary acidic protein (GFAP) levels are significantly higher in the serum of patients with mild traumatic brain injury or not. MATERIAL AND METHODS: The level of serum GFAP was measured in 176 patients suffering from brain trauma. The ability of GFAP in predicting the presence of intracranial lesions and the need for neurosurgical intervention was analyzed using the area under the receiver (AUC) operating characteristic (ROC). By passing three months from mild TBI, the Post-Concussion Symptoms Questionnaire (PCSQ) as well as the physical and mental evaluations were performed using the SF-36 questionnaire. RESULTS: Of 176 patients included, 79.5% had no complications and symptoms by passing three months from traumatic brain injury. The AUC for GFAP was 72.6%, which revealed a good accuracy in predicting the need for neurosurgical intervention. CONCLUSION: GFAP, as a predictive factor in people with mild TBI diagnosis who need neurosurgical operation, expressed a favorable diagnostic effect.

Intravenous furosemide vs nebulized furosemide in patients with pulmonary edema: A randomized controlled trial.

BACKGROUND AND AIMS: Pulmonary edema is one of the most common acute respiratory disorders that diagnosis and treatment of the disease still remain as a health problem. The aim of this study was to compare the efficacy of intravenous furosemide and nebulized furosemide in control of the symptoms of the patients with pulmonary edem. METHODS: In this clinical trial, 80 patients were enrolled with pulmonary edema. Patients were randomly divided into two groups. In the intervention group the patients received nebulized furosemide at a dose of 1 mg furosemide for 20 minutes in 2 mL of sodium chloride 0.9% and in the control group the patients received intravenous furosemide at a dose of 1 mg/kg. Then, hemodynamic parameters and estimation of the clinical severity of the pulmonary edema in both groups was performed for 2 hours. RESULTS: According to our results, we can say that nebulized furosemide is not superior to intravenous furosemide in reducing dyspnea and crackles in patients with acute pulmonary edema, but significantly improved respiratory rate and arterial blood oxygen and has less hemodynamic changes than the intravenous furosemide. CONCLUSIONS: The results of this study showed the beneficial effects of nebulized furosemide in the treatment of pulmonary edema, which can be prescribed as a treatment in addition to standard treatment and significantly lead in better control of pulmonary edema in the short term.

Serum Level of Galectin-3 in Early Detection of Acute Pancreatitis.

BACKGROUND Acute pancreatitis (AP) is a common cause of hospital admissions. Diagnosing AP in patients presenting to emergency departments remains a challenge for physicians. Thus, we aimed to evaluate the diagnostic accuracy of galectin-3 to find a new and effective method for detecting AP. METHODS In this prospective cross-sectional study, 43 patients with a manifestation of AP were enrolled. The serum levels of galectin-3 were measured at admission and 48 hours later and compared between the groups of patients with and without AP. RESULTS Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases compared with non-AP individuals. The area under the curve (AUC) for galectin-3 was 73.1%, which revealed a good accuracy in predicting the AP diagnosis. CONCLUSION Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases, and their diagnostic value was acceptable in the detection of AP.

Serum Cleaved Tau Protein and Clinical Outcome in Patients with Minor Head Trauma.

INTRODUCTION: Minor head trauma is due to the transfer of a mechanical energy to the brain caused by a traumatic event. The present study was accomplished aiming to investigate the cleaved tau protein (CTP) as a brain injury biomarker among patients with minor head trauma. PATIENTS AND METHODS: This observational study was performed on patients with minor head trauma in 2017 who referred to emergency department of Imam Khomeini Hospital and Golestan Hospital of Ahvaz, Iran. The patients over the age of 16 years old with minor head trauma, who had computed tomography (CT) scan at most 10 hrs after the incident, and consented to participate in the study, were enrolled. C-tau evaluation was performed by the enzyme-linked immunosorbent assay (ELISA) method with monoclonal antibodies detecting the C-tau marker. Investigation of the injury after 3 months of minor head trauma was conducted using a post-concussion syndrome questionnaire (RPCS). RESULTS: In this study, 86 patients were evaluated. CTP was positive in 14% of the patients and the results revealed that there was a significant relationship between traumatic brain injury (TBI) and positive CTP (p < 0.0001). The CTP had a sensitivity and specificity of, respectively, 92% and 100% in detecting intracranial trauma. In addition, positive and negative predictive powers for this marker were 100% and 98%, respectively. CONCLUSION: In general, contrary to previous studies, the findings of this study suggest that evaluation of the CTP levels can be a strong biomarker with high sensitivity and specificity in detecting TBI.

Dexmedetomidine versus Midazolam-Fentanyl in Procedural Analgesia Sedation for Reduction of Anterior Shoulder Dislocation: A Randomized Clinical Trial.

BACKGROUND: Shoulder joint dislocation is the most common dislocation of joints in the body. To reduce the anterior shoulder dislocation, it is necessary to have analgesia and sedation. METHODS: In this randomized clinical trial, patients were divided into two equal groups. Group I received midazolam-fentanyl (0.05 mg/kg fentanyl at a dose of 1 µg/kg) for 10 minutes and group II received dexmedetomidine (1 µg/kg in the initial dose and then 0.2 µg/kg/h) for 10 minutes. The levels of analgesia according to VAS criteria and the time to reach desired sedation were compared between the two groups. RESULTS: A total of 60 patients participated in this study. The time to reach the desired sedation was 8.60 ± 2.3 minutes in the dexmedetomidine group and 11.27 ± 3.57 minutes in the midazolamfentanyl group (p= 0.001). Also, the VAS score in both midazolam-fentanyl and dexmedetomidine groups was 3.3 ± 1.24 and 2.57 ± 0.9, respectively. The differences were statistically significant (p=0.015). There was significant relationship between the time to reach desired sedation and the level of analgesia. Moreover, there was no significant difference between patient age and the time to reach the desired level of analgesia. During this study, no side effect was observed. CONCLUSION: The findings of this study show that dexmedetomidine provides a higher level of analgesia than midazolam-fentanyl. Moreover, it was also shown that dexmedetomidine causes quicker procedural sedation than midazolam-fentanyl.

Comparison of the Analgesic Effect of Intravenous Ketamine versus Intravenous Morphine in Reducing Pain of Renal Colic Patients: Double-Blind Clinical Trial Study.

BACKGROUND: The effective relief of renal colic patients with low complications is one of the important concerns of emergency physicians. The aim of this study was to investigate the use of injectable ketamine as an alternative to routine drugs in the relief of pain in patients with renal colic. METHODS: This double-blind clinical trial was conducted on patients who had suffered kidney pain due to kidney stones in 2017, referred to Ahvaz Imam Khomeini Hospital. Patients were divided into 2 groups: the first group received intravenous ketamine (0.3 mg/kg) and the second group received intravenous morphine (0.1 mg/kg) in a double-blind form. Finally, the mean pain was evaluated before injection, after 10, 20, 30, and 60 minutes as the initial result while the side effects were considered as secondary results. RESULTS: In this study, 135 patients with renal colic participate in this study. The mean pain at the time of referral to the hospital in the group receiving morphine and ketamine was 9.2 and 9.2, respectively, which did not show any significant difference. Based on these findings, there was no significant difference between the factors evaluated during the study of the two groups. Only in the ketamine group, there were 3 cases of nausea and 1 of vomiting. However, there was a significant increase in the need for additional doses of fentanyl in the morphine recipient group (p = 0.02). CONCLUSION: The findings suggest that the use of ketamine can produce a more rapid relief effect, and decrease the use of opioids which create various complications, including nausea and vomiting in patients, especially patients with renal colic.

Comparison of the analgesic effects of haloperidol with or without morphine in patients with acute renal colic: A randomized double-blind clinical trial study.

BACKGROUND: Given the increasing number of patients with acute renal colic, the present study examined the analgesic effects of haloperidol with or without morphine in order to find an effective method with fewer side effects for pain reduction in these patients. METHOD: In the present randomized double-blind clinical trial study, patients with a pain severity score of above 3 were randomly divided into 2 equal groups: Group A received intravenous morphine and haloperidol, and Group B received intravenous morphine with normal saline. Pain severity was recorded at Times 0, 20, 40, and 60 min following the injections based on a visual pain analog scale (VPAS) from 0 to 10. RESULTS: A total of 140 patients were included in this study. A comparison of the recorded pain severity scores did not show a significant difference between the 2 study groups (P = 0.38). The mean heart rate, the mean systolic and diastolic blood pressures, and the mean incidence rate of nausea and vomiting were not significantly different between Group A and Group B. The frequency of extrapyramidal side effects was 4.3% in the haloperidol group, which was not significantly different from that of the other group. The frequency of extra analgesic requirement was not significantly different between the 2 groups (P = 0.05). CONCLUSION: In our patients with acute renal colic, haloperidol failed to reduce pain and the incidence of nausea or vomiting, while it caused extrapyramidal side effects. Therefore, the prescription of this medication for acute pains, especially in renal colic, is not recommended.

Effect of Nebulized 3% Hypertonic Saline with Salbutamol on Management of Acute Asthma in Outpatient Adults: A Double-blind, Randomized Clinical Trial in Emergency Department.

Asthma is one of the most common disorders of respiratory tract, management of which still remains as a serious health problem. This study aimed to compare the efficacy of 3% hypertonic saline (HS) plus salbutamol with solely salbutamol on management of acute adults' asthma based on peak flow meter findings. In this double-blind randomized clinical trial, 340 adult patients with acute asthma attacks admitted to emergency department of Ahvaz Golestan and Emam hospitals were enrolled during 2014-2015. The patients were allocated randomly to intervention group (nebulized 2.5 mg of salbutamol and 2.5 mL of 3% HS solution for three consecutive 20-min periods) and control group (nebulized only salbutamol in the same dose and time of the intervention group). The principal outcome measures were forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR), which were assessed at baseline, and 20, 40 and 60 minutes after treatment in both groups. HS plus salbutamol resulted in a significant increase compared with solely salbutamol in both PEFR and FEV1 in 40th min (0.11±1.36; p=0.036 and 0.05±1.16; p=0.033, respectively) and 60th min (0.15±1.12; p<0.001 and 0.11±1.22; p=0.011, respectively), while no significant difference was observed in baseline and 20th min. Also, PEFR and FEV1 in both groups significantly increased as the treatment processed and the time passed. The results showed the beneficial effects of 3% HS in management of adults with acute asthma in the short term.