The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevi...The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented degenerative joint disease and fragility fractures,and the risk of osteonecrosis.Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications,the recent ones reported acceptable outcomes.It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences;however,the weak immune profile has been associated with an increased probability of complications.Likewise,surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR.Therefore,a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.展开更多
After its identification in 1980s,HIV has infected more than 30 million people worldwide.Inthe era of highly active anti-retroviral therapy,anti-retroviral drug resistance results frominsufficient anti-retroviral pres...After its identification in 1980s,HIV has infected more than 30 million people worldwide.Inthe era of highly active anti-retroviral therapy,anti-retroviral drug resistance results frominsufficient anti-retroviral pressure,which may lead to treatment failure.Preliminary studiessupport the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developedworld;however,a highly heterogeneous horde of viral quasi-species are currently circulating indeveloping nations.Thus,the prioritizing of strategies adopted in such two worlds should be quitedifferent considering the varying anti-retroviral drug resistance prevalence.In this article,weexplore differences in anti-retroviral drug resistance patterns between developed and developingcountries,as they represent two distinct ecological niches of HIV from an evolutionary standpoint.展开更多
Inflammatory bowel disease(IBD)refers to a group of disorders characterized by chronic inflammation of the gastrointestinal(GI)tract.The elevated levels of nitric oxide(NO)in serum and affected tissues;mainly synthesi...Inflammatory bowel disease(IBD)refers to a group of disorders characterized by chronic inflammation of the gastrointestinal(GI)tract.The elevated levels of nitric oxide(NO)in serum and affected tissues;mainly synthesized by the inducible nitric oxide synthase(iNOS)enzyme;can exacerbate GI inflammation and is one of the major biomarkers of GI inflammation.Various natural and synthetic agents are able to ameliorate GI inflammation and decrease iNOS expression to the extent comparable with some IBD drugs.Thereby,the purpose of this study was to gather a list of natural or synthetic mediators capable of modulating IBD through the NO pathway.Electronic databases including Google Scholar and PubMed were searched from 1980 to May 2018.We found that polyphenols and particularly flavonoids are able to markedly attenuate NO production and iNOS expression through the nuclear factorκB(NF-κB)and JAK/STAT signaling pathways.Prebiotics and probiotics can also alter the GI microbiota and reduce NO expression in IBD models through a broad array of mechanisms.A number of synthetic molecules have been found to suppress NO expression either dependent on the NF-κB signaling pathway(i.e.,dexamethasone,pioglitazone,tropisetron)or independent from this pathway(i.e.,nicotine,prednisolone,celecoxib,β-adrenoceptor antagonists).Co-administration of natural and synthetic agents can affect the tissue level of NO and may improve IBD symptoms mainly by modulating the Toll like receptor-4 and NF-κB signaling pathways.展开更多
There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthenin...There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects.Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care.Muscle contractures are typically a consequence of the generated tension on the distracted muscle.It can be managed by physiotherapy initially and surgically in later severe stages.Furthermore,it is essential to avoid muscle contracture development,which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation.The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability.Joint stiffness is the other possible unfavorable effect of lengthening.It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening.Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness.Likewise,the effect of mental and physical rehabilitation programs should not be overlooked.展开更多
BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is y...BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is yet to be confirmed.A serious concern is the occurrence of various cardiac arrhythmias,particularly QT prolongation.AIM To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment(hydroxychloroquine alone or in combination with azithromycin)for COVID-19.METHODS We comprehensively searched Medline,Web of Knowledge,Google Scholar,Scopus,and Cochrane Central Register of Controlled Trials databases until October 31,2020 for all eligible studies under the considered keywords COVID19,arrhythmia,QT interval,therapy,azithromycin,and hydroxychloroquine until.The study protocols were established in compliance with PRISMA-P guidelines(Preferred Reporting Items for Systematic Review and Meta-Analysis–Protocols),and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies.Outcome measures were corrected QT(QTc)prolongation,cardiac arrhythmias,or sudden cardiac death.RESULTS Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included.The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766.The pooled prevalence rate of QTc prolongation was estimated to be 9.2%(95%confidence interval:4.5%to 18.1%).CONCLUSION Hydroxychloroquine±azithromycin regimen can significantly increase the risk of developing QTc prolongation.展开更多
Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively i...Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.展开更多
Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crash...Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crashes.Methods:We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement.An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020.Two teams include 2 reviewers each,screened independently the titles/abstracts,and after that,reviewed the full text of the included studies.The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology(STROBE)checklist.A third reviewer was assessed any discrepancy and all data of included studies were extracted.Finally,the data were systematically analyzed,and the related data were interpreted.Results:Five out of 16 studies were evaluated as high-quality according to the STROBE checklist.Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005.Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2%to 23%for car occupants and 2.8%to 46%for cyclists.Seven studies reported the risk of permanent medical impairment of the different body regions.Eleven studies stated the most common body region to develop permanent impairment,of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.Conclusion:The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world.This would facilitate decisionmaking about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.展开更多
The National Spinal Cord Injury Registry of Iran(NSCIR-IR)is a not-for-profit,hospital-based,and prospective observational registry that appraises the quality of care,long-term outcomes and the personal and psychologi...The National Spinal Cord Injury Registry of Iran(NSCIR-IR)is a not-for-profit,hospital-based,and prospective observational registry that appraises the quality of care,long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran.Benchmarking validity in every registry includes rigorous attention to data quality.Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid.We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries.In summary,the steering committee,funded and maintained by the Ministry of Health and Medical Education of Iran,the international collaborations,continued staff training,suitable data quality,and the ethical approval are considered to be the strengths of the registry,while limited human and financial resources,poor interoperability with other health systems,and time-consuming processes are among its main weaknesses.展开更多
文摘The incidence of human immunodeficiency virus(HIV)-infected cases that need total joint replacement(TJR)is generally rising.On the other hand,modern management of HIV-infected cases has enabled them to achieve longevity while increasing the need for arthroplasty procedures due to the augmented degenerative joint disease and fragility fractures,and the risk of osteonecrosis.Although initial investigations on joint replacement in HIV-infected cases showed a high risk of complications,the recent ones reported acceptable outcomes.It is a matter of debate whether HIV-infected cases are at advanced risk for adverse TJR consequences;however,the weak immune profile has been associated with an increased probability of complications.Likewise,surgeons and physicians should be aware of the complication rate after TJR in HIV-infected cases and include an honest discussion of the probable unwelcoming complication with their patients contemplating TJR.Therefore,a fundamental review and understanding of the interaction of HIV and arthroplasty are critical.
基金Supported by Tehran University of Medical Sciences(grant55/10848)
文摘After its identification in 1980s,HIV has infected more than 30 million people worldwide.Inthe era of highly active anti-retroviral therapy,anti-retroviral drug resistance results frominsufficient anti-retroviral pressure,which may lead to treatment failure.Preliminary studiessupport the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developedworld;however,a highly heterogeneous horde of viral quasi-species are currently circulating indeveloping nations.Thus,the prioritizing of strategies adopted in such two worlds should be quitedifferent considering the varying anti-retroviral drug resistance prevalence.In this article,weexplore differences in anti-retroviral drug resistance patterns between developed and developingcountries,as they represent two distinct ecological niches of HIV from an evolutionary standpoint.
文摘Inflammatory bowel disease(IBD)refers to a group of disorders characterized by chronic inflammation of the gastrointestinal(GI)tract.The elevated levels of nitric oxide(NO)in serum and affected tissues;mainly synthesized by the inducible nitric oxide synthase(iNOS)enzyme;can exacerbate GI inflammation and is one of the major biomarkers of GI inflammation.Various natural and synthetic agents are able to ameliorate GI inflammation and decrease iNOS expression to the extent comparable with some IBD drugs.Thereby,the purpose of this study was to gather a list of natural or synthetic mediators capable of modulating IBD through the NO pathway.Electronic databases including Google Scholar and PubMed were searched from 1980 to May 2018.We found that polyphenols and particularly flavonoids are able to markedly attenuate NO production and iNOS expression through the nuclear factorκB(NF-κB)and JAK/STAT signaling pathways.Prebiotics and probiotics can also alter the GI microbiota and reduce NO expression in IBD models through a broad array of mechanisms.A number of synthetic molecules have been found to suppress NO expression either dependent on the NF-κB signaling pathway(i.e.,dexamethasone,pioglitazone,tropisetron)or independent from this pathway(i.e.,nicotine,prednisolone,celecoxib,β-adrenoceptor antagonists).Co-administration of natural and synthetic agents can affect the tissue level of NO and may improve IBD symptoms mainly by modulating the Toll like receptor-4 and NF-κB signaling pathways.
文摘There is a clear clinical need for efficient physiotherapy and rehabilitation programs during and after bone lengthening and reconstruction for gaining the optimal effect and also prevention or treatment of lengthening side effects.Pin tract infection is the most prevalent side effect during lengthening which could be prevented and treated initially via proper wound care.Muscle contractures are typically a consequence of the generated tension on the distracted muscle.It can be managed by physiotherapy initially and surgically in later severe stages.Furthermore,it is essential to avoid muscle contracture development,which is the demonstration of the imbalanced muscle appeals on the joint to inhibit the following subluxation.The knee is the furthermost affected joint by the aforementioned problem due to the inherent lack of ligamentous and bony stability.Joint stiffness is the other possible unfavorable effect of lengthening.It happens because of extensive muscle contractures or may possibly be attributed to rigidity of the joint following the amplified pressure on the joint surface during the process of lengthening.Physiotherapy and occupational therapy including endurance and strength exercise as well as stretching play an important role during the rehabilitation periods for the prevention and also the treatment of muscle contracture and the following deformity and also joint stiffness.Likewise,the effect of mental and physical rehabilitation programs should not be overlooked.
文摘BACKGROUND Despite the controversies about the effectiveness of the current drug regimens for coronavirus disease 2019(COVID-19),these drugs are still the only options available.Moreover,the safety of these drugs is yet to be confirmed.A serious concern is the occurrence of various cardiac arrhythmias,particularly QT prolongation.AIM To summarize the incidence and estimate the risk of QT interval prolongation in patients scheduling for conventional treatment(hydroxychloroquine alone or in combination with azithromycin)for COVID-19.METHODS We comprehensively searched Medline,Web of Knowledge,Google Scholar,Scopus,and Cochrane Central Register of Controlled Trials databases until October 31,2020 for all eligible studies under the considered keywords COVID19,arrhythmia,QT interval,therapy,azithromycin,and hydroxychloroquine until.The study protocols were established in compliance with PRISMA-P guidelines(Preferred Reporting Items for Systematic Review and Meta-Analysis–Protocols),and a nine-star Newcastle-Ottawa Scale scoring system was used to assess the methodological quality of all eligible studies.Outcome measures were corrected QT(QTc)prolongation,cardiac arrhythmias,or sudden cardiac death.RESULTS Fifteen studies enrolling 8298 patients with targeted COVID-19 therapeutic regimes were included.The eligible studies found a significant increase in the mean QTc interval following treatment with the described medications compared to baseline QTc with weighted standard differences in means of 0.766.The pooled prevalence rate of QTc prolongation was estimated to be 9.2%(95%confidence interval:4.5%to 18.1%).CONCLUSION Hydroxychloroquine±azithromycin regimen can significantly increase the risk of developing QTc prolongation.
基金Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences,Iran(grant number is 96-02-38-35120).
文摘Purpose:To identify risk factors for developing pressure ulcers(PUs)in the acute care period of traumatic spinal fracture patients with or without spinal cord injuries(SCIs).Methods:Data were collected prospectively in participating the National Spinal column/Cord Injury Registry of Iran(NSCIR-IR)from individuals with traumatic spinal fractures with or without SCIs,in-clusive of the hospital stay from admission to discharge.Trained nursing staff examined the patients for the presence of PUs every 8 h during their hospital stay.The presence and grade of PUs were assessed according to the European Pressure Ulcer Advisory Panel classification.In addition to PU,following data were also extracted from the NSCIR-IR datasets during the period of 2015-2021:age,sex,Glasgow coma scale score at admission,having SCIs,marital status,surgery for a spinal fracture,American Spinal Injury Association impairment scale(AIS),urinary incontinence,level of education,admitted center,length of stay in the intensive care unit(ICU),hypertension,respiratory diseases,consumption of ciga-rettes,diabetes mellitus and length of stay in the hospital.Logistic regression models were used to es-timate the unadjusted and adjusted odds ratio(OR)with 95%confidence intervals(CI).Results:Altogether 2785 participants with traumatic spinal fractures were included.Among them,87(3.1%)developed PU during their hospital stay and 392(14.1%)had SCIs.In the SCI population,63(16.1%)developed PU during hospital stay.Univariate logistic regression for the whole sample showed that marital status,having SCIs,urinary incontinence,level of education,treating center,number of days in the ICU,age,and Glasgow coma scale score were significant predictors for PUs.However,further analysis by multiple logistic regression only revealed the significant risk factors to be the treating center,marital status,having SCIs,and the number of days in the ICU.For the subgroup of individuals with SCIs,marital status,AIS,urinary incontinence,level of education,the treating center,the number of days in the ICU and the number of days in the hospital were significant predictors for PUs by univariate analysis.After adjustment in the multivariate model,the treating center,marital status(singles vs.marrieds,OR=3.06,95%CI:1.55-6.03,p=0.001),and number of days in the ICU(OR=1.06,95%Cl:1.04-1.09,p<0.001)maintained significance.Conclusions:These data confirm that individuals with traumatic spinal fractures and SCIs,especially single young patients who suffer from urinary incontinence,grades A-D by AIS,prolonged ICU stay,and more extended hospitalization are at increased risk for PUs;as a result strategies to minimize PU development need further refinement.
基金funded by Sina Trauma and Surgery Research Center,Tehran University of Medical Sciences(grant number is 98-01-38-41758).
文摘Purpose:To systematically review the risk of permanent disability related to road traffic injuries(RTIs)and to determine the implications for future research regarding permanent impairment following road traffic crashes.Methods:We conducted this systematic review according to the preferred reporting items for systematic reviews and meta-analysis statement.An extended search of the literature was carried out in 4 major electronic databases for scientific research papers published from January 1980 to February 2020.Two teams include 2 reviewers each,screened independently the titles/abstracts,and after that,reviewed the full text of the included studies.The quality of the studies was assessed using the strengthening the reporting of observational studies in epidemiology(STROBE)checklist.A third reviewer was assessed any discrepancy and all data of included studies were extracted.Finally,the data were systematically analyzed,and the related data were interpreted.Results:Five out of 16 studies were evaluated as high-quality according to the STROBE checklist.Fifteen studies ranked the initial injuries according to the abbreviated injury scale 2005.Five studies reported the total risk of permanent medical impairment following RTIs which varied from 2%to 23%for car occupants and 2.8%to 46%for cyclists.Seven studies reported the risk of permanent medical impairment of the different body regions.Eleven studies stated the most common body region to develop permanent impairment,of which 6 studies demonstrated that injuries of the cervical spine and neck were at the highest risk of becoming permanent injured.Conclusion:The finding of this review revealed the necessity of providing a globally validated method to evaluate permanent medical impairment following RTIs across the world.This would facilitate decisionmaking about traffic injuries and efficient management to reduce the financial and psychological burdens for individuals and communities.
文摘The National Spinal Cord Injury Registry of Iran(NSCIR-IR)is a not-for-profit,hospital-based,and prospective observational registry that appraises the quality of care,long-term outcomes and the personal and psychological burden of traumatic spinal cord injury in Iran.Benchmarking validity in every registry includes rigorous attention to data quality.Data quality assurance is essential for any registry to make sure that correct patients are being enrolled and that the data being collected are valid.We reviewed strengths and weaknesses of the NSCIR-IR while considering the methodological guidelines and recommendations for efficient and rational governance of patient registries.In summary,the steering committee,funded and maintained by the Ministry of Health and Medical Education of Iran,the international collaborations,continued staff training,suitable data quality,and the ethical approval are considered to be the strengths of the registry,while limited human and financial resources,poor interoperability with other health systems,and time-consuming processes are among its main weaknesses.
