Hossein Fatemian

Acute ischemic stroke (AIS) is a major cause of mortality and morbidity, with hemorrhagic transformation (HT) as a severe complication. Accurate prediction of HT is essential for optimizing treatment strategies. This review assesses the accuracy and utility of deep learning (DL) and radiomics in predicting HT through imaging, regarding clinical decision-making for AIS patients. A literature search was conducted across five databases (Pubmed, Scopus, Web of Science, Embase, IEEE) up to January 23, 2025. Studies involving DL or radiomics-based ML models for predicting HT in AIS patients were included. Data from training, validation, and clinical-combined models were extracted and analyzed separately. Pooled sensitivity, specificity, and AUC were calculated with a random-effects bivariate model. For the quality assessment of studies, the Methodological Radiomics Score (METRICS) and QUADAS-2 tool were used. 16 studies consisting of 3,083 individual participants were included in the meta-analysis. The pooled AUC for training cohorts was 0.87, sensitivity 0.80, and specificity 0.85. For validation cohorts, AUC was 0.87, sensitivity 0.81, and specificity 0.86. Clinical-combined models showed an AUC of 0.93, sensitivity 0.84, and specificity 0.89. Moderate to severe heterogeneity was noted and addressed. Deep-learning models outperformed radiomics models, while clinical-combined models outperformed deep learning-only and radiomics-only models. The average METRICS score was 62.85%. No publication bias was detected. DL and radiomics models showed great potential in predicting HT in AIS patients. However, addressing methodological issues—such as inconsistent reference standards and limited external validation—is essential for the clinical implementation of these models. Graphical Abstract

Background: Neurally mediated syncope (NMS) is the primary cause of temporary and self‐limiting loss of consciousness. The tilt table test (TTT) has been consistently employed as a supplementary diagnostic tool for syncope evaluation. However, TTT requires specialized equipment, which is lacking in several emergency room and clinic environments. We hypothesized that patients susceptible to NMS may have higher parasympathetic tone. Thus, this study investigates the correlation between PR interval and Herat rate variability parameters as indicators of parasympathetic tone and TTT results.Methods: We included 213 patients referred to our cardiology clinic with an impression of NMS in 2022 and 2023. Data was retrospectively collected from 24‐h ambulatory electrocardiographic monitoring recordings, TTT results, and patients' history and physical examination records.Results: The analysis of the PR interval revealed a mean duration of 155 ms (95% CI: 148.61, 161.39) in negative TTT patients and 164.21 ms (95% CI: 158.44, 169.97) in positive TTT patients, indicating a statistically significant difference between two groups (p = 0.035). We also found that patients with a PR interval duration exceeding 160 ms demonstrated a significantly higher prevalence of positive TTT compared to those with a PR interval duration of less than 160 ms (p < 0.001, OR: 3.911, 95% CI: 2.143, 7.140).Conclusions: Our study suggests a PR interval longer than 160 milliseconds as a valuable tool for predicting TTT results and identifying patients at higher risk of NMS.

Rectal prolapse is prevalent in children and the elderly, impacting quality of life significantly. Traditional surgical interventions carry risks, especially in pediatric patients. Ethanol sclerotherapy offers a less invasive alternative, inducing fibrosis and thickening of the rectal wall. Despite its potential benefits, procedural complications are possible, emphasizing the need for careful patient selection and procedural expertise. This study aims to evaluate the safety and efficacy of sclerotherapy in treating rectal prolapse in a tertiary referral center in southern Iran. Patient records from Nemazee Hospital covering January 2014 to December 2023 were retrospectively analyzed. Pediatric patients undergoing ethanol sclerotherapy for rectal prolapse were included. Data on demographics, presentation, procedures, and outcomes were collected. Ethical approval was obtained, and specific inclusion/exclusion criteria were applied. Statistical analyses were conducted using SPSS version 26. One hundred thirty patients were evaluated, with a mean age of 10.74 ± 5.320 years. Most patients experienced constipation (56.9%). 74.2% responded well to sclerotherapy, with 12.9% needing a second injection. Complications were minimal, with bleeding being the most common (4.6%). Recurrence occurred in 18.6% of cases. Male patients showed a higher total complication rate (P = 0.010). Diarrhea-dominant patients had no recurrences post-sclerotherapy. Age significantly influenced treatment response and recurrence (P = 0.017, P = 0.035). Male predominance contradicted global pediatric rectal prolapse ratios, possibly influenced by cultural factors. Sclerotherapy remains effective, though response rates vary. Older age correlated with lower response rates and higher recurrence. Constipation-dominant prolapse was associated with increased recurrence risk. Male patients had a higher complication rate, highlighting the need for tailored management strategies.

Evidence-based medicine is defined as searching for medical information, reviewing and comparing it to each patient’s situation, and then judging the optimal decision. We aimed to measure the psychometric properties of the Evidence-Based Performance Profile (EBP2) Questionnaire among the students of health-related fields at Shiraz University of Medical Sciences. This cross-sectional study was conducted in 2021. The EBP2 questionnaire, which includes 74 five-Likert-scale items, was translated into the Persian language using the forward-backward translation method. A panel of five experts approved the face, content, and structural validity of the questionnaire. The Cronbach’s alpha and McDonald’s Omega coefficients were utilized to assess the questionnaire’s internal consistency. Furthermore, both confirmatory and exploratory factor analyses were used to assess the questionnaire’s construct validity. SPSS software version 25 and LISREL software version 8.8 were used for statistical analysis. Overall, 339 students participated in this study. The cultural adaptability, linguistic equivalence, and content validity of the Persian version of the EBP2 questionnaire were approved by a five-member team of medical experts. In addition, the results showed excellent internal consistency of the Persian version of the EBP2 questionnaire (Cronbach’s alpha = 0.962, McDonald’s Omega (ML) = 0.963). Moreover, all domains had acceptable reliability (> 0.7), except the Practice domain which had a marginally acceptable Cronbach’s alpha coefficient equal to 0.686. Exploratory factor analysis discovered six domains for the questionnaire. Moreover, the confirmatory factor analysis demonstrated that all indices except the comparative fit index (CFI) and adjusted goodness of fit (AGFI) confirmed the validity of the EBP2 questionnaire. The study’s findings indicate that the Persian translated of the EBP2 questionnaire exhibited satisfactory validity and reliability for assessing students’ evidence-based performance in health-related fields.

Cervical teratomas are rare congenital neoplasms that can cause neonatal airway obstruction if large. The female Persian neonate displayed respiratory distress at birth, with a 7 cm × 8 cm cystic solid mass identified on the left side of the neck. Antenatal ultrasonography revealed polyhydramnios. Despite initial stabilization, the infant required intubation and mechanical ventilation due to persistent respiratory distress. Imaging confirmed a cystic mass compressing the trachea, ruling out cystic hygroma. Surgical resection on postnatal day 17 revealed a 10 cm × 10 cm solid cystic structure, histologically identified as an immature teratoma. Despite risks of poor fetal and postnatal outcome from large cervical teratomas, early surgical resection after airway stabilization can result in recovery. Proper multidisciplinary management of respiratory distress from such tumors is paramount.

Objective: Cardiac Implantable Electronic Devices have emerged as an important treatment modality in the field of electrophysiology. The use of cardiac devices including pacemakers, implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT), has increased significantly over the past few decades. The long-term outcomes of these devices need to be investigated. Data description: The Iranian Electronic Physiology Registry (IEPR) will identify factors that may predispose patients to complications, long-term outcomes of cardiac devices, hospitalizations, and mortality rates.

Brugada syndrome (BS) is a hereditary cardiac channelopathy associated with premature sudden cardiac death and arrhythmic events. However, there are limited data on prevalence of BS in Iran. This study aimed to evaluate the prevalence of BS and Brugada pattern on the electrocardiogram (ECG) in a general population located in south of Iran. BS and Brugada pattern were defined as the presence of type I and type II-III Brugada spontaneously or after a sodium channel blocker test, respectively. A total of 4000 participants (52.3% women) were enrolled in this study. Only 12 patients (0.3%) had Brugada ECG pattern and 4 ECGs were consistent with BS (0.1%). All 16 cases were followed up for 60 months. No mortality or cardiovascular events were observed during this period. This study showed a very low prevalence of BS and Brugada pattern in ECG in the general population of Iran.

Background Tilt Table Test (TTT) is usually used for assessment of syncope with undefined etiology. Positive test occurs in those with parasympathetic overstimulation. This overactivation of parasympathetic system may affect QTc measurement; not only through rate modulation, but also from through potassium ionic channels as muscarinic activated inward rectifying K + current.Methods and Materials: in this cross-sectional study, 478 patients with syncopal attacks of unknown origin underwent evaluation with TTT as well as 24-hour Holter electrocardiogram monitoring. Schwartz score (for diagnosis of Long QT syndrome) was calculated for all of them. Those with secondary causes of long QT excluded from survey. Then the association of positive TTT and Schwartz score was assessed.Results 478 patients entered the study 208 (43.4%) of whom were male and 270 (56.4%) were female. The mean age of the patients was 42.43 ± 17.979 years old. TTT was positive in 289 (60.46%) patients and was negative in 189 (39.54%) patients. the mean Schwartz score was significantly higher in patients with positive TTT (2.77 ± 0.08 vs. 1.99 ± 0.12) (P < 0.001).Conclusion Diagnosis of long QT syndrome as a cause of syncope should not be made hesitantly by the use of Schwartz score as this scoring system might need to be modified based on the results of tilt table test.

Objectives: This systematic review and meta-analysis aimed to compare coronavirus disease 2019 (COVID-19) (Wuhan strain) features in children and adults during the initial pandemic phase. Methods: Until June 4, 2020, a systematic search was conducted on the EMBASE, PubMed, Web of Science, Google Scholar, and Scopus to find and collect studies based on available data among adults and children. The heterogeneity of the studies was assessed using I2 statistics and chi-square testing. The random-effect model was used to pool the effect sizes due to inter-study heterogeneity (chi-square P-value 0.1 and I2 >50%). Results: Fever (65.73%), cough (53.78%), expectoration (37.9%), gastrointestinal symptoms (37.01%), headache (23.41%), shortness of breath (21.65%), and myalgia (20.79%) were the most common symptoms reported in children, according to the pooled estimation analysis. Arthralgia (Effect estimate (ES): adults = 2.15, children = 17.94) and headache (ES: adults = 9.22, children = 23.41) were significantly observed higher in children (P-value = 0.019). Adult patients had a higher rate of abnormal computed tomography (CT)-scan findings, while most children had a normal imaging studies. Adults had significantly higher rates of comorbidities, whereas children had significantly higher rates of asthma (ES: 17.94% vs 8.85%; P-value = 0.026) and malignancy (ES: 10.36% vs 5.47%; P-value = 0.045). During initial pandemic phase, hydroxychloroquine (ES: 66.21% vs 29.01%; P-value = 0.001) and antibiotics (ES: 77.86% vs 38.01%; P-value = 0.001) were used much more frequently in adult patients. Adults used much more antibiotics than children. Nonetheless, antibiotics were given to around 40% of the children studied. Conclusions: Although children were afflicted less than adults in the early stages of the pandemic and had lower mortality, clinical and radiological findings, as well as prognostic factors, did not differ significantly between adults and children. However, with the advent of novel variants, clinical signs and symptoms, complications, and outcomes changed in children significantly.