Background: Coronavirus disease 2019 (COVID-19) has infected people in many countries worldwide. Discovering an effective treatment for this disease, particularly in severe cases, has become the subject of intense scientific investigation. Therefore, the objective of this study was to evaluate the efficacy of intravenous immunoglobulin (IVIg) in patients with severe COVID-19 infection.Methods: This study was conducted as a randomized placebo-controlled double-blind clinical trial. Fifty-nine patients with severe COVID-19 infection who did not respond to initial treatments were randomly assigned into two groups. One group received IVIg (human)—four vials daily for 3 days (in addition to initial treatment), while the other group received a placebo. Patients’ demographic, clinical, and select laboratory test results, as well as the occurrence of in-hospital mortality, were recorded.Results: Among total study subjects, 30 patients received IVIg and 29 patients received a placebo. Demographics, clinical characteristics, and laboratory tests were not statistically different (P > 0.05) between the two groups. The in-hospital mortality rate was significantly lower in the IVIg group compared to the control group (6 [20.0%] vs. 14 [48.3%], respectively;P = 0.025). Multivariate regression analysis demonstrated that administration of IVIg did indeed have a significant impact on mortality rate (aOR = 0.003 [95% CI: 0.001–0.815];P = 0.042).Conclusions: Our study demonstrated that the administration of IVIg in patients with severe COVID-19 infection who did not respond to initial treatment could improve their clinical outcome and significantly reduce mortality rate. Further multicenter studies with larger sample sizes are nonetheless required to confirm the appropriateness of this medication as a standard treatment.Trial registration: A study protocol was registered at the Iranian Registry of Clinical Trials (www.IRCT.ir), numberIRCT20200501047259N1. It was registered retrospectively on May 17th, 2020.

Acute pulmonary embolism (PE) is a critical medical emergency that necessitates prompt identification and intervention. Accurate prognostication of early mortality is vital for recognizing patients at elevated risk for unfavourable outcomes and administering suitable therapy. Machine learning (ML) algorithms hold promise for enhancing the precision of early mortality prediction in PE patients. To devise an ML algorithm for early mortality prediction in PE patients by employing clinical and laboratory variables. This study utilized diverse oversampling techniques to improve the performance of various machine learning models including ANN, SVM, DT, RF, and AdaBoost for early mortality prediction. Appropriate oversampling methods were chosen for each model based on algorithm characteristics and dataset properties. Predictor variables included four lab tests, eight physiological time series indicators, and two general descriptors. Evaluation used metrics like accuracy, F1_score, precision, recall, Area Under the Curve (AUC) and Receiver Operating Characteristic (ROC) curves, providing a comprehensive view of models' predictive abilities. The findings indicated that the RF model with random oversampling exhibited superior performance among the five models assessed, achieving elevated accuracy and precision alongside high recall for predicting the death class. The oversampling approaches effectively equalized the sample distribution among the classes and enhanced the models' performance. The suggested ML technique can efficiently prognosticate mortality in patients afflicted with acute PE. The RF model with random oversampling can aid healthcare professionals in making well-informed decisions regarding the treatment of patients with acute PE. The study underscores the significance of oversampling methods in managing imbalanced data and emphasizes the potential of ML algorithms in refining early mortality prediction for PE patients.

Association of serum uric acid level with mortality and morbidity of patients with acute ST-elevation myocardial infarction

We conducted a retrospective, single center study to evaluate the clinical characteristics and outcomes of all consecutive patients with prosthetic valve thrombosis (PVT) over a 10 year period. Data from 85 episodes of PVT in 80 patients treated over a 10-year period between 2001 and 2011 were analyzed. The diagnosis of PVT was confirmed by echocardiography and/or fluoroscopy. PVT was considered obstructive if there was an increased pressure gradient on the echo study or reduced or fixed leaflet mobility on fluoroscopy. The primary treatment approaches included: redo surgery or thrombolysis for obstructive PVT and the intensification of anticoagulation in nonobstructive PVT. The mean age was 49.4 ± 13.1 years (range: 13-79) and 40% were male. Thrombosed valves included 53 mitral, 22 aortic, six tricuspid, and both mitral and aortic position in nine patients. Subtherapeutic INR (less than 2.5) was observed in 58 patients (68.2%). Ten patients died before any definite therapeutic strategy in obstructive PVT. In ten patients, episodes were considered nonobstructive. Sixteen patients received fibrinolysis (streptokinase) that was successful in nine patients (56.2%). Intracranial hemorrhage occurred in three (18.7%) patients, and there were four deaths in this group. In the surgical group, 49 patients underwent operation as first line therapy and seven patients after failed thrombolysis. One brain hemorrhage and three (5.3%) deaths occurred during or after surgery. Total complications were significantly less frequent in the surgery group compared with those in the thrombolytic group (14.2% vs. 68.7%, p-value < 0.001). Higher NYHA functional class and lower systolic blood pressure were associated with in-hospital mortality. Thrombolysis is less effective and has more complications compared to surgery in treatment of obstructive PVT. Compromised hemodynamic status during presentation of these patients denotes higher in-hospital mortality.

Opiates are the second most prevalent abused illicit substance after cannabis in the world. The latest United Nations Office on Drugs and Crime (UNODC) report estimated 30% increment in opium cultivation worldwide. High prevalence of opium consumption in eastern countries may be due to the high availability and traditional misconceptions. Opium consumption has been linked to hypertension, diabetes mellitus, dyslipidemia, and coronary artery diseases (CAD). In this review, we will review the association between opium use, cardiovascular diseases, and clinical outcomes. The present evidence suggests that chronic opiate consumption may increase the risk of cardiovascular diseases and related mortality.