Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

Abstract Background: Emergency care systems worldwide face increasing challenges due to overcrowding, limited specialist availability, geographic disparities, and the need for rapid clinical decision-making. Telemedicine has emerged as an innovative approach to improve access to expert consultation, optimize emergency department (ED) workflows, and enhance patient-centered care. This systematic review evaluates the effects of telemedicine integration in emergency care on clinical outcomes, workflow efficiency, and patient satisfaction.

Methods: A systematic review conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Scopus, Web of Science, and Cochrane Library searched for studies evaluating telemedicine applications in emergency care. Eligible studies included randomized controlled trials, prospective and retrospective observational studies, and comparative studies reporting clinical outcomes, operational performance, or patient satisfaction measures. Data regarding study characteristics, telemedicine models, emergency conditions, outcomes, and quality indicators extracted and synthesized.

Results: 28 studies involving more than 120,000 emergency care encounters were included. Telemedicine implementation was associated with improved access to specialist consultation, reduced time-to-treatment, decreased emergency department length of stay, and enhanced diagnostic decision-making. The greatest benefits observed in stroke, trauma, cardiac emergencies, and rural emergency care settings. Meta-analysis demonstrated a significant reduction in treatment delays and improved workflow efficiency. Patient satisfaction was generally high, with users reporting improved communication, reduced travel burden, and increased confidence in medical decisions. However, challenges included technological limitations, provider training requirements, and integration with existing healthcare systems.

Conclusion: Telemedicine represents an effective strategy for improving emergency care delivery by enhancing clinical decision-making, accelerating treatment processes, and improving patient experiences. Successful implementation requires reliable technological infrastructure, standardized clinical protocols, and continuous evaluation of outcomes. Future research should focus on large-scale randomized studies and cost-effectiveness analyses to optimize telemedicine integration into emergency healthcare systems.

Abstract Background: Induction of general anesthesia frequently induces hemodynamic instability characterized by hypotension, necessitating timely administration of vasopressors. The causal relationship between heart rate (HR) and blood pressure (BP) during this critical period remains incompletely understood, limiting the development of predictive models for vasopressor requirements.

Objective: This study employed dynamic causal modeling (DCM) to characterize the directional interactions between HR and BP during anesthetic induction and to develop a systems-based predictive framework for vasopressor needs.

Methods: We prospectively enrolled 120 adult patients undergoing elective major surgery under general anesthesia. Continuous HR and invasive arterial BP data were recorded from 5 minutes pre-induction to 10 minutes post-intubation. A time-varying Granger causality analysis was applied to quantify the feedforward (HR→BP) and feedback (BP→HR) causal pathways. A dynamic Bayesian network integrating hemodynamic, pharmacodynamic, and patient-specific parameters was constructed to predict vasopressor requirements.

Results: Propofol induction significantly attenuated the feedback pathway (BP→HR) from baseline (causal coefficient: 0.42±0.11 vs. 0.18±0.09, p<0.001) while preserving the feedforward pathway (HR→BP). The magnitude of feedback attenuation correlated strongly with subsequent vasopressor dose (r=0.73, p<0.001). The DCM-based prediction model achieved an AUC of 0.89 (95% CI: 0.83-0.94) for predicting vasopressor requirements >50 µg phenylephrine equivalent.

Conclusion: Dynamic causal modeling of HR-BP coupling during anesthetic induction provides mechanistic insights into hemodynamic instability and enables accurate, individualized prediction of vasopressor requirements, offering a promising framework for precision hemodynamic management.

Abstract The increasing proportion of older adults presenting to emergency departments (EDs) has created significant challenges for healthcare systems worldwide. Older patients frequently present with complex multimorbidity, functional impairment, cognitive decline, and increased vulnerability to acute stressors. Frailty, defined as a state of decreased physiological reserve and increased susceptibility to adverse health outcomes, has emerged as an important predictor of hospitalization, mortality, and functional deterioration. Emergency department-based frailty assessment tools may provide rapid identification of high-risk older adults and support individualized clinical decision-making. This systematic review and meta-analysis aimed to evaluate the predictive performance of frailty assessment instruments applied in emergency departments for hospitalization, mortality, and other adverse outcomes among older adults. A comprehensive literature search performed in major biomedical databases to identify studies evaluating validated frailty assessment tools in ED populations aged ≥65 years. Eligible studies assessed the association between frailty measurements and clinical outcomes, including hospital admission, short- and long-term mortality, intensive care utilization, functional decline, and adverse events. Data regarding study characteristics, frailty instruments, predictive performance measures, and outcomes extracted and synthesized. The pooled evidence demonstrated that ED-based frailty assessment tools were significantly associated with increased risk of hospitalization and mortality. Instruments including the Clinical Frailty Scale (CFS), Identification of Seniors at Risk (ISAR), Emergency Department Frailty Index (ED-FI), and Frailty Phenotype demonstrated moderate-to-high predictive accuracy. Frailty assessment improved risk stratification beyond chronological age alone and provided clinically meaningful information regarding patient vulnerability. However, heterogeneity existed regarding assessment methods, outcome definitions, and follow-up periods. Frailty screening in emergency departments represents a valuable approach for identifying older adults at increased risk of adverse outcomes. Integration of rapid frailty assessment into routine emergency care may improve triage decisions, facilitate appropriate resource allocation, and support patient-centered management strategies.

Abstract Introduction: While COVID-19 vaccines substantially reduced global mortality, rare hypercoagulable safety signals such as immunothrombosis emerged. In critically ill ICU patients, pre-existing systemic inflammation and endothelial strain may compound these thrombotic risks within the delicate pulmonary vasculature. Consequently, this study aimed to evaluate the incidence and clinical characteristics of pulmonary vascular thrombosis in ICU patients following COVID-19 vaccination.

Material and methods: This cross-sectional study was conducted at Imam Reza Center, Tabriz, recruiting 250 ICU patients selected via convenience sampling based on Cochran’s formula. Eligible post-vaccination patients were evaluated for pulmonary vascular thrombosis using CTPA. Demographic, clinical, hemodynamic, and laboratory data—including D-dimer and anti-PF4 levels—were abstracted from medical records and analyzed to identify clinical predictors.

Results: Pulmonary vascular thrombosis significantly correlated with thrombocytopenia (61.8% vs. 17.6%, P < 0.001), elevated D-dimer (6.84±3.42 vs. 2.22±1.28 mg/L FEU, P<0.001), and higher mPAP (31.40±8.24 vs. 22.33±4.98 mmHg, P<0.001). Multivariable regression identified anti-PF4 positivity (aOR:6.842, 95% CI:2.418–19.362, P<0.001), thrombocytopenia (aOR:3.428, 95% CI:1.584–7.418, P=0.002), and adenoviral vaccination (aOR:2.815, 95% CI:1.382–5.735, P=0.004) as independent predictors.

Conclusion: Post-vaccination pulmonary vascular thrombosis in critically ill patients is independently driven by adenoviral vector platforms, thrombocytopenia, and anti-PF4 seropositivity, leading to marked hemodynamic compromise. Routine screening with D-dimer, platelet counts, and anti-PF4 antibody assays facilitates early risk stratification, timely intervention, and mitigated ICU mortality.

Abstract Introduction: Magnetic resonance imaging has emerged as a valuable adjunctive tool for evaluating persistent symptoms following total knee arthroplasty, particularly in differentiating synovitis from occult periprosthetic infection. Advances in metal artifact reduction techniques have expanded MRI’s diagnostic utility, enabling improved visualization of periprosthetic soft tissues and inflammatory changes that are often inadequately assessed by conventional diagnostic methods.

Material and methods: This systematic review comprehensively searched major databases without time limits to evaluate the effectiveness of MRI in detecting synovitis and occult infection after total knee arthroplasty.

Results: Magnetic resonance imaging provides a comprehensive assessment of symptomatic patients after total knee arthroplasty by capturing both prevalent inflammatory changes and diagnostically specific features. While synovitis is common and often reflects aseptic pathology, findings such as bone marrow edema, periprosthetic fluid collections, and sinus tracts enhance diagnostic discrimination, supporting MRI as a valuable adjunct for identifying or excluding occult periprosthetic joint infection.

Conclusion: The relatively high negative predictive value of MRI has significant clinical implications, particularly in excluding infection in symptomatic patients. A negative MRI study, characterized by the absence of marrow edema, significant fluid collections, or aggressive soft tissue abnormalities, provides reassurance that infection is unlikely.

Abstract Introduction: Basicervical femoral neck fractures are unstable injuries often resulting from trauma, particularly in patients with multitrauma. Effective fixation must ensure mechanical stability and allow early mobilization. This study compares the outcomes of dynamic hip screw (DHS) fixation combined with either a partially or fully threaded anti-rotational screw in traumatic basicervical fractures, aiming to identify the more effective method for improving clinical results in this challenging patient population.

Material and methods: This randomized, double-blind clinical trial was conducted at Shahda Hospital, affiliated with Tabriz University of Medical Sciences(2024-2025), involving approximately 50 patients with basicervical femoral neck fractures. Patients were randomly assigned to two groups: Group A underwent fixation with a Dynamic Hip Screw (DHS) plus a partially threaded anti-rotational screw, while Group B received DHS with a fully threaded anti-rotational screw.

Results: There were no significant differences between Group A and Group B in hospital stay (p=0.620), time to recovery (p=0.642), chronic pain incidence (p=0.545), avascular necrosis (p=0.402), non-union and infection rates (both p=0.321), or surgical success (p=0.572). Additionally, Harris Hip Score components and hip function measures at follow-ups showed no significant differences, with all p-values above 0.27, indicating comparable outcomes between the two fixation methods.

Conclusion: Based on the findings of this study, there were no statistically significant differences between partial thread and full thread screw fixation in treating basicervical femoral neck fractures regarding functional hip outcomes, postoperative complications, Harris Hip Scores, or early recovery parameters.

Abstract Introduction: Proximal femoral fractures present significant biomechanical fixation challenges, particularly within osteoporotic bone. Although the Proximal Femoral Nail Antirotation (PFNA) provides theoretical rotational and load-sharing advantages via helical blade compaction, clinical evidence regarding sustained performance remains inconsistent. Therefore, this systematic review comprehensively evaluated the short- and long-term clinical, radiological, and functional outcomes of PFNA in proximal femoral fractures.

Material and methods: This systematic review followed PRISMA guidelines and searched PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library without date restrictions. Randomized trials and prospective or retrospective observational studies evaluating PFNA for proximal femoral fractures were eligible. Two reviewers retrospective observational studies evaluating PFNA for proximal femoral fractures were eligible.

Results: Compared with extramedullary fixation, PFNA demonstrated superior union rates, reduced blood loss, and fewer mechanical failures, whereas comparisons with alternative cephalomedullary devices showed comparable clinical, functional, and complication profiles over 12 to8/9). Compared with extramedullary fixation, PFNA demonstrated superior union rates, reduced blood loss, and fewer mechanical failures, whereas comparisons with alternative cephalomedullary devices showed comparable clinical, functional, and complication profiles over 12 to 24 months of follow-up.

Conclusion: The available evidence indicates that PFNA is an effective and safe fixation modality for proximal femoral fractures, offering distinct biomechanical advantages over extramedullary implants and comparable efficacy to other cephalomedullary nails. Although complication rates remain clinically acceptable, high-quality, large-scale randomized trials are still needed to establish definitive superiority regarding long-term functional recovery and implant-specific morbidities across diverse patient cohorts.