https://www.jampbr.com/ Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR) en daily 1 Tue, 01 Sep 2026 00:00:00 +0330 Tue, 01 Sep 2026 00:00:00 +0330 https://www.jampbr.com/article_244940.html Background: Contrast-enhanced mammography (CEM) is an emerging alternative to breast magnetic resonance imaging (MRI) for detecting breast cancer, offering lower cost and shorter acquisition time. However, comparative diagnostic accuracy remains uncertain.Objective: To compare the diagnostic performance of CEM versus breast MRI for breast cancer detection using a systematic review and meta-analysis.Methods: We searched PubMed, Scopus, and Web of Science up to January 2026 for studies reporting sensitivity and specificity of both CEM and MRI in the same population, using histopathology or follow-up as reference standard. We calculated pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC). Quality was assessed using QUADAS-2.Results: Fifteen studies (2,148 patients) met inclusion criteria. Pooled sensitivity was 94% (95% CI: 91–96%) for CEM and 96% (95% CI: 93–98%) for MRI (p=0.12). Pooled specificity was 87% (95% CI: 83–90%) for CEM and 84% (95% CI: 80–88%) for MRI (p=0.09). DOR was 118 (95% CI: 72–194) for CEM and 132 (95% CI: 78–223) for MRI. AUC was 0.97 for CEM and 0.98 for MRI. No significant heterogeneity was found (I²<50% for most analyses).Conclusion: CEM demonstrates comparable diagnostic accuracy to breast MRI for breast cancer detection, with slightly lower sensitivity but similar specificity. CEM may serve as an accessible alternative where MRI is unavailable or contraindicated. https://www.jampbr.com/article_244830.html Background: Dental caries remains the most prevalent chronic disease-affecting children globally, with early childhood caries (ECC) disproportionately impacting underserved populations despite being largely preventable. Caries risk assessment (CRA) tools have developed to stratify patients and guide preventive interventions, yet the evidence base for their predictive validity and the comparative effectiveness of risk-based management protocols remains fragmented.Objectives: This systematic review and meta-analysis aimed to (1) evaluate the predictive performance of existing CRA tools for future caries development in children, (2) assess the clinical effectiveness of prevention and management protocols stratified by caries risk category, and (3) quantify the comparative efficacy of individual preventive interventions including fluoride varnish, silver diamine fluoride (SDF), and fissure sealants.Methods: A comprehensive literature search conducted in PubMed, Cochrane Library, Embase, Web of Science, and Scopus from inception to March 2026. Randomized controlled trials and prospective cohort studies evaluating CRA tools or risk-stratified preventive protocols in children aged 0-18 years were included. Risk of bias assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST) and Cochrane RoB 2.0 tool. Meta-analyses performed using random-effects models.Results: Thirty-eight studies (n=47,832 participants) met inclusion criteria. Meta-analysis of six CRA models demonstrated moderate discriminatory performance (pooled AUC: 0.79, 95% CI: 0.73-0.84) with significant heterogeneity (I²=78%). All CRA models exhibited high risk of bias per PROBAST criteria. For preventive interventions, SDF demonstrated superior caries arrest rates compared to placebo (RR: 2.34, 95% CI: 1.78-3.08) and fluoride varnish (RR: 1.42, 95% CI: 1.12-1.79). Fissure sealants showed higher caries prevention efficacy than fluoride varnish over 36 months (RR: 0.68, 95% CI: 0.54-0.86).Conclusions: Current CRA tools show modest predictive accuracy with significant methodological limitations. Risk-stratified protocols incorporating SDF for high-risk children and sealants for permanent molars supported by moderate-quality evidence. Future research must prioritize external validation of prediction models. https://www.jampbr.com/article_244831.html Introduction: Preeclampsia is one of the most important hypertension disorders in pregnancy with adverse consequences and even maternal death. Evaluation of social support and factors related to it can protect women with preeclampsia from adverse mental and physical health outcomes so this study aims to determine factors related to perceived social support in women with preeclampsia referred to a selected hospital in Ilam. Materials and methods: In this "descriptive-correlation" study, 233 women with preeclampsia referred to the emergency department of Taleghani Hospital in Ilam in 2024 participated by available sampling method. The data collection tool included SPSS 21 software and the data were analyzed based on descriptive and analytical tests (independent T-test and analysis of variance). Findings: The average score of perceived social support among the studied samples was equal to 71.05±6.04 out of a total of 84 points which indicates a high level of perceived social support among the studied samples. Also between the average score of perceived social support with smoking and tobacco use (P=0.001), history of stillbirth (P=0.02) and type of pregnancy (P=0.04). In the studied samples, a significant relationship was observed. Conclusion: According to the results of this study, the health officials of pregnant women and nurses working in medical centers should consider the measures and interventions necessary to improve the perceived social support according to individual, social and disease factors in women with preeclampsia. https://www.jampbr.com/article_250645.html 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. https://www.jampbr.com/article_250646.html Trauma remains one of the leading causes of death and disability worldwide, particularly among young adults. Uncontrolled hemorrhage is responsible for a substantial proportion of preventable trauma-related deaths and frequently occurs during the prehospital phase of care. Tranexamic acid (TXA), an antifibrinolytic agent that inhibits plasminogen activation and fibrinolysis, has emerged as a potentially life-saving intervention when administered early after traumatic injury. Several randomized controlled trials and observational studies have evaluated the efficacy and safety of prehospital TXA administration; however, uncertainty remains regarding its impact on mortality, neurological recovery, and long-term functional outcomes across diverse trauma populations. This systematic review and meta-analysis aimed to synthesize contemporary evidence regarding the effectiveness of prehospital TXA administration in trauma patients. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library conducted for studies published between January 2010 and December 2025. Eligible studies included randomized controlled trials and observational cohorts evaluating prehospital TXA administration in trauma patients. Primary outcomes included all-cause mortality, hemorrhage-related mortality, and functional outcomes. Secondary outcomes included thromboembolic complications, blood transfusion requirements, and intensive care unit (ICU) length of stay. Random-effects meta-analysis models used to calculate pooled effect estimates. Twenty-eight studies involving 46,872 trauma patients met inclusion criteria. Prehospital TXA administration was associated with a significant reduction in overall mortality (pooled risk ratio [RR] = 0.84; 95% CI: 0.77–0.92) and hemorrhage-related mortality (RR = 0.78; 95% CI: 0.70–0.87). Functional outcomes at six months demonstrated modest but statistically significant improvement among TXA-treated patients. No significant increase in thromboembolic events observed. The findings suggest that early prehospital administration of TXA improves survival and functional recovery in trauma patients while maintaining an acceptable safety profile. These results support broader integration of TXA into prehospital trauma protocols and reinforce the importance of early hemorrhage control strategies in modern trauma care. https://www.jampbr.com/article_250647.html Acute coronary syndrome (ACS) remains one of the leading causes of morbidity and mortality worldwide, accounting for a substantial proportion of emergency department (ED) visits. Rapid and accurate identification of patients with ACS is essential to optimize clinical outcomes, reduce unnecessary hospital admissions, and improve healthcare efficiency. High-sensitivity cardiac troponin (hs-cTn) assays have revolutionized the diagnostic approach to myocardial injury by enabling earlier detection of myocardial necrosis with greater analytical precision than conventional troponin assays. In recent years, several accelerated diagnostic pathways (ADPs) incorporating hs-cTn measurements have been developed and validated for rapid rule-out and rule-in of ACS in emergency settings. This systematic review and meta-analysis aimed to evaluate the diagnostic performance, safety, and clinical utility of hs-cTn-based accelerated diagnostic pathways in patients presenting with suspected ACS. A systematic search of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library conducted for studies published between January 2015 and December 2025. Eligible studies assessed accelerated diagnostic protocols using hs-cTn assays and reported diagnostic accuracy outcomes. Pooled sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic odds ratios calculated using random-effects meta-analysis models. Heterogeneity assessed using the I² statistic. Thirty-two studies involving 78,456 patients met the inclusion criteria. The pooled sensitivity for ruling out acute myocardial infarction was 98.7% (95% CI: 98.1–99.2%), while pooled specificity was 82.4% (95% CI: 79.1–85.3%). The pooled NPV exceeded 99%, supporting the safety of early discharge strategies. Accelerated pathways significantly reduced emergency department length of stay and hospital admissions without increasing major adverse cardiac events. The findings suggest that hs-cTn-based accelerated diagnostic pathways provide highly accurate and efficient strategies for evaluating suspected ACS in emergency departments. Their widespread implementation may improve patient flow, optimize resource utilization, and maintain patient safety while facilitating rapid clinical decision-making. https://www.jampbr.com/article_250648.html 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. https://www.jampbr.com/article_250649.html 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. https://www.jampbr.com/article_250650.html Background: Intraoperative hypotension (IOH) is a prevalent and perilous complication during surgery, strongly associated with adverse postoperative outcomes including acute kidney injury, myocardial injury, and increased mortality. Current predictive strategies often rely on invasive arterial monitoring or singular hemodynamic parameters, limiting their widespread applicability. This study introduces and validates a novel Composite Systematic Instability Score (SIS), integrating multiple non-invasive hemodynamic parameters to predict IOH events up to 15 minutes before onset. Methods: We conducted a prospective observational study across three tertiary care centers, enrolling 450 adult patients undergoing moderate-to-high risk non-cardiac surgery. Non-invasive hemodynamic data, including continuous blood pressure, heart rate variability, stroke volume variation, and systemic vascular resistance estimates, were collected using the ClearSight system. The SIS algorithm was developed using a machine learning approach combining five key physiological features: mean arterial pressure trend, hypotension prediction index (HPI), cardiac output variability, systemic vascular resistance index, and pulse pressure variation. The primary outcome was prediction accuracy for IOH (defined as MAP < 65 mmHg for ≥1 minute) within a 15-minute forecast window. Results: The SIS demonstrated excellent predictive performance with an Area Under the Receiver Operating Characteristic Curve (AUC-ROC) of 0.94 (95% CI: 0.91-0.97), significantly outperforming individual parameters. At optimal threshold (SIS > 65), sensitivity was 89.2%, specificity 85.7%, positive predictive value 82.3%, and negative predictive value 91.4%. The score enabled a 52.3% reduction in IOH duration compared to standard monitoring. Conclusion: The novel Composite Systematic Instability Score, derived entirely from non-invasive monitors, provides accurate, early prediction of IOH with excellent clinical utility. This approach offers a practical, accessible tool for proactive hemodynamic management across diverse surgical settings.