Prevalence of Posttraumatic Stress Disorder Symptoms Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis

Mirtazapine Improves Locomotor Activity and Attenuates Neuropathic Pain Following Spinal Cord Injury in Rats via Neuroinflammation Modulation

Neuroinflammation-related locomotor deficits and neuropathic pain are expected outcomes of spinal cord injury (SCI). The atypical antidepressant mirtazapine has exhibited potential neuroprotective and anti-inflammatory effects. This research aims to investigate the impacts of mirtazapine on post-SCI neuropathic pain and locomotor recovery, with a particular focus on neuroinflammation. The study utilized 30 male Wistar rats divided into five groups: Sham, SCI with vehicle treatment, and SCI administered with mirtazapine (3, 10, and 30 mg/kg/day, ip, for one week). Locomotor activity was assessed using the Basso, Beattie, and Bresnahan (BBB) scale. Mechanical, thermal, and cold allodynia were assessed using von-Frey filaments, tail flick latency, and the acetone test, respectively. ELISA was utilized to measure cytokines, while Western blotting was used to determine TRPV1 channel, 5-HT2A receptor, NLRP3, and iNOS expression. Histopathological analyses were also examined, including hematoxylin and eosin (H&E) and Luxol fast blue (LFB) staining. Mirtazapine (10 and 30 mg/kg/day) significantly improved locomotor recovery according to BBB score. It attenuated mechanical, thermal, and cold allodynia post-SCI. Moreover, it decreased pro-inflammatory cytokines TNF-α, IL-1β, IL-6, and IL-18, while increasing anti-inflammatory cytokine IL-4 and IL-10. Furthermore, it downregulated iNOS, NLRP3, and TRPV1 expression and upregulated the 5-HT2A receptor. H&E and LFB staining further revealed attenuated tissue damage and decreased demyelination. Our findings suggest that mirtazapine can alleviate neuropathic pain and reinforce locomotor recovery post-SCI by modulating neuroinflammatory responses, NLRP3, iNOS, TRPV1 channel, and 5-HT2A receptor expression.

Epidemiology of Post-traumatic Stress Disorder in Iranian Population From 2019 to 2024: A Systematic Review and Meta-analysis

BACKGROUND

Post-traumatic stress disorder (PTSD) is a disorder that arises from experiencing traumatic events such as traffic accidents, war, natural disorders, and job incidents. This study focused on determining the epidemiology of PTSD in the Iranian population from 2019 to 2024.

METHODS

In this systematic review and meta-analysis, we explored databases such as PubMed, Embase, Web of Knowledge, Scopus, and Magiran to achieve a maximum variety of screened articles. The quality of the included articles was evaluated using the STROBE checklist. For data analysis, due to the variation in reporting the PTSD prevalence across the reviewed articles, heterogeneity was assessed using the I2 index, and a random effect model was applied to account for this variation.

RESULTS

Out of 800 articles found in the initial review, only 15 articles were entered in the final analysis based on inclusion and exclusion criteria, with a total of 9868 participants. The overall PTSD prevalence in the Iranian population was 31.87% (95% confidence interval [CI]=17.87- 45.87, I2=95.29%, P<0.001). Additionally, PTSD prevalence in men (36.64%) was higher than in women (35.52%).

CONCLUSION

The prevalence of PTSD in young Iranian men is relatively high, and there was no statistically significant decrease in PTSD prevalence between 2019 and 2024.

Effectiveness of Behavioral and Pharmacologic Interventions for Depressive Symptoms After Spinal Cord Injury: Findings From a Systematic Review

OBJECTIVE

To summarize and evaluate evidence regarding the efficacy of interventions for depressive symptoms in adults living with spinal cord injury (SCI) and comorbid major depressive disorder or significant depressive symptoms to inform the development of clinical practice guidelines.

DATA SOURCES

Articles published since 2013 and available in Medline, The Cochrane Library, Embase, Scopus, CINAHL, or PsycINFO. Databases were searched in June 2022 and updated November 2023.

STUDY SELECTION

Inclusion criteria: age 18 years or older, traumatic SCI, and clinically significant depression (Population), mental health interventions including behavioral, pharmacologic, and complementary and alternative medicine (Intervention), inclusion of a control group (Comparator), with a primary outcome of depression symptom reduction (Outcome). Criteria were applied by multiple reviewers and disagreements were reconciled via unanimous decision among the entire research team. Eight articles of 2780 screened met the selection criteria.

DATA EXTRACTION

Data were extracted independently by multiple reviewers. Two reviewers independently assigned a quality score using the guidelines described by Hawker and associates and independently evaluated the risk of bias of each article using version 2 of the Cochrane risk-of-bias tool.

DATA SYNTHESIS

All studies assessed depressive symptoms during participant recruitment, screening, and/or at a baseline assessment stage. Pharmacotherapy with venlafaxine XR and several behavioral interventions appear promising, including an online mindfulness course and eye movement desensitization and reprocessing therapy. Remote interventions may be effective in reaching individuals who are unable to travel to in-person therapy sessions.

CONCLUSIONS

This systematic review provides valuable information for clinicians who treat individuals with SCI and comorbid major depressive disorder or significant depressive symptoms. It highlights the importance of considering a variety of interventions and individualizing treatment to meet individuals' needs and preferences. Future research should aim to identify effective interventions for treating depressive symptoms in individuals with SCI and optimal delivery methods for these interventions.

N-Terminal Prohormone Brain Natriuretic Peptide as a Prognostic Biomarker for the Risk of Complications in Type 2 Diabetes: A Systematic Review and Meta-Analysis

Objective

This systematic review and meta-analysis aimed at summarizing the existing clinical evidence to evaluate the prognostic performance of N-terminal prohormone brain natriuretic peptide (NT-proBNP) in predicting cardiovascular events, cardiovascular-related mortality, and all-cause mortality in patients with type 2 diabetes.

Methods

Searches were performed in Medline, Embase, Scopus, and Web of Science databases before August 1, 2021. The data were recorded as adjusted hazard ratio (HR).

Results

An increase in NT-proBNP increases the risk of cardiovascular events (HR = 1.63), cardiovascular mortality (HR = 1.86) and all-cause mortality (HR = 1.54). Seemingly, the best cutoffs for predicting cardiovascular events (HR = 2.30) and cardiovascular mortality (HR = 3.77) are levels greater than 100 pg/mL. The best cutoff of NT-proBNP in predicting all-cause mortality is levels greater than 225 pg/mL (HR = 4.72).

Conclusion

A moderate level of evidence demonstrated that NT-proBNP serum levels can predict future cardiovascular events, cardiovascular mortality, and all-cause mortality. Thus, it can be used as risk stratification for type 2 diabetes.