Background Recent in vitro and clinical studies have shown that ultrasound-accelerated catheter-directed thrombolysis (USACDT) can accelerate thrombolysis. Therefore, in this meta-analysis, we aimed to compare the efficacy and safety of USACDT with conventional catheter-directed thrombolysis in patients with deep vein thrombosis. Methods A systematic search of the following electronic databases was performed from their dates of inception to 20 June 2020: MEDLINE, Scopus, Google Scholar, CINAHL, Cochrane Library, and EMBASE. All randomized controlled trials that directly compared the complications and efficacy of USACDT and conventional catheter-directed thrombolysis in patients with deep vein thrombosis were identified. The statistical analysis was performed using comprehensive meta-analysis software. Results Finally, 18 studies with a total of 597 participants were included in our meta-analysis according to the eligibility criteria. Pooled proportion of USACDT success in patients with deep vein thrombosis was 87.8% (18 studies; 95% CI: 83.1–91.3). Success rate was significantly higher in USACDT treatment than in conventional catheter-directed thrombolysis treatment (seven studies; OR: 2.96; 95% CI: 1.69–5.16; P < 0.01)). Although the mean infusion time was higher in catheter-directed thrombolysis treatment compared to USACDT treatment, this difference was not statistically significant (three studies; MD: –1.46; 95% CI: –3.25–0.32; P = 0.10). Moreover, pooled rate of complications was lower in USACDT than catheter-directed thrombolysis which was not statistically significant (seven studies; OR: 0.49; 95% CI: 0.13–1.76; P = 0.27). Conclusion This meta-analysis revealed that USACDT significantly increased the success rate of thrombolysis compared to conventional catheter-directed thrombolysis. Furthermore, USACDT was associated with lower rate of complication and infusion time. Taken together, these findings confirm the superiority of this novel intervention over conventional catheter-directed thrombolysis in treatment of patients with deep vein thrombosis.

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Down syndrome (DS) is caused by complete or segmental chromosome 21 trisomy that results in neurodegeneration and progressive intellectual disability. Abnormal function in the prefrontal cortex, cerebellum, and hippocampus are the main reasons for cognitive deficits in DS that result in impaired cognitive function, delayed speech and language, learning and memory disability, and behavioral and emotional disorders. There is no specific treatment for DS, and our understanding of the mechanisms of the disorder is incomplete and causes to hamper the development of effective therapies regarding the development of neuropathology and memory loss in DS. Here, we review the literature on cognitive functioning, unique characteristics, environmental considerations, and recent findings on Alzheimer’s disease in DS.

The brain is one of the most sensitive organs to hypoxia and the most vulnerable to ischemia and vascular events. Zolpidem, as a GABA-A receptor agonist, has an inhibiting effect on the central nervous system. In this study, the possible side effects of zolpidem on brain perfusion were reported in a patient with zolpidem addiction. Moreover, the correlated literature has been reviewed. The patient was a 33-year-old man who was referred with a complaint of cognitive impairment, gait disturbance, confusion, and seizure. The patient reported taking the daily dose of 270 mg of zolpidem. He developed acute dystonia, rigidity, and bradykinesia during treatment with haloperidol in the psychiatric ward. Brain MRI and EEG were requested due to the prolongation of cognitive impairment and parkinsonism symptoms. The Neurologist utilized Brain MRA to determine the source of microvascular lesions found in the brain MRI. Unexpectedly, a reduction in Anterior Cerebral Artery (ACA) perfusion was detected after a comprehensive evaluation by Brain MRA. In addition, impairment of several cognitive domains was observed in the follow-up visit. Zolpidem could reduce cerebral perfusion in various vascular territories. It seems that in patients who take zolpidem with higher than therapeutic doses, vascular complications and a decreased cerebral perfusion have occurred, resulting in more neurological complications, including cognitive disorders and vascular events. A holistic investigation of the patient with zolpidem abuse and neurological symptoms would be recommended to determine the probable vascular complication of zolpidem.

Introduction: Misoprostol is a widely used prostaglandin to terminate pregnancy in the second trimester. The route of drug administration has a significant effect on the quality of treatment. Objectives: In this study, we aimed to compare efficacy and adverse effects of vaginal and intrauterine extra-amniotic administration of misoprostol in second-trimester termination. Patients and Methods: In a randomized clinical trial, 112 women with an intrauterine fetal death between 13– 24 weeks of gestation attended Akbarabadi hospital were enrolled during 2018-2019. Patients were randomly divided into two groups. In group A, 200 µg misoprostol was diluted in 10ml of normal saline and administered extra-amniotic every 4 hours. Group B received vaginal tablets (200 µg in each) according to FIGO protocol. The primary outcomes were the time needed to expel gestational products and hemoglobin level changes. Results: In group A, conception product expulsion occurred within an average of 7.52 ± 0.29 hours, significantly faster than group B (12.02 ± 0.42 hours; P<0.05). In group A, the Hemoglobin level decreased after intervention (-1.23 ± 1.20 g/dL), and the changes were more prominent than group B (-0.15 ± 0.51 g/dL; P<0.05). Conclusion: For pregnancy termination, intrauterine extra-amniotic administration of misoprostol is a more effective method than the vaginal route in the second trimester. However, regarding further hemoglobin decrease in this method, its safety is still unclear and needs to be approved by further clinical trials with a larger sample size. Trial Registration: The trial protocol was approved by the Iranian Registry of Clinical Trial (identifier: IRCT20190606043830N1; https://en.irct.ir/trial/40184, ethical code: IR.IUMS.FMD.REC1396.941129004).