seyed ali nabavizadeh

 Bacillus Calmette-Guérin (BCG) immunotherapy is a standard treatment for high-risk non-muscle invasive bladder cancer (NMIBC) after tumor resection. However, not all patients respond to BCG therapy. Reliable prognostic markers are needed to predict treatment outcomes.

 This study reviewed the prognostic value of systemic immune-inflammation index (SII) and related markers in BCG response.

 A systematic literature search was conducted in PubMed, Web of Science, and Scopus databases from inception to October 2023 for studies on SII index, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) in bladder cancer patients receiving BCG therapy. Four retrospective studies involving 1124 patients met the inclusion criteria and were included in qualitative synthesis. Three studies were included in the meta-analysis of progression-free survival (PFS) and recurrence-free survival (RFS). Data on study characteristics and demographics, follow-up duration, cancer stage/grade, and pre-treatment marker levels were extracted. Hazard ratios (HRs) were pooled using a random effects model.

 Elevated pre-treatment SII was associated with significantly worse PFS (HR: 3.72, 95% CI: 1.74-7.98, P<0.001) and RFS (HR: 3.72, 95% CI: 1.42-9.77, P=0.007). However, significant heterogeneity was found among trials in the overall survival (OS) (I2 =83.49, P=0.002) and RFS (I2 =89.69%, P=0.002). In multivariate analysis, SII>672.75 was an independent predictor of BCG failure (OR: 2.229, 95% CI: 1.172-4.238, P=0.015). NLR, PLR, and MLR also showed potential prognostic value with area under the curve (AUC) values ranging from 0.592 to 0.663 for predicting non-response to BCG therapy. Specifically, NLR>3.0435, PLR>123.4398, and MLR>0.1995 were significantly associated with non-response to BCG (P<0.001 for all). In univariate analysis, BCG non-response was associated with high pre-treatment levels of PLR, NLR, and MLR (P<0.001).

 Pre-treatment SII and other inflammatory markers may predict poor outcomes after BCG immunotherapy in bladder cancer patients. SII holds promise as an accessible prognostic biomarker that can guide treatment decisions. Further large prospective studies are warranted to validate these preliminary findings.

Previous studies have shown that patients with epilepsy (PWE) perceived significant disruption in the quality and provision of care due to the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to investigate the effect of this pandemic on seizure control status and changes in seizure frequency in PWE.  A consecutive sample of adult PWE registered in the database of Shiraz Epilepsy Center (Shiraz, Iran) was included in the study. In July 2021, phone interviews were conducted with all selected patients. Information such as age, sex, last seizure, seizure type, and frequency during the 12 months before the study, and history of COVID-19 contraction was extracted. The seizure control status of the patients in 2019 (pre-pandemic) was compared with that during the COVID-19 pandemic. Data were analyzed using SPSS software with the Fisher’s exact test and Pearson’s Chi squared test. P<0.05 was considered statistically significant.  A total of 158 patients were included in the study, out of which 62 (39.2%) patients had a stable seizure control status, 47 (29.7%) had fewer seizures, and 50 (31.6%) had more seizures. Breakthrough seizures were reported by 32 (34.4%) patients. Seizure frequency increased in 18 (27.7%) and decreased in 46 (70.7%) patients. Overall, the COVID-19 pandemic has not been a major precipitating factor nor has it affected the seizure control status of PWE. In treated epilepsy, a fluctuating course with periods of seizure freedom followed by relapses is part of its natural history.

To investigate the rates of stress, anxiety, and depression among people in south Iran.

We surveyed a sample of people during September, 2020: a group of the general population without a history of any chronic medical problems, patients with epilepsy, patients with diabetes mellitus (DM), and patients with cardiac problems. The survey included four general questions and two COVID-19 specific questions [contracting COVID-19, relatives with COVID-19]. Furthermore, the survey included the DASS (Depression-Anxiety-Stress Scale)-21 questionnaire.

487 people were surveyed (154 patients with epilepsy, 127 patients with DM, 98 patients with cardiac problems, and 108 healthy individuals). Among people without a history of chronic medical illnesses, 14% had psychological problems. The highest rates of depression and anxiety were observed among patients with DM (52% and 57%, respectively) and the highest rate of increased stress was observed among patients with cardiac problems (40%). Existence underlying medical problems was significantly associated with higher rates of depression, anxiety, and stress.

While many patients with underlying chronic medical conditions, including epilepsy, suffer from depression, anxiety, and stress during the COVID-19 pandemic, we cannot establish a cause and effect relationship between COVID-19 pandemic and increased psychological problems among these patients.