Background: Diabetic kidney disease has substantial burden and limited therapeutic options. An inadequate understanding of the complex gene regulatory circuits underlying this disorder contributes to the insufficiency of current treatment strategies. MicroRNAs (miRNAs) play a crucial role as regulators of functionally related gene networks. Previously, mmu-mir-802-5p was identified as the sole dysregulated miRNA in both the kidney cortex and medulla of diabetic mice. This study aims to investigate the role of miR-802-5p in diabetic kidney disease. Materials and Methods: The validated and predicted targets of miR-802-5p were identified using miRTarBase and TargetScan databases, respectively. The functional role of this miRNA was inferred using gene ontology enrichment analysis. The expression of miR-802-5p and its selected targets were assessed by qPCR. The expression of the angiotensin receptor (Agtr1a) was measured by ELISA. Results: miR-802-5p exhibited dysregulation in both the kidney cortex and medulla of diabetic mice, with two- and four-fold over-expressions, respectively. Functional enrichment analysis of the validated and predicted targets of miR-802-5p revealed its involvement in the renin-angiotensin pathway, inflammation, and kidney development. Differential expression was observed in the Pten transcript and Agtr1a protein among the examined gene targets. Conclusion: These findings suggest that miR-802-5p is a critical regulator of diabetic nephropathy in the cortex and medulla compartments, contributing to disease pathogenesis through the renin-angiotensin axis and inflammatory pathways.

Background: Little information is available on the characteristics of cognitive ability among retirees. This study aimed to identify factors associated with cognitive impairment among Korean retirees. Materials and Methods: We used data from the Korean Longitudinal Study of Ageing survey. A total of 1755 retirees aged 45 years or older who had normal cognition were followed up for 12 years to identify cognitive impairment. Stepwise multivariate logistic models were used to assess odds ratios (ORs) and 95% confidence intervals (CIs) for cognitive decline. Results: Well-known risk factors, such as age (OR, 1.07; 95% CI, 1.06–1.09), female sex (OR, 1.49; 95% CI, 1.08–2.04), low education (OR, 2.45; 95% CI, 1.91–3.14), and depressive mood (OR, 1.51; 95% CI, 1.16–1.97), remained significantly associated with cognitive decline. Sex-stratified analysis revealed that depressive mood was significantly associated with cognitive decline in male retirees only (OR, 1.90; 95% CI, 1.31–2.75). Conclusion: Our finding indicates that screening male retirees for depressive mood is required to retard cognitive aging.

Background: This study aimed to determine the effect of breastfeeding on children's growth indices. Materials and Methods: Longitudinal data of children's growth (height, weight, and head circumference) were as a dependent variable and type of nutrition as an independent variable with using multivariate t linear mixed model. Results: The indicated that the height, weight, and head circumference of infants who were fed with breast milk showed a statistically significant difference (P < 0.05) with those of infants receiving formula. Conclusion: Exclusive feeding with breast milk, especially in the first 6 months of life, has a significant impact on the child's growth indicators compared to formula or, or a combination of both.

Background: This study aimed to compare the rate of scheduled surgery and no-show rates between online-scheduled appointments and traditionally scheduled appointments. Materials and Methods: All scheduled outpatient visits at a single large multi-subspecialty orthopedic practice in three U.S. states (PA, NJ, and NY) were collected from February 1, 2022, to February 28, 2022. Visits were categorized as “online-scheduled” or “traditionally scheduled” and then further grouped as “no-show,” “canceled,” or “visited.” Finally, visits were categorized as either “new patient” or “follow-up.” Results: There was no significant difference between scheduling systems for patient progression to any procedure within 3 months of the initial visit (P = 0.97) and patient progression for surgery only within 3 months of the initial visit (P = 0.88). However, we found a significant difference with a higher rate of progression to surgery in traditionally scheduled than online-scheduled visits when accounting for only new patient visits that progressed to surgery within 3 months of the initial encounter (P = 0.036). No-show rates between scheduling systems were not significant (P = 0.79), but no-show rates were significant when comparing the practice's subspecialties (P < 0.001). Finally, no-show rates for online-scheduled compared to traditionally scheduled patients for both new and follow-up appointments were not significantly different (P = 0.28 and P = 0.94, respectively). Conclusion: Orthopedic practices should utilize online-scheduling systems as there was a higher progression to surgery of traditionally scheduled appointments compared to online. Depending on the subspecialty, no-show rates differed. Furthermore, online-scheduling allows for more patient autonomy and less burden on office staff.

Background: Some studies showed the cerebrovascular manifestation in patients with recently pandemic coronavirus 2 named the coronavirus disease 2019 (COVID-19). However, there are rare reports about stroke subtypes in these patients. Here, we reported the stroke subtype in patients with laboratory-confirmed diagnosis of COVID-19 and treated at our hospitals, which are located in Isfahan, Iran. Materials and Methods: This is a retrospective, observational case series. Data were collected from March 01, 2020, to May 20, 2020, at three designated special care centers for COVID-19 of Isfahan University of Medical Sciences. The study included 1188 consecutive hospitalized patients with laboratory-confirmed diagnosis of COVID-19. Results: Of 1188 COVID-19 patients, 7 (0.5%) patients developed stroke. Five (0.4%) had ischemic arterial stroke, 1 (0.08%) hemorrhagic stroke and 1(0.08 %) cerebral venous and sinus thrombosis. Sixty percent of ischemic stroke were cardioembolic stroke (CE) and the rest 2 (40%) were embolic stroke of undetermined source. Three male patients (40%) had stroke as a presenting and admitted symptom of COVID-19. Four patients (57%) had severe COVID-19. Conclusion: Stroke was an uncommon manifestation in COVID-19 patients. CE was a common subtype of stroke in COVID-19 patients in our centers.

Background: Blood loss of postoperative after prostate surgery could be related with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. This study aimed to evaluate the effectiveness TXA administration in reducing bleeding in benign prostatic hyperplasia (BPH) patients who underwent open prostatectomy. Materials and Methods: This double-blind randomized clinical trial was conducted on patients with BPH who underwent open prostatectomy. The first group received TXA (1 gr IV from during surgery to 48 h after surgery, 3 times/day). Twenty-four hours after surgery, the two groups were compared in terms of bleeding rate. Hemoglobin (Hb), hematocrit (HCT), and platelet (Plt) counts were also assessed before and after the intervention. Results: Intervention and control groups were comparable in terms of basic and baseline values of variables at the beginning of the study (P > 0.05). The mean bleeding volume in TXA group was significantly lower than the control group 112.11 ± 53.5 and 190.00 ± 97.5 CC; P ≤ 0.001). Mean hospitalization (3.28±0.46 vs. 4.38 ± 0.95 days P < 0.001) and surgery duration (98.11 ± 37.11 vs. 128.00 ± 39.12 h; P = 0.001) were significantly lower in TXA group compared to control intervention. Conclusion: According to the findings of the current study, the administration of TXA led to reduce bleeding in BPH patients who underwent open prostatectomy. Furthermore, the mean Hb, HCT, levels were significantly affected by TXA. TXA treatment approach also can reduce the surgery and hospitalization time effectively. TXA approach is recommended as effective procedure in BPH patients who underwent open prostatectomy.

Background: The aim of the present study was to investigate and compare the relationship between the anatomical distribution of pulmonary lesions in computed tomography scan of patients with COVID-19. Materials and Methods: This is a cross-sectional study that was performed in 2020–2021 in Isfahan on 300 patients infected with COVID-19 pneumonia. We collected data on the age, gender, and comorbidities of patients. In addition, we gathered data on the clinical manifestations of the patients from their medical records. Results: We noted a significant decline in symptoms such as fever and sputum production in the second and third peak in comparison to the first peak (P < 0.05). Moreover, cough and muscular pain were higher in the second and third peaks compared to the first peak (P < 0.05). Cough was the most common clinical manifestation related to the peripheral distribution of the involvements, bilateral lung disease, and right lower lobe (RLL) involvements in the first peak. In the second COVID-19 peak, fever and cough were the most common clinical findings, respectively, that were mostly associated with peripheral distribution and left lower lobe involvement. Conclusion: Cough was the most common clinical manifestation related to the peripheral distribution of the involvements, bilateral lung disease, and RLL involvements in the first peak. In the second COVID-19 peak, fever and cough were the most common clinical findings.

Background: Cancer patients, as a highly vulnerable population, are receiving a great deal of attention in the current crisis of coronavirus 2019 (COVID-19). To date, shreds of evidence are not sufficient to the description of COVID-19 outcomes in patients with cancer. This study was performed to evaluate the demographic and clinical characteristics and subsequent outcomes of COVID-19 in cancer patients. Materials and Methods: A hospital-based study was conducted involving 66 cancer patients with a confirmed diagnosis of COVID-19 from January 15, 2020, to December 21, 2020, in Isfahan, Iran. The clinical information was collected by interview and medical records. The statistical analyses were performed to describe categorical variables as well as mean, standard deviation, median, and the interquartile range for quantitative variables. Results: In our study, 66 cancer patients with confirmed COVID-19 (age: 17–97 years; 50% female) were included. Leukemia and bone marrow cancer with a frequency of 25.7% were the most common types of cancer among them. Cancer patients mostly complained of fever, cough and fatigue, and shortness of breath. Among 76.9% of patients discharged from the hospital with relative recovery, 23% died; the most common cause of death was acute respiratory distress syndrome. Age, gender, and type of cancer did not affect cancer mortality. COVID-19 had no potential effect to increase the risk of side effects of anticancer therapies. Conclusion: The results of our studies revealed that cancer is an important risk factor for the higher rate of mortality in patients with COVID-19. These findings could help physicians for the management, treatment, and supportive care of COVID-19 cancer patients.

Background: This study aimed to evaluate the effects of compact food bar (CFB) designed on cardiopulmonary function in men athletes who serve in military service. Materials and Methods: In this randomized, single-blind, controlled clinical trial, 46 men of military staff were arranged into 2 groups and studied for 28 days; one branch used 3 packs daily, 700 kcal each, of CFB with Functional compounds (Caffeine and L-arginine) and the other group used regular food during training course. Maximal oxygen uptake (VO₂ Max) in vitro with cardiopulmonary exercise test, body composition, and physical activity were assessed and recorded at baseline and end of the study period. Results: VO₂ Max (P = 0.05) significantly increased in CFB group compared with baseline. Moreover, VO₂ Max (P = 0.01), VO₂/HR (P = 0.04), oxygen uptake/heart rate (VO₂/HR) (P = 0.03), and ventilation per minute/oxygen uptake (VE/VO₂) (P = 0.03) significantly increased in CFB group compared with control group. In comparison, there was no significant difference in mean ventilation per minute/carbon dioxide production (VE/VCO₂) (P = 0.41), ventilation per minute (VE) (P = 0.69), and breathing frequency (P = 0.056). No significant effect of CFB was found on weight, body mass index (P = 0.23), lean body mass (P = 0.91), and body fat mass (P = 0.91). Conclusion: Our results show that intervention with CFB is more effective than regular diet in improving cardiopulmonary function in men athletes who serve in military service.

Background: Adhesion of Candida to host cell receptors, hemolysin production, and proteinase activity are assumed as principal virulence factors and infection establishment. These virulence factors are essential for colonization, biofilm formation, and attack on the host cells. Materials and Methods: A total of 97 Candida albicans isolates obtained from gastroesophageal lesions and urinary tract infections were included in the study. Adhesion assay, proteinase activity, and hemolysin production were measured. Statistical analysis was performed using the independent t-test and Chi-square test to compare quantitative and qualitative data between the two groups. Results: The adherence ability to the buccal epithelial cells was the same in the two groups. Proteinase activity was seen in all clinical isolates. Hemolytic activities were not statistically significant in the two groups. Conclusion: Our results recommend that the pathogenicity of C. albicans in the mucous membranes cannot be connected to the infected site.

Background: Streptococcus mutans involved in caries pathogenesis is classified into four serotypes, namely serotypes c, e, f, and k. Candida albicans can be found in the plaque of children with early childhood caries (ECC). Aims: The aim of this study was to analyze the quantity of the antigens of S. mutans serotype e and C. albicans and its correlation with the salivary flow rate in ECC. Materials and Methods: The antigen quantities of caries plaque samples and caries-free were determined using an enzyme-linked immunoassay with 450-nm optical density. Results: There was a significant difference between the quantity of S. mutans serotype e and C. albicans antigens in each salivary flow rate category (P < 0.05). The relationship between the antigen quantity of S. mutans serotype e and C. albicans was r = 0.624 (P > 0.05) for caries plaque samples and r = 0.628 (P > 0.05) for caries-free samples. Conclusion: the antigen quantities of S. mutans serotype e and C. albicans and the salivary flow rate might correlate to the pathogenesis of ECC.

Background: This study aimed to determine changes in microvascular endothelial function with upper arm arteriovenous fistula (AVF) creation and maturation in patients with chronic kidney disease (CKD). Materials and Methods: This prospective cross-sectional study was performed at Hospital Universiti Sains Malaysia, a tertiary hospital in Malaysia. Forty CKD patients (stage 4–5) who were scheduled for elective AVF creation over the upper extremity for maintenance hemodialysis were recruited using convenience sampling method. Microvascular endothelial-dependent vasodilation was measured using laser Doppler flowmetry and the process of iontophoresis preoperatively and postoperatively at weeks 2 and 6. Fistula maturation was assessed at week 6. Results: Thirty-two patients had successful AVF maturation. Endothelial-dependent vasodilation (acetylcholine (Ach)%) was higher (246.48 [standard deviation (SD) 209.38] vs. 104.95 [SD 43.29], P = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], P = 0.017) in this group as compared to unsuccessful AVF group. No significant changes were seen in overall microvascular endothelial-dependent vasodilation during the 6-week study period (day 0, 246.48 [SD 209.38]; week 2, 201.14 [SD 198.19]; and week 6, 203.53 [SD 145.89]). Conclusion: Upper arm AVF creation does not affect microvascular endothelial function up to 6 weeks post operation and may not contribute to the success of AVF maturation. However, the lower microvascular endothelial-dependent vasodilation and higher systolic blood pressure in unsuccessful AVF subjects need to be further studied.

Background: The objective of this study was to evaluate the antibiotic resistance pattern of Helicobacter pylori strains isolated from patients in Isfahan province. Materials and Methods: Gastric antrum biopsy specimens of patients undergoing endoscopy were cultured. The samples with the growth of H. pylori underwent antibiotic susceptibility test by disk diffusion method. Reaults: Of 96 samples, 50 samples (53%) were positive for H. pylori. The rates of antibiotic resistance were as follows: amoxicillin, 6%; azithromycin, 20%; furazolidone, 22%; levofloxacin, 16%; metronidazole, 20%; rifampin, 12%; and tetracycline, 22%. Conclusion: H. pylori strains in our area have high rates of resistance to azithromycin, levofloxacin, metronidazole, tetracycline, and furazolidone.

Background: Neurological manifestations of coronavirus disease 2019 (COVID-19) have been highlighted. COVID-19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID-19 with and without new-onset acute ischemic stroke (AIS). Materials and Methods: In this single-center retrospective case–control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID-19 and AIS (group A) and 160 patients with COVID-19 and without AIS (group B). Results: Patients in group A were significantly older, more likely to present with critical COVID-19 (P = 0.004), had higher rates of admission in the intensive care unit (P < 0.001), more duration of hospitalization (P < 0.001), and higher in-hospital mortality (P < 0.001). At the time of hospitalization, O₂ saturation (P = 0.011), PH (P = 0.04), and HCO3 (P = 0.005) were lower in group A. White blood cell count (P = 0.002), neutrophil count (P < 0.001), neutrophil-lymphocyte ratio (P = 0.001), D-Dimer (P < 0.001), blood urea nitrogen (BUN) (P < 0.001), and BUN/Cr ratio (P < 0.001) were significantly higher in patients with AIS. Conclusion: Stroke in COVID-19 is multifactorial. In addition to conventional risk factors of ischemic stroke (age and cardiovascular risk factors), we found that patients with more severe COVID-19 are more prone to ischemic stroke. Furthermore, leukocyte count, neutrophil count, neutrophil-lymphocyte ratio, D-Dimer, BUN, and BUN/Cr ratio were higher in patients with AIS following COVID-19 infection.

Background: We aimed to investigate the prevalence of nephrocalcinosis (NC) among children with diagnosed congenital adrenal hyperplasia (CAH). Our findings would be helpful for earlier diagnosis, management, and prevention of NC-related complications. Materials and Methods: In this cross-sectional study, children with CAH, aged <18 years old who were regularly referred for follow-up, were included. The information of the patients was extracted from their medical files, and they underwent renal ultrasonography for evaluation of the presence of NC. Results: From 120 studied patients with CAH, four patients (3.3%) had NC. The prevalence of NC was higher in males than females (P = 0.05). Mean age and age of CAH diagnosis had a trend to be lower in CAH patients with NC than those without. Regression analysis indicated significant association between NC and sex (P = 0.027, r = 2.24). Conclusion: The results of this study indicated a 3.3% prevalence rate of NC for children with CAH. NC had a trend to be more prevalent in male children with CAH. Though it was not significantly different but given that the mean age and age at diagnosis of CAH in children with CAH and NC was lower that CAH patients without NC, it is suggested that in patients with CAH and NC other factors such as genetic background or unknown disease related factors are associated with hypercalcemia and NC.

Background: In multisystem inflammatory syndrome in children (MIS-C) temporarily associated with coronavirus disease-19 (COVID-19), myocardial damage has been reported. Materials and Methods: A retrospective observational cohort study included children under 18 who had a myocardial injury related to COVID-19 treated in mother and child health institute from April 2020 to August 2020. Myocardial injury related to COVID-19 was manifested by elevated serum cardiac troponin and NT-proBNP with LV dysfunction, arrhythmias, and coronary arteries (CAs) dilatation or aneurysms. During the short-term follow-up, cardiac testing (electrocardiography, laboratory analysis, echocardiography, 24-h Holter monitoring, exercise stress test, and cardiac magnetic resonance) was performed. Results: Six male adolescents (14.7 ± 2.4 years) were included in the analysis (2/6 had MIS-C shock syndrome). All patients had elevated acute-phase reactants and NT-proBNP, whereas troponins were elevated in 5/6 patients. Echocardiography revealed left ventricular (LV) systolic dysfunction (EF 45.2 ± 6.9%); 2/6 had dilated CAs. IVIG was prescribed to all patients with MIS-C. Four patients required inotropic drug support. During hospitalization, a significant reduction of CRP, LDH, NT-proBNP, and D-dimer (P < 0.05) was registered. LV systolic function recovery was registered 3 days after applied therapy (P < 0.001). None of the patients developed dilated cardiomyopathy or CA aneurysms. Conclusions: With early recognition and adequate MIS-C therapy, children recovered entirely, maintained in the short-term follow-up period.

Background: Evaluation of insulin-like growth factor-1 (IGF-1) association with retinopathy of prematurity (ROP) is our object. Materials and Methods: This study was conducted on IGF-1 levels of 40 neonates <34 weeks gestational age and 2000 g at 1^st week and 4–6 weeks after birth. All participants were evaluated for ROP after 31 weeks of gestation. Results: IGF-1 levels showed a significant difference between neonates ≤1500 and 1500–2000 g (1 and 4–6 weeks, P = 0.008, P = 0.039, respectively). No significant association was found between IGF-1 and ROP. Conclusion: Finding a meaningful association between IGF-1 and ROP requires consideration of factors affecting the IGF-1.

Background: With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs. Materials and Methods: This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs. Results: Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely. Conclusion: Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.

Background: Chemotherapy-induced nausea and vomiting (CINV) is considered as the most common complications of chemotherapy which has a detrimental influence on the quality of life of patients with cancer. We assessed the efficacy of Apple (Malus domestica) syrup for reducing CINV. Materials and Methods: This study was a randomized, double-blind, placebo-controlled trial carried out in a Hematooncology Clinic affiliated to Mazandaran University of Medical Sciences, Sari, Iran (from October 2017 to August 2018). Subjects were randomly allocated to receive apple syrup or placebo along with their previous antiemetic treatment and chemotherapy regimen, three times a day. Thirty-four patients received apple syrup (n = 16) or placebo (n = 18). Statistical analysis was conducted using SPSS software Version 21^® (SPSS Inc., Chicago, IL, USA). A P < 0.05 indicated statistical significance. Results: Both acute and delayed nausea grades were significantly lower in M. domestica syrup in comparison to placebo syrup (P = 0.001 and 0.001, respectively). The duration of nausea (P = 0.04) was lower in intervention group compared to placebo group. Conclusion: These findings demonstrated that M. domestica syrup can reduce the severity and duration of nausea in cancer patients who received chemotherapy.

There are hundreds of ventilator modes on different ventilators. Despite different names, many are similar in functions and options. Educational institutions only teach a limited collection of ventilator modes of a few numbers of models; therefore, graduates may have substantial difficulties encountering new ventilator models with unfamiliar mode names on them. In this article, an Android application for finding similar modes on different ventilators is presented. The aim is to help an intensive care practitioner to easily find a familiar mode on a new ventilator.

Background: Some studies have been reported the rates of co-infection between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus in the different regions. In this study, we report the co-infection rates between SARS-CoV-2 and influenza type B in Isfahan, Iran. Materials and Methods: All patients with a definite diagnosis of coronavirus disease 2019 (COVID-19) from Isfahan COVID-19 registry (I-core) study were enrolled from February 2020. Results: Of the 1639 laboratory COVID-19 confirmed in Isfahan province, only two persons were positive for Influenza B from Isfahan COVID-19 registry (I-core). Both patients were symptom-free after 3 months' follow-up. Conclusion: During influenza season, differentiating other causes of respiratory illness from COVID-19 is difficult, because common clinical manifestations of COVID-19 mimic those of influenza. It seems that evaluating for co-infection with different types of influenza viruses in patients with specific settings should be considered.

Background: Migraine patients often have painful trigger points, especially in the area of head and neck. Thus, we aimed to investigate the effect of myofascial release and stretching techniques in the management of migraine headache. Materials and Methods: This was a randomized controlled trial study on 40 migraine patients. The subjects in the experimental group received three sessions with a duration of 20 min per session techniques. Databases were analyzed using 2 × 3 repeated-measures analyses of variance (P < 0.05). Results: Experimental group showed a significant reduction in pain intensity (P < 0.001) and the neck disability index score (P < 0.001) and an increase in cervical range of motion (P < 0.001) in all time points after the intervention as compared with baseline and control group (P < 0.001). Conclusion: Myofascial release and stretching techniques were effective in improving symptoms in patients with migraine headache.

Background: The aim of the study was to describe the epidemiological characteristics of Nursing Homes (NHs) residents infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to compute the related case-fatality rate. Materials and Methods: The outcomes were mortality and case-fatality rate with related epidemiological characteristics (age, sex, comorbidity, and frailty). Results: During the COVID-19 outbreak lasted from March 1 to May 7, 2020, 330 residents died in Fondazione Don Gnocchi NHs bringing the mortality rate to 27% with a dramatic increase compared to the same period of 2019, when it was 7.5%. Naso/oropharyngeal swabs resulted positive for COVID-19 in 315 (71%) of the 441of the symptomatic/exposed residents tested. The COVID-19 population was 75% female, with a 17% overall fatality rate and sex-specific fatality rates of 19% and 13% for females and males, respectively. Fifty-six percent of deaths presented SARS-CoV-2-associated pneumonia, 15% cardiovascular, and 29% miscellaneous pathologies. Conclusion: Patients' complexity and frailty might influence SARS-CoV-2 infection case-fatality rate estimates. A COVID-19 register is needed to study COVID-19 frail patients' epidemiology and characteristics.

The COVID-19 outbreak is public health emergency, spreads easily from human to human, and may cause acute severe respiratory syndrome. The anesthesia teams who perform this procedure are at risk aerosolization and need special consideration and safety measures. Cardiac anesthesiologist follows two aims, recognition of COVID-19 patients that need surgery and decreasing the risk of perioperative viral transmission to coworkers. An isolated operating room (negative pressure operating room for COVID-19) should be available. It is important to regulate workflow and practices, anesthesia management, healthcare, and staff. Cardiac anesthesiologist and health-care workers must be use guidelines to treat patients with COVID-19.

Background: Considering the role of Vitamin D in cardiovascular disease (CVD) and the relationship between coronary artery calcification (CAC) and CVD, we aimed to investigate the association between the serum level of Vitamin D and CAC. Materials and Methods: This was a cross-sectional study on 67 consecutive patients who were referred for performing computed tomography angiography. We used Spearman correlation to evaluate the relationship between Vitamin D and CAC and then linear regressions to control for demographics and vascular risk factors. Results: There was no association between CAC and Vitamin D levels (Spearman coefficient = −0.03, P = 0.805). After controlling for age, sex, hypertension, hyperlipidemia, diabetes mellitus, and smoking, there was still no association between Vitamin D and CAC score (estimate = 0.001, S. E. = 0.020, P = 0.942). Conclusion: We did not find the association between the serum level of Vitamin D and coronary artery calcification.

Health authorities usually exploit after-action reports to collect data on their experience in responding to public health emergencies. To develop an effective approach to manage and learning from health emergencies, we have launched Isfahan COvid-19 REgistry for data collection during routine clinical careas a first “critical incident registry” in Iran. Registries can be employed to explain the natural history of the disease, learn about a particular disease in terms of patient outcomes, the cost-effectiveness of clinical management, monitoring the quality of health-care service, and developing research hypotheses.

Background: Cardiac rehabilitation exerts anti-inflammatory effect on several cardiovascular diseases; however, these effects were not described for Chagas cardiomyopathy, which is associated with pro-inflammatory imbalance. Materials and Methods: Ten patients with severe Chagas cardiomyopathy performed 8 months of exercise training in a cardiac rehabilitation program. Interleukin-1 beta (IL-1β), IL-8, IL-10, interferon gamma (IF-γ), tumor necrosis factor alpha (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) serum levels were measured using enzyme-linked immunosorbent assay at baseline, 4, and 8 months. The influence of exercise on cytokine levels was evaluated using the one-way analysis of variance for repeated measurements, with Bonferroni posttest for multiple comparisons. Results: Levels of pro-inflammatory (TNF-α, IL-1β, IL-8, IF-γ, and (MCP-1) and anti-inflammatory (IL-10) cytokines did not vary significantly during the observation period. Conclusion: Exercise may benefit patients with severe Chagas cardiomyopathy by curbing the production of pro-inflammatory cytokines in this disease characterized by a continuous state of inflammation.

Background: Percutaneous dilatational tracheostomy (PDT) is the most commonly used minimally invasive procedure in patients with prolonged mechanical ventilation. However, during the procedure withdrawal, the endotracheal tube (ET) may cause substantial gas leak and sometimes the airway could be lost, and the patient exposed to severe hypoxemia. In order to prevent hypoxemia during ET withdrawal and needle stuck in ET during PDT and also for performing the procedure more safe and easy. Material and Meyhods: In this study , we introduce a new instrument “downpipe endotracheal tube” that has been registered as a patent and examined it in eight patients to confirm practical advantage of this tube. Results: These patients were five female and three male, with a mean weight of 71.7 kg and the mean age of 65.12 years. The cause of tracheostomy was difficult weaning from mechanical ventilation. Conclusion: The procedure was safe in all cases. We did not find any complications during the procedure.

Background: Conventional hepatitis B virus vaccination fails to achieve efficient protection in about 5%–10% of the world population. Different factors influence the immunogenicity of hepatitis B vaccine. This study aimed to evaluate these factors in health-care workers. Materials and Methods: This was a descriptive study which was implemented among 140 of medical and dental staff working as health-care workers who were low responder after vaccination entered the study. Results: Age (> 40 years), weight (body mass index >25), immunodeficiency diseases, (primary immune deficiency and immunosuppressant drugs), diabetes mellitus, and smoking were the important factors. Conclusion: In the high-risk group of hepatitis B disease, the risk factors of immunogenicity must be evaluated at vaccination and check titers of antibody after vaccination.

Background: Although cognitive impairment is common in multiple sclerosis (MS) patients, language difficulties are controversy and little information is available on nonEnglish languages. Therefore, the present cross-sectional study was conducted to assess the naming accuracy in Persian relapsing-remitting MS (RRMS) patients. Materials and Methods: Thirty RRMS patients were recruited from Kashani Comprehensive MS Center, Isfahan, Iran. Their performance on measures of mini mental state examination (MMSE), Expanded Disability Status Scale, and Naming Test was compared with control participants. Results: MS patients were found to have much more naming errors than the control group (2.1 ± 1.8 vs. 0.54 ± 1.1 P = 0.02). Average MMSE score of MS patients was 27.23 (range = 18–30, standard deviation [SD] = 2) versus 28.96 (range = 19–30, SD = 3.2) in controls. Conclusion: The present study suggests that naming ability can be impaired in RRMS regardless of disability score. Specific language function tests including naming should be considered in the process of evaluating and rehabilitating patients with MS.

Background: This study aimed to determine the prevalence of glucose metabolism disorder and dyslipidemia in 14–18-year-old girls with different phenotype polycystic ovary syndrome (PCOS). Materials and Methods: This descriptive, cross-sectional study was conducted on 3200 high-school adolescents aged 14–18 years in Shiraz in 2010. Selected parameters of metabolic syndrome (fasting blood glucose, glucose tolerance test [GTT], insulin level, triglyceride (TG), cholesterol, and high-density lipoprotein [HDL]), based on adult treatment panel ø definition criteria, were compared between the “PCOS” and control groups. Results: Results were compared at four main phenotypes. The level of serum TG was increased in the Phenotype B (P = 0.03) and Phenotype D (P = 0.01), compared to the control group. Cholesterol and low-density lipoprotein levels (P < 0.05) and GTT (P < 0.05) were increased, and HDL was decreased (was below 50) in all the four phenotypes and the control group (P < 0.05). Conclusion: The risk of metabolic alterations of glucose metabolism disorder and dyslipidemia in PCOS adolescents was more than non-PCOS counterparts.

Background: Despite the available data on demographic information of oral squamous cell carcinoma (OSCC), the changing trend of histopathologic pattern of OSCC has not conducted yet, in Iran. The aim was to investigate the pattern of histopathologic features of OSCC in Iran by analyzing the patients referred to Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015. Materials and Methods: The study was a retrospective institutional study. The pathology records with the diagnosis of OSCC were retrieved from Iran National Tumor Bank, Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran, during 2006-2015. The demographic characteristics and histopathologic features were recorded and analyzed for possible trend. Descriptive analysis was used for statistical interpretation. Results: The data showed an increasing number of moderately and poorly differentiated OSCC. Accordingly, higher increasing rate in tumor size and vascular, perineural invasion was detected. Conclusion: On the basis of histopathologic features, moderately differentiated OSCC with increasing rate of tumor size and vascular, perineural invasion was indicated in recent decade. Based on the findings, lower differentiation potentially is compatible with worsen prognosis.

Background: The present study was conducted to determine antimicotic susceptibility of Candida species (sp.) from patients with symptomatic candiduria. Materials and Methods: Identification of Candida sp. and determination of efficacy of most routine antifungals were done using polymerase chain reaction-restriction fragment length polymorphism method and E-test, respectively. Results: The results from susceptibility test reveal that caspofungin and amphotericin B have high antifungal activity against both albicans (100% and 96%, respectively) and nonalbicans (95.11% and 72.72%, respectively) isolates. Conclusion: The present study suggests that caspofungin and amphotericin B have the excellent ability to eradicate both Candida groups that showed decreased susceptibility to other compounds.

Background: Environmental, genetic, and immunological factors may play a role in the pathogenesis of age-related macular degeneration (AMD). In an attempt to better understand the pathogenesis of AMD, in this study, we evaluated the serum interferon (IFN) levels in patients with AMD and compared it with persons without AMD. Materials and Methods: In this case–control study, 42 patients with AMD and 42 healthy individuals (without AMD) were enrolled as the case and control groups, respectively. The two groups were matched regarding their age and sex. We classified the case group as dry-type and wet-type AMD. Blood samples were obtained and the serum was collected and frozen at −20°C. Alpha-, beta-, and gamma-IFN levels were measured using the sandwich ELISA method and compared between and within the groups. Results: The mean beta IFN levels in both case and control groups were 46.88 ± 27.25 pg/ml and 34.90 ± 18.81 pg/ml (P = 0.021), respectively. Regarding gamma and alpha IFN, the serum levels were not detectable in most of the patients and no significant difference was detected between the case and control groups. Conclusion: We found that serum beta IFN levels are higher in patients with AMD. This finding may have diagnostic, therapeutic, and prognostic value in AMD patients and can be a beginning for further evaluation.

Background: The present study aimed to determine the frequency of the IL28B polymorphism rs8099917 in patients with genotype 1 hepatitis C virus (HCV) infection treated with pegylated-interferon-α2b (PEG-IFN-α2b) and ribavirin (RBV) and its treatment outcome. Materials and Methods: The IL28B rs8099917 genotypes were determined among 100 HCV-infected patients and the viral load was also estimated. PEG-IFN-α2b and RBV combination were administrated to the patients for 48 weeks and the treatment outcome was defined. Results: Sixty-seven (67%), 27 (27%), and 6 (6%) of 100 patients were determined as TT, GT, and GG genotype, respectively. The response rate to treatment was significantly higher in patients with TT genotype. Conclusion: According to the results of the present study, patients with IL28B rs8099917 TT genotype achieve higher sustained virological response than the GT and GG genotypes. Thus, when there are no alternatives, treatment with PEG-IFN-α2b and RBV combination can be suggested in patients with IL28B TT genotype.

Background: According to an Anglo-Saxon study, in breast cancer survivors, there is a high prevalence of impaired fasting glucose. Our aim was to assess the impaired fasting glucose occurring in Mexican woman survivors of breast cancer. Materials and Methods: At a general hospital in Mexico City, women with breast cancer with a surviving ≥2 years, without type 2 diabetes mellitus, were studied. The analysis included demographic and anthropometric features, time of surviving, and blood levels of lipids and glucose. Results: The sample was 119 women. Impaired fasting glucose happened in 53 (44.5%). In those with normal weight (n = 28), impaired fasting glucose occurred in 9 (32.1%); however, in overweight participants (n = 48), it developed in 22 (45.8%) and in obese participants (n = 43) in 22 (51.1%). Conclusion: Impaired fasting glucose is usual in Mexican breast cancer survivors. It is more in obese and overweight women compared to normal weight.

Background: Advantage of using local sedation during upper gastrointestinal endoscopy (UGE) is still challenging. In the current study, the effect of lidocaine spray versus lidocaine viscous solution for pharyngeal local anesthesia during UGE has been compared. Materials and Methods: This is a randomized clinical trial conducted on 130 patients conducting UGE in 2013. Patients were randomly divided into two groups of viscous lidocaine solution (Group V) and lidocaine spray (Group S). Patients' tolerance, satisfaction, pain/discomfort, and anxiety (based on 11-point numerical score scale) and ease of endoscopy were compared. Results: Ease of procedure, patients' tolerance, and patients' satisfaction were not statistically different between two groups (P > 0.05). Patients' pain/discomfort and anxiety during endoscopy were significantly different between groups (P < 0.05). Conclusion: As a conclusion, there was not any difference between two groups except for pain, discomfort, and anxiety that was higher in those who administered spray that might be due to the method of usage.

Background: This study aimed to use social network analysis (SNA) indicators and clique analysis to investigate collaboration between different departments and research centers in Journal of Research in Medical Sciences (JRMS) in 2012–2016. Materials and Methods: The study was a scientometric study using micro- and macro-indicators of SNA to investigate the performance of departments and research centers in JRMS. The population consisted of 1073 articles published in JRMS in 2012–2016. Ravar Matrix, UCINET, and VOSviewer software were used for data analysis. Results: According to the productivity and triple centrality indicators, “Department of Epidemiology and Biostatistics,” “Department of Pathology,” and Department of “Internal Medicine” allocated the first three ranks. Analyzing the cliques of co-authorship network for departments and research centers showed that this network consists of 19 cliques with at least 7 members in each clique. Furthermore, only 30 nodes (8.90% of all nodes in the network) had the presence in minimum clique size of at least 7. Conclusion: Given the importance and position of scientific collaboration in medical research and its effect on other performance indicators such as efficiency, effectiveness, and number of citations, it is necessary for policy-makers to propose new strategies for improving scientific collaboration.

Background: In high-fat diet-fed mice, interleukin-1 beta (IL-1 beta) has been shown to play a key role in hepatic steatosis. However, it remains unknown whether IL-1 beta could be associated with different grades of steatosis in obese humans. Materials and Methods: Morbidly obese patients (n = 124) aged 18–65 years were divided into four groups: no steatosis (controls), mild steatosis, moderate steatosis, and severe steatosis using abdominal ultrasound. IL-1 beta serum levels and liver function tests were measured and significant differences were estimated by one-way ANOVA followed by Tukey test. Results: IL-1 beta serum levels significantly increased in morbidly obese patients with mild (11.38 ± 2.40 pg/ml), moderate (16.72 ± 2.47 pg/ml), and severe steatosis (23.29 ± 5.2 pg/ml) as compared to controls (7.78 ± 2.26 pg/ml). Liver function tests did not significantly change among different grades of steatosis. Conclusion: IL-1 beta serum levels associate better with steatosis degree than liver function tests in morbidly obese population.

Background: Lead effects on children and pregnant women are grave, and screening tests would be logical to detect high blood lead levels (BLLs) in early stages. Materials and Methods: Blood samples were taken from the pregnant mothers who referred to midwifery clinic with further phone interview postdelivery. Results: In 100 patients evaluated, the mean age was 29 ± 5 years (median interquartile range gestational age of 33 [24, 37] weeks). There was a significant correlation between polluted residential area and median BLL (P = 0.044) and substance exposure (P = 0.02). The median BLL was significantly lower in those without a history of lead toxicity in the family (P = 0.003). The only factor that could predict the BLL levels lower than 3.2 and 5 μg/dL was living in the nonindustrial area. All pregnant women delivered full-term live babies. Conclusion: Positive history of lead toxicity in the family and living in polluted areas may pose a higher BLL in pregnant women.

Background: The pathogenesis of ventilator-associated pneumonia (VAP) is not clearly known. Recently, the role of gastric bacterial colonization has been proposed. The role of gastric colonization with Helicobacter pylori in pathogenesis of VAP was determined by comparing the prevalence of H. pylori in patients with VAP and control participants. Materials and Methods: One hundred and eighteen mechanically ventilated patients were divided into two groups; 59 participants with VAP and 59 without VAP. Serologic tests for H. pylori were registered. Results: Mean age in seropositive patients was significantly higher. About 71.2% in VAP group and 61.01% in controls were IgG seropositive (P = 0.24). IgM seropositivity was 23.73% versus 8.47% in VAPs and controls, respectively (P = 0.024). By increasing the time of intubation, more patients became seropositive for IgM (Pearson's correlation coefficient = 0.4, P = 0.002). Conclusion: IgM seropositivity and serum levels were significantly higher in VAP patients. Furthermore, by increasing the duration of intubation, serum levels for IgM increased significantly.

Background: According to increasing rate of using assisted reproductive technology (ART) which result in higher rates of multiple birth and natal difficulties, we aimed to determine the prevalence rate of multiple birth pregnancies. Materials and Methods: A descriptive cross-sectional study evaluating birth files in 2009–2010 of main hospitals of Isfahan, Iran. Results: Among 31640 files' studies, 614 cases of multiple birth pregnancies were investigated. The product of these pregnancies were 1286 (50.2% females) infants including 557 twins (17.6/1000), 56 triplets (1.8/1000), and one case of quadruple (0.03/1000). Infants weigh <2500 g were 84.9% of all. Mothers had a mean age of 27.9 ± 4.9 which 30.4% of them had a positive history of using ART. Conclusion: The prevalence of multiple birth pregnancies is growing. The need for more mother and child care is important. Using ART world wide is leading more multiple birth which could be a cause for more complicated pregnancies.

Background: Rapid and accurate identification and evaluation of antifungal susceptibility pattern of Candida isolates are crucial to determine suitable antifungal drugs for the treatment of patients with vulvovaginitis candidiasis. Materials and Methods: Vaginal samples were collected from 150 women with suspicious vaginal candidiasis, and then cultured on Sabouraoud's Dextrose Agar with chloramphenicol to isolate Candida species. After identification of Candida isolates using polymerase chain reaction-restriction fragment length polymorphism technique, antifungal susceptibility testing of four azolic antifungal drugs was carried out using broth microdilution method according to the CLSI M27-A3. Results: Candida species were isolated from eighty suspected patients (61.79%). The most common pathogen was Candida albicans (63.75%). Resistance to fluconazole and ketoconazole was observed in 27.5% and 23.75% of Candida isolates, respectively, and only 2% of Candida isolates were resistant to miconazole. Interestingly, resistance to fluconazole in C. albicans was more than other Candida species. Conclusion: The results indicated that therapy should be selected according to the antifungal susceptibility tests for the prevention of treatment failure and miconazole therapy can be considered as the best therapeutic choice in the management of vulvovaginitis.

Background: Acute kidney injury (AKI) can happen due to different factors such as anemia. Packed cell (PC) transfusion is an important cause of AKI occurrence. The aim of the study is to investigate whether appropriate blood component (BC) therapy can reduce blood transfusion and it would result in AKI decreasing. Materials and Methods: We conducted a cohort study of 1388 patients who underwent cardiac surgery in one university hospital. A serum creatinine higher than 2 mg/dl, renal disease history, renal replacement therapy (chronic dialysis) were our exclusion criteria. Results: from our 1088 samples, 701 (64.43%) patients had normal kidney function, 277 (25.45%) were in the AKI-1 group, 84 (7.72%) had an AKI-2 function, and the rest of patients were classified as end stage. A mean of more than three PC units were transfused for the second and third stage of AKI, which was significantly higher than other AKI groups (P = 0.009); this higher demand of blood product was also true about the fresh frozen plasma, platelet, and fibrinogen. However, there were no needs of fibrinogen in the patients with normal kidney function. The cardiopulmonary bypass time had an average of 142 ± 24.12, which obviously was higher than other groups (P = 0.032). Total mortality rate was 14 out of 1088 (1.28%), and expiration among the AKI stages 2 and 3 was meaningfully (P = 0.001) more than the other groups. Conclusion: A more occurrence of AKI reported for the patients who have taken more units of blood. However, BC indicated to be safer for compensating blood loss because of low AKI occurrence among our patients.