Erythropoiesis-stimulating agent (ESA) has been recognized as an effective way in the treatment of anemia due to chronic kidney disease, but we sometimes see intractable hemodialysis (HD) patients. The causes of ESA-resistant anemia in HD patients include deficiency of trace elements. We report the case of an 89-year-old male who developed pancytopenia after taking an excessive amount of zinc formulation for ESA-resistant anemia during maintenance dialysis. He was prescribed zinc acetate hydrate formulation about 6 months before his presentation. He was found to have pancytopenia 1 month before his presentation, at which point he was introduced to our hospital. We suspected a copper deficiency at the first visit and stopped zinc and added copper, and his condition subsequently improved without being handicapped. Zinc antagonizes copper, so we must take care to diagnose patients ingesting zinc supplements.

Background: Since December 2019, coronavirus (COVID-19) spread throughout the world. The high rate of infection and its unknown nature led specialists to report the condition of patients. The aim of this study is to systematically review of symptoms, laboratory and radiologic findings, treatment, and outcomes of patients with COVID-19. Materials and Methods: Databases such as PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane were searched. Finally, 46 articles were appropriate for the aim of the study. After quality evaluation, the necessary data were extracted and meta-analysis was performed. Results: 4858 articles were retrieved until March 30, 2020. After screening, the full-text of 46 articles was assessed. Of the reported cases, 31.7% had no comorbidities, 21.4% had high blood pressure, 70.6% had fever, and lymphopenia was reported in 55.2% of patients. For 16% bilateral patchy shadowing in radiography and for 51% ground-glass opacity was reported. Outcomes were remarkable for recover to death. Conclusion: COVID-19 leads to healthcare problems for countries. Nonspecific symptoms have made it difficult for differential diagnoses without computed tomography-scan or corona Test, but they are not available in many countries. Therefore, this systematic review can help health care staff to make decisions based on symptoms, treatments, and outcomes..

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.

Insulin resistance (IR) is mentioned to be a disorder in insulin ability in insulin-target tissues. Skeletal muscle (SkM) and liver function are more affected by IR than other insulin target cells. SkM is the main site for the consumption of ingested glucose. An effective treatment for IR has two properties: An inhibition of β-cell death and a promotion of β-cell replication. Gamma-aminobutyric acid (GABA) can improve beta-cell mass and function. Multiple studies have shown that GABA decreases IR probably via increase in glucose transporter 4 (GLUT4) gene expression and prevention of gluconeogenesis pathway in the liver. This review focused on the general aspects of IR in skeletal muscle (SkM), liver; the cellular mechanism(s) lead to the development of IR in these organs, and the role of GABA to reduce insulin resistance.

Background: Preeclampsia (PE) and premature rupture of membrane (PROM) are considered significant risk factors for lower neonatal birth weight and birth length. However, very limited studies have reported the impact of PE and PROM on neonatal birth weight and birth length by gestational week. Therefore, we aimed to determine the effect of PE and PROM on neonatal birth weight and length by gestational age. Materials and Methods: A total of 9707 singleton neonates were selected for this study. All the data were collected and documented in the obstetric register by the trained nurses in the Gynecology and Obstetrics Department. Results: The neonatal mean birth weights and birth lengths were statistically significantly (P < 0.05) lowered among preeclamptic mothers compared to mothers without PE throughout the gestational age. Statistically significantly (P < 0.05) lowered mean birth weights and birth lengths were found among neonates born to mothers with PROM than among neonates born to mothers without PROM by all gestational weeks except for 32 weeks and 36 weeks. Moreover, in a multiple linear regression model, PE and PROM were significantly negatively associated with neonatal birth weights and birth lengths by almost all gestational weeks (β <0, P < 0.05). Conclusion: We concluded that after adjustment for covariates and confounding factors, PE and PROM had a significantly negative association with neonatal birth weights and birth lengths by all gestational weeks.

Background: Pulmonary embolism (PE) is one of the major causes of maternal mortality; however, its diagnosis based on clinical presentation is a significant challenge; therefore, imaging is required. This study aims to determine the nondiagnostic rate of PE in pregnant women who initially undergone computed tomographic pulmonary angiography (CTPA) or perfusion scan. Materials and Methods: In this cross-sectional study, all pregnant or 6-week postpartum women with clinical suspicion of PE were evaluated and underwent CTPA or perfusion scan between March 2017 and June 2019. The nondiagnostic rate of each method was defined as the outcome of this study. Results: One hundred and eighty-two women with a clinical suspicion of PE were included, among which the initial imaging method was CTPA in 122 (67.03%) and perfusion scan in 60 (32.97%) women. The nondiagnostic imaging for CTPA was significantly lower than the perfusion scan (9 cases (7.4%) versus 25 cases (41.7%), respectively). Logistic regression assessment revealed a statistical outcome by controlling the confounders including gestational trimester at diagnosis, hypertension, ejection fraction, and tachycardia (odds ratio 15.911, 95% confidence interval: 5.177–48.897, P < 0.001). Conclusion: Based on the current study, CTPA is superior to perfusion scans to diagnose PE among pregnant or postpartum women with normal chest X-ray suspicion for PE.

Background: Colonoscopy plays a vital role for the diagnosis and treatment of colonic diseases but can be associated with anxiety and discomfort or pain. We tested whether unsedated colonoscopy impacts quality indicators and investigated predictors of pain during colonoscopy. Materials and Methods: This randomized controlled trial was performed on candidates for elective colonoscopy at AL Zahra Hospital, Isfahan at 2018–2019. Balanced block randomization was used to allocate 275 cases into two groups. At finally, 124 patients in case and 122 patients in control group enrolled in analysis. Patients in the sedation group received midazolam with/out pethidine before colonoscopy. Pain intensity in rectal examination (PIREX), preprocedural anxiety, pain intensity during colonoscopy, hemodynamics, duration of colonoscopy, polyp detection rate, cecal intubation rate, bloating within 24 h after colonoscopy, and willingness to repeat colonoscopy were assessed and compared between two groups. Results: Compared to the group with sedation, cecal intubation time was shorter and bloating was less frequent (7% vs. 16%, P = 0.02) in the unsedated group. There was no difference between the two groups regarding polyp detection rate, cecal detection rate, and willingness to repeat colonoscopy. Pain during rectal examination was significantly associated with pain during colonoscopy (P < 0.001, 95% confidence interval; 0.5–1.3). Conclusion: The assessment of pain intensity during rectal examination may help to identify patients who can benefit from sedation during colonoscopy. Colonoscopy with sedation does not seem to have a negative impact on colonoscopy quality indicators, and may even reduce cecal intubation time and bloating following procedure.

Background: Diabetic nephropathy, the leading cause of chronic renal failure, is related to diabetes poor control. Some antihyperglycemic drugs like dipeptidyl peptidase-4 inhibitors have shown to prevent diabetic nephropathy. This study endeavors to assess the effect of sitagliptin on proteinuria in Iranian type 2 diabetics. Materials and Methods: A total of 90 type 2 diabetic patients aged between 30 and 80 years with glycated hemoglobin (HbA1C) <8.5 and normotensive under treatment of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers were randomly assigned into two groups. One group received 50 mg sitagliptin per day and the other group received placebo. The two groups were evaluated for albumin–creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) at baseline and 3 months later. Results: Eighty-four patients, 38 (45%) males and 46 (55%) females, were enrolled in this study. The mean age was 58.47 ± 7.33. The two groups did not differ in baseline characteristics. After 3 months, in the sitagliptin group, HbA1C (7.89 ± 0.39 to 7.37 ± 0.61, P < 0.001), fasting blood sugar (FBS) (136.86 ± 22.51 to 130.53, P = 0.04), systolic blood pressure (BP) (124.39 ± 9.70 mmHg to 119.32 ± 9 mmHg), diastolic BP (76.44 ± 6.53 to 73.13 ± 5.34 mmHg, P < 0.001), and ACR (314.40 ± 414.64 to 293.49 ± 400.71, P < 0.001) were significantly decreased and eGFR was significantly increased (73.35 ± 10.73 to 76.86 ± 10.59, P < 0.001) at 3 months compared to the placebo group. ACR reduction was higher in macroalbuminuric (Ma) patients compared to microalbuminuric (Mi) patients in the sitagliptin group (−30.25 ± 35.57 vs. −11.12 ± 14.01, P = 0.02). No significant difference was observed between the Ma and Mi subgroups regarding changes in eGFR. Univariate analysis showed that changes in ACR correlated with FBS (r = 0.68, P < 0.0001), insulin (r = 0.44, P = 0.03), and homeostatic model assessment for insulin resistance (r = 0.69, P < 0.0001) and did not correlate with eGFR and BP. Conclusion: In conclusion, sitagliptin is a well-tolerated drug that improves glycemic control, lowers BP, and reduces urinary albumin excretion, especially in Ma type 2 diabetic patients.