Coagulopathy and derangements in the coagulation parameters are significant features of COVID-19 infection, which increases the risk of disseminated intravascular coagulation, thrombosis, and hemorrhage in these patients, resulting in increased morbidity and mortality. In times of COVID-19, special consideration should be given to patients with concurrent chronic kidney disease (CKD) and COVID-19 (CKD/COVID-19 patients) as renal dysfunction increases their risk of thrombosis and hemorrhage, and falsely affects some of the coagulation factors, which are currently utilized to assess thrombosis risk in patients with COVID-19. Hence, we believe extra attention should be given to determining the risk of thrombosis and bleeding and optimizing the timing and dosage of anticoagulant therapy in this unique population of patients. CKD/COVID-19 patients are considered a high-risk population for thrombotic events and hemorrhage. Furthermore, effects of renal function on paraclinical and clinical data should be considered during the evaluation and interpretation of thrombosis risk stratification. Individualized evaluation of clinical status and kidney function is necessary to determine the best approach and management for anticoagulant therapy, whereas there is a lack of studies about the population of CKD/COVID-19 patients who need anticoagulant therapy now.

Background: Hepatocellular carcinoma (HCC), a deadly malignancy of the liver, is considered the third leading reason behind cancer deaths. It is more frequent in men than in women of ages above 50. Liver disease, leading to liver cirrhosis (LC), is mostly caused by alcoholism abuse, reaction diseases of the liver, or viral hepatitis B or C infection. Interleukin-6 (IL-6) is considered an effective pro-inflammatory cytokine, which plays a crucial role in the host defense mechanism. Its level is higher in HCC patients than in LC cases, indicating that tumor cells increase the production of cytokines. The X-ray repair cross-complementing group 1 (XRCC1) gene is a major DNA repair gene. It acts as a scaffold of various activities that are concerned in the repairing method by interacting with components of base excision repair. This study aims to measure the serum concentrations of IL6 and C-reactive protein (CRP) and investigate whether XRCC1 Arg194Trp and Arg399Gln polymorphisms are related to HCC disease. Materials and Methods: Whole-blood DNA was extracted from 123 HCC patients and 123 healthy volunteers. Tetra-primer amplification refractory mutation system was performed in the detection of XRCC1 Arg399Gln and Arg194Trp polymorphisms. Results: Serum concentration levels of IL-6 and CRP are significantly higher in patients with HCC than in control subjects. The allelic and genotype frequency distributions of XRCC1 (Arg399Gln and Arg194Trp) are significantly increased in HCC cases compared to healthy volunteers. Conclusion: Arg/Gln, Arg/Trp, Gln/Gln, and Trp/Trp genotypes are associated with higher risk HCC than the Arg/Arg genotype.

Background: Ketamine has been a safe and effective sedative agent commonly used for painful pediatric procedures in the emergency department (ED). This study aimed to compare the effect of dexmedetomidine (Dex) and propofol when used as co-administration with ketamine on recovery agitation in children who underwent procedural sedation. Materials and Methods: In this prospective, randomized, and double-blind clinical trial, 93 children aged between 3 and 17 years with American Society of Anesthesiologists Class I and II undergoing short procedures in the ED were enrolled and assigned into three equal groups to receive either ketadex (Dex 0.7 μg/kg and ketamine 1 mg/kg), ketofol (propofol 0.5 mg/kg and ketamine 0.5 mg/kg), or ketamine alone (ketamine1 mg/kg) intravenously. Incidence and severity of recovery agitation were evaluated using the Richmond Agitation-Sedation Scale and compared between the groups. Results: There was no statistically significant difference between the three groups with respect to age, gender, and weight (P > 0.05). The incidence of recovery agitation was 3.2% in the ketadex group, 22.6% in the ketofol group, and 22.6% in the ketamine group (P = 0.002, children undergoing short procedures were recruited). There was a less unpleasant recovery reaction (hallucination, crying, and nightmares) in the ketadex group compared with the ketofol and ketamine groups (P < 0.05). There was no difference in the incidence of oxygen desaturation between the groups (P = 0.30). Conclusion: The co-administering of Dex to ketamine could significantly reduce the incidence and severity of recovery agitation in children sedated in the ED.

Background: Enteral tube feeding intolerance (ETFI) is one of the most common complications of enteral nutrition (EN), which may lead to increased mortality and length of intensive care unit (ICU) stay. This study aimed to determine the prevalence of ETFI and effects on feeding intolerance on nutrition and clinical outcomes in Iran. Materials and Methods: This cross-sectional study was conducted in 2019 at the three general ICUs of Imam Reza Hospital in Mashhad, Iran, during 7 days on 245 patients. The collected data included demographic characteristics, primary diagnosis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, duration of mechanical ventilation, and length of ICU stay. Feeding intolerance was assessed using daily questionnaires for 7 days. ETFI was determined as the interruption of EN based on gastrointestinal causes, including large gastric residuals, abdominal distension, vomiting, diarrhea, and subjective discomfort. Results: Overall, 245 critically ill patients (122 males and 123 females) were included in this study, with a mean age of 58.43 ± 19.2 years in three general ICUs. The highest prevalence rate of ETFI was 91.8%, which occurred on the 2^nd day although the rate decreased in the following days. The minimum ETFI was observed on the last day (38.8%). Feeding intolerance was associated with the increased APACHE II scores (P = 0.04), SOFA scores (P < 0.001), and duration of mechanical ventilation (P < 0.001) compared with the tolerant patients. The most common causes of ETFI in the patients admitted to the ICU were gastric residual volume (GRV), large GRV, vomiting, and distension. Conclusion: ETFI was prevalent in almost two-third (66%) of the critically ill patients receiving EN based on the GRV. ETFI was associated with deteriorated nutritional status and clinical outcomes.

Background: Cataract is a chronic disorder that is related to antioxidant–oxidant imbalance situation. We aimed to investigate the association between food diversity and serum antioxidant and oxidant indices in cataract patients compared to healthy subjects. Materials and Methods: In this case–control study, ninety volunteers (aged > 50 years) were divided into the cataract (n = 45) and healthy control (n = 45) groups. Anthropometric variables, physical activity and stress levels, food diversity score, serum total oxidant capacity (TOC), and total antioxidant capacity (TAC) measurements were done for all participants. Results: Serum TAC, even after adjustment for stress level, was significantly higher in healthy people compared to cataract patients (P < 0.001). In addition, serum TOC was significantly lower in healthy controls compared to cataract patients (P < 0.002). In healthy group, there was a weak significant positive association between serum TAC and meats group diversity (r = 0.149, P = 0.047). In addition, there was a moderate negative association between meats group diversity and TOC in the healthy controls (r = −0.712, P = 0.041). In the cataract group, there was a significant negative association between serum TOC and diversity score of fruits (r = −0.811, P = 0.017) and meats group (r = −0.926, P = 0.046) as well as total score of food diversity (r = −0.466, P = 0.003). Conclusion: It seems that increase in total dietary diversity and food groups' diversity can have a beneficial effect on oxidant situation among cataract patients.

Background: There is no validated measurement tool to assess vaginal symptoms (VS), sexual matter (SS), and quality of life (QOL)among Persian-speaking women. This study aimed at translating and assessing the validity and reliability of the Persian version of the International Consultation on Incontinence Questionnaire for Vaginal Symptoms (PICIQ-VS). Materials and Methods: In this cross-sectional study, after obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ) Advisory Board, the English version of ICIQ-VS was translated into Persian per a standard translate and back translate process, and the validity and reliability were studied. Two hundred women with and without pelvic organ prolapse were asked to complete the PICIQ-VS (mean age: 52.1, range: 22–84 years). A panel of 10 experts evaluated the content and face validity of the questionnaire. Cronbach's alpha examined the internal consistency reliability of the measure. To evaluate the test–retest reliability, we redistributed the questionnaire among 30 patients 2 weeks after their initial visit using intra-class correlation coefficient (ICC). Results: Content and face validity of the questionnaire was confirmed after some light modification (content validity ratio ranged from 0.69 to 1.00, and content validity index ranged from 0.79 to 1.00). PICIQ-VS showed an acceptable internal consistency and stability reliability (VS: α = 0.64, ICC = 0.84; SM: α = 0.69, ICC = 0.88; and total scale: α = 0.72, ICC = 0.91, respectively). Significant differences were observed between the asymptomatic and symptomatic groups for VS and the total score (P < 0.05). Conclusion: In the light of the results, interestingly, PICIQ-VS could be utilized as a valid and reliable tool to assess the VS among Persian-speaking women, both in research and clinical practice.

Background: Pain during the neonatal period has been associated with immediate and long-term adverse effects. One of the most frequent painful procedures that neonates face in neonatal intensive care unit is the endotracheal intubation. Midazolam has been a candidate for premedication before neonatal intubation. Our aim was to evaluate the effects of midazolam as the premedication on endotracheal intubation of premature infants during surfactant administration. Materials and Methods: In a double-blind clinical trial, 80 preterm infants were undertaken for tracheal intubation following the use of atropine associated to either midazolam or placebo. Patient's vital signs and general conditions were constantly monitored, and pain was assessed using premature infant pain profile (PIPP) score. Results: The mean ± standard deviation for postnatal age was 95.38 ± 50.04 and 111.63 ± 49.4 min in control and midazolam groups, respectively. The patients in the midazolam group had significantly better outcomes across several intubation outcome measures such as duration of endotracheal intubation (23.5 ± 6.7 vs. 18.8 ± 4.8 s, P = 0.001), oxygen saturation level (88.05% ±13.7 vs. 95.1 ± 1.8%, P = 0.002), intubation failure (34.2% vs. 2.5%, P = 0.0001), awake and resistance during intubation (95% vs. 20%, P = 0.0001), and excellent patient condition during intubation (0% vs. 82.5%, P = 0.0001). In addition, PIPP score was significantly lower in the midazolam group (5.2 ± 2.06 vs. 12.9 ± 2.9, P = 0.0001). Conclusion: Premedication with midazolam in newborns before intubation, can hold promising effects that manifests as better overall outcomes, less complications, better vital signs, more comfortable situation, and lesser pain for these patients.

Background: Some studies show changes in the microbiota in people undergoing antineoplastic treatment. Currently, there is not enough evidence of this effect in the treatment of cervical cancer (CC). The objective was to determine changes in the diversity of local cervical bacteria in women with CC receiving chemotherapy, radiotherapy, and brachytherapy. Materials and Methods: A descriptive, longitudinal, and prospective study was conducted in 68 women with locally advanced CC with a treatment plan based on the administration of chemotherapy, external beam radiotherapy, and brachytherapy. Cervical-vaginal fluid samples were taken during antineoplastic treatment. The samples were used to isolate bacterial strains. The bacteria were identified at the molecular level by comparing sequences of the 16S ribosomal RNA gene. Results: The bacteria identified belonged to three phyla: Firmicutes, Proteobacteria, and Actinobacteria. Nine genera and 25 species of bacteria were identified. The most frequent species were Staphylococcus epidermidis, Corynebacterium amycolatum, and Enterococcus faecalis. There were statistically significant differences when comparing bacterial diversity found in the different stages of treatment (≤0.05). Bacterial diversity decreased as antineoplastic treatment progressed and increased at the end of therapy. Conclusion: Antineoplastic treatments generate changes in the diversity of local cervical bacterial communities of women with CC.

Background: Brucellosis is one of the most common infectious diseases worldwide which is caused by direct contact with affected animals or their products. It puts a huge impact on the economy, society, and the environment. Iran is the fourth endemic country for brucellosis in the world. It has been described a new epidemiological feature of the disease and its trends in Isfahan province, as one of the endemic areas of brucellosis in Central Iran. Materials and Methods: This is a cross-sectional, population-based study. Data collection was performed using epidemiological questionnaires through Epi-2006 software from the private and public sectors in 22 districts of Isfahan province over 9 years (2010–2018). The results were obtained by the description statistics using the SPSS Statistics software version 20 (SPSS Inc., Chicago, IL, USA). Results: Altogether, 5751 new brucellosis patients were recorded over 9 years. About 70% of these cases were male. The majority of cases had occurred in the age group of 21–30 years. The average incidence of brucellosis over the 9 years was 14.1 cases/100,000 population including 8.8 in the urban versus 45.2 cases in the rural areas. During the 9-year study period, the incidence of brucellosis was increased between 2010 and 2014. From 2014 to 2017, the trend has been decreasing, but in the last year of the study, the trend has been increasing again. Seasonally, the incidence rate was variable between the lowest from October to January and the highest from June to July. Conclusion: According to the fluctuation of incidence trend of brucellosis during the 9-year study period in Central Iran, it seems some policy changes regarding to the control and prevention of brucellosis have a role, changes that should be fixed and corrected.

Background: The alarming trends of obesity/overweight in youth have been interested policy makers and other stakeholders to exact follow and analysis of related scientific evidence. The present paper quantify the trends of outputs of youth obesity/overweight researches in Middle East countries. Materials and Methods: The Scopus database systematically searched as the most comprehensive multidisciplinary database, for all related obesity/overweight that focused on youth age groups concerns, from 2000 to 2017. These scientometrics analysis included the trends of scientific products, citations, and other scientometric index in Middle East countries. Results: During 2000–2017, in the field of youth obesity, 2350 papers published (0.40% of total 591,105 indexed paper of this region) by Middle East countries. In this regard, Iran with 574 publication (24.43%) had the first rank. After that Turkey and Saudi Arabia, respectively, with 489 (20.81%) and 313 (13.32%) papers, had the next ranks. Over 18-year period, based on the findings all of Eastern Mediterranean countries follow the progressive plans for topics related to youth obesity. Between them, Iran and Turkey have significant growth rates (0.77% and 0.40%, respectively). Scientometric indicators such as “number of published papers,” “number of citations” confirmed that during the 2000–2017 the P-trends of total number of related published papers and the correspond citations, in region countries, were significant (2168 papers and 34,132 citations, P < 0.001). Conclusion: Most of countries at global and regional levels follow ascending trends in publications and citations in obesity/overweight fields. Iran's position has grown significantly among them. Maintaining and promoting this position requires careful planning and special attention. The findings also could be used for better health policy and complementary researches.

Background: Pain is the most common postoperative complication of hemorrhoidectomy. We evaluated the effectiveness of intrasphincteric Botox injection on posthemorrhoidectomy complications including pain reduction and wound healing. Materials and Methods: In this randomized, double-blind clinical trial, patients with Grades 3 or 4 symptomatic hemorrhoids who underwent open (Milligan-Morgan) hemorrhoidectomy were enrolled. The experimental group received intrasphincteric Botox injection during hemorrhoidectomy, while the controls received normal saline injection. Hemorrhoid grades, constipation status, history of hemorrhoidectomy, duration of operation, pain at rest and after defecation in six follow-up periods (6, 12, 24, and 48 h and 7 and 14 days after operation), wound healing (during follow-up after discharge with a 2-week period), analgesic use, and Botox side effects were evaluated and compared in the two experimental and control groups. Results: In this trial, 34 and 33 patients were randomly allocated in the experimental and control groups, respectively. Operation time was significantly higher in Botox group (P = 0.009). Mean dose of analgesics use in Botox was significantly lower (P < 0.001). Rate of wound healing during follow-ups was significantly higher in Botox group in the fifth follow-up (P = 0.009). Frequency of urinary retention (P = 0.02) and moderate itching (P = 0.01) was significantly higher in placebo than Botox group. Mean of postoperative pain at rest in Botox group was significantly lower at 12^th, 24^th, and 48^th h and 7^th and 14^th days after operation (P < 0.01). Mean of postoperative pain in Botox group was significantly lower at 3^rd to 5^th defecation (P < 0.01). Conclusion: Our findings indicated that a single-dose injection of Botox during Milligan-Morgan hemorrhoidectomy is associated with less postsurgical pain at rest and during defecation and improved wound healing. It is suggested that it is a safe and effective procedure during hemorrhoidectomy regarding the procedure-related complications.

Background: Prediabetes is a high-risk state for developing diabetes at an annual rate of 5%–10%. Early intervention can prevent further complications, including metabolic syndrome. Bisphosphonates are commonly used for osteoporotic postmenopausal women. The purpose of this study was to assess the effects of bisphosphonates on lipid profile including triglyceride (TG), total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) of prediabetic postmenopausal women with osteopenia. Materials and Methods: In this triple-blind randomized controlled trial, sixty prediabetic, postmenopausal women with sufficient Vitamin D and osteopenia, aged 45–60 years, were randomly enrolled in two groups of intervention (receiving 70-mg alendronate for 12 weeks [duration for maximum metabolic effect of bisphosphonates], n = 30) and control (receiving placebo, n = 30) according to a randomized block procedure of size 2 and 1:1 allocation ratio. The primary outcome of the study, the lipid profile, was evaluated before and after the interventions. The effect of the intervention was assessed using analysis of covariance. Results: The lipid profiles showed no significant differences to the mean values at the baseline in both the groups (all P > 0.05). At the end of the study, the differences between the groups were not significant for 25(OH) D₃ (mean difference: −11.09, 95% confidence interval: −32.43–10.25), T (4.19, −30.58–38.97), cholesterol (8.13, −13.07–29.33), LDL-cholesterol (5.07, −10.18–20.31), and HDL-cholesterol (−0.86, −6.04–4.31) when the baseline values and confounders were adjusted (all P > 0.05). Conclusion: No statistically significant difference was detected in the serum lipid profile of prediabetic postmenopausal women with osteopenia as a result of alendronate intervention. More studies with larger sample sizes and longer intervention periods are recommended.