Effect of Pioglitazone on Nonalcoholic Fatty Liver Disease in Morbid Obese Patients; a Randomized Controlled Trial.

Background: Nonalcoholic fatty liver disease (NAFLD) is a common obesity-related disease. In this study, we aimed to investigate the effects of pioglitazone on NAFLD in morbid obese patients. Materials and Methods: This is a randomized controlled trial study that was performed in 2020-2021 on 44 patients who had grade 3 NAFLD. At the beginning of the study, we collected the following data: age, gender, body mass index (BMI), fasting blood glucose (FBS), lipid profile, aspartate aminotransferase, alanine aminotransferase (ALT), and the total size and volume of the liver and the left lobe of the liver. Patients in the control group were given a special diet. For patients in the treatment group, pioglitazone 15 mg tablets were administered twice daily for 4 months. Results: At the beginning of the study, all patients in both groups had grade 3 of NAFLD. After the treatments, 50% of the pioglitazone group had grade 1 NAFLD, and 50% of other patients had grade 2 that showed significant improvements in patients (P < 0.001). We also found significant improvements in the following items in the intervention group: liver size (P < 0.001), size of the left liver lobe (P < 0.001), FBS (P = 0.036), ALT (P = 0.011), and BMI (P < 0.001). No significant improvements were found in the control group (P > 0.05). Conclusion: The use of pioglitazone for 4 months resulted in improvements in fatty liver stage, liver size, BMI, FBS, and lipid profile. These data show the effectiveness of pioglitazone in NAFLD.

Severity of Disease and COVID-19 Complications During Hospital Stay: A Prospective Cohort Study.

BACKGROUND: COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. METHODS: A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1-47). Severe COVID-19 was defined by respiration rate≥30 times/min, oxygen saturation level≤88% in the resting position, and pulse rate≥130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. RESULTS: During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions in hospital were reported. After adjustment for potential confounders, severity of the disease was positively associated with risk of mortality, invasive ventilation and ICU admissions (hazard ratio [HR]: 5.99; 95% CI: 2.85, 12.59; P<0.001, HR: 7.09; 95% CI: 3.24, 15.52; P<0.001 and HR: 4.88; 95% CI: 2.98, 7.98; P<0.001, respectively). In addition, greater age (HR=1.04; 95% CI=1.02-1.07; P=0.002), chronic kidney disease (HR=3.05; 95% CI=1.35, 6.90; P=0.008), blood urea nitrogen (BUN) (HR=1.04; 95% CI=1.03-1.05; P<0.001) and creatinine (HR=1.44; 95% CI=1.26-1.65; P<0.001) were probably significant risk factors for mortality in severe COVID-19 patients. CONCLUSION: More intensive therapy and special monitoring should be implemented for patients with older age, hypertension and kidney disease who are infected with COVID-19 to prevent rapid worsening.

Risk Factors for the Mortality in Hospitalized Patients with COVID-19: A Brief Report.

The cumulative rate of death of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated better recognizing the risk factors of the disease and the COVID-19-induced mortality. This cross-sectional study aimed to determine the potential risk factors that predict COVID-19-related mortality concentrating on the initial recorded laboratory tests. We extracted admission's medical records of a total of 136 deaths related to COVID-19 and 272 discharged adult inpatients (≥18 years old) related to four referral centers from February 24th to April 12th, 2020, in Isfahan, Iran, to figure out the relationship between the laboratory findings and mortality beyond demographic and clinical findings. We applied the independent sample t test and a chichi square test with SPSS software to compare the differences between the survivor and non-survivor patients. A P value of less than 0.05 was considered significant. Our results showed that greater length of hospitalization (P≤0.001), pre-existing chronic obstructive pulmonary disease (P≤0.001), high pulse rate, hypoxia (P≤0.001), and high computed tomography scan score (P<0.001), in addition to high values of some laboratory parameters, increase the risk of mortality. Moreover, high neutrophil/lymphocyte ratio (OR, 1.890; 95% CI, 1.074-3.325, P=0.027), increased creatinine levels (OR, 15.488; 95% CI, 0.801-299.479, P=0.07), and elevated potassium levels (OR, 13.400; 95% CI, 1.084-165.618, P=0.043) independently predicted in-hospital death related to COVID-19 infection. These results emphasized the potential role of impaired laboratory parameters for the prognosis of fatal outcomes in adult inpatients.

Anxiety, quality of work life and fatigue of Iran health care providers in health care centers in COVID-19 pandemic.

BACKGROUND AND AIM: The aim of this study was to investigate the status of anxiety, quality of work life, and fatigue of healthe care providers in six educational and medical centers of Shahrekord University of Medical Sciences in the southwest of Iran in the Covid-19 pandemic. MATERIALS AND METHODS: The present study was a cross-sectional study and included the statistical population of healthcare providers in six educational and medical centers of Shahrekord University of Medical Sciences in the southwest of Iran. Using random sampling method, 181 people who had direct involvement with patients with Covid-19 were selected and compared with 261 staff in other wards who had no direct contact with patients with Covid-19. For data collection, demographic information (demographic characteristics questionnaire), Covid-19 Anxiety Questionnaire, quality of work life and Rhoten fatigue questionnaires were used by self-administered online questionnaires. RESULTS: The results showed that the quality of life in both groups decreased and fatigue and anxiety caused by Covid-19 increased, but there was no statistically significant difference between anxiety derived fatigues of personnel involved with Covid-19 with personnel of other wards which were no directly faced Covid-19 patients. Regarding the quality of work life, no significant difference was observed in other components except in the component of human resource development. The results also showed that there was a statistically significant relationship between the level of anxiety caused by Covid-19 with quality of work life and fatigue. CONCLUSION: According to the results of the present study, Covid-19 had a negative effect on physical, mental and various aspects of quality of life of health care staff and led to increased fatigue.

COVID-19-associated encephalopathy with fulminant cerebral vasoconstriction: CT and MRI findings.

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can cause various mild to severe neurologic symptoms, leading to significant morbidity and mortality. We hereby present a fatal case of a 50-year-old male health care provider, admitted due to altered mental status due to encephalopathy, cerebral edema, and fulminant cerebral vasoconstriction caused by SARS-Cov-2. Our case highlights the importance of considering SARS-Cov-2 infection in the differential diagnosis for patients with unexplained central nervous system dysfunction and cerebral edema to prevent delayed diagnosis and render rapid treatment.

Hearing Thresholds Changes after MRI 1.5T of Head and Neck.

INTRODUCTION: Exposure to high intensity noise produced by MRI is a cause for concern. This study was conducted to determine the temporary and permanent effects of exposure to noise created by performing MRI on the hearing threshold of the subjects using conventional and extended high frequency audiometry. METHODS: This semiexperimental study was performed on 35 patients referred to Shahid Rahnemoun Hospital for head and neck MRI due to different clinical conditions. The hearing threshold of patients was measured before, immediately after, and 24 hours after performing 1.5 Tesla MRI using conventional and extended high frequency audiometry. SPSS version 18 was used to compare the mean hearing thresholds before and after MRI using paired T test and repeated measures analysis. RESULTS: Comparison of auditory thresholds in conventional and extended high frequencies before and immediately after MRI showed a significant shift at 4 KHz (P = 0.008 and P = 0.08 for right and left ears), 6 KHz (P = 0.03 and P = 0.01 for right and left ears), and 14 KHz (P =0.03 and P = 0.31 for right and left ears). However, there was no significant difference between audiometric thresholds before and 24 hours after MRI. CONCLUSION: Noise due to 1.5 Tesla MRI can only cause transient threshold shift.

Diagnostic efficacy of sonography for diagnosis of ovarian torsion.

OBJECTIVES: Misdiagnosing ovarian torsion is now suggested as an important issue in clinical setting. The aim of this study was to determine the diagnostic accuracy of sonography for ovarian torsion. Methods : In this study 323 women with acute pelvic pain with highly suspected ovarian torsion signs and symptoms attending Imam Reza Medical Center in Kermanshah between 2011 through 2012 were included and underwent a transabdominal sonography (2-5 MHz probes). Then findings of sonography were compared with laparatomy. Results : The ultrasound correctly diagnosed 72.1% of ovarian torsion and missed 27.9% of them (false negatives). However, one free subject (0.4%) was misclassified as ovarian torsion (false positive). There was a strong correlation between sonography and laparatomy with a kappa value of 84.0%. The sensitivity and specificity of sonography were 72.1% and 99.6%, respectively. Sonography had a positive predictive value of 96.9%, a negative predictive value of 95.9%, and a total accuracy of 96.0% for detection of ovarian torsion. CONCLUSION: Sonography appears to be an excellent method to evaluate patients with suspected ovarian torsion. Abnormal blood flow detected by sonography is highly predictive of ovarian torsion and is therefore useful in the diagnosis of this phenomenon.