Efficacy of rituximab therapy in children with nephrotic syndrome: a 10-year experience from an Iranian pediatric hospital.

BACKGROUND: There are controversy results in the optimal management of children with steroid-dependent and steroid-resistant nephrotic syndrome (SDNS, SRNS). This study aimed to determine the efficacy and safety of rituximab (RTX) in these pediatric patients. METHODS: Medical records of 1-18-year-old Iranian children with SDNS (n = 26) and SRNS (n = 22) with a follow-up for at least 24 months were included from 2009 to 2019. The short- and long-term responses to RTX were respectively evaluated to determine the random protein-to-creatinine ratio after 6 and 24 months and classified as complete (CR) and partial (PR) remission or no response. RESULTS: Male patients (n = 26) were slightly predominate. The median age of patients at the time of RTX therapy was 8.6 ± 4.01 years. At the end of the 6-month follow-up, CR and PR occurred in 23 (47.9%) and 12 (25%) patients, respectively. Of 23 patients with CR, 18 (69.2%) and 5(22.7%) had SDNS and SRNS, respectively (p < 0.005). However, only 18 (37.5%) of patients after 24 months had been in CR. No significant difference in the CR rate was found between the two groups. RTX was more effective when administered during the proteinuria-free period (p = 0.001). CONCLUSION: In the short term, RTX significantly was efficient in inducing complete or PR in SDNS and SRNS patients. However, the favorable response rate in a long-term follow-up was insignificantly lower between the two groups.

Health complaints in individual visiting primary health care: population-based national electronic health records of Iran.

BACKGROUND: The mission of medical schools is a sustainable commitment to orient education, research, and services based on the priorities and expectations of society. The most common complaints of patients from comprehensive health service centers (CHSCs) based on the data from electronic health records were assessed in order to determine primary health care (PHC) priorities for the educational planning of medical students in Iran. METHODS: A population-based national study was designed to assess clinical complaints of patients in all age groups who were referred to CHSCs at least once to be visited by physicians. All the data in the census were extracted from electronic health records in PHC system during 2015-2020, classified by the International Classification of Primary Care 2nd edition (ICPC-2e-English), and statistically analyzed. The total number of complaints that were recorded in the system was 17,430,139. RESULTS: 59% of the referring patients were women. The highest number of referrals was related to the age group of 18-59 years (56.9%), while the lowest belonged to the elderly people (13.3%). In all age and sex groups, the first ten complaints of patients with three top priorities in each category included process (follow-up, consultation, and results exam), digestive (toothache and gum complaint, abdominal pain, and diarrhea), respiratory (cough, sore throat, and runny nose), general (fever, pain, and weakness and fatigue), musculoskeletal (back pain, leg complaint, and knee injuries), endocrine and nutritional (weight gain, Feeding problem, and weight loss), cardiovascular (hypertension, palpitations, and Postural hypotension), neurological (headache, dizziness, and paralysis), sexual dysfunction (vaginal complaint, discharge, and irregular menstruation), and dermatological (pruritus, rash, and inflammation) problems. CONCLUSION: High priorities in referring to PHC had a key role in assessing the country's health needs. Since this study was in line with the national pattern of complaints and patients' profile, the present findings can be helpful to amend policy-making, educational planning and curricula development in medical schools.

Pregnant women and infants against the infection risk of COVID-19: a review of prenatal and postnatal symptoms, clinical diagnosis, adverse maternal and neonatal outcomes, and available treatments.

BACKGROUND: The establishment of a risk-appropriate care approach for pregnant women and newborn infants under the COVID-19 pneumonia is vital to prevent the main pregnancy complications. OBJECTIVES AND DESIGN: This study reviewed the vertical transmission (VT) potential of COVID-19 pneumonia in pregnant women. Key-related symptoms and adverse clinical outcomes for mothers and infants before and after childbirth were summarized. Some practical therapies and preventive health solutions were also proposed. RESULTS: There was a high susceptibility in pregnant women to COVID-19 infection, especially in the third trimester of pregnancy. The most common symptoms in 22-40-year-old patients infected with COVID-19 were fever (87.6%), cough (52.3%), dyspnea (27.6%), fatigue (22.4%), sore throat (13.5%), malaise (9.4%), and diarrhea (3.4%), respectively. The viral infection led to an increase in preterm labor and cesarean delivery without any intrauterine infection and severe neonatal asphyxia. No infection in the newborn infants was reported despite a high risk of the VT phenomenon. The most important therapies were the reception of antiviral and antibiotic drugs, oxygenation therapy, psychological interventions, and food supplements with health-promoting effects. The best proposed medical strategies to control the COVID-19 infection were bi-monthly screening and following-up the mothers' and fetuses' health, not using the potent broad-spectrum antibiotics and corticosteroids, providing the delivery room with negative pressure for emergency cesarean section, and the immediate isolation of newborns after childbirth without direct breastfeeding. CONCLUSION: Babies with respiratory problems may be born to some mothers with COVID-19, who have weak immune systems. Thus, the virus transmission cycle should be disrupted to prevent adverse maternal and fetal outcomes by integrating individual health guidelines, efficient medical care therapies, and hospital preventive practices.

Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis.

BACKGROUND: The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. METHODS: A retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated. RESULTS: 92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI. CONCLUSIONS: Low BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.

Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study.

BACKGROUND: Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. OBJECTIVE: A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics. METHODS: A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection. RESULTS: Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis). CONCLUSION: There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.

A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns.

BACKGROUND: Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. METHODS: A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008-2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. RESULTS: Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. CONCLUSION: As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.

Iranian kidney transplant recipients with COVID-19 infection: Clinical outcomes and cytomegalovirus coinfection.

BACKGROUND: There is a high risk of COVID-19 in kidney transplant recipients (KTRs) because of chronic immunosuppression and severe cytomegalovirus (CMV) pneumonitis. CASE PRESENTATION: A case series of 10 KTRs with COVID-19 in Iran was developed. Participants consisted of two female and eight male patients, aged 46-68 years old. The data related to clinical laboratory tests, outcomes, diagnosis, and drug treatments were collected. The RT-PCR confirmed the COVID-19 infection in KTRs. The assessment of serum biochemical and blood hematological factors showed that there was a strong correlation between COVID-19 intensity and high serum Cr, BUN, and ALT levels, high CRP concentration, and lower lymphocyte and platelet counts in male KTRs. Ground-glass opacity (GGO) was the main radiologic pattern visible on both chest radiographs of computed tomography scans. The COVID-19 and CMV coinfection in KTRs resulted in large-size kidneys with severe parenchymal echogenicity and hydronephrosis. The combined use of effective antibiotic and antiviral drugs was suitable to prevent COVID-19 progression in KTRs. CONCLUSIONS: The coincidence of COVID-19 and CMV in KTRs may potentially increase the mortality risk of patients. The levels of Cr, BUN, ALT, and CRP as well as lymphocytes count in these patients should be continuously controlled.

Promoting sustainable physical activity among middle-aged Iranian women: a conceptual model-based interventional study.

BACKGROUND: Physical inactivity enhances the risk of adverse health conditions such as non-communicable diseases, morbidity, and mortality among middle- and older-aged population. This study is aimed to design, implement, and evaluate a conceptual model of physical activity (PA) promotion among middle-aged Iranian women (MAIW). METHODS: An interventional study was conducted with 80 women aged between 30 and 59 years in intervention and control groups during 2018-2019. The subjects referred to health centers were selected by the available convenience sampling method. Data collection tools to assess the MAIW' PA level (metabolic equivalent tasks (MET)-min/week) included face-to-face interviews, body mass index (BMI) measurements, the four-question form of PA vital signs in the framework of Iran's Package of Essential Non-communicable (IraPEN) program, and the questionnaire is based on the Health Belief Model (HBM) constructs. RESULTS: The intervention led to a three-fold increase in the average PA (from 280.63 to 927.70 MET-min/week) of the intervention group. Although no significant difference in the BMI between both groups was found before the intervention, this educational program decreased the mean BMI from 30.36 to 28.83 kg/m2 (p = 0.01). After the intervention, the values of HBM-based perceived sensitivity/severity and self-efficacy were increased from 62.09 to 71.03% and from 27.01 to 83.15%, respectively (p < 0.0001). There were no significant differences in the cue to action and perceived benefits and barriers after the intervention. CONCLUSION: The developed model by increasing the motivation of MAIW could remarkably improve the PA level with a decrease in their BMI. Trial register Iranian Registry of Clinical Trials (IRCT): IRCT20200717048124N1 at 2020-08-05, retrospectively registered.

Iranian children with overweight and obesity: an internet-based interventional study.

BACKGROUND: Obesity or overweight in children is an excessive accumulation of adipose tissue that can potentially regress health indicators and increase the likelihood of various diseases. OBJECTIVES: This model was implemented to improve the nutritional status and lifestyle behavior of children aged 6-12 years with overweight/obesity. METHODS: A quasi-experimental design with 90 participants in each control and intervention group with a multistage cluster random sampling method after reviewing the literature, and their screening by experts were adopted. RESULTS: After 6 months there were significant differences in Body Mass Index and weight for age percentile values of children allocated in control and intervention groups after controlling for beginning values (p = 0.024, Partial eta2 = 0.028, 0.044, Partial eta2 = 0.023), respectively. Although there was an increased rate in BMI and weight for age percentile in both groups this increase in the control group after the 6th month significantly was more than that in the intervention group after the 6th months. A considerable difference in BMI of girls after the intervention was observed in the experimental group (p = 0.006, Partial eta2 = 0.092). However, our results showed that there was no significant difference in BMI of boys in the intervention and control groups before and 6 months after the intervention (p = 0.507). CONCLUSIONS: We conclude that though the weight increase rate was lower in the experimental group, the implemented model alone was not enough. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20200717048124N1 at 05/08/2020, retrospectively registered.

Correction to: The intake assessment of diverse dietary patterns on childhood hypertension: alleviating the blood pressure and lipidemic factors with low-sodium seafood rich in omega-3 fatty acids.

An amendment to this paper has been published and can be accessed via the original article.

The intake assessment of diverse dietary patterns on childhood hypertension: alleviating the blood pressure and lipidemic factors with low-sodium seafood rich in omega-3 fatty acids.

BACKGROUND: Childhood hypertension (CH) is related to the dietary intake and diversity of children. The study aimed to assess the critical role of dietary diversity, and seafood long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs) in reducing CH among the Iranian community. METHODS: A cross-sectional two-phase study with 7-12-year-old Iranian students was designed. In the initial phase, the socio-demographic characteristics, and blood pressure status (normal, pre-hypertension, and hypertension) based on systolic (SBP) and diastolic (DBP) blood pressure data were assessed. The 24-h dietary recall questionnaire was used to generate the dietary diversity score (DDS, count of consumed food groups) and dietary variety score (DVS, the cumulative number of daily consumed food items). In the second phase, the association between CH reduction and changes in serum 25-hydroxyvitamin D (25OHD), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) levels of schoolchildren intervened by a seafood diet rich in omega-3 fatty acids were assessed using the regression analyses. RESULTS: The pre-hypertension and hypertension prevalence rates were 7.8 and 9.15%, respectively. CH was significantly associated with age, gender, and DDS. A significant inverse association was found between the high intake of seafood and CH (P = 0.032). The gas-chromatography analysis showed the high presence of α-linolenic (ALA, 6.72%), eicosapentaenoic (EPA, 7.62%), docosapentaenoic (DPA, 5.88%), and docosahexaenoic (DHA, 18.52%) acids in the seafood-based diet (p <  0.05). The low blood pressure levels with regular consumption of this healthy-functional diet were significantly associated with a reduction in BMI, LDL, TC, and TG, and a remarkable increase in 25OHD and HDL levels. The multiple linear regression showed that the SBP was highly associated with the TC (p <  0.001; ß = 0.464). CONCLUSIONS: The age and DDS were efficient predictors for the different CH status. A regular seafood-rich dietary pattern due to the high LC n-3 PUFAs contents could significantly reduce the obesity-related cardiovascular risk factors.

Patients' preferences in selecting family physician in primary health centers: a qualitative-quantitative approach.

BACKGROUND: The role of family physicians (FPs) in the metropolitan area is critical in identifying risk factors for disease prevention/control and health promotion in various age groups. Understanding patients' preferences and interests in choosing a FP can be an effective and fundamental step in the success of this program. In this study factors affecting the FP selection by Iranian patients referred to health centers in the most populous areas in the south of Tehran were assessed and ranked. METHODS: A sequential mixed-method (qualitative-quantitative) triangulation approach was designed with three subject groups of patients, physicians, and health officials. The Framework method was used to analyze interviews transcribed verbatim. After implementing an iterative thematic process, a 26-item quantitative questionnaire with high validity and reliability was drafted to evaluate the different factors. A convenient sampling method was used to select 400 subjects on a population-based scale to quantitatively rank the most critical selection factors as a mean score of items. RESULTS: The selection factors were divided into six centralized codes, including FPs' ethics, individual, professional and performance factors; patients' underlying disease and individual health, and disease-related factors, office's location and management factors, democracy factors, economic factors, and social factors. After filling out the questionnaires, the most important factors in selecting FP were a specialist degree in family medicine (FM) (4.49 ± 0.70), performing accurate examinations with receiving a detailed medical history (4.43 ± 0.68), and spending enough time to visit patients (4.28 ± 0.75), respectively. However, the parameters such as being a fellow-citizen, being the same gender, and physician's appearance were of the least importance. CONCLUSION: There is a possibility to screen the most important factors affecting the FP choice through the combination of qualitative and quantitative studies. The first and last patients' priority was physicians' specialty in FM and being a fellow-citizen with them, respectively. The clinical and administrative healthcare systems should schedule the entire implementation process to oversee the doctor's professional commitment and setting the visit times of FP.

Antimicrobial stewardship program (ASP): an effective implementing technique for the therapy efficiency of meropenem and vancomycin antibiotics in Iranian pediatric patients.

BACKGROUND: Antimicrobial stewardship program (ASP) is a distinguished method to improve the prescription and efficacy of antibiotics. AIM: The efficacy of ASP and conventional methods was compared to measure the effectiveness of meropenem (MPM) and vancomycin (VMN) antibiotics in pediatric patients. DESIGN: In an interventional quasi-experimental study, 135 children admitted in Children's Hospital affiliated to University of Medical Sciences in time periods of 2014-2015 and 2015-2016 were assessed. METHODS: The conventional and ASP methods in 2014-2015 and 2015-2016 were respectively utilized to provide the best antimicrobial therapy of MPM and VMN antibiotics in patient children. The data of mortality rate (MR), antibiotic prescription (AP), antibiotic dose (ADe), antibiotic duration (ADn), length of hospital stay (LOHS), and blood cultures (BCs) were compared across the years using the Chi square, independent t test, and Fisher's exact test. RESULTS: The levels of MR, AP, ADe, ADn, LOHS, and positive BCs using the ASP method in 2015-2016 were significantly lower those of in 2014-2015 using the conventional one (p < 0.05). CONCLUSIONS: The ASP method versus conventional one with a better efficacy can be employed as an antibiotic administration guide for MPM and VMN in the therapy of patients in community-based hospitals.

Upregulation of FNDC5 gene expression in C2C12 cells after single and combined treatments of resveratrol and ATRA.

BACKGROUND: Irisin is a newly discovered myokine that secreted from skeletal muscle cells. Several studies showed that irisin involves in thermogenesis and increases the expression of browning markers such as uncoupling protein-1 that in turns induces the conversion of white adipose tissue to brown fat. Resveratrol (Res) and all-trans retinoic acid (ATRA) can also upregulate the expression of thermogenesis genes. In the present study, the effects of single and combined treatments of Res and ATRA on fibronectin type III domain containing 5 (FNDC5) gene expression was explored. METHODS: The mouse myoblasts, C2C12 cells, were seeded in 6-well plastic plates and cultured in DMEM media. After differentiation, in a pilot study, C2C12 myotubes were treated with different concentrations of Res and ATRA for 12 h. The best result was obtained by treatment of 1and 25 µM of Res and 1 µM of ATRA. Then the main study was continued by single and combined treatment of these compounds at chosen concentration. After treatments, total RNA was extracted from C2C12 cells. Complementary DNA (cDNA) was generated by the cDNA synthesis kit and FNDC5 mRNA expression was evaluated by the real-time PCR method. RESULTS: The FNDC5 gene expression in C2C12 myotubes of alone-treated with 1 µM, 25 µM Res and 10 µM ATRA did not change compared to vehicle group. However, in combination-treated the expression of FNDC5 gene was significantly increased compared to vehicle group. CONCLUSION: This is the first evidence that Res and ATRA can regulate FNDC5 gene expression in C2C12 myotubes. More investigations are necessary to explore the therapeutic effects of these nutrients in obesity, diabetes, cardiac and neurovascular disease.

Assessment of CT angiographic findings in comparison with echocardiography findings of chest among patients with aortic arch anomalies.

The objective of this study was to examine the findings of computed tomographic (CT) angiography in patients with aortic arch anomalies in comparison with transthoracic echocardiography findings who referred to a private imaging center in Tehran during 2009-2012. The cases included 203 patients with clinical symptoms or echocardiogram of congenital heart disease to assess the presence of aortic arch anomalies among patients referred to imaging center. This study is a retrospective study based on the CT angiographic findings in comparison with transthoracic echocardiography findings of chest among patients with aortic arch anomalies. In this study, 203 patients with congenital anomalies were enrolled in the study, among those, 107 patients were men and 96 were female. The most common anomaly of the aortic arch was found to be coarctation (19.7%), followed by right sided arch with mirror image branching (19.2%). Furthermore, the most common cardiac anomalies associated with aortic arch anomalies were VSD, PA and PDA. The sensitivity and specificity of transthoracic echocardiography in the diagnosis of aortic arch anomalies was 59% and 100% in comparison with CT angiography. In addition, the agreement between the two methods (kappa) in the diagnosis of aortic arch anomalies was 0.72. But, transthoracic echocardiography is the first diagnostic method for patients with congenital heart disease. In some patients, the ability of this method was limited to the detection of coronary artery anomalies and thoracic vessels. Therefore, CT is used for morphological evaluation of congenital heart disease (CHD) due to its main advantages including fast acquisition time, large anatomical coverage, high speed, and great spatial resolution. Moreover, CT is essential for proper evaluation of CHD regarding its high spatial and temporal resolution.

Quality of life and psychological distress in women with recurrent miscarriage: a comparative study.

BACKGROUND: This study aimed to evaluate quality of life and psychological distress in Iranian women with recurrent miscarriage and to compare it in women without miscarriage. METHODS: This was a comparative study of quality of life among women with and without recurrent miscarriage. Cases were selected from patients with complain of recurrent miscarriage and comparison group were selected from women attending to two teaching hospitals for annual screening. Quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). In addition the Hospital Anxiety and Depression Scale (HADS) were used to measure anxiety and depression. Comparison was made between two groups using the independent samples t-test and chi-square. RESULTS: In all 105 women with recurrent miscarriage and 105 healthy women were studied. The socio-demographic status for both groups was similar. Women with recurrent miscarriage showed a significant higher degree of psychological distress [mean (SD) anxiety score was: 10.6 (2.3) vs. 9.1 (2.2), P < 0.0001; and mean (SD) depression score was: 11.0 (2.3) vs. 9.5 (1.9), P < 0.0001]. In addition women with recurrent miscarriage reported significantly lower level of quality of life in all domains (role physical, general health, vitality, social functioning, role emotional, and mental health, all P values < 0.0001), except for physical functioning (P = 0.06) and bodily pain (P = 0.17). CONCLUSION: The findings demonstrated that women with recurrent miscarriage reported extensive functional disability, and lower level of well-being compared to women without recurrent miscarriage. The findings have some implications for prenatal care and suggest that appropriate treatment of recurrent miscarriage is essential.

Differential expression of two genes Oct-4 and MUC5AC associates with poor outcome in patients with gastric cancer.

Gastric cancer (GC) is the most frequent leading cause of cancer-associated mortality worldwide that is linked to poor prognosis due to the lack of appropriate biomarkers. Our aim was to evaluate the MUC5AC and Oct-4 expression levels in GC and to assess their association with clinical factors. Immunohistochemical analysis (IHC) and qRT-PCR were performed in GC patients to examine the MUC5AC and Oct-4 expression levels. The mRNA level of MUC5AC was significantly decreased in tumour tissues compared with non-cancerous tissues (1.11 ± 0.69 vs 3.7 ± 0.71; P = .024). On the other hand, Oct-4 mRNA level was upregulated in tumour tissues as compared to normal tissues (2. 86 ± 0.78 vs 0.87 ± 0.54; P = .0015). Decreased expression of MUC5AC was detected in 27 patients (67.5%), while high to moderate expression levels were observed in 13 cases (32.5%), but in normal tissues the expression levels of MUC5AC were increased (P = .001). The decreased expression of MUC5AC was associated with aggressive tumour characteristics, such as TNM stage (P = .023), histologic type (P = .012) and lymph node metastasis (P = .001). High expression of Oct-4 was detected in 24 tumour tissues (60%), while 16 cases (40%) showed low expression level. Increased Oct-4 expression was correlated with clinicopathological characteristics such TNM stage (P = .002), histologic type (P = .008) and lymph node metastasis (P = .001). Our results showed that high Oct-4 expression and the reduction of MUC5AC expression may be involved in the progression and an unfavorable prognosis of GC.

Evaluation of the efficacy and safety of an innovative flavonoid lotion in patients with haemorrhoid: a randomised clinical trial.

OBJECTIVE: Haemorrhoids are one of the most common gastrointestinal and anal diseases. In olive oil and honey propolis, flavonoids have beneficial effects on improving vascular function and decreasing vascular resistance. In this study, we aimed to produce a combination of these two substances in the form of lotions and assess their healing and side effects in comparison with routine treatment, anti-haemorrhoid ointment (containing hydrocortisone and lidocaine). DESIGN: In this randomised clinical trial study, 86 patients with grade 2 or more haemorrhoid degrees, diagnosed by colonoscopy, were divided into two groups, the case (n=44) and control (n=42). The case group was treated with flavonoid lotion, and the control group was treated with anti-haemorrhoid ointment two times per day for 1 month. Patients were followed weekly with history and physical examination. The data of the two groups were collected before and after the intervention and statistically analysed. RESULTS: Post-treatment reduction in haemorrhoid grade was significant in the case group (p=0.02). This ratio was insignificant in the control group (p=0.139). Flavonoid lotion (p<0.05) significantly reduced the signs and symptoms of haemorrhoids more than anti-haemorrhoid ointment. CONCLUSION: According to the results, flavonoid lotion can be an excellent alternative to topical chemical drugs, such as anti-haemorrhoid ointment, in treating haemorrhoid disease. Besides its effectiveness and safety, it can be easily manufactured and widely available to patien.

Iranian patients co-infected with COVID-19 and mucormycosis: the most common predisposing factor, clinical outcomes, laboratory markers and diagnosis, and drug therapies.

BACKGROUND: The newly emerged pandemic of coronavirus disease-2019 (COVID-19) is the world's main health challenge because infected patients become vulnerable to a variety of opportunistic diseases. OBJECTIVE: This study aimed to assess clinical outcomes, diagnosis, utilized drug therapies, and ongoing COVID-19 practices in Iranian cases co-infected with COVID-19 and mucormycosis. PARTICIPANTS AND METHODS: A case-series analysis was conducted in the presence of 10 patients with COVID-19 and mucormycosis co-infection (two men and eight women; mean age of 48.8 years) from March to October 2020. Demographic variables, signs/symptoms, and comorbidities of all patients were recorded. COVID-19 was confirmed with reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swab tests and high-resolution computed tomography (HR-CT)_ scans. RESULTS: All patients had a positive RT-PCR for SARS-CoV-2. Eight patients had a history of diabetes, while three of them exhibited a hypertension history. Remarkable laboratory findings were elevated fasting blood sugar in 6 cases and anaemia in four patients. A rhino-orbital-cerebral of mucormycosis in all patients was detected based on HR-CT scans and otorhinolaryngological or ophthalmological examinations. Neurological disorders including facial, trigeminal, optic, and oculomotor nerve involvement resulted in paraesthesia, pain, ptosis, no light perception, blurred vision, and papilledema in five cases. Maxillary and ethmoid sinuses were the most common sites of involvement. CONCLUSION: Vulnerable COVID-19 patients with comorbidities, any facial involvements, or treated by excessive doses of glucocorticoids and antibiotics should undergo precise examinations during the appearance of early signs and hospitalization to diagnose and treat mucormycosis using the standard care and antifungal treatments.

Decreasing the main maternal and fetal complications in women undergoing in vitro fertilization (IVF) trained by nutrition and healthy eating practices during pregnancy.

PURPOSE: In vitro fertilization (IVF) can lead to undesirable consequences for pregnant women and their newborns. Reducing the adverse maternal (mainly, gestational diabetes mellitus (GDM) and preeclampsia (PE)), and fetal outcomes in IVF-pregnant women (IVF-PW) was aimed with the correct training of nutrition principles during pregnancy. MATERIALS AND METHODS: A quasi-experimental clinical trial with 170 IVF-PW in intervention and control groups was conducted. The subjects before the dietary intervention completed questionnaires of nutritional and lifestyle and 24-h food recall. The intervention group was trained with the diet modification programs from early (12-16 weeks) to late (week 34) pregnancy in six weekly, 15-20-min sessions. The GDM diagnosis was based on 75-g OGTT and FBS tests, respectively, in 24-28 weeks' gestation. Other adverse maternal (e.g. PE, cesarean delivery, and preterm delivery (<37 weeks)), and fetal (e.g. intrauterine growth retardation (IUGR), birth weight, and fetal viability) outcomes were also monitored. The dataset was assessed using both inferential and descriptive statistics. RESULTS: A diet modification program with an increased intake of lactose, fiber, and some minerals (e.g. magnesium and zinc) and vitamins (e.g. B3 and B5) in conjunction with a lower intake rate of glucose and lipid could control the prevalence of adverse maternal and neonatal outcomes in IVF-PW. Although the GDM reduction in the two intervention (8.2%) and control (20.0%) groups was statistically insignificant, there was a significant difference in PE prevalence at a lower rate (39.0%) in the intervention group than the control. No significant difference in cesarean delivery (94.1-95.2%), and preterm delivery (45.9%) between the two groups was found. The IUGR (24.7-25.9%), birth weight (2.791-2.820 kg), and fetal viability (95.3-97.6%) also did not change significantly after the healthy eating practices during pregnancy. CONCLUSIONS: Diet-based interventions in IVF-PW during pregnancy were efficient in improving the outcomes for both mother and baby.