Evaluating the factors affecting clinical outcomes in critically ill COVID-19 unvaccinated patients admitted to the intensive care unit in a lower-middle-income country.

Background: COVID-19, the most destructive pandemic of this century, caused the highest mortality rate among ICU patients. The evaluation of these patients is insufficient in lower-middle-income countries with limited resources during pandemics. As a result, our primary goal was to examine the characteristics of patients at baseline as well as their survival outcomes, and propose mortality predictors for identifying and managing the most vulnerable patients more effectively and quickly. Methods: A prospective analysis of COVID-19 ICU-admitted patients was conducted in our healthcare centre in Iran, from 1 April until 20 May 2020. Ninety-three patients were included in the study, and all were unvaccinated. A multi-variate logistic regression was conducted to evaluate mortality-associated factors. Results: There were 53 non-survivors among our ICU-admitted patients. The mean duration from symptoms' onset to hospitalization was 6.92 ± 4.27 days, and from hospitalization to ICU admission was 2.52 ± 3.61 days. The average hospital stay for patients was 13.23 ± 10.43 days, with 8.84 ± 7.53 days in the ICU. Non-survivors were significantly older, had significantly lower haemoglobin levels and higher creatine phosphokinase levels compared to survivors. They had marginally lower SpO2 levels at admission, higher vasopressor administrations, and were intubated more significantly during their ICU stay. The use of immunosuppressive drugs was also significantly higher in non-survivors. Logistic regression revealed that a one-point increase in APACHE II score at ICU admission increased mortality by 6%, and the presence of underlying diseases increased mortality by 4.27 times. Conclusion: The authors presented clinical mortality prediction factors for critically ill patients infected with COVID-19. Additional studies are necessary to identify more generalized mortality indicators for these patients in lower-middle-income countries.

Prevalence of Thromboembolic Events, Including Venous Thromboembolism and Arterial Thrombosis, in Patients with COVID-19: A Systematic Review with Meta-Analysis.

Background: Many studies have evaluated thromboembolic events in COVID-19 patients, and most of them have reported a high estimation of the prevalence of such events. The present study sought to evaluate the prevalence of thromboembolic events in patients with COVID-19. Methods: This study is a systematic review with meta-analysis that investigated thromboembolic events in patients with COVID-19 from the start of the pandemic to August 31, 2021. The 4 main databases for collecting articles were Medline, Scopus, Google Scholar, and Web of Science. Deep vein thrombosis, pulmonary embolism, arterial thrombosis, and the overall rate of thromboembolic events were considered primary outcomes. Results: In a total of 63 studies (104 920 patients with COVID-19), the overall thrombosis rate was 21% (95% CI, 18% to 25%), the rate of deep vein thrombosis was 20% (95% Cl, 16% to 25%), the rate of pulmonary embolism was 8% (95% Cl, 6% to 10%), and the rate of arterial thrombosis was 5% (95% Cl, 3% to 7%). The prevalence of all primary outcomes in critically ill patients admitted to the intensive care unit (ICU) was significantly higher (P<0.05). In older patients, the prevalence of overall thrombosis, pulmonary embolism, or deep vein thrombosis was significantly higher (P<0.05). Conclusion: This study showed that COVID-19 increases the risk of thromboembolic events, especially in elderly and critically ill patients admitted to the ICU. Therefore, more strategies are needed to prevent thromboembolic events in patients with COVID-19, especially in ICU-admitted and elderly patients.

Time Series Modeling and Forecasting of Drug-Related Deaths in Iran (2014-2016).

Background: Investigating the temporal variations and forecasting the trends in drug-related deaths can help prevent health problems and develop intervention programs. The recent policy in Iran is strongly focused on deterring drug use and replacing illicit drugs with legal ones. This study aimed to investigate drug-related deaths in Iran in 2014-2016 and forecast the death toll by 2019. Methods: In this longitudinal study, Box-Jenkins time series analysis was used to forecast drug-related deaths. To this end, monthly counts of drug-related deaths were obtained from March 2014 to March 2017. After data processing, to obtain stationary time series and examine the stability assumption with the Dickey-Fuller test, the parameters of the Autoregressive Integrated Moving Averages (ARIMA) model were determined using autocorrelation function (ACF) and partial autocorrelation function (PACF) graphs. Based on Akaike statistics, ARIMA (0, 1, 1) was selected as the best-fit model. Moreover, the Dickey-Fuller test was used to confirm the stationarity of the time series of transformed observations. The forecasts were made for the next 36 months using the ARIMA (0,1,2) model and the same confidence intervals were applied to all months. The final extracted data were analyzed using R software, Minitab, and SPSS-23. Findings: According to the Iranian Ministry of Health and the Legal Medicine Organization, there were 8883 drug-related deaths in Iran from March 2014 to March 2017. According to the time series findings, this count had an upward trend and did not show any seasonal pattern. It was forecasted that the mean drug-related mortality rate in Iran would be 245.8 cases per month until 2019. Conclusion: This study showed a rising trend in drug-related mortality rates during the study period, and the modeling process for forecasting suggested this trend would continue until 2019 if proper interventions were not instituted.

Educational Intervention of Improve Student's Oral Health: A Systematic Review and Meta-Analysis School-Based.

Background: The present research aimed to assess the effects of oral health intervention programs at school level on students' oral hygiene in developing countries. To this aim, a systematic review and meta-analysis approach was employed. Methods: The present research was done by surfing electronic databases with MEDLINE Ovid (Embase Ovid, Scopus), Web of Science from 2000 to Mar 2020. The data were collected using a standard type of data collection including specific studies to observational ones, and the data entered RevMan 2014. The eligibility criteria were individually randomized controlled trials (RCTs) or cluster-RCTs including quasi-experimental papers with oral health interventions. The RevMan 2014 package was used for a meta-analysis done through random-effects models. Results: Meta-analyses revealed statistically significant divergences in terms of knowledge (SMD 3.31, 95% CI 2.52 to 4.11; I2 = 98; P<0.001), attitude (SMD 1.99, 95% CI 0. 43 to 3.54; I2 = 99; P<0.001), behavior (SMD 4.74, 95% CI 3.70 to 5.77; I2 = 99; P<0.001), plaque index (SMD -1.01, 95% CI -1.50 to -0. 51; I2 = 97; P<0.001) and Gingival index (SMD 0. 33, 95% CI -0. 36 to 1. 02; I2 = 98; P=0.34) in the case of students who received educational interventions versus those with ordinary care. Conclusion: The present findings attested to the effectiveness of the educational interventions in improving oral health knowledge, attitudes, behaviors, and so on which can presumably contribute to a better oral hygiene, lower incidence of oral diseases, and lower costs of the treatments imposed by oral diseases.

The association between tissue doppler-derived E/(e's') ratio and coronary atherosclerosis severity measured by the SYNTAX score in patients with non-ST elevation-acute coronary syndrome.

BACKGROUND: The prognosis of patients hospitalized with non-ST elevation-acute coronary syndrome (NSTE-ACS) is typically determined by the existence and severity of myocardial necrosis and left ventricular (LV) remodeling. AIM: The present study was to assess the association between the E/(e's') ratio and the coronary atherosclerosis severity, measured by the SYNTAX score, in patients with NSTE-ACS. METHODS: Utilizing a descriptive correlational research design, this study was prospectively conducted on 252 patients with NSTE-ACS, undergoing an echocardiography to determine the left ventricular ejection fraction (LVEF), the left atrial (LA) volume, the pulsed-wave (PW) Doppler-derived transmitral early (E) and late (A) diastolic velocities, and the tissue Doppler (TD)-derived mitral annular early diastolic (e') and peak systolic (s') velocities. After that, a coronary angiography (CAG) was performed, and the SYNTAX score was calculated. RESULTS: The patients were divided into two groups, viz., those with the E/(e's') ratio < 1.63 and the cases with the ratio ≥ 1.63. The results revealed that the patients with a high ratio were older, had a higher prevalence of females, a SYNTAX score ≥ 22, and a lower glomerular filtration rate than those with a low ratio (p-value < 0.001). Besides, these patients had larger indexed LA volume and lower LVEF than others (p-value: 0.028 and 0.023, respectively). Furthermore, the multiple linear regression outcomes established a positive independent association between the E/(e's') ratio ≥ 1.63 (B = 5.609, 95% CI 2.324-8.894, p-value = 0.001) and the SYNTAX score. CONCLUSION: The study results demonstrated that the patients hospitalized with NSTE-ACS and the E/(e's') ratio ≥ 1.63 had worse demographic, echocardiographic, and laboratory profiles and a higher prevalence of a SYNTAX score ≥ 22 than those with a lower ratio.

Otomycosis: The foremost aetiological agent causing otitis externa and the antifungal susceptibility pattern in North-Western Iran.

BACKGROUND: Otomycosis is considered a recurring fungal ear infection. The external auditory canal provides an appropriate and optimal situation for fungal growth. OBJECTIVES: The study aimed to identify the causative agents of otomycosis and determine corresponding antifungal drug susceptibility patterns in north-western Iran. METHODS: From October 2020 until November 2021, 200 patients attended an otolaryngology referral centre with otitis externa, and their ear discharge and debris were examined and cultured. The identification of the fungal agents was implemented by polymerase chain reaction-restriction fragment length polymorphism and sequencing. In vitro antifungal susceptibility testing of the isolates was conducted in accordance with the CLSI broth microdilution protocols. RESULTS: The prevalence of otomycosis was measured 50.5% (n = 101/200). The majority of patients were in their forties (n = 35, 34.6%) and female (n = 57, 56.4%), and the most prevalent symptom was otalgia (56.4%). The most underlying factor was remarked manipulation employing a cotton swab (65.3%). Regarding fungus, Aspergillus section Nigri (58.57%) was the foremost isolate, followed by Aspergillus section Flavi (19.23%) and Candida parapsilosis (14.96%). The predominance of Aspergillus isolates had minimal in vitro sensitivity to tioconazole and nystatin. Candida species represented higher geometric mean minimum inhibitory concentrations (MIC) against nystatin. The MIC of three Aspergillus species isolates shown above the epidemiologic cut-off values (ECV) against itraconazole. CONCLUSIONS: Otomycosis incidence surpassed in comparison with the previous study as the most common cause of otitis externa. The MIC distribution of Aspergillus species isolates against triazole antifungals is close to the defined ECVs and likely outrun it over time.

Drug-related Death low Registration in Iran: A Mixed Method Approach for Causes, Recommendations to Solve This Problem and Geographical Evaluation of an Intervention.

Background: The death registration is conducted by different systems in Iran. The drug-related death registration is exclusively conducted by Ministry of Health and Medical Education (MOHME) and Legal Medicine Organization (LMO). This study investigates the causes of undercounting drug-related deaths (DRDs) in Iran, provides recommendations for addressing this issue, and provides a geographical evaluation of the integrity and quality of drug-related mortality registration (2014-2017). Methods: This is a mix-method study. In part1, individual targeted interviews were conducted with 12 experts in death registration in MOHME and LMO to collect data on the causes of low registration in Iran and provide recommendations for resolving the issue. Part2 of the study involved an intervention in the form of a memorandum of understanding on reduction of low-registrations. This memorandum was signed to transfer information about the corpses between the MOHME and LMO. First, the number of DRDs (2014- 2017) was examined using capture-recapture method and, then, we calculated and compared the rate of pre-intervention (2014-2016) and post-intervention (2017) under-registration to assess whether this memorandum of understanding had been effective in reduction of under-registrations. Findings: In part1, according to the participants, the causes of undercounting DRDs in LMO and MOHME were arranged and categorized into 4 categories: weak administration system, physician and personnel training problems, system constraints, and client-related problems. Also, some suggestions were presented to help resolving the problem of undercounting; these suggestions concern the administrative system, technology, and educational domains. In part 2, about half of the provinces in Iran had a positive performance in reducing the undercount. Conclusion: At the macro level, the memorandum of understanding between the two organizations responsible for registering deaths was effective. However, increasing the quality of data registrations requires monitoring at the micro and organizational levels to lead to a positive performance in reducing death under-registration in all provinces.

Spatial distribution and temporal trend of drug-related deaths in the Islamic Republic of Iran during 2014-2017.

Background: Research suggests that there is an increasing trend in drug-related deaths worldwide: an estimated 69 000 individuals lose their lives due to substance abuse annually. Aims: To determine the geographical pathology of drug-related deaths in the Islamic Republic of Iran and to evaluate incidence trends, with a focus on identifying high- and low-risk regions. Methods: For this ecological study, we collected data from the 2 main sources (the Legal Medicine Organization and the Ministry of Health and Medical Education) responsible for registering substance-related deaths during 2014-2017. Data analysis was conducted using Joinpoint regression analysis, Global Moran's I and Anselin Local Moran's I. Results: Of the 12 386 drug-related deaths in 2014-2017, most occurred during the summer months; 7162 of these were among middle-aged individuals. The mean age of children and adolescents who died of substance abuse was 5.2 [standard deviation (SD) 4.6] years. In the young adult group, mean age at death was 20.7 (SD 2.5) years; it was 34.2 (SD 5.4) years for adults and 55.6 (SD 9.8) years for older adults. Changes in mortality rate peaked in 2017 (annual percentage change = 0.52); in the last months of the study period there was a nonsignificant decrease (annual percentage change = -6.99) in the incidence (average annual percentage change = -0.5; 95% confidence interval: -3.2, 2.3). Conclusion: Deaths due to substance abuse will remain a huge public health problem unless policy- and decision-makers determine why this problem continues to increase despite the extensive efforts on regulation and find ways to mitigate it.

Major and minor criteria for gastric dystemperaments in Persian Medicine: Sari gastric dystemperament criteria-I (SGDC-I).

Background: Gastric disorders are one of the most common human ailments, which impose a huge economic burden on countries. In Persian Medicine (PM), it is possible to predict the susceptibility to gastric diseases with diagnosis of gastric Mizajes (temperaments) and dystemperaments. The semiology of gastric dystemperaments has been investigated in PM textbooks, although the value of each sign and symptom is not mentioned. Consequently, this research is designed to determine the major and minor criteria for classifying gastric dystemperaments on the basis of valid manuscripts and with the help of PM specialists in the present era. Methods: This was a consensus-based study consisting of four phases. In the first phase, reference PM textbooks were studied. Symptoms and signs of gastric dystemperaments were collected and listed in four groups. In the second phase, semi-structured interviews with a sample of PM experts were carried out. Phase three included a focused group discussion with experts. Eventually, findings were integrated from the three study phases in a two-day meeting in Sari City. Results: Selected criteria included eight major and eight minor criteria for hot-cold dystemperament, as well as six major and eight minor criteria for wet-dry gastric dystemperament. Conclusion: Modern lifestyles and the interfering factors are responsible for some changes in diagnostic signs and symptoms according to PM. This was the first step to coordinate PM diagnostic criteria for gastric dystemperaments. Further studies are recommended to reach a unique protocol in the field of PM diagnostics. The next step includes design and validation of national diagnostic tools.

A global study of the association of cesarean rate and the role of socioeconomic status in neonatal mortality rate in the current century.

INTRODUCTION: Caesarean section (C/S) rates have significantly increased across the world over the past decades. In the present population-based study, we sought to evaluate the association between C/S and neonatal mortality rates. MATERIAL AND METHODS: This retrospective ecological study included longitudinal data of 166 countries from 2000 to 2015. We evaluated the association between C/S rates and neonatal mortality rate (NMR), adjusting for total fertility rate, human development index (HDI), gross domestic product (GDP) percentage, and maternal age at first childbearing. The examinations were also performed considering different geographical regions as well as regions with different income levels. RESULTS: The C/S rate and NMR in the 166 included countries were 19.97% ± 10.56% and 10 ± 10.27 per 1000 live birth, respectively. After adjustment for confounding variables, C/S rate and NMR were found correlated (r = -1.1, p < 0.001). Examination of the relationship between C/S rate and NMR in each WHO region resulted in an inverse correlation in Africa (r = -0.75, p = 0.005), Europe (r = -0.12, p < 0.001), South-East Asia (r = -0.41, p = 0.01), and Western Pacific (r = -0.13, p = 0.02), a direct correlation in America (r = 0.06, p = 0.04), and no correlation in Eastern Mediterranean (r = 0.01, p = 0.88). Meanwhile, C/S rate and NMR were inversely associated in regions with upper-middle (r = -0.15, p < 0.001) and lower-middle (r = -0.24, p < 0.001) income levels, directly associated in high-income regions (r = 0.02, p = 0.001), and not associated in low-income regions (p = 0.13). In countries with HDI below the centralized value of 1 (the real value of 0.9), the correlation between C/S rate and NMR was negative while it was found positive in countries with HDI higher than the mentioned cut-off. CONCLUSIONS: This study indicated that NMR associated with C/S is dependent on various socioeconomic factors such as total fertility rate, HDI, GDP percentage, and maternal age at first childbearing. Further attentions to the socioeconomic status are warranted to minimize the NMR by modifying the C/S rate to the optimum cut-off.

Hepatitis C Virus Coinfection in People With Human Immunodeficiency Virus in Iran: A Systematic Review and Meta-Analysis.

Background: Hepatitis C virus (HCV) coinfection is associated with higher mortality and morbidity in people with human immunodeficiency virus (PWH). Methods: We aimed to characterize the epidemiology and factors associated with HCV coinfection among PWH in Iran. In this systematic review, we searched 3 English databases (MEDLINE, SCOPUS, Embase) and 2 Farsi databases (Scientific Information Database and Magiran) for studies that measured the prevalence of HCV coinfection among PWH, published between 2000 and January 1, 2021. We included studies with a minimum sample size of 5 PWH. Reviews, editorials, conference abstracts, theses, studies with no relevant data, and unclear serological assays were excluded. Results: We summarized the HCV coinfection prevalence by random-effect meta-analysis and assessed the sources of heterogeneity by a meta-regression model. Of the 858 records identified, 69 eligible studies with 12 996 PWH were included. Overall, HCV coinfection prevalence was 64% (95% confidence interval [CI], 58-69). The prevalence was higher among older (mean age ≥35 years) PWH (69%; 95% CI, 64-74) and PWH who inject drugs (77%; 95% CI, 71-82). Furthermore, we found that coinfection was higher among studies conducted between 2000 and 2014 (67%; 95% CI, 59-75) versus 2015-2020 (57%; 95% CI, 50-64). Conclusions: The prevalence of HCV coinfection is high in Iranian PWH, with significant geographical variations. Hepatitis C virus screening and treatment among PWH are warranted to avoid the future burden of HCV-related liver damage, cancer, and mortality.

Gargle test for successful extubation in critically ill patients underwent head and neck surgeries: A new test.

Background: Improvement of predictive tools for recognition of airway edema is crucial for safe extubation and patient safety. This study aimed to evaluate the diagnostic accuracy of the Gargle test (GT) as a new test for assessing airway edema and predicting successful extubation in patients admitted to the intensive care unit (ICU). Method: In this prospective observational study, patients underwent head and neck surgeries and admitted to ICU included. All the patients were weaned based on the same protocol.Quantitative Cuff Leak Test (CLT) and qualitative CLTwere first applied followed by GT with normal saline 0.9%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated. Results: One hundred and eighteen (male 67, female 51) participated in this study. The agreement between GT and CLT was low (Kappa: quantitative CLT 0.07, qualitative CLT 0.21). The GT compared to CLT had higher sensitivity (33.3% vs 16.6%), specificity (96.3% vs qualitative CLT 92.8%, quantitative CLT 79.4%), PPV (33.3% vs qualitative CLT 11.11%, quantitative CLT 4.0%), NPV (96.3% vs qualitative CLT 95.4%, quantitative CLT 94.6%), and accuracy (92.92% vs qualitative CLT 88.98%, quantitative CLT 76.27%. The cut-off value for GT was estimated 16.5% (sensitivity 74.1% and specificity 60%). Conclusion: The GT is a simple accurate test and can be used as a new test in the ICU for recognition of airway edema and prediction of safe extubation in patients with head and neck surgeries.

Prevalence and specificity of red blood cell alloantibodies and autoantibodies in transfused Iranian ß-thalassemia patients: A systematic review and meta-analysis.

BACKGROUND: Repeated allogeneic blood transfusions in thalassemia major patients stimulate the patient's immune system to generate antibodies against foreign erythrocyte antigens. This study was carried out to systematically review the findings of available studies about the prevalence of alloantibodies and autoantibodies, as well as the type of causative antigens among transfusion-dependent thalassemia patients in Iran. METHODS: Electronic search was conducted on Medline, PubMed, Cochrane, EMBASE, ScienceDirect, and Persians databases. All relevant articles published from January 1990 to July 2018 were included. Abstracts of conference booklets which that been published in the last 5 years were also included in the meta-analysis. The search language was restricted to English and Persian. The quality of studies was evaluated according to a checklist developed by authors, and Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. RESULTS: Twenty-three relevant articles met all the inclusion criteria. The prevalence of alloimmunization was 13%. Our study showed that anti-D (25%) and anti-K (25%) were most prevalent among Iranian ß-thalassemia patients. Data analysis shows the autoantibody prevalence to be 1% among 3787 patients. Meta-regression revealed that the prevalence of alloantibodies increases with each year as the average age of the study population increases. CONCLUSION: The prevalence of red blood cell (RBC) alloantibodies in transfused Iranian ß-thalassemia patients was high. Appropriate preventive strategies such as RBC phenotyping for patients before beginning transfusion and using extended RBC donor-recipient matching, specifically for Rh and Kell system, could be implemented to avoid complications in thalassemia patients.

Years of Life Lost (YLLs) due to drug-related deaths in the Islamic Republic Of Iran (2014-2017): a temporal and geographic pattern.

The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.

Investigating the relationship between satisfaction of basic psychological needs, general health, and some background variables in the Iranian older adults: a cross-sectional study.

BACKGROUND: Promoting the health and mental health (MH) of the older adults making up a large part of the world's population in the coming years can provide the necessary conditions for their health and well-being of them. This study aimed to investigate the relationship between the satisfaction of basic psychological needs (BPNs), general health (GH), and some variables in Iranian older adults. METHODS: The present descriptive-correlational study was conducted on 780 older adults from Sarpol-e Zahab (Kermanshah) in 2019 including the study by multi-stage cluster random sampling. The data collection tool was BPNs satisfaction and GH questionnaire and a researcher-made questionnaire of individual and background information. Was used for data analysis using the SPSS version 16 program and descriptive statistics and tests Pearson correlation coefficient, chi-square test, independent-sample T-test, and multivariate linear regression. RESULTS: In the present study, participating a total of 780 older adult men aged 73.0 ± 29.32 years. There was a significant relationship between the satisfaction of BPNs and GH (p <  0.001). Also, 41% of the older adults were in poor GH and 30% were high in BPNs. Multiple logistic regression showed that the BPNs, age, income satisfaction, weather, and war zone were strong predictors of GH. the adjusted R2 value of 0.55 shows that the model described 55% of changes in the GH score. CONCLUSION: According to the findings of the study on the relationship between the satisfaction of BPNs and GH, providing insurance, social and economic support by developing health policies, creating supportive health environments, strengthening community action, and developing individual skills in the older adults can help improve their MH and that of the community.

Magnesium Sulfate for Prevention of Post-ERCP-Pancreatitis: A Randomized Controlled Trial.

BACKGROUND: Acute pancreatitis is one of the most common complications of endoscopic retrograde cholangiopancreatography (ERCP). Studies suggest that intrapancreatic calcium has an important role in activating pancreatic enzymes; in addition, elevated intraductal pressure is required for development of pancreatitis. Magnesium sulfate (MS), as a calcium antagonist and a muscle relaxant of the Oddi sphincter, is suggested to reduce the incidence and severity of post-ERCP-pancreatitis (PEP) in this article. METHODS: We included 270 patients who referred for ERCP between March 2017 and March 2018. They were enrolled into MS (2 g) and placebo (normal saline) groups, administered 1 hour before and 6 hours after the procedure. The ERCPs were done by fellows of gastroenterology under supervision of expert physicians. The incidence and severity of PEP were followed. RESULTS: PEP was seen in 12 (8.9%) patients in the MS group and 17 (12.6%) in the placebo group (P value=0.33). The incidence of PEP in high risk patients group (P value=0.017). CONCLUSION: Although the usage of MS was not able to prevent PEP in all patients enrolled in this study, but it could significantly reduce the incidence of PEP in high risk patients of intervention group in comparison with placebo group. The median length of hospital stay was also significantly lower in new drug group in contrast to placebo.

Melatonin as adjunctive therapy in patients admitted to the Covid-19.

Objective: Coronavirus has disrupted the natural order of the world since September 2019 with no specific medication. The beneficial effects of melatonin on sepsis and viral influenza were demonstrated previously, but its effects on covid-19, especially COVID -19 ICU, is unclear. Therefore, our aim was to determine the effects of melatonin in COVID-19 ICU patients. Methods: This is a retrospective cohort study in which the records of patients admitted to COVID -19 ICU of (XXX) during March to June 2020 were reviewed. According to inclusion criteria, patients who received 15 mg of melatonin daily were called MRG and the rest were called NMRG. Results: Thirty-one patients were included and analyzed, of which twelve patients were in MRG. Demographic and clinical characteristics, and laboratory data were similar between two groups at ICU admission. Melatonin had no significant effect on ICU duration, CRP and ESR, also the trend of changes was in favor of melatonin. Nevertheless, melatonin significantly reduced the NLR (OR = -9.81, p = 0.003), and also declined mortality marginally (p = 0.09). Melatonin was well tolerated with no major adverse effects, moreover the thrombocytopenia occurrence was significantly lower in MRG (p = 0.005). In MRG, survival increased and mortality risk decreased, although the difference between groups wasn't significant (p = 0.37), which might be related to the small sample-size. Conclusion: Our study showed that melatonin is unlikely to reduce mortality among COVID19 patients and with no significant effect on disease-specific biochemical parameters.

Effects of intrathecal and intravenous dexamethasone on complications associated with intrathecal morphine after cesarean section: A comparative study.

BACKGROUND: Pain and nausea and vomiting are of serious complications following the use of opiates after surgery, especially cesarean section. Control of postoperative complications is one of the necessities of quality promotion of health-care system. Medications with few side effects such as corticosteroids including dexamethasone can be an appropriate option. In addition, the route of administration can have a significant effect on the effectiveness of the drug. The aim of the present study was to compare the effects of intrathecal with intravenous dexamethasone in reducing the complications associated with intrathecal morphine after cesarean section. MATERIALS AND METHODS: The study was a double-blind randomized controlled clinical trial and determined the effect of intrathecal and intravenous dexamethasone on the incidence and severity of complications of intrathecal morphine after cesarean section on 120 patients and its relationship with serious complications after surgery. Descriptive and analytical statistics were used to examine the characteristics of the case and control groups, and STATA SPSS software was used to compare the two groups. RESULTS: There was no significant association between the two groups in terms of baseline characteristics. Pain score in the intrathecal injection group was lower than the intravenous injection group, with a statistically significant difference (P = 0.02). In addition, there was a significant association regarding to the incidence of nausea, vomiting, and itching between intrathecal and intravenous injection groups (P = 0.008). CONCLUSION: Dexamethasone was effective to reduce opiate complications after cesarean section. Establishing a suitable association between dexamethasone half-life, efficacy, type of use, and time of use can result the best outcomes and promote patients' satisfaction in cesarean section.

Aloe vera for Prevention of Acute Radiation Proctitis in Colorectal Cancer a Preliminary Randomized, Placebo-Controlled Clinical Trial.

OBJECTIVE: To examine the preventive effects of Aloe vera in colorectal cancer patients undergoing radiotherapy. MATERIAL AND METHOD: Twenty colorectal cancer patients, who received radiation, were randomized to receive Aloe vera 3% or placebo ointment, 1 g twice daily for 6 weeks. At weekly visits, acute radiation proctitis (ARP) was evaluated by Radiation Therapy Oncology Group and clinical presentation criteria as the primary endpoint. We also evaluated secondary endpoints of quality of life, psychosocial status, by applying Hospital Anxiety-Depression (HAD) Scale and laboratory measures of quantitative measurement of C-reactive protein (CRP) as a marker for systemic inflammation. RESULTS: There was a significant improvement in the symptom index (before treatment vs. after treatment with Aloe vera) for diarrhea (p = 0.029, median score: 0.5 vs. 0.001). The overall primary and secondary outcomes favored Aloe group, while the measures of toxicity did not achieve a statistical significant difference. The lifestyle score improved significantly with A. vera (p = 004), and they also had a lower depression score in HAD scale (p = 0.008). Furthermore, quantitative CRP decreased significantly during the course of treatment with Aloe vera. CONCLUSION: The use of topical formulation of Aloe vera 3% diminishes the severity of ARP in colorectal cancer patients.

Years of Life Lost (YLLs) due to drug-related deaths in the Islamic Republic Of Iran (2014-2017): a temporal and geographic pattern / Anos de Vida Perdidos (AVP) devido a mortes relacionadas a drogas na República Islâmica do Irã (2014-2017): um padrão temporal e geográfico

Abstract The present study aimed to measure the mortality burden caused by premature death due to substance abuse in different geographical regions of Iran from 2014-17. In this serial cross-sectional study, the data related to individuals who had died of drug abuse were first collected from two sources (Iranian Ministry of Health and Medical Education and the Iranian Legal Medicine Organization). Then, using the capture-recapture method, the number of drug-related deaths was estimated. The years of life lost (YLLs) for all provinces of Iran was calculated based on age, sex, and year. During these four years, the total number of deaths was 12029. The mean age of the individuals was 37.3±14.1. The mean age of dead people was constant in women and men over this period; however, the mean age of dead women due to substance abuse was lower than that of men. The mean YLLs per dead person was 70131.3329 years for men and 9321.1125 years for women. The potential years of life lost (YLLs) showed an upward trend, which was stronger in women than men. It is necessary to perform more regional overviews for finding differences in the number of YLLs due to substance abuse so that specific regional policies can be adopted.

Resumo O presente estudo teve como objetivo medir a carga de mortalidade causada por morte prematura por abuso de substâncias em diferentes regiões do Irã de 2014-17. Neste estudo transversal serial, os dados relacionados aos indivíduos que morreram por abuso de drogas foram coletados primeiramente em duas fontes (Ministério da Saúde e Educação Médica do Irã e Organização de Medicina Legal do Irã). Em seguida, usando o método de captura-recaptura, estimou-se o número de mortes relacionadas a drogas. Os anos de vida perdidos (AVP) para todas as províncias do Irã foram calculados com base na idade, sexo e ano. Durante quatro anos, o número total de óbitos foi de 12029. A média de idade dos indivíduos foi de 37,3±14,1. A média de idade dos mortos foi constante em mulheres e homens ao longo desse período; entretanto, a média de idade das mulheres mortas por abuso de substâncias foi menor do que a dos homens. O AVP médio por pessoa morta foi de 70131,3329 anos para homens e 9321,1125 anos para mulheres. Os anos potenciais de vida perdidos (APVP) apresentaram tendência ascendente, sendo mais forte nas mulheres do que nos homens. É necessário realizar mais análises regionais para encontrar diferenças no número de AVP devido ao abuso de substâncias.