A Single-group, Clinical Interventional Study on the Effect of Iron Deficiency Anemia on Blood Glucose and Insulin Resistance in Women with Type II Diabetes.

AIMS: Iron deficiency anemia (IDA) is one of the disorders recently associated with an increase in insulin resistance (IR) and, consequently, diabetes mellitus (DM) affection by causing oxidative stress. In this study, we look at how IDA may contribute to developing type II diabetes mellitus (T2DM), controlling diabetes, and reducing IR in women with T2DM. METHODS: In this single group, clinical interventional study, we enrolled 40 women with T2DM and IDA. Before and after intervention with ferrous sulfate tablets, their blood glucose (BG) levels and IR levels were evaluated. This study was approved by the Ethics Committee of Qom University of Medical Sciences (ethics code: IR.MUQ.REC.1397.031) and registered at the Iranian Center for Clinical Trials (No. IRCT20170215032587N3). A significant level was considered p <0.05. RESULT: The mean age of patients was 48.18 ± 4.6 years, with 5.3-5.8 years duration of T2DM. After the intervention, the mean fasting blood glucose (FBG) level reached 198.53 ± 48.11 to 170.93 ± 37.41, which was significant (p <0.0001). Also, hemoglobin A1C level reached from 8.49 ± 0.9 to 7.96 ± 0.58, which was significant (p <0.0001). Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) demonstrating a significant reduction of IR levels after intervention with ferrous sulfate tablets (p <0.018). CONCLUSIONS: IDA treatment in patients with T2DM can significantly reduce the BG and IR levels. To better control BG, checking iron status and its correction may provide better clinical outcomes in these patients. CLINICAL TRIAL REGISTRATION NUMBER: IRCT20170215032587N3.

The effect of interferon in the therapy of severe coronavirus infection.

BACKGROUND: So far, several protocols have been used for the treatment of coronavirus disease-2019 (COVID-19). In this study, we aimed to study the effect of interferon on the treatment of hypoxemia caused by COVID-19. MATERIALS AND METHODS: This was a quasi-experiment with a nonequivalent group design. All participants were admitted to Shahid Beheshti Hospital, Qom province. In total, 60 patients were enrolled in the study, and inclusion criteria were age over 18 years, positive PCR test result, pulmonary involvement in computed tomography (CT) scan, and SpO2 level below 93%. Individuals were divided into two control (hydroxychloroquine + lopinavir/ritonavir [Kaletra]) and intervention (hydroxychloroquine + lopinavir/ritonavir [Kaletra] + interferon-ß 1a [recigen]) groups. The data were analyzed in Stata/SE 14.2 using Chi-square, t-test, and Mann-Whitney U test. RESULTS: The mean ± standard deviation (SD) age of patients was 63 ± 16.12 years and 43.3% were male. In terms of outcome variables, 20% of patients in the intervention group and 53.3% of subjects in the control group died and this difference was significant (P = 0.007). According to the quick sequential organ failure assessment (qSOFA) score, the severe cases were 16.7% in the intervention group and 50% in the control group (P = 0.006). In addition, the median days of hospitalization were 11.5 days-significantly higher than those in the control group (5.5 days) (P < 0.001). CONCLUSION: Based on the results of this study, the use of interferon in the treatment of COVID-19 can improve health and reduce the severity of the disease and mortality.

Discharge of Confirmed COVID-19 Patients Based on WHO or Regional Criteria? A Cohort Study.

BACKGROUND: Increasing the number of COVID-19 patients raises concerns about the capacity of the health care system. This issue emphasizes reducing the admission rate and expediting patient discharge. OBJECTIVE: This study aimed to develop a discharge protocol for COVID-19 patients based on the existing capacity of the healthcare system and to assess its post-discharge outcomes. METHODS: This is a multicenter cohort study. All COVID-19 patients referred to selected medical centers in Qom, Iran, from Feb. 19 to Apr. 19, 2020, were target populations. Eligible patients were classified into a) the criterion group and b) the non-criterion group. Patients were followed up daily for 14 days after discharge by phone, and the required data was gathered and recorded in follow-up form. Univariate (chi-square and t-tests) and multivariate multiple (multivariate probit regression) analysis were used. RESULTS: A total of 2775 patients were included in the study (1440 people in the criterion group and 1335 in the non-criterion group). Based on multivariate probit regression, death was statistically associated with discharge outside our criteria (p<0.001), rising age (p<0.001), and being male (p=0.019), and readmission were associated with discharge outside our criteria (p<0.001), rising age (p=0.009), and having the history of underlying diseases (p=0.003). Furthermore, remission had statistically significant associations with discharge based on our criteria (p<0.001), decreasing age (p=0.001), and lack of a history of underlying diseases (p<0.001). CONCLUSION: Mortality and readmission were significantly lower according to our discharge criteria. Our designed criteria apply to less developed and developing countries due to the limited capacity and resources available in the health care system.

COVID-19 in Patients with Rheumatic Disease Using Immunomodulatory Drugs: Imaging Findings and Predictors of Hospitalization.

Introduction: SARS-CoV-2 causes more severe symptoms in most chronic diseases, and rheumatic disease is no exception. This study aims to investigate whether there is an association between the use of immunomodulatory medications, including conventional disease-modifying agents (csDMARDs), glucocorticoids, and biologic DMARDs, and outcomes such as hospitalization and lung involvement in patients with rheumatic disease with COVID-19. Methods: We performed a cross-sectional study on 177 COVID-19 cases with rheumatologic diseases using immunomodulatory drugs as their regular treatment. All patients were evaluated regarding their initial chest computed tomography (CT) scan, COVID-19 symptoms, and comorbidities. We ran predictive models to find variables associated with chest CT-scan involvement and hospitalization status. Results: CT findings showed lung involvement in 87 patients with chest CT-scan severity score (C-ss) of less than 8 in 59 (33%) and more than 8 in 28 (16%) of our patients. Of all patients, 76 (43%) were hospitalized. Hospitalized patients were significantly older and had more comorbidities (P = 0.02). On multivariate analysis, older age [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.31-3.08] and comorbidity (OR 2.75, 95% CI 1.06-3.66) were significantly associated with higher odds of hospitalization (P = 0.03). On multivariate analysis, older age (OR 1.15, 95% CI 0.94-2.01), pulmonary diseases (OR 2.05, 95% CI 1.18-3.32), and treatment with csDMARDs (OR 1.88, 95% CI 0.37-1.93) were associated with higher C-ss (P = 0.039). Conclusions: This study found that advanced age and comorbidities, similar to the general population, are risk factors for hospitalization in patients with COVID-19 with rheumatic disorders. Administration of csDMARDs, older age, and pulmonary disorders were linked to increased risk of COVID-19 pneumonia in these individuals.

Comparing the Sensitivity and Specificity of Lung CT-scan with RT-PCR for Diagnosis of COVID-19.

BACKGROUND: The lung is one of the major organs affected by the SARS-CoV-2 virus. Lung CT scan and RT-PCR are the most valuable diagnostic methods in the early diagnosis and management of COVID-19. Due to the possible inconsistency of the false-negative results for the RT-PCR test, in our study, we aimed to evaluate the sensitivity and specificity of lung CT-scan as an accurate diagnostic method of COVID-19. METHODS: In this cross-sectional study, patients suspected of COVID-19 and referred to Shahid Beheshti Hospital in Qom city from February 26 to April 13, 2020, were enrolled. For a definitive diagnosis of COVID-19, chest CT scan and RT-PCR testing was performed for 644 patients, and both sensitivity and specificity of lung CT scan were evaluated. RESULTS: According to the findings, and comparing to the RT-PCR test as the gold standard, sensitivity, specificity as well as, positive predictive and negative predictive values of lung CT-scan were found as follow; 94.47% (95% CI: 90.73 - 97.02%), 24.71% (95% CI: 20.70 - 29.07%), 40.73% (95% CI: 36.58 - 44.99%), 89.08% (95% CI: 82.4 - 94.05%), respectively. CONCLUSION: According to the findings, the lung CT scan has a better diagnostic value than RTPCR in symptomatic patients who were referred to the hospital for COVID-19 diagnosis. Performing lung CT-scan in patients with negative RT-PCR tests should be assessed.

Long-Term Follow-Up of Thalassemia Major Patients with Hepatitis C Virus Treated with Sofosbuvir and Daclatasvir: A Cohort Study.

BACKGROUND: Treatment of Chronic Hepatitis C virus (HCV) infection in patients suffering from hereditary ß-thalassemia major is a concern due to drug complications and liver malfunction. The aim of the present study was to evaluate treatment outcome of Direct-Acting Antiviral (DAA) therapy in thalassemia major patients infected with HCV in a three year follow-up. METHODS: In a cohort study, long-term safety and efficacy of DAA therapy were evaluated in a group of thalassemia major patients suffering from chronic HCV infection. Hematologic and biochemical parameters as well as liver Fibroscan monitoring were assessed at the onset and three years after the treatment. RESULTS: From among 84 patients enrolled in the study, 53.6% were males, 36.9% had cirrhosis, 96.4% had a history of Desferal usage, and 78.6% had a history of splenectomy. Unfortunately, 7 participants (8.3%) died prior to the end of follow-up with nearly half of them having Iron overload and heart failure complications. Fibroscan score, ALT, AST, and ferritin were significantly lower compared with baseline evaluation, while Hb, creatinine, and direct bilirubin increased significantly in the third year after the treatment. CONCLUSION: Safety and efficacy of Sofosbuvir and Daclatasvir in thalassemia patients assessed previously but our three year follow-up showed their mild complications and death into a long-term period after DAAs treatment and 91.7% three year survival rate, which may affected by other confounding factors, such as liver malfunction and Iron overload.

Uncommon cause of respiratory failure due to a bezoar in the hypopharynx: a case report.

BACKGROUND: Trichotillomania and trichophagia cause trichobezoars, which are masses made of hair. The main presentation of this condition is abdominal pain. However, other complications include gastric outlet obstruction, nausea, vomiting, weight loss, malnutrition, hematemesis, diarrhea, and constipation. CASE PRESENTATION: A 57-year-old woman with trichotillomania was admitted to the Emergency Department with the chief complaints of dyspnea on exertion, shortness of breath, dysphagia, generalized weakness, and hoarseness. Spiral chest computed tomography (CT) scan did not reveal any parenchymal lesions Pulmonary CT angiography did not reveal pulmonary embolism. The patient was admitted to the Surgery Department for hand fasciotomy due to contrast leakage, and during laryngoscopy, a trichobezoar was detected that was removed with Magill forceps. CONCLUSIONS: Rare cases of trichobezoars can be observed in humans with gastrointestinal and respiratory symptoms. Precise and timely diagnosis are key for the prevention of more invasive diagnostic procedures.

Bilateral pneumothorax: The cause of hypoxia during endoscopic retrograde cholangiopancreatography.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is recognized as a significant diagnostic and therapeutic procedure for the administration of different pancreatic and biliary problems. This procedure runs a considerable risk of complications despite its substantial safety. The rate of significant inconveniences is reported to range from 5.4% to 23.0% and the general mortality from 0.1 to 1%. Post-ERCP pneumothorax is an uncommon complication that is usually underestimated. CASE PRESENTATION: In the present study, we report a 65-year-old woman who develops hypoxemia during the ERCP. Based on the obtained results, it was revealed that this patient had perforation-related bilateral pneumothorax and hypoxemia. CONCLUSION: Based on the obtained results, it was revealed that this patient had perforation-related bilateral pneumothorax and hypoxemia.

Intestinal Ischemia Due to Mesenteric Vascular Thrombosis in a Patient with Positive SARS-Cov-2 RNA without Primary Pulmonary Symptom: A Case Report.

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness caused by novel coronavirus SARS-CoV-2. The clinical manifestations of this infection have a range and typically include impairment of smell, taste disturbance, cough, fever, and shortness of breath. Gastrointestinal manifestations have been reported in anywhere from 3% to 50% of patients with concomitant SARS-CoV-2 pulmonary infection. Abnormalities in coagulation markers have been reported in patients hospitalized with COVID-19. During this article, we will introduce a patient with COVID 19 but with the most manifestation of abdominal pain due to intestinal ischemia and mesenteric vascular thrombosis.

Comparing the Effect of Two Low-dose and High-dose Four-drug Regimens of Furazolidone in Eradicating Helicobacter Pylori.

BACKGROUND Antibiotic resistance is a major cause of Helicobacter pylori (H. pylori ) treatment failures. The increased resistance to clarithromycin and metronidazole has reduced the ability of this therapeutic regimen and prompted researchers to look for other drugs. One of the antibiotics of interest in this regard is furazolidone because of its low drug resistance. The aim of this study is compare two-drug regimens including low-dose and high-dose furazolidone in the treatment of H. pylori. METHODS This study is a clinical trial in which the studied subjects were categorized into two groups. The first group underwent treatment with amoxicillin 1000 mg-BD, furazolidone 100 mg-BD, omeprazole 20 mg-BD, and bismuth subcitrate 240 mg-BD for two weeks (low-dose OFAB). The second group received furazolidone 200 mg-BD (high-dose OFAB). Then eight weeks after completion of the treatment, they were examined in terms of eradication via the UBT test. RESULTS 85 participants completed the study in each group. The response to treatment was 76% and 83% in the low and high-dose groups, respectively, based on intention to treat analysis. Based on per protocol analysis the response to treatment was 78% and 84%, respectively, if excluded patients had completed their protocol and had response to treatment, and 72% and 79%, respectively, if excluded patients had completed their protocol and did not have response to treatment (p = 0.298). In the low-dose and high-dose groups, 16.5% and 24.7% of the participants suffered the complications of treatment with furazolidone (p = 0.18), respectively. Three patients in the high-dose group and one in the low-dose group did not complete the treatment because of the medication's bad taste (p = 0.03). CONCLUSION Low doses of furazolidone had a comparable therapeutic effect compared with high doses, but patients experienced significantly lower levels of bad taste, which was a major cause of reluctance to continue treatment. Therefore, we think four-drug low-dose furazolidone treatment is a good choice in eradicating H. pylori.

Function of circular RNAs in the pathogenesis of colorectal cancer.

Circular RNAs (circRNAs) comprise a group of noncoding RNAs with a circular conformation being constructed by either classic spliceosome-mediated or lariat-kind of splicing. They have tissue and temporal specificity and are involved in different biological functions. A vast body of literature has demonstrated critical roles of circRNAs in the formation or progression of neoplasms. Hsa_circ_0066631, hsa_circ_0082096, ciRS-7, circMAT2B, circ_052666, circMBOAT2, circPACRGL and circ_0128846 are among up-regulated circRNAs in CRC. Instead, expression levels of circTADA2A, circ_022743, circ_004452, circ-FBXW7, circ0106714, circFNDC3B and circ_cse1 have been decreased in CRC samples. Finally, expression levels of circRNA-100876, hsa_circ_0002320, circNOL10, circ_0056618, circ_0060745, circ-0004277, hsa_circRNA_102958, circPPP1R12A, hsa_circ_0007534, circ_0079993 and hsa_circ_0005075 can be used for prediction of clinical outcome of patients CRC.

Prevalence of coronavirus disease 2019 in rheumatic patients and evaluation of the effect of disease-modifying anti-rheumatic drugs.

One of the most controversial issues among rheumatologists is the best approach to managing a rheumatic patient (RP) with coronavirus disease 2019 (COVID-19). This study aims to evaluate the prevalence of COVID-19 in RPs compared to the general population and to relatively assess the potential role of RPs' treatment regimen against COVID-19. In a cross-sectional study, all RPs with an updated medical record between December 1, 2019, and February 29, 2020, at the rheumatology clinic of Shahid Beheshti Hospital, Qom, Iran were included (as the case group), and the prevalence of COVID-19 was compared to the paired control group-individuals without RDs, randomly selected from the Qom Health Network's database. Qom was the first city in Iran in which COVID-19 was identified and spread rapidly. Both groups were paired regarding sex, age, and underlying severe conditions. The prevalence of COVID-19 was lower in RPs than the control group (p = 0.028). Moreover, patients who were under treatment with disease-modifying anti-rheumatic drugs (DMARDs) and biologic agents seemed to possess a lower risk for COVID-19. Two RPs died from COVID-19, both of whom had granulomatosis and polyangiitis (GPA). The prevalence of COVID-19 in the RPs was lower than the control group, which could be associated with more adherence to the quarantine and social distancing rules by RPs and stricter routine follow-ups than the general population. Besides, taking DMARDs, such as leflunomide, might possess a protective effect against severe COVID-19, probably as a result of preventing cytokine storm.

Effect of gastric lavage with hemostasis powder® on upper gastrointestinal bleeding (Conversion of emergency endoscopy to elective endoscopy).

BACKGROUND: From many years ago, gastric lavage has been one of the main pillars of the classic treatment for upper gastrointestinal bleeding (UGIB). The present study investigated the effect of gastric lavage with hemostatic powder on the UGIB complications. METHODS: This clinical trial study was performed on 54 patients who referred to the emergency department during 2017-2018. The subjects were divided into two groups (n=27 per group). Gastric lavage with saline and hemostasis powder® was performed in the control and experimental groups, respectively. The patients' information was collected and analyzed using SPSS software Version. 18. The significance level was set to p<0.05%. RESULTS: In this study,59.2% and 18.5% of the patients in the gastric lavage with Hemostasis Powder® and saline required no treatment during the early endoscopy, respectively (p=0.002). The duration of endoscopy was shorter in the experimental group (p=0.001), (4.83±8.04 hours vs.6.73±14.12 hours, respectively) (p=0.001). Moreover, the gastric lavage with Hemostasis Powder® significantly improved the quality of endoscopy .There was no difference between the two groups in terms of their need for blood transfusion (p=0.4). CONCLUSION: Gastric lavage with hemostasis powder® is a useful measure in the primary treatment of patients with UGIB and can convert emergency therapeutic endoscopy to diagnostic elective endoscopy with higher quality.

Resistance-associated substitutions (RASs) to HCV direct-acting antivirals (DAAs) at baseline of treatment in thalassemia patients: a referral center study.

Patients with thalassemia major are at high risk of hepatitis C through blood transfusion from donors infected by hepatitis C virus (HCV). The use of direct-acting antiviral (DAA) therapy against such HCV infections has increased in different populations. However, resistant viral variants can affect treatment outcomes, and therefore improved surveillance strategies are needed. Accordingly, we aimed to evaluate resistance-associated substitutions (RASs) to HCV DAAs at the baseline of treatment in thalassemia patients in a referral center. Out of 89 thalassemia patients who suffered from HCV infection and were referred to our center between 2016 and 2017, 43 underwent further analysis of the HCV nonstructural proteins NS5A and NS5B using polymerase chain reaction (PCR) sequencing methods. Unique primers were designed using bioinformatics software for separate detection of HCV subtypes 1a, 3a, and 1b. Detection of RASs was performed based on previously published literature. Statistical analysis was carried out using SPSS version 19. The participants, 60.4% (26/43) of whom were male, had a mean age ± standard deviation (SD) of 33.0 ± 5.0 years. HCV subtype 1a was found in 27 cases, 3a in 13, and 1b in three. In HCV subtype 1a there were 163 mutations in NS5A and 212 mutations in NS5B. The frequency of RASs was 20.9% (8 RASs in 9 patients), including M28V and H58P in subtype 1a, L28M, R30Q, C316N, and C316S in subtype 1b, and S24F in subtype 3a. Statistically, the subtype 1b and a higher mutation rate in NS5A were associated with RASs (p-value < 0.05). The emergence of natural RASs to HCV DAAs serves as a warning of the risk of drug resistance in response to the broad usage of antivirals. However, relapses in these DAA-treated HCV-infected thalassemia patients are rarely reported. Our findings indicate that the prevalence of RASs prevalence at baseline was 20.9% in these patients, and this calls for extrapolation to a larger population study, as highlighted in other studies, with larger sample sizes, high-throughput methods, and follow-up in order to fully evaluate treatment outcomes in RASs-detected individuals. Optimized therapeutic strategies, particularly in complex, difficult-to-cure patients, can effectively prevent DAA treatment failure as a result of selection for RASs.

Evaluating the effect of a herb on the control of blood glucose and insulin-resistance in patients with advanced type 2 diabetes (a double-blind clinical trial).

BACKGROUND: Different benefits of various herbal medicines in decreasing blood sugar have been reported in different clinical trials so far. Considering the growing tendency toward these combinations and the booming market, inappropriate advice is growing accordingly. Hence, it is necessary to evaluate the effects and possible complications of such combinations on health status and blood glucose control. METHODS: Two 38-subject groups were formed and a 12-week treatment program was administered for both groups. The inclusion criteria were failure to control blood glucose with two oral medicines, unwillingness to inject insulin. The medicine was prepared in capsules by Booali Company. Each capsule weighed 750 mg and contained nettle leaf 20% (w/w), berry leaf 10% (w/w), onion and garlic 20% (w/w), fenugreek seed 20% (w/w), walnut leaf 20% (w/w), and cinnamon bark 10% (w/w) all in powder. RESULTS: At the beginning of the study, there was no significant difference between the subjects regarding the evaluated parameters, but after the intervention, the level of glucose was significantly lower in fasting (P=0.0001) and 2-hour postprandial (P=0.002) levels. The level of glycated hemoglobin A1c (HbA1c) (P=0.0001) also decreased from 0.33±9.72 % to 0.20±8.39 %. Finally, the level of insulin resistance reduced from 1.9±4.1 to 1.4±2.6 (P=0.001) after consuming herbal medicine. CONCLUSION: According to the results of the current study, the herbal combination was effective in controlling blood sugar, and considering the reduction of HbA1c by 1.31 %, it seems that the herbal combination is an effective medicine to treat diabetes.

Plasmapheresis with corticosteroids and antiviral: a life-saving treatment for severe cases of Covid 19.

BACKGROUND: COVID-19 pandemic is a global concern. Unfortunately, there is no exclusive treatment for critical patients to survive. In this study, we suggest using a novel three-dimensional treatment mainly based upon immune system modulation to fix the virus chaos, through cytokine storm as the main character of COVID-19 infection scenario. CASE PRESENTATION: A young man infected by SARS-CoV-2 who suffered from respiratory arrest and loss of consciousness, underwent cardiopulmonary resuscitation and endotracheal intubation. Following ICU administration and confirmed diagnosis of COVID-19, considering critical condition of the young patient, plasmapheresis was performed once on a daily basis, three doses of interferon beta(IFN-ß-1b) was injected subcutaneously every other day and dexamethasone was given at a dose of 4 mg every 8 hours along with common antiviral regimen. After 2 days, the patient was extubated and transferred from the ICU to the ward where plasmapheresis was performed 4 times daily for 4 days. Finally, after 7 days of hospitalization, the patient was discharged with a good general condition. CONCLUSION: We modulated the immune system through plasmapheresis to sweep out the released cytokines. Also, corticosteroid along with interferon was added to common antiviral treatments. Our data suggest that this combined method is effective for critically ill COVID-19 patients.