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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.

BackgroundKawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years.MethodsA 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.ResultsChildren 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.ConclusionAs 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.

Type 1 diabetes mellitus (T1DM) is the most common chronic metabolic disease in childhood and adolescence. The increasing use of social networks among adolescents provides a unique opportunity to implement self-care educational programs for improving self-efficacy in diabetic adolescents in terms of awareness, attitude, and performance. This study aimed to assess the effectiveness of a self-care educational program provided by mobile-based social networking (MBSN) on the self-efficacy of diabetic adolescent girls. A quasi-experimental study with 76 Iranian 14- to 18-year-old girls with T1DM was conducted in 2018–2019. The subjects were selected with aconvenient sampling method and randomly assigned to the experimental and control groups. The MBSN was applied to implement a self-care educational program in the experimental group for 12 weeks. The Diabetes Management Self-Efficacy Scale (DMSES) questionnaire with the main domains of blood sugar control (BSC), diet control (DC), medical care (MC), and exercise was used to evaluate the self-efficacy level before and 4 weeks after the intervention. The mean age and T1DM duration of participants were 15.9 ± 1.5 and 7.24 ± 3.9 years, respectively. No significant difference in the self-efficacy of the two groups before the intervention was found. The self-efficacy level in the experimental group was increased after the intervention so that there was a significant difference in this parameter between the experimental and control groups (p < 0.0001). Three DMSES domains of BSC (p = 0.003), DC (p = 0.011), and MC (p = 0.016) after the intervention significantly differed between the two groups. As the self-care education with MBSN significantly increased the self-efficacy level of girls with T1DM, this technique would be a complementary of health care in educating and supporting diabetic patients in other age groups.

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.

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.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.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.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.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.

Since December 2019, an emerging outbreak of a novel coronavirus (SARS-CoV-2) has begun from Wuhan, China, and spread rapidly throughout the world. This systematic review aimed to discuss the involvement of the body's systems during COVID-19 infection comprehensively. PubMed database was used to identify relative studies to be included in this review. Four authors searched PubMed independently using determined search terms. Then, the results were merged and duplicates were removed. The inclusion and exclusion criteria were specified and at least two review authors assessed the eligibility of the studies. The full texts of included studies were reviewed in detail by the authors and the relevant content was extracted and summarized. The pulmonary tract is the most frequent system involved with a wide range of involvement from no pneumonia to white lung and acute respiratory distress syndrome. Computed tomography is the best imaging modality to diagnose COVID-19 infection. Cardiac and renal system injuries are seen during COVID-19 infection and must be taken seriously. Gastrointestinal manifestations are frequently observed during the infection and are probably associated with more severe disease. The placenta acts as an important physiological and immunological barrier that prevents transplacental vertical transmission. COVID-19 infection is a multiorgan involving infection which needs a team of different expertise to diagnose and manage the disease. Although there are many studies available about COVID-19 infection, most of them are focused on pulmonary involvement and the effects of the virus on many other organs and systems remain unclear that shows the necessity of further investigations about the disease. Copyright (C) 2020 Wolters Kluwer Health, Inc. All rights reserved.

Purpose The effectiveness of an Internet-based guided self-help cognitive-behavioral therapy (I-GSH-CBT) was assessed in alleviating childbirth fear (CBF), depression, anxiety, and stress of pregnant women during the first delivery. Design and methods In a quasi-experimental study, pregnant women in the intervention group used the I-GSH-CBT program during pregnancy. The Wijma Delivery Expectancy/Experience Questionnaire, and the Depression, Anxiety, and Stress Scale 42-item (DASS-42) questionnaires were used to collect the psychometric data. Findings Implementing the I-GSH-CBT significantly reduced CBF, DASS-42 scores, and cesarean section preference. Practice implications The I-GSH-CBT program effectively decreases the adverse mood symptoms in nulliparous pregnant women.

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 p 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.

The influential factors in decreasing the quality of marital relations among Iranian couples during the first three months were assessed. There were significant differences in marital relationship ...

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.

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.

Synbiotic yogurts (SYs) are potential natural cures with improved health outcomes and prevention and control of chronic diseases through the synergistic action of probiotic bacteria and prebiotic compounds. Recent clinical achievements in consuming SYs in healthy and patient pediatric and adult populations were critically reviewed. Some forthcoming challenges and interesting solutions to increase healthy nutritional effects of these dairy products have also been addressed. The use of SY-based nutrition pattern in children can considerably increase their body's immunity with an improvement in social and school functioning. SY consumption not only reduces childhood digestive problems but also remarkably decreases the illness duration and symptoms' severity. Increasing the number of bifidobacteria and lactobacilli in gastrointestinal (GI) tract of healthy adults consuming SYs can significantly reduce the pathogenic bacteria in feces. The regular intake of SYs with enhanced bioavailability of bioactive compounds in a short intestinal transit time reduces the risk of cardiovascular disease among hypercholesterolemic adults. Also, a meaningful improvement in the health status of adult patients with irritable bowel syndrome and nonalcoholic fatty liver disease has been assessed after eating this bio-functional supplement product. Administration of a healthy SY-based diet purposefully alters microbiota composition, provides a microbial balance in the gut, and promotes GI functions in pediatric and geriatric age groups. Full recovery without any further complications during the follow-up period in elderly patients can also be obtained by implementing the SY-based dietary guideline.

Purpose: This study aimed to assess socio-economic status (SES) and psychological factors affecting maternal lifestyle and its correlation with adverse pregnancy outcomes among pregnant women. Methods: This prospective cross-sectional study was conducted in Tehran from August 2016 to July 2017. 400 eligible vulnerable pregnant women living in five poor regions of Tehran and attending referral hospitals for prenatal care were randomly selected. Data was collected through personal interviews, anthropometric measures, and medical records at 26-30 gestational weeks. Significant findings: There was a high prevalence of obesity (43.8%) among vulnerable women. Women with lower education level and income was significantly associated with more than 5-7 daily serving carbohydrate, sedentary life (OR = 2.25, 95%CI: 0.93-4.57) and being obese (OR = 2.01, 95%CI: 0.4-3.30). Participants with lower income was significantly associated with ≥ 5-7 daily serving carbohydrate (OR = 2.81, 95%CI: 0.002-5.4) and sedentary life. Also, higher perceived stress are positively associated with ≥5-7 daily serving carbohydrate, more intake of caffeine, and smoking compared to mothers with lower psychosocial score. Unhealthy lifestyle, higher body mass index (BMI) and lower social support were significantly associated with risk of maternal and neonatal complications. Conclusion: Multiple unhealthy lifestyles during pregnancy were consistently associated with SES and increased risk of adverse perinatal outcomes.

Introduction: The increasing prevalence of overweight and obesity is one of the most critical issues of urban health. The current study investigated the effects of community-based interventions on modification of overweight and obesity. Methods: A program based on the Urban Health Equity Assessment and Response Tool (Urban HEART) was developed and implemented in 2013-2014. A total of 166 Iranian females aged 15 years or older who were classified as overweight or obese using body mass index (BMI) were randomly selected and gave verbal consent to participate in this study. The intervention was carried out for a duration of 4 months. Results: The mean age of subjects was 43.6±12.2 years. The total number of overweight and obese individuals were 75 (45.2%) and 91 (54.8%), respectively. The mean BMI of the patients before and after the intervention was 30.3 ± 2.7 and 29.4 ± 2.7 kg/m2, respectively (P < 0.05). Higher education level and greater floor area were recognized as valid predictors for reduced BMI after the intervention (P < 0.001). Conclusion: This study successfully represents the collaborative role of the community in improving health status by reducing overweight and obesity. The Urban HEART provided distinct opportunities for presenting the promising results of interventions to health policymakers and managers so they can adjust macro and micro policies for achieving better community health outcomes.

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 ...

Introduction: Occupational burnout among nurses is a major factor affecting the quality of nursing care. Assessing the prevalence of burnout and its related factors is necessary for discouraging the development of burnout. Aim: The aim of this study is determining the burnout among nurses of Ziaeian Hospital, which has not done before. Methods: In this cross-sectional study, all the nursing staff (287 people) was included after filling the informed consent. Occupational burnout was detected using the Maslach occupational burnout inventory tool. Data were analyzed by SPSS software and the significance threshold was set at p < 0.05. Results: Most of the subjects were female, married, had a bachelor’s degree, worked as a nurse, and had less than 5 years of work experience. The mean score of emotional exhaustion was 29.25 ± 12.64, personal performance was 37.31 ± 7.9, and depersonalization was 14.7 ± 5.1. Altogether, 75% of the population had severe emotional exhaustion and depersonalization and mild personal dysfunction. The severity of emotional exhaustion, depersonalization and individual performance impairment weregreater in staff with higher degree. Job position also affected the intensity of emotional exhaustion and depersonalization. Additionally, there was a significant association between marital status and depersonalization. Conclusion: Nurses of Ziaeean Hospital have severe emotional exhaustion and depolarization; and mild personal function impairment. The findings of this research are a guide for the next steps to solve burnout in this hospital.

Microwave-assisted extraction (MAE) is an emerging technology to obtain polysaccharides with an extensive spectrum of biological characteristics. In this study, the hypoglycemic, hypolipidemic, prebiotic, and immunomodulatory (e.g., antiinflammatory, anticoagulant, and phagocytic) effects of algal- and plant-derived polysaccharides rich in glucose, galactose, and mannose using MAE were comprehensively discussed. The in vitro and in vivo results showed that these bioactive macromolecules with the low digestibility rate could effectively alleviate the fatty acid-induced lipotoxicity, acute hemolysis, and dyslipidemia status. The optimally extracted glucomannan- and glucogalactan-containing polysaccharides revealed significant antidiabetic effects through inhibiting α-amylase and α-glucosidase, improving dynamic insulin sensitivity and secretion, and promoting pancreatic β-cell proliferation. These bioactive macromolecules as prebiotics not only improve the digestibility in gastrointestinal tract but also reduce the survival rate of pathogens and tumor cells by activating macrophages and producing pro-inflammatory biomarkers and cytokines. They can effectively prevent gastrointestinal disorders and microbial infections without any toxicity.

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 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.

Cavitary lung formation with spontaneous pneumothorax has been rarely reported as a complication of COVID-19 pneumonia. We report a rare case of a 38 years-old male patient affected by COVID-19 pneumonia, exceptionally complicated by a simultaneous giant cavity in the right upper lung and a small right pneumothorax in the right hemithorax. Whilst pneumothorax emphysema, giant bullae and pneumothorax with alveolar rupture are known to potentially develop in COVID-19 patients as a result of high-flow O2 support, the exact origin of the giant lung cavitation in our patient could be not confirmed. Cavitary lesions – featured by high mortality rate - are reportedly associated with lung infarctions and can be the aftermaths of pulmonary embolism, a rather common sequela of COVID-19 pneumonia. Radiological imaging is critical to support clinical decision making in the management of COVID-19 pneumonia, since not only it can visualize and stage the disease, but it can also detect and monitor the eventual onset of complications over time, even following patient discharge from hospital.

BackgroundObesity or overweight in children is an excessive accumulation of adipose tissue that can potentially regress health indicators and increase the likelihood of various diseases.ObjectivesThis model was implemented to improve the nutritional status and lifestyle behavior of children aged 6–12 years with overweight/obesity.MethodsA 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.ResultsAfter 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).ConclusionsWe conclude that though the weight increase rate was lower in the experimental group, the implemented model alone was not enough.Trial registrationIranian Registry of Clinical Trials (IRCT):IRCT20200717048124N1at 05/08/2020, retrospectively registered.

Background: Upper urinary tract infection (UTI) or pyelonephritismay increase the pathogenesis rate and risk of severe complications in children due to the atrophy of the kidneys.Objective: A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to reach early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics.Methods: A cross-sectional study was conducted on 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018. The ultrasound examination of kidneys and urinary tract during the hospitalization period, the incidence of clinical symptoms, and the monitoring of laboratory markersin blood and urine were studied 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, andvomiting, whileotherswere asymptomatic. A considerable frequency of pyuria(88.4%), Escherichia coli in urine (92%), leukocytosis (81.7%), and high ESR (> mm/h, 80%) and CRP (> 10mg/L, 82.8%) was observed. The kidney and urinary tract ultrasonography onlyin 32.7% of children showed in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis).Conclusion: In the majority of patients, there was a high prevalence of clinical signs and laboratory markers associated with pyelonephritis. Since most patients have normal sonography, ultrasound alonecould notbe an efficient tool fortracingfebrile UTI.

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.

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.

AIM: The objective of this study was to evaluate the frequency of risk factors for bacteremia in children less than 15 years of age was determined in Bahrami Hospital during 2013-2016. METHODS: This study conducted on 84 children aged 3 months’ to15 years old, who hospitalised in the pediatrics ward and the PICU in Bahrami Hospital from 2012 to 2016. Our study consisted of 46 boys (54.2%) and 38 girls. Moreover, 24.1% of subjects (20 patients) were entered in the study as young as three months old, followed by three months to three years (49.4 %; 41 subjects), and 3 to 15 years of age (26.5%; 22 individuals). RESULTS: The average hospitalization duration was determined to be 15.30 ± 8.75 days. Moreover, our results revealed that a history of blood transfusion in 11.2% of patients. On the other hand, 35.7% of cases were determined to be positive for blood cultures. The microorganisms reported from positive blood cultures include Enterobacter (81.48%), Escherichia coli (11.11%) and Klebsiella (3.70%). Also, 50% of patients were hospitalised in the internal ward, 12% received immunosuppressive drugs, and 96.4% of the patients had a history of vaccination. CONCLUSION: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.

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

Alternative and herbal therapies for the treatment of neonatal jaundice (NJ) in Iranian children and infants have recently been developed, to reduce the side effects and toxicity of pharmaceutical drugs. In this study results of ethnomedicinal-based clinical trial studies to treat NJ are critically reviewed. Cotoneaster manna was the most important medicinal plant to treat the neonate's hyperbilirubinemia. The maternal consumption of cotoneaster drops, pomegranate paste, and chicory aroma water reduced the serum bilirubin and length of hospitalization. The topical barley flour and oral jujube extract remarkably reduced NJ severity. The topical and oral application of many products of medicinal plants grown in Iran are useful for NJ treatment. However, further studies are required to assess the safety and efficacy of these herbal remedies in larger pediatric populations.

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.