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Background. In December 2019, China has experienced an outbreak of novel coronavirus disease 2019 (COVID-19). Coronavirus has now spread to all of the continents. We aimed to consider clinical characteristics, laboratory data of COVID-19 that provided more information for the research of this novel virus.

Background: One of the most effective treatments for patients with acute ischemic stroke (AIS) is intravenous recombinant tissue plasminogen activator (rtPA) which can minimize mortality and morbidities. In this historical cohort study, we investigate the factors affecting clinical outcomes after IV thrombolysis for AIS. Methods: We included 87 patients with acute ischemic stroke who were treated with rtPA between 2015 and 2019. Demographic and clinical data were recorded. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the clinical outcomes. Results: 36 patients showed lack of improvement at discharge. In unadjusted model, hypercholesterolemia was the only predictor of lack of improvement (P= 0.043; OR=0.304; CI= 0.096-0.963). After adjusting, hypertension (P= 0.018; OR= 0.18; CI= 0.043-0.749) and hypercholesterolemia (P= 0.008; OR= 8.68; CI= 1.773-42.54) were independent determinants of lack of clinical response. To evaluate risk factors in association with the duration of hospitalization, we found variables which lengthened hospitalization span including; age over 60 years (HR= 0.42 P= 0.002), hypercholesterolemia (HR= 2.19 P= 0.031), Angiotensin-converting enzyme (ACE) Inhibitors consumption (HR= 1.87 P= 0.022), and type of infarction (non-lacunar) (HR= 0.51 P= 0.026). Results indicated no considerable relationship between dose of rtPA and the appropriate response to treatment (OR=8.686 P= 0.324). Conclusion: The closer dose of rtPA goes up to standard range, the more chance of improvement will gain without increasing the risk of symptomatic intra-cerebral hemorrhage (SICH). Determining factors involved in intravenous reperfusion outcomes help physicians to identify the patients who benefit the most from rtPA. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Although immunodeficient patients are less prone to develop Coronavirus disease 2019 (COVID‐19)‐mediated cytokine storm, secondary infections can cause serious complications in this vulnerable population. They are more likely to develop opportunistic infections that can mimic the symptoms of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Herein, we presented a 27‐year‐old male patient of SARS‐CoV‐2 infection, who was complicated with Pneumocystis jirovecii pneumonia (PJP), following treatment with rituximab. First, he was hospitalized for 5 days with fever, cough, and dyspnea due to COVID‐19 infection, and treated with remdesivir and glucocorticoid. Then, he has been referred to our center with cough, dyspnea, body pain, and fever. Due to persistent fever, the progression of pulmonary lesions, and reduced oxygen saturation, we began treatment with piperacillin + tazobactam, vancomycin, and levofloxacin. Nevertheless, the patient's fever did not stop after the aforementioned empiric treatment and his condition got worse and he was admitted to the intensive care unit. The result of BAL fluid, tested for P. jirovecii by RT‐PCR, turned out to be positive. Therefore, we started trimethoprim‐sulfamethoxazole and dexamethasone, which improved his condition. We hope this article helps clinicians consider causes other than COVID‐19, especially opportunistic infections such as PJP, in patients with respiratory symptoms and fever. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to assess the reduction of breast surface dose, breast radiationinduced cancer incidence, and mortality risks when the lead apron shielding was positioned on the chest regions during head computed tomography (CT). Material and Methods: In this study, routine head CT scans were performed on 28 female patients with a mean body mass index (BMI) of 25.2 ± 2.8 kg/m². The common lead aprons (0.5 mm thicknesses) were folded and positioned in the chest regions. The breast surface doses were measured using six thermoluminescent dosimeters (TLD-100), three TLDs were located above the apron and three ones positioned under the apron. Breast radiation-induced cancer incidence and mortality risks were estimated using the Biological Effects of Ionizing Radiation (BEIR-VII) model. Finally, the measured doses and cancer/mortality risks were compared using Paired sample T-Test in SPSS software. Results: The breast surface doses under and over the apron were obtained at 0.18±0.06 and 0.49±0.13 mGy, respectively, (P-value<0.05). Although all cancer/mortality risks for both groups (over and under the apron) were very low, using the lead apron could decrease (significantly) breast cancer incidence risk ([1.24±0.32]×10-3 % over the apron vs. [0.46±0.15] ×10-3 % under the apron) and mortality risk ([0.30±0.08]×10-3 % over the apron vs. [0.11±0.04] ×10-3 % under the apron) about 63% in all patients. Conclusion: The use of common lead aprons in the chest regions for patients undergoing head CT scans could significantly reduce the breast surface doses and radiation-induced cancer/mortality risks. [ABSTRACT FROM AUTHOR]

Background: Frequent waves of corona virus disease (COVID-19) and lack of specific drugs against that, warrant studies to reduce the morbidity and mortality of this pandemic disease. In this study, we investigated the association between influenza vaccination and the severity and outcome of COVID-19 disease in Iranian patients living in the North. Methods: This retrospective case-control study was performed on186 patients with COVID- 19 infection between March and April, 2020. Patients with positive PCR were divided into two groups of case and control; Patients with moderate to severe and normal to mild lung involvement, respectively. The lung opacities in all of the 5 lobes were evaluated on chest CT images using a CT severity scoring system. The history of influenza vaccination during the fall of 2019-2020 was determined by a phone call. Statistical analysis was done using the chi-square test, student's t-test, and logistic regression. The significance level was p<0.05. Results: The mean age of patients was 54.67±15.05years. Most patients had pulmonary manifestations including ground-glass opacity (57%), consolidation (80%) and pleural effusion (3.2%). Adjusting for age, gender, and history of underlying disease, vaccination is an effective factor in the severity of pulmonary involvement (AOR=0.39; 95%CI: (0.21, 0.73); P=0.003). Furthermore, the chance of ICU admission decreased via influenza vaccination (OR=0.21, P=0.001). Conclusion: The results showed that the severity of COVID-19 pulmonary involvement and outcome as ICU admission, and severe symptoms in patients with history of influenza vaccination were significantly lower than those without history of vaccination. This strategy can be used to prevent and reduce the complications of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta is one of the known causes of maternal mortality and morbidity. If diagnosed before delivery, appropriate actions can be taken. The aim of this study was to investigate the role of scaling combination of risk factors in predicting placenta accreta spectrum (PAS). Methods: In this cross-sectional study, 120 pregnant women with two criteria and more of placenta previa in their ultrasound, underwent MRI. Clinical scores (history of surgery, cesarean section, previa, etc.) and paraclinical scores (ultrasound and MRI) were recorded and combined. In cases of hysterectomy, pathological examination was performed. The results were compared and analyzed using SPSS Version 22. The significance level was less than 0.05. Results: Of the120 studied patients, 90 (75%) women were diagnosed with placenta previa in which, 32(36%) patients had placenta accreta and 12 patients had placenta accreta without placenta previa. The mean ultrasound score in women without and with placenta accreta were 0.05±0.32 and 2.43±1.83 (p<0.001). The mean MRI score in women without and with placenta accreta were 0.05±0.27 and 2.07±2.02, respectively. The cut-off point, sensitivity and specificity were 0.50, 100% and 93.4%, respectively. The mean clinical score without and with placenta accreta were 1.97±1.32 and 4.89±3.21, respectively. The cut-off point, sensitivity and specificity were 2.50, 70% and 80%, respectively. The cut-off point of combination score, sensitivity and specificity were 3.50, 89%, 83%. Conclusion: The results of the present study showed that the most specific test to confirm the definitive diagnosis of placenta accreta is paraclinical score, alone. [ABSTRACT FROM AUTHOR]

Background: Computed tomography (CT) is a routine procedure for diagnosing using ionization radiation which has hazardous effects especially on sensitive organs. Objective: The aim of this study was to quantify the dose reduction effect of lead apron shielding on the testicular region during routine chest CT scans. Material and Methods: In this measurement study, the routine chest CT examinations were performed for 30 male patients with common lead aprons folded and positioned in testis regions. The patient's mean body mass index (BMI) was 26.2 ± 4.6 kg/m². To calculate the doses at testis region, three thermoluminescent dosimeters (TLD-100) were attached at the top surface of the apron as an indicator of the doses without shielding, and three TLDs under the apron for doses with shielding. The TLD readouts were compared using SPSS software (Wilcoxon test) version 16. Results: The radiation dose in the testicular regions was reduced from 0.46 ± 0.04 to 0.20 ± 0.04 mGy in the presence of lead apron shielding (p < 0.001), the reduction was equal to 56%. Furthermore, the heritable risk probability was obtained at 2.0 ×10-5 % and 4.6 ×10-5 % for the patients using the lead apron shield versus without shield, respectively. Conclusion: Applying common lead aprons as shielding in the testis regions of male patients undergoing chest CT scans can reduce the radiation doses significantly. Therefore, this shield can be recommended for routine chest CT examinations. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses a case of a forty two days old boy, who have idiopathic sigmoid colon perforation with manifestation of pneumoscrotum.

Background: One of the most effective treatments for patients with acute ischemic stroke (AIS) is intravenous recombinant tissue plasminogen activator (rtPA) which can minimize mortality and morbidities. In this historical cohort study, we investigate the factors affecting clinical outcomes after IV thrombolysis for AIS., Methods: We included 87 patients with acute ischemic stroke who were treated with rtPA between 2015 and 2019. Demographic and clinical data were recorded. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the clinical outcomes., Results: 36 patients showed lack of improvement at discharge. In unadjusted model, hypercholesterolemia was the only predictor of lack of improvement (P= 0.043; OR=0.304; CI= 0.096-0.963). After adjusting, hypertension (P= 0.018; OR= 0.18; CI= 0.043-0.749) and hypercholesterolemia (P= 0.008; OR= 8.68; CI= 1.773-42.54) were independent determinants of lack of clinical response. To evaluate risk factors in association with the duration of hospitalization, we found variables which lengthened hospitalization span including; age over 60 years (HR= 0.42 P= 0.002), hypercholesterolemia (HR= 2.19 P= 0.031), Angiotensin-converting enzyme (ACE) Inhibitors consumption (HR= 1.87 P= 0.022), and type of infarction (non-lacunar) (HR= 0.51 P= 0.026). Results indicated no considerable relationship between dose of rtPA and the appropriate response to treatment (OR=8.686 P= 0.324)., Conclusion: The closer dose of rtPA goes up to standard range, the more chance of improvement will gain without increasing the risk of symptomatic intra-cerebral hemorrhage (SICH). Determining factors involved in intravenous reperfusion outcomes help physicians to identify the patients who benefit the most from rtPA., Competing Interests: The authors declared that they have no conflict of interest.