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Cervical ectopic pregnancies (CEPs) are rare, comprising less than 1% of ectopic pregnancies. On one hand, the abundant blood supply of the cervix and its incompatibility to keep the pregnancy in progress increases the potential for bleeding following CEP, mortality, complications, and infertility in affected women. CEPs are more difficult to diagnose and get identified at later gestational ages. CEP is one of the rarest forms of ectopic pregnancies and most commonly are a consequence of assisted reproductive technology (ART); while definitive risk factors are not fully known. Possible risk factors include cervical and uterine anomalies, previous curettages or cesarean sections, smoking, tubal factor infertility, or in vitro fertilization (IVF) treatment. Our analysis of literature in 200 patient restricted to retrospective case series , showed that a history of previous C-section, uterine curettage or D&C procedures, and a history of using assisted reproductive technology might be some of the potential risk factors. The increasing application of Hegar dilators was hypothesized as the cause of the rise in CEPs. Dilation and curettage (D&C) might also make the subject vulnerable to CEP development in the future. Previous D&C history could be a potential predisposing factor that is common among CEP patients. In this review, we critically reviewed these potential risk factors. In conclusion, the risk factors of CEP and their effect on fertility are also not studied properly. The rarity of these cases makes it difficult to predict as well if the risk of their recurrence is elevated.

Abstract Coronavirus disease 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease may be associated with several factors. Here, we review clinical features of COVID-19 inpatients with different severities. This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February–April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P

Introduction: Novel Coronavirus outbreak has posed a global threat. While the infection appears to be mild in most patients, considering its high rate of transmission, a large number of people are at risk of developing severe to critical illness in total which makes prognosis studies a priority.The aim of the present study was to evaluate red blood cell distribution width (RDW) as a predictive factor for diagnosing severe cases of coronavirus disease 2019 (COVID-19).Materials and Methods: A total number of 204 inpatients diagnosed with COVID-19 including 122 men and 82 women (Mean age: 58.83±15.93 years old) treated at Imam Reza Hospital, Mashhad, Iran were included in the study. Patients were divided into severe and moderate groups according to their clinical signs and examinations and pulmonary imaging features. Demographic Data, laboratory test results, treatments, patients’ complications and outcome were recorded. Mann-Whitney U test and spearman correlation coefficient (r) were performed to assess RDW correlation with severity and serious complications in patients including intensive care unit (ICU) admission, shock, secondary infections, intubation, length of hospitalization and death. Receiver operating characteristics (ROC) curves analysis was carried out to define the reliability of RDW as a predictive indicator in severe COVID-19.Results: The results showed statistical significant correlations between high levels of RDW and developing secondary infections and longer hospitalization (P values ≤0.001). The optimal cutoff for RDW to predict the length of hospitalization (≤ 7 days or more than 7 days) was estimated to be 14.65% with 94% sensitivity and 71.3% specificity. The area under curve was calculated to be 0.895 through Roc curve analysis.Conclusion: High predictive value of RDW, a routine blood test parameter, could be used in diagnosing COVID-19 patients at higher risk for developing secondary infections and longer hospital stay which in turn helps with better management of the disease.

Background: Coronavirus disease 2019 (COVID-19) has rapidly emerged as a threatening pandemic. Clinical features of this pandemic involve a wide range of manifestations and are not completely known. Here, we present six cases of thrombotic events in patients with COVID-19. Case presentation: In this case series, we present six patients with confirmed COVID-19, according to real-time polymerase chain reaction, who were referred to our emergency department and were found to have thrombotic events. Pulmonary thromboembolism was diagnosed in three patients by computed tomography (CT) angiography. One patient was found to have deep vein thrombosis in Doppler ultrasonography. Another patient who presented with loss of consciousness, was finally diagnosed with cerebrovascular accident using brain CT. One of the patients had developed a myocardial infarction that was evident in the electrocardiography. Conclusion: It is ostensible that COVID-19 puts the patients at an increased risk for developing thrombotic conditions, possibly through formation of hyper-inflammatory and hyper-coagulative states. However, further prospective studies are recommended to confirm these findings.

Recent evidence suggests that probiotics can restore the mucosal barrier integrity, ameliorate inflammation, and promote homeostasis required for metabolism in obesity by affecting the gut microbiota composition. In this study, we investigated the effect of Akkermansia muciniphila and its extracellular vesicles (EVs) on obesity-related genes in microarray datasets and evaluated the cell line and C57BL/6 mice by conducting RT-PCR and ELISA assays. A. muciniphila-derived EVs caused a more significant loss in body and fat weight of high-fat diet (HFD)-fed mice, compared with the bacterium itself. Moreover, treatment with A. muciniphila and EVs had significant effects on lipid metabolism and expression of inflammatory markers in adipose tissues. Both treatments improved the intestinal barrier integrity, inflammation, energy balance, and blood parameters (i.e., lipid profile and glucose level). Our findings showed that A. muciniphila-derived EVs contain various biomolecules, which can have a positive impact on obesity by affecting the involved genes. Also, our results showed that A. muciniphila and its EVs had a significant relationship with intestinal homeostasis, which highlights their positive role in obesity treatment. In conclusion, A. muciniphila-derived EVs can be used as new therapeutic strategies to ameliorate HFD-induced obesity by affecting various mechanisms.