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Background As a common complication of midline laparotomy, Incisional hernia (IH) imposes an additional cost on the healthcare system. The wound closure method has been considered one of the most critical risk factors for IH.Methods This randomized clinical trial was conducted on elective laparotomy patients between January 2018 and January 2019. All the patients were randomly allocated to two simple interrupted and continuous suture groups. All the surgeries were performed by a single surgeon and used PDS sutures. Demographic information and data on CBC, abdominal ultrasonography reports, and dehiscence or hernia were recorded in a pre-designed checklist. Patients were followed up for one year regarding surgery site pain and infection and the incidence of incisional hernia or fascia dehiscence.Results We analyzed 56 male and 34 female patients with a mean age of 49.53 ± 14.58 in two simple interrupted and continuous suture groups. After a one-year follow-up, 12 (26.6%) patients in simple interrupted and 9(20%) patients in the continuous suture group developed incisional hernia (p = 0.455). In addition, 5 (11.1%) patients in the simple and 3 (6.6%) patients in the continuous suture group had fascial dehiscence (p = 0.459). After the operation, 4(8.8%) patients in the simple and 3 (6.6%) patients in the continuous group developed wound infection (p = 0.694). In addition, there was no significant difference between the two groups on the pain scale following surgery (p = 0.262).Conclusions There are no significant differences between simple interrupted and continuous laparotomy incision closure methods regarding incisional hernia, fascial dehiscence, wound infections, and pain scale.

Objective: The primary goal of the present study was to measure the implications of hypoxemia in COVID-19 patients with a history of coronary artery disease (CAD). Methods: A systematic search of the literature published from November 1, 2019 to May 1, 2021, was conducted on PubMed/MEDLINE, Embase, and Web of Science databases. Afterwards, an observational study was designed based on the electronic health records of COVID-19 patients hospitalized in a tertiary referral hospital during the same period. A total of 179 COVID-19 cases were divided into two groups: cases with a history of CAD and percutaneous coronary intervention (CAD/PCI+, n = 89) and controls (n = 90). Clinical data were extracted from the electronic database of the hospital and statistically analyzed. Results: After the application of inclusion/exclusion criteria, only three studies were deemed eligible, one of which was concerned with the impact of CAD on the all-cause mortality of COVID-19. Results from our observational study indicated that the cases were older (median age: 74 vs. 45) and more likely to develop hypoxemia (25.8% vs. 8.8%) than the controls. CAD/PCI+ was correlated with a more severe COVID-19 (11% vs. 1%). Age was a moderately significant independent predictor of increased COVID-19 severity, while hypoxemia was not. Conclusion: Considering the negative impact of hypoxemia on the prognosis of COVID-19 and its higher prevalence among COVID-19 patients with underlying CAD, further research is warranted to unravel the negative effects of COVID-19 on the mechanisms of gas exchange and delivery in patients with pre-existing CAD.

Background Lactic acid bacteria (LAB) are one of the most important strains of probiotics. Some of them are normal flora of human mucous membranes in the gastrointestinal system, skin, urinary tract, and genitalia. There is evidence suggesting that LAB has an antiviral effect on viral infections. However, these studies are still controversial and a systematic review was conducted to evaluate the antiviral effects of LAB on viral infections. Methods The systematic search was conducted until the end of December 17, 2022, in international databases such as Scopus, Web of Science, and Medline (via PubMed). The keywords of our search were Lactic acid bacteria, Lactobacillales, Lactobacillus (as well as its species), Probiotics, Antiviral, Inhibitory effect, and Virus. Results Of 15.408 potentially relevant articles obtained at the end of our search, 45 eligible in-vivo human studies were selected for inclusion in the study from databases and registers and citation searching. We conducted a systematic review of the antiviral effects of the LAB based on the included articles. The most commonly investigated labs are Lactobacillus Rhamnosus GG and Lactobacillus Casei. Conclusion Our study indicates that most of our included articles support the positive effect of LAB on viral infections although some studies showed no significant positive effect of LABs on some viral infections.

Purpose The present research was conducted to evaluate the effect of the severity of dumping syndrome (DS) on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) in patients with class III obesity. Methods The present retrospective cohort study used the dumping symptom rating scale (DSRS) to evaluate the severity of DS and its correlation with weight loss outcomes in 207 patients 1 year after their RYGB. The patients were assigned to group A with mild-to-moderate DS or group B with severe DS. Results The mean age of the patients was 42.18 ± 10.46 years and their mean preoperative BMI 42.74 ± 5.59 kg/m2. The total weight loss percentage (%TWL) in group B was insignificantly higher than that in group A, but besides that was not significantly different in the two groups. Conclusion The present findings suggested insignificant relationships between the presence and severity of DS after RYGB and adequate postoperative weight loss.

Backgrounds: Portal Venous Thrombosis after sleeve gastrectomy can be due to changes in portal vein flow. The present study was designed to compare the portal vein flow before and after sleeve surgery using Doppler ultrasonography to investigate any changes in the type of portal vein flow after the sleeve surgery. Methods: This study is a prospective study in which all people (n=60) referred to our hospital in Tehran from June to August 2020 for Sleeve gastrectomy surgery were evaluated. Participants’ information was collected from patients’ medical records through a researcher-made checklist. Using proper statistical tests, all statistical analyses significant at less than 0.05 were analyzed. Results: Among 60 patients under sleeve gastrectomy, 51 (85%) were females. The mean age was 35.63 ± 9.004. Based on postoperative follow-up (3 days after sleeve gastrectomy), portal vein flow has decreased (proportion: 0.3667, 95% CI: 0.25 – 0.49 cc/min) in 22 patients (36.67%). In these patients, both the mean of portal vein flow (955.90 ± 177.88 cc/min) and the mean of portal vein diameter (10.43 ± 0.80 mm) was significantly decreased (PConclusion: The complications following the sleeve surgery are rare, but considering the various reports of thrombosis after sleeve surgery, it is necessary to pursue high-risk people and keep them under consideration to prevent any complications after surgery.

On 25 November 2021, the world health organization listed Omicron as a newly arisen and the fifth variant of concern (VoC) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The genome sequence of Omicron showed the utmost number of mutations compared to other known VoCs up to now, and it was regarded as the only SARS-CoV-2 variant with changes in the receptor-binding domain (RBD). However, the Omicron is still detectable via previous polymerase chain reaction (PCR) tests. Clinical presentation of the disease is identical to previous VoCs, however in vitro and in vivo studies revealed a higher transmission rate. The biggest obstacles posed by Omicron are the immune escape and reduction in vaccine effectiveness, as indicated by many simulations and real-world studies. Although the efficacy of the two-dose vaccinations is suboptimal for Omicron, preliminary studies have considered the injection of a booster shot is beneficial and can decrease the risk of severe disease. All these new features of Omicron warranted close investigation of this VoC as a new chapter in the pandemic, especially with emersion of subvariants BA.4 and BA.5. This review presents a conspectus of the current knowledge on the COVID-19 Omicron variant biological, clinical, and epidemiological changes.

Introduction: Obesity is associated with albuminuria and impaired renal function. Bariatric surgery has been shown to improve and resolve diabetes and improve renal function in patients with morbid obesity. This study investigates the potential effects of sleeve gastrectomy on the improvement of renal function and albuminuria in diabetic and non-diabetic morbidly obese patients and discusses probable mechanisms. Material and methods: This prospective study included, 137 morbidly obese patients (44 diabetics and 93 non-diabetic) who underwent laparoscopic sleeve gastrectomy who were evaluated clinically (anthropometric measurements) and biochemically before surgery and at 1 year from surgery. Results: Sleeve gastrectomy significantly decreases weight and body mass index, improves glycemic parameters, hyperfiltration, and urinary albumin excretion in diabetic and non-diabetic patients; (P < 0.001). Alterations in C- reactive protein (CRP) levels are strongly associated with ACR decline in diabetic patients. Conclusion: Our findings revealed significant decreases in weight, body mass index, and glycemic parameters after sleeve gastrectomy in diabetic and non-diabetic patients, accompanied by the resolve of hyperfiltration, urinary albumin excretion, and improvement of renal function via reduction of the systemic inflammation.

Cernunnos deficiency is a rare radiosensitive form of severe combined immunodeficiency (SCID). Herein, we report a patient with recurrent infections, birdlike face, microcephaly, Failure to thrive (FTT), and hypogammaglobinemia accompanied by considerable and rare features of sensorineural hearing loss and hypothyroidism with a mutation in splicing site of the third intron of non-homologous end joining 1 (NHEJ1) gene. The mutation was associated with T-B-NK + in flowcytometry. Distinct clinical manifestation along with a rarely reported genetic site mutation was noticeable in the reported case. The clinicians should be sensitive enough to suspect SCID in any patient with recurrent infections, microcephaly, FTT, and hypogammaglobinemia. Also, it is highlightable that every case of SCID with microcephaly should prompt us to the SCIDs with genetic mutations sensitive to radiation and further investigations are mandatory in highly suspicious patients.

IntroductionCoronavirus Disease 2019 (COVID -19) pandemic challenged the healthcare system drastically, and it was concomitant with a remarkable decline in surgeries and modified routine care of patients worldwide. This systematic review and meta-analysis aimed to compare the surgical complications before COVID -19 (Pre-COVID) and after COVID -19 (post-COVID) appearance using the Clavien-Dindo classification (CDC).Methodsbetween January 1, 2019, to November 3, 2021, we performed a comprehensive search in PubMed/Medline and Scopus for studies reporting the postoperative complications based on/transformable to CDC.ResultFrom 909 screened articles, 34 studies were included for systematic review. Among included articles, 11 were eligible for meta-analysis. Nineteen thousand one hundred thirty-seven patients (pre-COVID: 3522, post-COVID: 15615) were included, mostly undergoing elective surgeries (86.32%). According to CDC classification, there were no significant change between pre-COVID and post-COVID for grade 1 (Odds ratio (OR) and 95% confidence interval (95-CI): 0.99, 0.60-1.63, p=0.96), grade 2 (OR and 95-CI: 0.65, 0.42-1.01, p = 0.055), grade 3 (OR and 95-CI: 0.86, 0.48-1.57, p=0.64), grade 4 (OR and 95-CI: 0.85, 0.46-1.57, p =0.60). However, the postoperative mortality was lower before the COVID -19 outbreak (OR and 95-CI: 0.51, 0.27-0.95, p= 0.035). The included studies for systematic review and meta-analysis had a low risk of bias and unsignificant publication bias.ConclusionAlthough delivering routine surgery was challenging, the postoperative complications during the pandemic remained identical to the pre-pandemic era. The stricter patient selection tending to choose more critical states and more advanced clinical stages of the operated patients may explain some extent of higher mortality during the pandemic. Adopting preventive strategies helped deliver surgeries during the outbreak of COVID -19 while limiting the capacity of operations and admissions.

Objective The actual impact of the pandemic on COVID-19 specific mortality is still unclear due to the variability in access to diagnostic tools. This study aimed to estimate the excess all-cause mortality in Iran until September 2021 based on the national death statistics. Results The autoregressive integrated moving average was used to predict seasonal all-cause death in Iran (R-squared = 0.45). We observed a 38.8% (95% confidence interval (CI) 29.7%–40.1%) rise in the all-cause mortality from 22 June 2020 to 21 June 2021. The excess all-cause mortality per 100,000 population were 178.86 (95% CI 137.2–220.5, M:F ratio = 1.3) with 49.1% of these excess deaths due to COVID-19. Comparison of spring 2019 and spring 2021 revealed that the highest percent increase in mortality was among men aged 65–69 years old (77%) and women aged 60–64 years old (86.8%). Moreover, the excess mortality among 31 provinces of Iran ranged from 109.7 (Hormozgan) to 273.2 (East-Azerbaijan) per 100,000 population. In conclusion, there was a significant rise in all-cause mortality during the pandemic. Since COVID-19 fatality explains about half of this rise, the increase in other causes of death and underestimation in reported data should be concerned by further studies.

Introduction Type 1 diabetes (T1D) is the second most common autoimmune disease among children. There is evidence suggesting that dysbiosis of some gut colonizing bacteria are associated with the pathogenesis of T1D. However, these studies are still controversial and a systematic review was conducted to evaluate the association between gut microbiota and T1D. Methods A systematic search was carried out in Medline (Via Pubmed) and Embase from January 2000 to January 2019 for all original cross-sectional, cohort, case–control or nested case–control studies investigating the association between gut microbiota and T1D. Results Of 568 articles identified, 26 studies met the inclusion criteria. The total population study of these articles consists of 2600 children (under 18 years old) and 189 adults. Among the included studies, 24 articles confirmed the association between gut microbiota dysbiosis and T1D. The most common bacterial alterations in T1D patients included Bacteroides spp., Streptococcus spp., Clostridium spp., Bifidobacterium spp., Prevotella spp., Staphylococcus spp., Blautia spp., Faecalibacterium spp., Roseburia spp., and Lactobacillus spp. Conclusion Our study showed a significant association between alterations in intestinal microbial composition and T1D; however, in some articles, it is not clear which one happens first. Investigation of altered gut microbiota can help in the early detection of T1D before seropositivity. Targeted microbiome modulation can be a novel potential therapeutic strategy.

Introduction Cholesteatoma is a benign tumoral lesion of squamous epithelial cells in middle ear that can exist as congenital or acquired forms. Presentation of cases A 35-year-old housewife presented to ENT clinic of a private hospital in Kabul, Afghanistan, with a complete facial nerve paralysis in the right side. In her antecedents, there is a tympanomastoidectomy due to chronic middle ear infection. First symptom was right side earache without any discharge. She started to notice a progressive nodule in the posterior-inferior side of her right ear. The patient was taken to the operating room. She underwent general anesthesia, an extensive cholesteatoma was removed, and a limited area of the fallopian canal in which facial nerve oedema or redness was evident. Post-operative House Brackmann grade was 1 on day 15 after the surgery. Discussion Cholesteatoma is primarily managed surgically and currently there is no suitable medical substitute treatment strategy for cholesteatoma. Hearing improvement, making the ear dry and total omission of cholesteatoma are primary goals of surgical interventions in cholesteatoma management. Conclusion Cholesteatoma after surgical manipulations of middle ear is a rare complication with notable morbidity that has been reported almost from all around the world but our patient is the first reported case of cholesteatoma formation after surgical management of COM from Afghanistan that presented with facial nerve paralysis and hear decline., Highlights • Although cholesteatoma is a benign tumoral lesion of middle ear it can cause serious morbidity. • Facial nerve paralysis after otologic surgical interventions should make physicians suspicious to cholesteatoma formation. • There is not any medical substitution for surgery in management of cholesteatoma.

Objectives: The rapidly evolving coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization on March 11, 2020. It was first detected in the city of Wuhan in China and has spread globally resulting in substantial health and economic crisis in many countries. Observational studies have partially identified the different aspects of this disease. Up to this date, no comprehensive systematic review for the clinical, laboratory, epidemiologic and mortality findings has been published. We conducted this systematic review and meta-analysis for a better understanding of COVID-19. Methods: We reviewed the scientific literature published from January 1, 2019 to March 3, 2020. Statistical analyses were performed with STATA (version 14, IC; Stata Corporation, College Station, TX, USA). The pooled frequency with 95% confidence intervals (CI) was assessed using random effect model. Publication bias was assessed and p

Introduction: The 2019 novel coronavirus (COVID-19) has been declared a public health emergency worldwide. The objective of this systematic review was to characterize the clinical, diagnostic, and treatment characteristics of hospitalized patients presenting with COVID-19. Methods: We conducted a structured search using PubMed/Medline, Embase, and Web of Science to collect both case reports and case series on COVID-19 published up to April 24, 2020. There were no restrictions regarding publication language. Results: Eighty articles were included analyzing a total of 417 patients with a mean age of 48 years. The most common presenting symptom in patients who tested positive for COVID-19 was fever, reported in up to 62% of patients from 82% of the analyzed studies. Other symptoms including rhinorrhea, dizziness, and chills were less frequently reported. Additionally, in studies that reported C-reactive protein (CRP) measurements, a large majority of patients displayed an elevated CRP (60%). Progression to acute respiratory distress syndrome (ARDS) was the most common complication of patients testing positive for COVID-19 (21%). CT images displayed ground-glass opacification (GGO) patterns (80%) as well as bilateral lung involvement (69%). The most commonly used antiviral treatment modalities included, lopinavir (HIV protease inhibitor), arbidiol hydrochloride (influenza fusion inhibitor), and oseltamivir (neuraminidase inhibitor). Conclusions: Development of ARDS may play a role in estimating disease progression and mortality risk. Early detection of elevations in serum CRP, combined with a clinical COVID-19 symptom presentation may be used as a surrogate marker for the presence and severity of the disease. There is a paucity of data surrounding the efficacy of treatments. There is currently not a well-established gold standard therapy for the treatment of diagnosed COVID-19. Further prospective investigations are necessary.

ObjectivesThe 2019 novel coronavirus (COVID-19) has been declared a public health emergency worldwide. The objective of this systematic review was to characterize the clinical, diagnostic, and treatment characteristics of patients presenting with COVID-19.MethodsWe conducted a structured search using PubMed/Medline, Embase, Web of Science and the Cochrane Library to collect both case reports and case series on COVID-19 published up to February 30, 2020.ResultsThirty-four articles were included analyzing a total of 99 patients with a mean age of 46.2 years. The most common presenting symptom in patients who tested positive for COVID-19 was fever, reported in up to 83% of patients from 76.4% of the analyzed studies. Other symptoms including rhinorrhea, dizziness, and chills were less frequently reported. Additionally, in studies which reported C-reactive protein (CRP) measurements (44%), a large majority of patients displayed an elevated CRP (73%). Progression to acute respiratory distress syndrome (ARDS) was the most common complication of patients testing positive for COVID-19 (33%). CT images displayed ground-glass opacification (GGO) patterns (80%) as well as bilateral lung involvement (71.0%). The most commonly used antiviral treatment modalities included, lopinavir (HIV protease inhibitor), arbidiol hydrochloride (influenza fusion inhibitor), and oseltamivir (neuraminidase inhibitor).ConclusionsDevelopment of ARDS may play a role in estimating disease progression and mortality risk. Early detection of elevations in serum CRP, combined with a clinical COVID-19 symptom presentation may be used as a surrogate marker for presence and severity of disease. There is a paucity of data surrounding the efficacy of treatments. There is currently not a well-established gold standard therapy for the treatment of diagnosed COVID-19. Further prospective investigations are necessary.