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Background & Objective: Anemia, thrombocytosis, and leukocytosis, are commonly found in a variety of malignancies. The prognostic role of preoperative leukocytosis, anemia, and thrombocytosis on stages and grades of endometrial cancer (EC) in women undergoing surgery was the subject of this study. Materials & Methods: In this cross-sectional study, 105 women suffering from EC at Babol Ayatollah Rouhani Hospital from 2011 to 2018 were considered. Anemia, thrombocytosis, and leukocytosis were defined as prognostic factors. Then, the patients were placed at stages I, II, III, and IV, and ECs were graded as well, moderately and poorly differentiated or undifferentiated. SPSS 22 software, Chi-square, analysis of variance (ANOVA), and receiver operating characteristic (ROC) were used for statistical analysis (p < 0.05). Results: Higher rates of leukocytosis (54.3%), anemia (47.4%), and thrombocytosis (66.7%) were detected in tumor grades III, II, and III, respectively. A higher rate of leucocytosis (51.4%), anemia (60.5%), and thrombocytosis (51.9%) were reported in tumor stages III, I, and III, respectively. The relationship between tumor grade and tumor stage with leucocytosis and thrombocytosis was statistically significant (p <0.001). The white blood cell (WBC) sensitivity (70%) and specificity (70%), Hb sensitivity (37%) and specificity (39%), and platelets sensitivity (73%) and specificity (74%) were determined. There was a significant relationship between levels below the 3-variable curve and tumor stage with WBC (p <0.001) and platelet (p <0.001). Conclusion: Preoperative leukocytosis and thrombocytosis are related to the severity, stages, and grades of EC. Both of them have a prognostic role in women suffering from EC. [ABSTRACT FROM AUTHOR]

Background: The prevalence of pulmonary hypertension (PH) is reported between 17% and 56% in hemodialysis patients. The pathogenesis of PH in hemodialysis patients is still unclear. Malnutrition may be associated with impaired pulmonary function in hemodialysis patients. Objectives: The present study aimed to investigate the association between PH and nutritional and biochemical markers in hemodialysis patients. Methods: In this cross-sectional study, 80 patients undergoing hemodialysis at the Kowsar Medical Center, Semnan, Iran, from 1 March 2016 to 31 August 2016 were enrolled by complete enumeration. Pulmonary artery pressure was determined by echocardiography between hemodialysis sessions. Arm circumference, triceps fat mass, and body mass index (BMI) were determined. Other laboratory tests included transferrin, serum albumin, cholesterol, triglyceride, and hemoglobin. The source of receiving protein was recorded in a questionnaire. The data were analyzed by the chi-square test and logistic regression analysis at a significance level of less than 0.05. Results: Pulmonary hypertension ( > 25 mmHg) was found in 32 (40%) of the 80 patients studied. The mean of pulmonary pressure in patients with PH was 34.66 ± 5.6 mmHg compared to 16.85 ± 3.7 mmHg in patients without PH. Age, gender, arm circumference, frequency of dialysis per year, and serum levels of albumin, transferrin, triglyceride, and total cholesterol were not significantly different between patients with and without PH. There was a significant difference in the mean hemoglobin level between patients with and without PH (P = 0.003). The likelihood of developing PH was reduced by 0.3 in those with hemoglobin ≥ 11 g/dL compared to patients with hemoglobin levels below 11 g/dL (OR = 0.400, P = 0.003). The likelihood of developing PH in patients with albumin ≥ 3.8 g/L decreased by 0.126 compared to those with albumin less than 3.8 (OR = 0.126, P = 0.003). Conclusions: The results of our study indicated a higher incidence of PH in patients with lower levels of hemoglobin and albumin. So, patients undergoing hemodialysis are recommended to be regularly screened for these two variables. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative Acute renal failure related to cardiac surgery is a common complication due to cardiac surgery and is estimated to influence up to 30% of patients. Serum lactate is a famous biomarker of tissue ischemia and is regularly checked during surgery. Methods: In this retrospective observational research, the records of 395 patients undergoing CABG were examined. Patients were classified into 4 groups based on the difference between the maximum lactate level measured during surgery and its baseline level. Also creatinine and urea levels, blood sugar, hemoglobin, and hematocrit pre, postoperative were recorded. The intraoperative and postoperative use of inotropes and the durations of surgery, cardiopulmonary bypass pump, and aortic cross-clamping were also recorded. Results: According to the results, pre, post and 24-hour postoperative blood urea nitrogen were not significantly related to intraoperative lactate changes. Also, pre and 24-hour postoperative creatinine had no significant relationship with intraoperative lactate changes, while postoperative creatinine was significantly associated with intraoperative lactate changes (P value = 0.05). The duration of cardiopulmonary bypass (P value = 0.02), intraoperative inotrope infusion (P value = 0.03), inotrope infusion during the first six hours in ICU (P value = 0.049), and receiving packed cell (P value = 0.006) and receiving platelets during surgery (P value = 0.04) were significantly related to intraoperative lactate changes. Furthermore, no significant relationship was observed between the duration of hospitalization in the ICU and the hospital and intraoperative lactate changes. Conclusion: According to the results, blood lactate level is an unreliable marker for predicting renal dysfunction postoperative. [ABSTRACT FROM AUTHOR]

Aim: Identifying risk factors associated with mortality in elderly patients hospitalized with COVID-19 can be helpful in managing the disease in this age group. Therefore, the aim of this study was to determine the risk factors of death in elderly patients hospitalized with COVID-19 in Hamadan in 2020. Subject and methods: This cross-sectional study was performed on the medical records of 1694 patients aged 60 years and older who were diagnosed with COVID-19 disease between March and August 2020 and were admitted to Shahid Beheshti and Sina Hospitals. A researcher-made checklist included demographic information, clinical information, laboratory results, type of procedures performed for the patient in the hospital, and the number of hospitalization days. Results: The results showed that 30% of the elderly patients died due to COVID-19 complications. The results of adapted logistic regression showed that the variables of gender, age, inpatient ward and laboratory indices of albumin, hemoglobin, ESR, and LDH were the main predictors of COVID-19 related death in elderly patients (p < 0.05). Conclusion: The rate of COVID-19 related death in the hospitalized elderly patients is remarkable. The death rate increased among male patients, age older than 75 years, hospitalization in the ICU, increased ESR and HDR levels, and decreased albumin and hemoglobin. [ABSTRACT FROM AUTHOR]

In this report, we describe a 6-year-old girl with a medical history of pallor, mild icterus, anemia, blood transfusion and abnormal hemoglobin variant analysis on capillary electrophoresis. She was referred for further analysis. DNA sequencing of the proband revealed a de novo mutation in Codon 88 (CTG > CCG) of the β-globin gene (HBB: c.266T > C) in a heterozygous state compatible with hemoglobin Santa Ana, an unstable hemoglobin. This is the first case of Hb Santa Ana from Iran associated with moderate to severe anemia who underwent splenectomy with clinical improvement. [ABSTRACT FROM AUTHOR]

Background: The objective is to evaluate the prevalence of acute kidney injury (AKI) as an early complication of the percutaneous nephrolithotomy (PCNL) procedure. Materials and Methods: From May 2022 to October 2022, we conducted a retrospective study on patients undergoing PCNL procedures in two of the tertiary medical centers affiliated with Isfahan University of Medical Sciences. Patients' baseline characteristics, laboratory values, perioperative data, and stone features were documented. AKI was defined either as a ≥0.3 mg/dL increase in the serum creatinine level within 2 days, or a ≥1.5-fold increase in baseline serum creatinine level within 7 days after the operation. Laboratory values were measured 1 day before PCNL and daily thereafter until discharge. Patients were followed 1 week later to detect all of the possible cases of AKI. Results: The final analysis was performed on 347 individuals. AKI developed in 16 (4.61%) cases. The two groups were comparable regarding age (P = 0.887), gender (P = 0.566), and underlying comorbidities including diabetes mellitus (P = 0.577) and hypertension (P = 0.383). The mean body mass index (BMI) (P < 0.001) and both frequency and severity of hydronephrosis (P < 0.001) were significantly different. A higher mean PCNL duration (P < 0.001), period of hospitalization (P < 0.001), and blood loss volume (P < 0.001) were observed in those who developed AKI. Overall, 56.3% (9) of patients in the AKI group and 2.7% (9) in the non-AKI group required the establishment of more than one access tract, during the procedure (P < 0.001). A lower preoperative hemoglobin level was observed in the AKI group (P < 0.001). Those with AKI had significantly larger stones (3.08 ± 0.46 vs. 2.41 ± 0.23 cm, P < 0.001) and higher Hounsfield units (P < 0.001). In addition, in the AKI group, most of the calculi (81.3%, 13) were of staghorn type, whereas in the non-AKI group, calculi were most frequently located in the middle calyx (30.2%, 100), (P < 0.001). Conclusion: The prevalence of post-PCNL AKI is approximately 4.61%. The mean BMI, preoperative hemoglobin level, PCNL duration, intraoperative blood loss volume, and hospitalization period were significantly higher among patients who developed AKI. Those with AKI had significantly larger stones with higher Hounsfield units and more frequently of staghorn type. The two groups were not statistically different regarding age, gender, and presence of comorbidities (hypertension and diabetes mellitus). [ABSTRACT FROM AUTHOR]

INTRODUCTION: The COVID-19 pandemic, as the most important health challenge in the world today, has made numerous irretrievable damages to the social, economic, and health dimensions of societies, especially in developing countries. An essential measure that can be taken to prevent and control the disease is to identify risk factors related to its prognosis and mortality rate. Therefore, this study aimed at investigating COVID-19 survival and mortality risk factors and their relationship with the demographic characteristics of the subjects diagnosed with the disease. MATERIAL AND METHODS: The present study is cross-sectional and descriptive. The samples consist of 1395 patients diagnosed with COVID-19 admitted to medical centers affiliated with Fasa University of Medical Sciences. The subjects were selected by census sampling. Data were collected using demographic information forms, paraclinical and radiological tests, and clinical examinations. Data were analyzed using SPSS version 18 via descriptive tests, paired t-tests, one-way ANOVA, and post hoc tests. RESULTS: According to the data, the participants' average age was 57.72 ± 4.63 years, and most of them (56.41%) were male. The mortality rate among the participants was estimated to be 13.19%. The results of the study showed a significant relationship between the survival status of patients with COVID-19 and underlying chronic diseases such as diabetes and cardiovascular and renal diseases (p < 0.05). CONCLUSIONS: Identifying high-risk groups is an important measure that health professionals should consider in controlling epidemics. The findings of this study showed that the presence of underlying chronic diseases such as diabetes and cardiac and renal conditions, which are associated with immune system defects, are among the most important factors related to the COVID-19 mortality. [ABSTRACT FROM AUTHOR]

Introduction: Defining accurate age‐ and sex‐specific reference intervals (RIs) for hematology parameters, especially for the pediatric population, is important for making an appropriate clinical diagnosis. To address gaps, we established age‐specific RIs for 11 hematologic parameters in Iranian children younger than 30 months for the first time. Methods: Fresh whole blood samples collected from a total of 344 participants (males: 158 and females: 186) ages 3 days to 30 months, with a mean age of 12.91 ± 7.15 months, were recruited from healthcare centers in Mashhad, Iran. Hematologic parameters, including complete blood count (CBC), were analyzed on the Sysmex auto‐analyzer system (KX‐21 N). RIs were calculated with 90% confidence intervals using the direct method based on CLSI Ep28‐A3 and C28‐A3 guidelines. Results: None of the CBC parameters required sex partitioning. Of 11 CBC parameters, six required age partitions of 3 days–<4 months, 4–<10, 10–<15, and 4–<30 months. Five parameters (i.e., white blood cell count, mean corpuscular hemoglobin concentration, mean platelet volume, red cell distribution width, and platelet distribution width) did not demonstrate age‐specific changes. RIs of red blood cell count and hematocrit, as well as hemoglobin, increased with age, while mean corpuscular volume, mean corpuscular hemoglobin, and platelet count, decreased with age. Conclusion: In this study, we established RIs for 11 hematology parameters in young children. Age partitioning was required for six parameters demonstrating marked changes during the early period of growth and development and necessitating the use of pediatric‐specific reference standards. [ABSTRACT FROM AUTHOR]

Background. It is well known that laboratory markers could help in identifying risk factors of severe illness and predicting outcomes of diseases. Here, we performed a retrospective modeling study of severity and mortality predictors of hematological and biochemical laboratory parameters in Iranian COVID-19 patients. Methods. Data were obtained retrospectively from medical records of 564 confirmed Iranian COVID-19 cases. According to the disease severity, the patients were categorized into two groups (severe or nonsevere), and based on the outcome of the disease, patients were divided into two groups (recovered or deceased). Demographic and laboratory data were compared between groups, and statistical analyses were performed to define predictors of disease severity and mortality in the patients. Results. The study identified a panel of hematological and biochemical markers associated with the severe outcome of COVID-19 and constructed different predictive models for severity and mortality. The disease severity and mortality rate were significantly higher in elderly inpatients, whereas gender was not a determining factor of the clinical outcome. Age-adjusted white blood cells (WBC), platelet cells (PLT), neutrophil-to-lymphocyte ratio (NLR), red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), erythrocyte sedimentation rate (ESR), mean corpuscular hemoglobin (MCHC), blood urea nitrogen (BUN), and creatinine (Cr) also showed high accuracy in predicting severe cases at the time of hospitalization, and logistic regression analysis suggested grouped hematological parameters (age, WBC, NLR, PLT, HGB, and international normalized ratio (INR)) and biochemical markers (age, BUN, and lactate dehydrogenase (LDH)) as the best models of combined laboratory predictors for severity and mortality. Conclusion. The findings suggest that a panel of several routine laboratory parameters recorded on admission could be helpful for clinicians to predict and evaluate the risk of disease severity and mortality in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) has emerged as the most significant health crisis in recent years, leading to over 6 million deaths globally due to the disease. Objectives: Given the prevalence of multisystem inflammatory syndrome in children (MISC) following the COVID-19 pandemic, this study aims to examine the imaging findings and prognoses of clinical and subclinical myocarditis in children with MISC through cardiac magnetic resonance (CMR) imaging. Patients and Methods: This prospective cohort study carried out over eighteen months from May 2021 to November 2022, included 14 patients who underwent CMR imaging. A census of all eligible patients during the study period served as the sampling method. Inclusion criteria were patients with confirmed COVID-19 infection through serological tests, polymerase chain reaction (PCR), or recent exposure to COVID-19 patients. Exclusion criteria included patients with a history of congenital heart disease (CHD) or pulmonary disease. Additional diagnostic tests performed included blood sample tests, chest X-ray (CXR), electrocardiogram (ECG), and echocardiography. CMR imaging was conducted on patients with cardiac involvement. A diagnosis of myocardial inflammation was made if a patient met at least two of the Lake Louise Criteria. The Chi-square, Fisher's exact, and Mann-Whitney tests were used to examine the relationship between quantitative variables and treatment outcomes. Additionally, the Wilcoxon signed rank, and McNemar's tests assessed changes in echocardiography findings from admission to follow-up. A significance level of 0.05 was set. Results: Among the 14 patients studied, 8 (57.10%) were girls and 6 (42.90%) were boys. The average age was 6.03 ± 3.71 years. The median time to CMR imaging after symptom onset was 4 weeks (interquartile range (IQR): 2 - 12, range: 30). Global function assessment using left ventricular ejection fraction (LVEF) showed that 5 (35.70%), 3 (21.40%), and 6 (42.90%) patients had normal function, mild dysfunction, and significant LV dysfunction, respectively. 71.40% of patients who recovered had mild tricuspid regurgitation (TR) and no cardiomegaly. Significant differences in mean values of polymorphonuclear neutrophil (PMN) (37.71 ± 11.75 vs. 81.44 ± 13.06), lymphocytes (48.71 ± 20.08 vs. 12.51 ± 7.26), hemoglobin (Hb) (12.60 ± 1.55 vs. 10.10 ± 1.62), mean corpuscular volume (MCV) (85.90 ± 5.67 vs. 79.37 ± 5.23), erythrocyte sedimentation rate (ESR) (8.86 ± 13.60 vs. 30.29 ± 21.33), and C-reactive protein (CRP) (18.91 ± 27.25 vs. 100.57 ± 85.67) were observed between non-recovered and recovered patients, respectively (P < 0.05). However, no statistically significant association was found between other variables, including N-terminal pro--B-type natriuretic peptide (NT-proBNP), D-dimer, and Troponin I (TPI), with treatment outcomes (P > 0.05). Conclusion: Our findings indicate that a negative COVID-19 test does not exclude an established clinical COVID-19 infection in children with MISC. The results suggest that all children with MISC and a history of COVID-19 infection should undergo assessment for myocardial fibrosis, regardless of ejection fraction (EF) as determined by Echocardiography, laboratory tests, and COVID-19 test results. Strain analysis, conducted during both the acute phase and subsequent follow-ups through CMR imaging or Echocardiography, is recommended to enhance the understanding of the prognosis. [ABSTRACT FROM AUTHOR]

Background: While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney. Methods: In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation. Results: Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate. Conclusion: Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients. [ABSTRACT FROM AUTHOR]

Background and Objectives Many of hip fracture patients need transfusion. We examined the frequency of blood transfusion, the relative factors, and the threshold of hemoglobin in hip fracture patients receiving blood transfusion before and during pelvic surgeries. Materials and Methods This retrospective cross-sectional study was conducted on all patients with proximal femur fractures who underwent hip surgery at Shahid Chamran Hospital in Shiraz in 2020. The frequency of blood transfusion, hemoglobin threshold, and the related factors was investigated. Results Out of 218 patients, 65 (29.8%) had received blood out of whom 23 patients (35.4%) had received blood before surgery. The hemoglobin threshold before transfusion was 10.99. The average hemoglobin in patients who received blood was less than the patients who did not receive blood (p< 0.001) 10.55 ± 1.61 versus 12.45 ± 1.61. The average number of units used in patients who received blood was 2.30 ± 0.72 (1 to 4 blood units). The frequency of blood transfusion was related to hemoglobin before surgery, gender, type of anesthesia, type of surgery, history of anemia, duration of surgery, and surgeon. The amount of blood consumption did not depend on the patient age . Conclusions The average hemoglobin before transfusion was higher than previous studies. It seems that the blood transfusion threshold was higher than in previous studies. Considering the risks and costs of blood transfusion, it seems that physicians' education and emphasis on the use of restrictive transfusion strategy can lead to reduction of blood consumption, reduction of complications, and better blood management. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for management of benign prostatic hyperplasia (BPH). With the growing aging population, a considerable percentage of octogenarians (80–90 years old) and nonagenarians (>90 years old) require surgical management for BPH. We aimed to assess the outcomes of HoLEP in those age groups. METHODS: We reviewed a maintained database for HoLEP patients in a tertiary center. Patients were assigned to two groups: above (group A) and below (group B) 80 years old. Perioperative outcome and postoperative followup data were compared between both groups. RESULTS: The study included 1090 patients, 201 and 889 in groups A and B, respectively. Median age was 83 and 70 years in groups A and B, respectively. Group A showed longer operative time, longer catheterization time, and higher 30-day emergency room visits and readmission rates. Hemoglobin drop was comparable, although associated with higher rate of blood transfusion in group A. Overall, 30-day postoperative complications were higher in group A (20.8% vs. 9.3%, p=0.008), although the majority of complications in both groups were grade I and II. The rate of complications over Clavien-Dindo grade II were statistically comparable (3.4% vs. 1.79%, p=0.133). Followup at six weeks, three months, and one year showed comparable functional outcomes in both groups. CONCLUSIONS: HoLEP is a safe and effective option in the geriatric population of octogenarians and even nonagenarians. HoLEP is associated with higher overall complication rate in older age groups; however, most complications were minor. [ABSTRACT FROM AUTHOR]

Hospital‐acquired infections (HAIs) are considered a major challenge in health care systems. One of the main HAIs, playing an important role in increased morbidity and mortality, is surgical wound infection. Therefore, this study aimed to determine the incidence rate and risk factors of surgical wound infection in general surgery patients. This cross‐sectional study was performed on 506 patients undergoing general surgery at Razi hospital in Rasht from 2019 to 2020. Bacterial isolates, antibiotic susceptibility pattern, antibiotic administration, and its type, operation duration and shift, the urgency of surgery, people involved in changing dressings, length of hospitalisation, and levels of haemoglobin, albumin, and white blood cells after surgery were assessed. The frequency of surgical wound infection and its association with patient characteristics and laboratory results were evaluated. The SPSS software package (version 16.0, SPSS Inc., Chicago, IL, USA) was used to analyse the data. Quantitative and qualitative variables were presented using mean (standard deviation) and number (percentage). The Shapiro–Wilk test was used to evaluate the normality of the data in this study. The data did not have a normal distribution. Hence, χ2 and Fisher's exact tests were used to evaluate the relationship between variables. Surgical wound infection occurred in 4.7% (24 cases) of patients with a mean age of 59.34 (SD = 14.61) years. Preoperative (>3 days) and postoperative (>7 days) hospitalisation, history of immunodeficiency (P < 0.001), and interns responsible for changing dressings (P = 0.021) were associated with surgical wound infection incidence. About 9.5% and 4.4% of surgical wound infection cases were significantly associated with pre‐ and postoperative antibiotic use. Gram‐positive cocci were the most prevalent strains isolated from 24 surgical wound infection cases (15/24, 62.5%). Among these, Staphylococcus aureus was the predominant species, followed by coagulase‐negative staphylococci. In addition, the most common Gram‐negative isolates identified were Escherichia coli bacteria. Overall, administration of antibiotics, emergency surgery, surgery duration, and levels of white blood cells and creatinine were identified as surgical wound infection‐associated risk factors. Identifying important risk factors could help control or prevent surgical wound infections. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate haemoglobin (Hb) changes before and after packed red blood cell (RBC) transfusion in burn patients. This study was a retrospective cross‐sectional study that was conducted on burn patients in Velayat hospital in Rasht, Iran. The sampling method of this study was consecutive sampling. Data were collected using patient records, including age, gender, body mass index (BMI), total body surface area (TBSA) percentage, length of hospitalisation, Frequency of receiving packed RBCs, and Hb level before each packed RBC transfusion and 4 to 6 hours after transfusion. Paired t tests and analysis of variance (ANOVA) were used to compare the study variables. Pearson's correlation coefficient was used to investigate the relationship between Hb changes after the transfusion of packed RBCs and the study variables. A total of 110 burn patients participated in this study. The average Hb before and after transfusion was 8.07 (SD = 0.97) and 9.16 (SD = 1.01), respectively, which were significantly different (P =.0001). The results showed that there was a significant negative relationship between the variables of age (r = −0.188, P =.0001), BMI (r = −0.110, P =.035), and TBSA percentage (r = −0.122, P =.019) with changes in Hb after transfusion. Also, the duration of hospitalisation had a significant positive relationship with Hb changes after transfusion (r = 0.124, P =.017). In sum, Hb level compensation through packed RBC transfusion in elderly burn patients has more challenges. The number of changes in Hb level after receiving packed RBCs decreased with increasing TBSA, BMI, and age. Also, there was a positive correlation between the duration of hospitalisation and changes in Hb levels. [ABSTRACT FROM AUTHOR]

Diabetes, a major non-communicable disease, presents challenges for healthcare systems worldwide. Traditional regression models focus on mean effects, but factors can impact the entire distribution of responses over time. Linear mixed quantile regression models (LQMMs) address this issue. A study involving 2791 diabetic patients in Iran explored the relationship between Hemoglobin A1c (HbA1c) levels and factors such as age, sex, body mass index (BMI), disease duration, cholesterol, triglycerides, ischemic heart disease, and treatments (insulin, oral anti-diabetic drugs, and combination). LQMM analysis examined the association between HbA1c and the explanatory variables. Associations between cholesterol, triglycerides, ischemic heart disease (IHD), insulin, oral anti-diabetic drugs (OADs), a combination of OADs and insulin, and HbA1c levels exhibited varying degrees of correlation across all quantiles (p < 0.05), demonstrating a positive effect. While BMI did not display significant effects in the lower quantiles (p > 0.05), it was found to be significant in the higher quantiles (p < 0.05). The impact of disease duration differed between the low and high quantiles (specifically at the quantiles of 5, 50, and 75; p < 0.05). Age was discovered to have an association with HbA1c in the higher quantiles (specifically at the quantiles of 50, 75, and 95; p < 0.05). The findings reveal important associations and shed light on how these relationships may vary across different quantiles and over time. These insights can serve as guidance for devising effective strategies to manage and monitor HbA1c levels. [ABSTRACT FROM AUTHOR]

Background. The available evidence has made the long-term accompaniment of COVID- 19 and its other variants with human life predictable. Different studies have proposed different and, in some cases, contradictory findings as factors determining the duration of hospitalization of patients with COVID-19. The present study aimed to identify the factors related to the duration ofICU length in patients with COVID-19. Methods. The present study retrospectively analyzed the data related to patients aged 1 to 97 years with COVID-19 registered in Isfahan's COVID-19 registration system. The data of those patients with COVID-19 who were alive at the time of discharge (n=453) were analyzed in the present study. Information related to laboratory findings, clinical data, and co-morbidities were collected. T-test, correlation, and analysis of variance tests were used in crude analysis. The linear regression model was used to determine the factors related to the ICU length and their importance. Results. The mean (SD) of intensive care unit days was 0.64 (2.39). Higher than normal values of INR, hemoglobin, and creatinine increased the average length of stay in ICU by 2.45 (p=0.001), 3.82 (p <0.001), and 0.72 (p <0.001) days, respectively. Among underlying co-morbidities, the presence of other respiratory diseases significantly increased the average length of stay in the ICU by 1.5 days (p=0.024). Standardized regression coefficients also showed that higher-than-normal hemoglobin and increased WBC values were the most important variables predicting ICU hospitalization length. Conclusion. The higher-than-normal values of hemoglobin and increased WBC values are the most important predictors of the length of hospitalization in the ICU. The findings of the present study can be helpful in the decision-making of specialists to reduce the duration of hospitalization in the ICU and to help diagnose more critical cases. [ABSTRACT FROM AUTHOR]

Objectives. The purpose of this study was to evaluate the hematotoxic, hepatotoxic and nephrotoxic responses following lead exposure among battery workers. Methods. Seventy-eight battery workers exposed to lead and 78 non-exposed subjects were studied. Fasting blood samples were collected to assess kidney and liver function and hematological parameters. To determine the breathing zone and blood lead levels (BLLs), the samples were analyzed in accordance with NIOSH methods 7082 and 8003, respectively. Results. The battery workers had significantly higher breathing zone lead and BLLs than the non-exposed group. In battery workers, most hematological parameters, including red blood cells, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration, have significantly decreased. In contrast, the white blood cell count has shown a significant increase as compared to the controls. The mean levels of alanine aminotransferase and aspartate aminotransferase as biomarkers of liver damage and the creatinine serum levels as a result of renal failure were significantly higher in the exposed group than in the non-exposed group. Conclusions. These observations indicate that occupational exposure to lead exceeding its current threshold limit value and biological exposure index is associated with hematological symptoms and liver and kidney dysfunction. [ABSTRACT FROM AUTHOR]

Background & Aims: Iron deficiency anemia is the most common anemia worldwide with significant clinical consequences. The disease is caused by not having enough iron to produce hemoglobin for reasons such as dietary iron deficiency, insufficient iron absorption, chronic bleeding, and genetic factors. Hepcidin protein is the main regulator of systemic iron homeostasis hormone ferroportin. The role of hepcidin is to control the expression of iron-releasing ferroportin levels in duodenal cells and macrophages, modulating iron uptake and recycling. Hepcidin inactivation causes severe iron overload, while increased hepcidin causes anemia. Several factors regulate hepcidin synthesis, including matriptase-2, which reduces hepcidin synthesis. Matryptase-2 is a type 2 membrane serum proteinase, encoded by the TMPRSS 6 gene. This gene is located on the long arm of chromosome 22 and is mainly expressed in the liver. In humans, inactivation of this protein leads to a rare autosomal recessive disease called IRIDA. Several genetic polymorphisms related to iron status have been identified using genomerelated studies. The aim of this study was to investigate the polymorphism of TMPRSS6rs2111833 in patients with iron deficiency anemia in the west of the country. Methods: The present study is a case-control study. Using the sample size determination method available, sampling was performed at a time interval of 3 months with the cooperation of private laboratories in Sanandaj, Dehgolan and Kermanshah. A total of 91 people were randomly included with respect personal consent. Of these, according to the results of ferritin, hemoglobin, red blood cells, white blood cells and platelets 43(47.25%) with iron deficiency anemia and 48(52.75%) healthy controls were enrolled. Five ml of blood sample was collected from all participants and placed in CBC tubes containing anticoagulant and after inverting several times, it was placed in freezer -20. DNA extraction was performed using the extraction kit of Kwsar Company and according to the kit instructions. The quantity and quality of the extracted DNAs were determined using light absorption in spectrophotometer and electrophoresis on 1% agarose gel. The isolated DNA was stored in separate microtubes at -20 ° C until PCR. Then the genotype of individuals was obtained using ARMS-PCR technique and primer sequences used in previous studies. Amplification of the desired fragment was performed using Sinagene Company PCR kit by Rotor-Gene Q (Corbett Life Science) cyclotron device according to the protocol and the PCR product was loaded on 1.8% agarose gel and the quantity and quality were determined. Finally, a statistical test was performed to compare the frequency of genotypes in all samples using Windows SPSS tool and the value of p <0.05 was statistically described. Results: The results showed that the frequency of GG, AG and AA in all participants were 45%, 22% and 33%, respectively, and so for sick and healthy individuals were 47 and 44, 23 and 21 and 30 and 35, respectively. Also, out of 200 alleles, 120(56%) and 80(44%) alleles were G and A, respectively. The portion of G allele in patients and controls group was 58 and 54% and the share of A allele was 42 and 46%, respectively. Hardy Weinberg and heterozygosity equilibria were also examined for the two groups. The Hardy-Weinberg test showed that the assessed population was balanced. Heterozygosity for a gene locus is defined as the frequency of heterozygous individuals for that locus relative to the total population. A gene locus is polymorphic if its heterozygosity is greater than 0.1, and if it is greater than 0.7, it is highly polymorphic. Based on the results of this study, it was seen that the difference between observed and expected heterozygosity in the studied polymorphism is less than 0.1, so the gene position is not polymorphic. Also, co-dominant, dominant, recessive and super-dominant models were examined and in all cases, the Pv value was greater than 0.05. On the other hand, Sixty-nine percent of participants had normal hemoglobin, 41% normal iron, 51% normal ferritin, 83% normal red blood cells, 92% normal platelets and 82% normal white blood cells. On the other hand, 22% of participants had abnormal hemoglobin, 65% abnormal iron, 54% abnormal ferritin, 22% abnormal red blood cells, 2% abnormal platelets and 26% abnormal white blood cells. rs 2111833 showed no significant association with decreased serum hemoglobin, serum iron, serum ferritin, platelets, red and white blood cells. Conclusion: This results showed that the rs2111833 polymorphism were not significantly associated iron deficiency anemia in the studied population. In addition, no significant association was found between rs2111833 and hemoglobin, iron, ferritin, platelets, RBCs and WBCs clinical parameters. Beutler and colleagues investigated the role of TMPRSS6 gene polymorphisms in adults with iron deficiency anemia. Their observations highlighted the role of matriptase-2 in controlling iron metabolism and erythrocyte parameters. Sylvester et al. Reported the association of TMPRSS6 mutations with iron deficiency anemia. Previously, Feinberg et al. reported several mononucleotide polymorphisms associated with iron deficiency anemia, including rs 869320724, rs 767094129, rs 786205059, rs 137853120 and rs 137853119.7 Several studies have shown that the polymorphism rs 2111833 is associated with decreased iron and hemoglobin levels therefore, it related with an increased risk in iron deficiency anemia. In 2015, Gichohi-Wainaina et al. Identified some changes in the partial frequencies of the rs 2111833 alleles in Asian populations compared to the Caucasian population, which matched our findings. Anemia remains a widespread and significant global health problem that needs to be adequately addressed. Although iron deficiency anemia is the leading cause of anemia in most areas, recent research shows that the cause of anemia is complex and specific to each region. To better understand how to help the underlying causes of anemia, including iron deficiency anemia and other nutritional deficiencies, diseases, and hemoglobin disorders, efforts need to be made to make appropriate interventions work under certain conditions. Further studies on a larger patient scale are also necessary to identify potential haplotypes and polymorphisms responsible for the low response to oral iron therapy and may be useful for planning a proper iron supplementation. There were some limitations to this study, such as an insufficient total number of participants. However, these results could enhance our understanding of the role of genetics, particularly single nucleotide polymorphisms, in increasing susceptibility to a variety of diseases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to assess the status of iron stores and the frequency of iron deficiency anemia in Celiac disease (CD) patients referred to the Golestan Research Center of Gastroenterology and Hepatology, Gorgan, Iran. Background: Studies have shown that nutritional deficiencies affect 20-38% of patients with CD due to malabsorption and as a result of a gluten-free diet. Methods: In this study, 59 out of 100 CD patients were assessed. The presence and severity of anemia were determined using the concentration of serum hemoglobin according to WHO criteria. The status of body iron stores was also assessed based on serum ferritin levels. Results: Mean and SD of age, duration of disease, serum hemoglobin, ferritin, TIBC, and serum iron were 39.9±11.9 years, 69.8±45.4 months, 12.6±1.99 g/dl, 54.3±55.3 mg/dL, 365.9±49.1 μg/dL, and 84.1±37.1 μg/dL, respectively. 68.42% had no anemia, 19.3% had mild anemia, 8.77% had moderate anemia, and 3.51% had severe anemia. 25.42% of patients had depleted iron stores, 71.19% had normal iron stores, and 3.39% were exposed to iron overload. There was a statistically significant correlation between serum hemoglobin and the duration of disease diagnosis (P=0.037, r=0.302). Conclusion: In this study, 31.58% of CD patients on a gluten-free diet had some degree of anemia. In addition, 25.42% of patients had depleted iron stores. These results suggest that CD patients should be evaluated for iron status, even with a gluten-free diet. [ABSTRACT FROM AUTHOR]

Introduction. Identification of factors associated with blood pressure (BP), including hemoglobin, can be used in diagnosing, controlling, and predicting the prognosis of patients. This study aims to investigate the cross-sectional association between hemoglobin concentration and BP in people aged 35–70 years in a cohort study of Rafsanjan, Iran. Method. This cross-sectional study was conducted on 9398 urban and rural population of Rafsanjan adult cohort study as a part of the prospective epidemiological research studies in Iran (PERSIAN). Demographic information, medical history, history of smoking and alcohol intake, systolic and diastolic BP, and hemoglobin concentration were collected. A logistic regression test was performed to evaluate the relationship between hemoglobin concentration and BP in 4 unadjusted and adjusted models based on demographic indicators, clinical and laboratory findings using SPSS.24 software and SAS software version 9.2. Results. The mean age of the participants was 49.78 ± 9.53 years, and 53.2% (5002 people) were women. Adjusted models 3 and 4 showed a positive association between BP and hemoglobin. For each unit increase in hemoglobin, the odds ratio (OR) of BP in the adjusted model 3 was 1.062 (95% CI: 1.005–1.121), and in the adjusted model 4, it was 1.090 (95% CI: 1.031–1.153). Conclusion. Based on the results, the positive trend of BP and hemoglobin levels may indicate the need to pay more attention to these people as higher-risk groups for hypertension. [ABSTRACT FROM AUTHOR]

Introduction: Regular exercise is considered as a physiological stimulus for the release of hematopoietic stem cells from the bone marrow. The aim of this study is to determine the effect of one week of aerobic training on the production of CD34+ hematopoietic cells and the amount of white blood cells and hemoglobin after autologous transplantation in leukemia patients. Materials and Methods: In this semi-experimental study, 39 patients who were candidate for autologous stem cell transplantation referred to Taleghani Hospital were randomly divided into two experimental and control groups. The experimental group exercised on the treadmill with an intensity of 40-60% of the reserve heart rate for one week. But the control group did not receive any intervention. The blood sample was taken from each patient immediately after training and at the time of hospitalization and discharge. T-test was used to analyze the data using SPSS22 software. Results: The number of CD34+ cells increased after training in both groups (P >0.0001), But there was no significant difference between the two groups. The amount of white blood cells did not increase significantly in two groups. The amount of hemoglobin decreased significantly in both groups (P>0.05). However, at the time of discharge, there was no significant difference between the two groups in the amount of white blood cells and hemoglobin. Conclusion: Although the combination of G-CSF treatment and aerobic exercise does not facilitate faster recovery of blood cells, it does not delay recovery and does not pose a risk to patients who underwent autologous peripheral blood stem cell transplantation. [ABSTRACT FROM AUTHOR]

Introduction: There is inconsistent data regarding COVID-19 prognosis in patients with background hypothyroid disorder. The present study aimed to evaluate the severity of symptoms and blood parameters in COVID-19 patients with hypothyroidism. Material & Methods: This study investigated 100 COVID-19 patients (50 individuals with a history of hypothyroidism and 50 patients without thyroid disorder [euthyroid]). Demographic and clinical characteristics were collected from the COVID-19 registry database in Shahid Mustafa Khomeini Hospital. All patients were admitted and treated between March and December 2020. Hospitalization duration, the ICU admissions rate, and blood laboratory tests were evaluated in this study. Findings: Hospitalization period was significantly longer in the hypothyroid group, compared to the euthyroid group (P=0.009). The number of red blood cells (RBCs), hemoglobin level, and hematocrit percentage were lower in the hypothyroid group (P=0.001, P=0.003, and P=0.003, respectively). Nevertheless, the number of white blood cells (WBCs) and inflammatory indicators, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the same in both groups. (Ethic code: IR.MEDILAM.REC.1401.186) Discussion & Conclusion: Although background hypothyroidism had no significant effect on inflammation severity caused by COVID-19; however; it extended hospital stay in these patients. Anemia, a common problem in hypothyroidism, may explain longer hospitalization in hypothyroid COVID-19 patients. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative anemia is an important and relatively common problem in patients undergoing cardiac surgery, and its treatment is crucial in improving postoperative outcomes. The use of recombinant erythropoietin is one of the suggested methods in this field. Therefore, in the present study, we sought to evaluate the effects of recombinant erythropoietin on hemoglobin (Hb) levels and blood transfusion needs in cardiac surgery in patients with preoperative anemia.Methods: This randomized nonblind clinical trial was performed on patients with mild-to-moderate anemia (Hb <12 g/dL in men and Hb <11 g/dL in women) undergoing cardiac surgery at a referral heart hospital (Tehran, Iran). The patients were randomly divided into two groups of 33 patients. In the intervention group, recombinant erythropoietin was administered at a dose of 500 IU/kg one to three days before surgery. Intra- and postoperative Hb levels and the need for blood transfusion were recorded during surgery and for 3 days afterward.Results: The use of packed red blood cells in the operating room was similar in the intervention and control groups (P = 0.156), but it was significantly lower in the intensive care unit in the intervention group (P = 0.030). The mean Hb, which was initially identical in the two groups (P > 0.05), showed a significantly lower decrease in the intervention group (P = 0.001). No significant differences were observed concerning other variables.Conclusions: The use of recombinant erythropoietin (500 IU/kg/day) one to three days before cardiac surgery in our anemic patients blunted a reduction in Hb levels and decreased blood transfusion needs. [ABSTRACT FROM AUTHOR]

Background and Objectives Mortality is one of the common consequences of non-trauma patients (NTP) admitted to the intensive care unit. In this study, hemoglobin concentration and its relationship with clinical outcome in NTP was investigated Materials and Methods This cross-sectional study was performed on the records of 400 non-trauma patients admitted to the General Intensive Care Unit of Besat Hospital in Hamadan during 2020-2022 in terms of hemoglobin concentration and its relationship with clinical outcome. Study data were analyzed using SPSS software version 23 and Student t-tests, one-way analysis of variance, and Pearson correlation coefficient. Results In this Cross-sectional study, cancer (18.8%), drug poisoning (14.8%), poisoning (14.5%), and DKA (8.8%) were the most common causes of non-trauma hospitalization. The incidence of in-hospital death was 18.8%. Sepsis, pulmonary embolism, myocardial infarction, meningitis and DIC with 46.7%, 22.7%, 18.7%, 6.7% and 5.3% were the most common causes of death, respectively. There was a significant relationship between hemoglobin concentration with age, sex and duration of hospitalization (p<0.05). A significant relationship was observed between lower hemoglobin concentration before and during hospitalization with increased mortality (p<0.001). Conclusions In the present study, the hemoglobin of non-trauma patients decreased during hospitalization compared to pre-hospitalization period and this decrease in hemoglobin level was associated with increased mortality of non-trauma patients in the hospital. [ABSTRACT FROM AUTHOR]

Hemoglobin H (Hb H) disease is a subtype of α-thalassemia caused by deletional and/or non-deletional mutations in three alpha-globin genes in which the various genotypes determine the disease severity. This study was aimed to investigate the frequency of alpha gene mutations and genotypes and their correlation with hematological and clinical characteristics in Iran. Among 202 patients diagnosed with Hb H disease through a national study in Iran according to standard methods, we had access to the hematologic and clinical findings and genetic data of 101 patients in whom genetic study was performed. Genomic DNA from peripheral blood was extracted and analyzed for identification of α-globin gene mutations using Multiplex Gap Polymerase Chain Reaction, Reverse Hybridization Assay, and finally Direct DNA Sequencing method. Twenty-one different mutations and thirty genotypes were detected in 101 patients with Hb H disease. In total, 39 patients (38.6%) were deletional and 62 patients (61.4%) were non-deletional type of the disease. The --MED mutation was highly prevalent in almost half of the patients (56.4%). Among various genotypes, –MED/-a3.7 (29.7%) and -α20.5/-α5NT (6.9%) were the most prevalent genotypes found in the studied group. Patients with non-deletional type presented with more severe hematological and clinical findings. Hb H percentage and serum ferritin levels were significantly higher in non-deletional patients in comparison to the deletional group (p < 0.05). 12 (11.9%) and 40 (39.6%) out of 101 patients were on regular and occasional transfusions, respectively. 83% of those with regular transfusion belonged to the non-deletional group. Among transfusion-dependent patients, –MED/αCSα and α20.5/-α5NT were the most common genotypes. In this study, two patients with -α20.5/αCSα and –MED/α−5NT genotypes experienced thrombotic events. This study indicated that although non-deletional genotypes of Hb H disease were responsible for more clinical severity of the disease, due to the presence of severe phenotypes even in deletional types, no definite correlation was found between genotype and phenotype. [ABSTRACT FROM AUTHOR]

Background and Objectives Aortic aneurysm repair surgery (AAAs) is associated with massive bleeding that causes coagulation disorders during and after surgery. Considering that blood consumption in these patients has been studied in a few articles, we decided to investigate more. Materials and Methods In a cross-sectional study, patients with abdominal aortic aneurysms requiring surgical repair from January 2018 to August 2020 were evaluated at Shohada-e-Tajrish Hospital. The blood component utilization was evaluated. Graph Pad prism 9.0.0 (121) software was used for statistical analysis (p < 0.05 was considered significant). Results Of 20 patients with aortic aneurysm repair, 16 (80%) were male and 4 (20%) were female. Seven cases (35%) of them received Fresh frozen plasma (FFP) in addition to packed red blood cells (PRBCs). The mean of FFP utilization was 3.7 ± 1.5 units and in 13 patients (65%) only PRBcs were transfused. Platelets was not transfused in any of the patients. The relationship between red blood cells transfusion with the hemoglobin level before surgery and patient age was evaluated. Also, the relationship between INR before surgery and FFP transfusion was assessed, none of which was statistically significant. Conclusions Despite extensive aortic artery surgery and massive bleeding, in 65% of patients only packed red blood cells were transfused. In 35% of patients, in addition to PRBC, FFP was transfused, but no platelets was administered. [ABSTRACT FROM AUTHOR]

In this study, we describe a new missense variant on the β-globin gene in a heterozygous form in a female individual. Standard methods were used to determine red blood cell indices and perform hemoglobin analyses. Molecular studies were performed on the genomic DNA isolated from peripheral blood cells. Beta-globin genes were amplified and sequenced. We report a novel mutation on the β-globin gene (HBB), c.134 C > T; p.S44F variant, in the heterozygote state which was detected in a female of Persian ethnic origin in the Khuzestan province, southern Iran, that we named Hb Narges Lab (HbNL) variant. This mutation was predicted to be disease-causing in all except one in silico prediction tools. This variant was reported for the first time worldwide, had no shown hematological abnormalities but should be considered when inherited in the compound heterozygous form with β-thalassemia (β0-thal) carrier, which might result in the phenotype of thalassemia intermedia. [ABSTRACT FROM AUTHOR]

Background: It is difficult to classify a small fraction of α- and β-thalassemia (α- and β-thal) carriers based on their Hb A2 levels. Here, we report the results of a molecular investigation in a cohort of thalassemia carriers with borderline Hb A2 levels originated from western Iran. Results: The documents of 5956 α- or β-thal carriers were reviewed. The frequency of individuals with borderline Hb A2 levels in this cohort was 436 (7.32%). A total of 12 different α-thal and 27 different β-thal variants were identified in this study. Conclusions: Our data showed that individuals with borderline Hb A2 are not uncommon in our population. Moreover, preselection of α- and β-thal carriers with borderline Hb A2 levels based on Hb A2, mean corpuscular volume (MCV), and mean cell hemoglobin (MCH) is not advisable in our population. Therefore, it is necessary to investigate both α- and β-globin genes in cases with borderline Hb A2 levels, especially if the partner is a carrier of β-thal or α0-thal. [ABSTRACT FROM AUTHOR]

Background & Aims: COVID-19 is a viral respiratory disease caused by SARS-COV-2, which affects the lower respiratory tract, and causes pneumonia in patients. The disease rapidly spread around the world after the outbreak in late 2019, and became one of the challenges of health care systems. Older adults and patients with underlying diseases such as cardiovascular diseases, hypertension, and diabetes are at a higher risk for COVID-19, and need more care. Due to its prevalence in older adults and normal population, diabetes is important in terms of putting a burden on intensive care systems during the COVID-19 pandemic. Diabetes is also one of the most common comorbidities in patients with COVID-19, which is considered a risk factor for these patients. In addition, the association between diabetes and respiratory distress syndrome is not yet fully understood. Some studies have suggested that diabetes is not associated with respiratory distress syndrome while some others suggest that pulmonary dysfunction follows diabetes. It is also unclear what factors are associated with disease prognosis and mortality in COVID-19 patients with diabetes. In the current study, we aimed to investigate the status of demographic factors, comorbidities, lifestyle and laboratory results in diabetic patients with COVID-19, and compare them with the non-diabetic population and determine the prognostic factors in diabetic patients with COVID-19. Methods: This study is a cross-sectional study performed on 415 patients with COVID-19 in the COVID-19 ward of Shahid Mohammadi Hospital of Hormozgan University of Medical Sciences from February to September 2020. Based on their diabetes, these patients were divided into diabetic and non-diabetic groups. Then, data on demographic factors, smoking, opioids and alcohol consumption, comorbidities (chronic lung disease, asthma, obesity, chronic kidney disease, type 2 diabetes, dementia, malnutrition, chronic neurological disease, rheumatic disease, hypertension, hyperthyroidism, hypothyroidism, favism, hyperlipidemia, and malignant neoplasms), some personal lifestyle features were determined in diabetic patients and compared with non-diabetic populations. Also, the information on biochemical variables, including hemoglobin, white blood cells, lymphocyte, neutrophils, hematocrit, platelets, prothrombin time, alanine aminotransferase, bilirubin, aspartate transaminase, lactate dehydrogenase, blood urea nitrogen, creatinine, blood glucose, sodium, potassium, C reactive protein were measured patients of the two groups. Also, heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, temperature, and oxygen saturation were determined in diabetic and non-diabetic patients. Quantitative variables were described by number (n) and percentage (٪). Qualitative variables were described using mean and standard deviation (SD), median and interquartile range (IQR). The Shapiro-Wilk test was used to assess the normality of quantitative variables. Independent t-test or Man-Whitney U test, and Chi-square or Fisher's exact tests were used to compare variables. In all statistical analyses, a p-value less than 0.05 was considered statistically significant. Statistical analysis was performed by IBM SPSS version 22 (IBM Corporation, Armonk, NY, USA). Results: The findings of our study showed that in the diabetic patients’ group 82 patients (41.2%) and in the non-diabetic population 135 patients (55.32 %) were men. In the diabetic group, the mean age of recovered patients was 58.52 years and the mean age of those in the deceased was 57.73 years, which was not statistically significant. In the non-diabetic group, the mean age of patients recovered was 47.98 years and the mean age of those in the deceased was 62.58 years, which was statistically significant (p <0.001). In the diabetic population, 773 patients (42.69 %) and in the non-diabetic population, 132 patients (54.09 %) had positive PCR. In the diabetic population, 18 patients (10.59 %) and in the nondiabetic population, 10 patients (4.09 %) had chronic kidney disease. In the diabetic population, 11 patients (6.43 %) and in the non-diabetic population, 13 patients (5.32 %) smoked. In the population of diabetic patients, the mean level of hemoglobin (P = 0.002) and lymphocyte count (P = 0.043) in the living cases were significantly lower than those in the deceased. The mean levels of neutrophils (P = 0.012), aspartate transaminase (P = 0.020), lactate dehydrogenase (P = 0.041), blood urea nitrogen (P = 0.003), and creatinine (P = 0.011) in the diabetic population were significantly higher in the living cases than those in the deceased, but the comparison of these cases in the non-diabetic population did not show a significant difference. In diabetic patients, there was a significant difference between the number of survival and death in each group of positive and negative PCR (P = 0.011); While the difference in mortality and survival between PCR positive and negative groups in non-diabetic subjects was not significant. In diabetic patients, a significant difference was also reported between the number of survival and death in groups with CKD and without CKD; while in nondiabetic participants there was no significant difference between CKD and non-CKD groups in terms of survival and death. Corticosteroid treatment also significantly led to a difference in the number of survival and death cases among the diabetic population, but a comparison of these cases in the non-diabetic population did not show a significant difference. In the group of diabetic patients, respiration rate (number of breaths per minute) was significantly lower among the living cases compared to those in the deceased (P < 0.05), while our findings in this regard did not show a significant difference in non-diabetic individuals. Also, in diabetic patients, the amount of oxygen saturation was significantly higher among the living cases than those in the deceased (P < 0.05), in which case the same results were observed in non-diabetic patients (P < 0.05). Conclusion: In this study, the mortality rate in diabetic patients was significantly associated with lymphopenia, elevated aspartate transaminase, lactate dehydrogenase, blood urea nitrogen, and creatinine compared to non-diabetic patients. Our findings suggest that individuals with type 2 diabetes are more prone to complications of COVID-19 and its related mortality; therefore these patients need more medical attention in the COVID-19 pandemic. Also, considering that so far limited studies have focused on the possible differences in the complications of Covid-19 disease and its mortality in diabetic individuals compared to non-diabetic individuals, it is recommended that more studies with higher sample sizes in other populations be performed to confirm the results of the present study. [ABSTRACT FROM AUTHOR]

The objective of present study is to investigate the effects of walk training with and without blood flow restriction (BFR and no-BFR) on lipid profiles, inflammatory and haematological factors in over-weighed men. Participants were divided into BFR (n = 9) or no-BFR (n = 9) groups. Both groups were exposed to 8-week walk training on a treadmill: 3 sessions/week at a speed of 50 m/min, 5 sets × 2 min/session. There were differences in pre- to post-levels of (TG) and fibrinogen in the BFR group (p ≤ 0.05) that were accompanied by changes in red blood cells (RBC), haemoglobin (HGB) and haematocrit (HCT) levels (p ≤ 0.05). RBC levels were increased in the BFR group (p ≤ 0.05). The groups differed in their mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC). These findings suggest the efficiency of BFR walk training in individuals exposed to chronic diseases associated with overweight, such as metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background and Objectives Given transfusion complications, high expenses, inadequacy of resources and time constraint in ensuring blood products, it is necessary to investigate the status of blood consumption and factors affecting the proper use of products. In this study, the consumption status of RBCs was investigated in Imam Khomeini Hospital in Mahallat city. Materials and Methods In this retrospective descriptive cross-sectional study, patient hemoglobin data were collected at the time of hospitalization, at the time of blood order, after blood administration, and at discharge. At the same time, the data on physician name, reason for hospitalization, platelet count, patient PT and PTT tests, and ratio of crossmatch by blood transfusion (C/T) were collected. Results Out of 356 patients injected with RBCs, 91.7% were anemic at the time of blood request and 51.7% had the hemoglobin levels higher than 8 g/dL and received RBCs. The average C/T index was 1.06 with the highest value (1.8) pertaining to the surgical department and the lowest to the dialysis ward. There was no significant correlation between age, gender, PT, PTT, cause of hospitalization, and physician with frequency of blood transfusion. Conclusions The results showed C/T ratio to transfusion being lower than the acceptable value and indicated the ratio of blood order to transfusion being desirable. There was a significant correlation between blood order and hemoglobin reduction. Given the average hemoglobin threshold of patients at the time of blood order, it has been shown that mainly liberal transfusion strategy has been used in the hospital. [ABSTRACT FROM AUTHOR]

Background Iron Deficiency Anemia (IDA) is the most common form of anemia. Understanding the relationship between IDA and hearing loss may provide new insights into managing hearing loss. Objective This study aimed to investigate the relationship between IDA and hearing loss in women aged 12-45 years referred to Amir Al-Momenin and Al-Zahra hospitals in Rasht City, Iran. Methods In this case-control study, 315 women aged 12-45 years with IDA and without IDA were included. Study groups were matched by age. The amount of hemoglobin (based on the last blood test in the past month) of the subjects was measured and recorded. IDA was considered when the hemoglobin level was less than 12 mg/dL. Audiometry was performed for all participants. Results In total, 169 individuals in the case group and 146 individuals in the control group participated in the study. The Mean±SD hemoglobin level in the case and control groups were 10.9±1.36 and 12.67±1.47 mg/dL, respectively. There were higher hearing thresholds in low and high frequencies among the case group than the controls (P=0.002 and P=0.032, respectively). Logistic regression analysis after age adjusting showed odds of abnormal Distortion Product Otoacoustic Emissions (DPOAE) in the frequencies of 750 Hz and 1000 Hz more than 2 times in women with IDA compared to controls (OR= 2.21, P= 0.006 and OR= 2.40, P= 0.020, respectively). Conclusion The study results showed a significant negative relationship between IDA and mean hearing threshold. Because of the high prevalence of IDA in women, this group may be at greater risk of hearing loss. [ABSTRACT FROM AUTHOR]

Background: Exercise can reduce hepcidin, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 and improve the iron status, but the intensity of exercises is very important. This study will compare the effect of resistance training (RT) intensity on hepcidin levels, iron status, and inflammatory markers in overweight/obese girls with and without iron stores deficient. Materials and Methods: In this quasi-experimental study, 40 students of the University of Isfahan (18-22-year old, with 35 > body mass index [BMI] ≥25) voluntarily participated in the study. Participants were divided into two groups with 20 participants, based on serum ferritin (>30 ng/ml or ≤30 ng/ ml). Participants in each group were randomly and equally assigned to one of the moderate or high-intensity training groups. RT was performed 8 weeks, 4 days a week, and each session for 1 h, with an elastic band. The iron levels, hepcidin, total iron-binding capacity, ferritin, hemoglobin, TNF-α, and IL-6 before and after intervention were collected with the blood samples. Two-way analysis of variance was used to assess the impact of exercise and ferritin level and their interaction, and the paired test was utilized for test changes from baseline. Results: There are no significant interactions between ferritin levels and exercise intensity for the main outcomes (all P > 0.05). The significant impact of the mode of exercise was observed in TNF-α (P < 0.05), and a significant difference between low and high levels of ferritin was observed in hepcidin (P = 0.002). Besides, in all four groups, significant decreases were observed in BMI (28.00 ± 3.00 to 27.00 ± 3.00), hepcidin (1234.02 ± 467.00 to 962.06 ± 254.00), and TNF-α (223.00 ± 99.00 to 174.00 ± 77.00) compared to the baseline measurements (all P < 0.05). Conclusion: Basal ferritin levels appear to be effective on hepcidin levels, TNF-α, and IL-6 after the intervention. RT with two different intense can reduce BMI, hepcidin, ferritin, and TNF-α in all groups. It seems that performing RT reduces inflammation and hepcidin in obese/overweight participants with different iron stores. [ABSTRACT FROM AUTHOR]

Background/Aim In noncontrast computed tomography (NCCT), an apparently hyper-attenuated cerebral venous sinus (CVS) may lead to suspicion of CVS thrombosis. Understanding the factors affecting attenuation of CVS can guide us toward true diagnosis. Hence, the aim of the study was to determine the effect of different factors such as hematocrit, hemoglobin, age, blood urea nitrogen (BUN), creatinine, leukocyte and platelet count, and sex on the attenuation of CVS on brain NCCT. Material and Methods Total 1,680 patients were included in this study, and their demographic and laboratory data and brain NCCT were reviewed. In their brain NCCT, the average attenuation of superior sagittal sinus and both right and left sigmoid sinuses was measured. Data analysis was conducted using the Statistical Package for the Social Sciences version 21.0 software by Kolmogorov-Smirnov, Spearman's correlation coefficient, and multiple linear regression tests. The significance level was considered less than 0.05. Results Hematocrit (B = 0.251, p < 0.001), hemoglobin (B = 0.533, p < 0.001), and creatinine (B = − 0.270, p = 0.048) were determined as predictors of attenuation of superior sagittal sinus. For both sigmoid sinuses, hematocrit (p < 0.001) and hemoglobin (p < 0.001) were determined as positive predictors, and creatinine (p < 0.001) and BUN (p < 0.002) were determined as negative and positive predictors, respectively. Conclusion Hemoglobin, hematocrit, creatinine, and BUN are the main factors that should be considered in the assessment of CVS density on brain NCCT. As with increasing hematocrit and hemoglobin of the subject, the CVS density in NCCT increases, and with increasing creatinine and in some instance decreasing BUN of the subject, the CVS density in NCCT decreases. [ABSTRACT FROM AUTHOR]

Background and Objectives According to the relevant studies, among the reported TMPRSS6 polymorphisms associated with iron deficiency anemia, rs855791 has the highest association with hemoglobin level and disease severity. The aim of this study was to investigate the relationship between rs855791and iron deficiency anemia in Sanandaj. Materials and Methods In this case-control study conducted in the Spring of 2016, the frequency of rs855791 polymorphism in TMPRSS6 gene was evaluated in 40 patients with iron deficiency anemia and 80 healthy randomly selected individuals without age and sex restrictions by PCR-RFLP method. Then, the relationship between rs855791 and the level of hemoglobin, ferritin, and MCV in sick and healthy individuals was investigated by SPSS V19 statistical software. Results The frequencies of CC, CT, and TT among 40 patients were 15, 37.5, and 47.5 and they were 33.75, 42.5, and 23.75% among 80 healthy controls, respectively. Therefore, there was a significant relationship between TT genotype and disease (p= 0.010). Also, a significant relationship was observed between the frequency of CC and the absence of disease [OR= 0.34, p= 0.035]. The higher frequency of CT in the control group than the indicates a lower risk of people with CT genotype. The results also show a significant relationship between low Hb, MCV, and Ferritin with the genotype so that people with TT genotype had lower Hb, MCV, and ferritin than people with CC and TC genotypes. Conclusions TMPRSS6 rs855791 polymorphism was shown to be effective in subject patients with iron deficiency anemia in Sanandaj city. [ABSTRACT FROM AUTHOR]

Background and Objectives Chronic blood transfusion can cause alloimmunization in patients with thalassemia. Estimating the frequency of alloimmunization in thalassemia patients can lead to the recognition of existing limitations and the development of appropriate strategies to prevent alloimmunization in thalassemia patients. In this study, we evaluated the prevalence of alloimmunization among patients of thalassemia. Materials and Methods In this cross-sectional and retrospective study, the study population was 92 patients with thalassemia referred to Besat Hospital in Hamadan in 2019. The data of all thalassemia patients was collected by census method and entered into SPSS software version 16. The Data was analyzed using Logestic Regression and significance level by p < 0.05. Results 92 patients including 54 male (58.7% ) and 38 female (41.3%), aged 2-50 years were studied. Among 92 patients, 7 people (7.6%) had positive antibody screening results. The most prevalent detected alloantibodies were anti-c with 6 patients (33.3%), anti-e with 3 patients (16.6%) and anti-JKa with 3 patients (16.6%). The meaningful relation was observed between alloimmunization and hemoglobin concentration (p = 0.006), and alloimmunization and number of blood transfusion (p= 0.009). But there was no significant relation between alloimmunization and age. Conclusions According to the results of this study, anti-c, anti-e, and anti-JKa are the most prevalent alloantibodies in the thalassemia patients in Hamadan. This point could be useful to provide suitable matched blood units for thalassemia patients. [ABSTRACT FROM AUTHOR]

Aim: This this study aimed to investigate the causes and prognoses of liver re-transplantation in patients referred to Imam Khomeini Hospital Liver Transplantation Center. Background: Organ shortage is a major problem in the world, a high demand for liver transplantation has exacerbated this problem. Thus, providing more information on the causes of liver re-transplantation, its prognosis, and other issues related to this procedure is of great importance. Methods: This study was conducted in 2018 as a historical cohort. In this study, the records of liver transplantation patients at Imam Khomeini Hospital Liver Transplantation Center between 2000 and 2016 were studied, and data was extracted from the records of patients undergoing liver transplantation. Patient data was entered into SPSS 20 software and analyzed. Results: In this study, 1030 patients with a mean age of 43.15 ± 14.57 years were studied. There were 426 women (41.4%) and 604 men (58.6%). The number of primary transplants was 966 with a mean age of 43.19 ± 14.72, and the number of re-transplants was 64 with a mean age of 42.56 ± 12.82. Significant differences were found between the two groups in terms of MELD and CHILD scores, cold ischemic time, total and direct bilirubin levels, liver function factors (ALT, AST, and alkaline phosphatase), hemoglobin, and WBC. There was no significant difference between the two groups in terms of age, sex, or platelets (> 0.05). The mortality rate was 241 (23.39%) in all patients and the mortality rate was 206 (21.32%) and in liver transplant patients was 35 (54.68%). The mortality rate in the transplant group was statistically higher (p<0.001). Secondary was primary non-functional graft (PNF) (37.5%) with 1-, 3, and 5-year survival rates of 82%, 81%, and 70% in primary group and 59%, 43% and 32% in re-transplantation, respectively. There was a significant difference in survival between the two groups (p <0.05). Hemoglobin and alkaline phosphatase were predictors of survival rates in transplant patients. Conclusion: The results of this study showed that the survival rate of re-transplant patients was significantly lower than that of primary transplant patients, and the mortality rate in re-transplant patients was significantly higher. [ABSTRACT FROM AUTHOR]

Background: Iron deficiency anemia disrupts the concentration of adolescent girls; reduces their academic achievement, productivity, and physical strength, and increases the risk of infection. This research aim was to evaluate the effectiveness of the PRECEDE model nutrition education on iron deficiency anemia among female students of Fasa City, Fars Province, Iran.Methods: This quasi-experimental study was done on 160 students (80 experimental and 80 control groups) who were selected using a random sampling method in Fasa City, Fars Province, Iran, in 2018-2019. The educational intervention included six sessions based PRECEDE model for 45 or 50 min. A scale of this study consisted of two parts; demographic information, and PRECEDE constructs were used to determine the nutritional behaviors status concluding preventing iron deficiency anemia and hemoglobin, hematocrit, and ferritin blood level in two (before and 4 months after intervention) times.Results: In the experimental group of the students the mean age was 13.85 + 1.72 years and in the controlled group was 13.60 + 1.81 years. Moreover, there was no significant difference in the PRECEDE constructs, and nutritional behaviors preventing iron deficiency anemia before the intervention in two groups of study. However, the experimental group showed a significant increase 4 months after the intervention. Also, there was no significant difference in the mean score of hemoglobin, hematocrit, and ferritin blood level between the two groups before the intervention. However, in ferritin level, a significant increase was shown in 4 months after the intervention in the experiential group.Conclusions: Based on results, the nutrition intervention education base on PRECEDE model has a positive effect to improve iron deficiency anemia preventive behaviors in female students. [ABSTRACT FROM AUTHOR]

Background: Recently, the correlation between necrotizing enterocolitis (NEC) and packed cell transfusion (PCT) has been identified. Evidence shows that 25 - 35% of NEC cases are associated with PCT. Objectives: this study aimed to determine the association between PCT and feeding tolerance in healthy preterm newborns. Methods: Materials and Methods: This clinical trial was performed on preterm infants, admitted to the neonatal intensive care unit (NICU) of Mofid Children's Hospital, Tehran, Iran, from April 2017 to May 2018. A total of 70 healthy premature infants (birth weight < 1500 g and gestational age < 32 weeks) with enteral feeding, who required PCT, were included in this study. The eligible infants were divided into two groups by block randomization. In the intervention group (n = 35), breastfeeding was withheld only during PCT and then continued as usual. On the other hand, in the control group (n = 35), feeding was performed as usual, regardless of PCT. Feeding tolerance within the first 72 hours post-transfusion was compared between the two groups. Sick newborns were excluded from the study. Data analysis was performed in SPSS version 20. Results: The mean gestational age, birth weight, and postnatal age of the neonates were 30.13 weeks, 1245.71 g, and 17 days in the intervention group and 29.97 weeks, 1169.43 g, and 15.46 days in the control group, respectively; there was no significant difference between the two groups. Except for pre-transfusion hemoglobin and hematocrit levels, other characteristics of the two groups were similar. Feeding tolerance was reported in 32 (91.2%), 33 (94.73%), and 34 (97.1%) newborns at 24, 48, and 72 hours post-transfusion in both groups, without any significant difference. There was no significant difference between neonates with and without feeding tolerance in either of the groups. Conclusions: According to the present results, withholding feeding during PCT is not necessary in healthy preterm neonates with a good general condition, and continued breastfeeding seems to be a safe option. [ABSTRACT FROM AUTHOR]

Background: For many patients with neurological complaints, a non-enhanced brain computed tomography (CT) scan is the first workup. In some of these patients, there is no pathological finding. Anemia is a condition that can present with neurological symptoms without any imaging findings. The correlation of dural venous sinus density with hemoglobin (Hb) level has been shown in some recent studies. Objectives: This study aimed to propose a strategy to predict the level of Hb and investigate the possibility of underlying anemia based on dural venous sinus density to facilitate treatment. Patients and Methods: The CT scans of selected patients, who were referred to Faghihi Hospital in Shiraz, Iran, from October 2018 until February 2019, were reviewed in this study; the complete blood count (CBC) was measured for cases without any findings. The data of 78 patients, including CBC parameters and the mean Hounsfield unit (HU) in the superior sagittal sinus (SSS), torcula herophili (TH), and transverse sinuses (TS), were also analyzed. Results: A relatively strong direct linear correlation was found between the Hb level and HU. The Hb level was calculated based on the following formula: Hb level = 0.2 x SSS HU + 1.2 x sex factor - 0.01 x age (where sex factor is zero for females and one formales). Besides, measurement of the cutoff point for the mean HU of SSS, based on the ROC curve to predict anemia, showed that with SSS HU ≤ 50, anemia could be predicted with 84.62% sensitivity, 75.38% specificity, and 75.64% accuracy in the general population. Conclusion: A significant positive correlation was found between the Hb level and the mean HUof dural venous sinuses. Therefore, the level of Hb is predictable based on HU, and differential diagnoses are limited. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this double-blind clinical trial, was to examine the effect of supplementation with the synbiotic and probiotic on the mental health, quality of life, and anemia in HD patients. Methods: Seventy-five HD patients were randomly assigned to receive the synbiotic (n = 23) as 15 g of prebiotics, 5 g of probiotic powder containing Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium lactis, and Bifidobacterium longum (2.7 x 107 CFU/g each); probiotics (n = 23) as 5 g probiotics similar to the synbiotic group with 15 g of maltodextrin as placebo; and placebo (n = 19) as 20 g of maltodextrin. Serum hemoglobin (Hb) and albumin (Alb) were measured. Beck depression and anxiety index (BDI/BAI) was used to assess symptoms of depression and anxiety. The health-related quality of life (HRQoL) was assessed using the questionnaire SF-36. Results: From baseline to 12 weeks, synbiotic and probiotic supplementation resulted in a significant decrease in BDI and BAI score in comparison to the placebo (P < 0.05). Between and intergroup comparison showed no significant changes between the groups in terms of HRQoL. However, the serum Hb level increased significantly in the synbiotic and probiotic group compared to the placebo group (P < 0.001). Conclusion: Overall, 12 weeks of synbiotic and probiotic supplementation resulted in an improvement in mental health and anemia compared with the placebo, whereas they failed to enhance the quality of life in HD patients. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy is the most commonly used modality for the removal of kidney stones larger than 2 cm in size. Like other stone removal methods, percutaneous nephrolithotomy also has some complications, including bleeding and delayed hematuria. These complications are improved with conservative management and bed rest most of the time. However, it may require more invasive treatments. Angioembolization following an abnormal renal angiography is an efficient treatment modality for delayed hematuria. Furthermore, nephrectomy is suggested in uncontrolled cases of delayed hematuria when renal angiography is normal., Case Presentation: We described two cases of uncontrolled delayed hematuria after percutaneous nephrolithotomy and angioembolization were carried out rather than potential nephrectomies. The first case was a 61-year-old Iranian man with left kidney stones, for whom percutaneous nephrolithotomy was planned. The patient was referred to the hospital after discharge with massive hematuria and had normal angiographic findings. An angioembolization was suggested for the patient and was carried out. His hematuria was dramatically improved within 30 minutes, and his hemoglobin level started to increase 2 days later. The second case was a 53-year-old Iranian man with kidney stones who was a candidate for right kidney percutaneous nephrolithotomy. The patient was referred to the hospital 4 days after discharge with a decreased hemoglobin level and massive hematuria. The patient had normal angiographic findings and was planned for angioembolization to control his hemorrhage, which dramatically decreased after the angioembolization within 60 minutes., Conclusion: Embolization of the segmental arteries of the targeted calyx can eliminate hematuria of the patient and prevent further nephrectomy., (© 2024. The Author(s).)

Objectives: Chronic lymphocytic leukemia (CLL) is characterized by the accumulation of apparently mature B-type lymphocytes in the lymphohematopoietic organs. Methylation in promoters of tumor suppressor genes is one of the mechanisms that causes blood malignancy. In this study, we evaluated the promoter DNA methylation status of miR-129-2 tumor suppressor gene and its association with clinical and laboratory parameters of patients with CLL. Methods: We studied the promoter DNA methylation frequency of the miR-129-2 gene in 50 patients with CLL and 50 healthy controls using methylation-specific polymerase chain reaction methods. Statistical analysis was performed using SPSS-18 software, and a p-value < 0.050 was considered statistically significant. Results: The frequency ofpromoter DNA methylation ofthe miR-129-2 gene was significantly higher in the CLL group compared with control group (38.0% vs. 0.0%, p < 0.001; χ² = 23.457). The promoter DNA methylation frequency of miR-129-2 gene was not significantly different between the two sexes (p = 0.236). A significant but weak correlation was seen between the methylated state of the miR-129-2 gene and organomegaly (p = 0.019, r = 0.330) as well as hemoglobin levels (p = 0.020, r = -0.233). However, binary logistic regression analysis indicated organomegaly as the only clinical biomarker with a statistically significant association with the hypermethylated miR-129-2 gene state (p = 0.046). Conclusions: The high frequency of promoter DNA methylation of the miR-129-2 gene in the CLL group compared to the control group, as well as its significant association with organomegaly, suggests the importance of this epigenetic biomarker in the pathogenesis and prognosis of CLL disease. [ABSTRACT FROM AUTHOR]

Background and Objectives To perform open heart surgery, the patient needs to be placed on the bypass system. This initial volume causes excessive dilution of the patient's blood and the use of blood products, which can alter the surgical procedure and recovery of the patient. The purpose of this study was to evaluate the usefulness of performing a retrograde autologous prime to reduce blood products consumption. Materials and Methods This is a prospective randomized clinical trial to evaluate whether RAP can reduce hemodilution in CPB and prevent allogeneic blood transfusion. In this study, 59 consecutive patients were randomly divided into two groups of RAP - with reverse autologous priming (n = 28) and control (Non RAP) - with normal priming (n = 31) being evaluated at Shahid Rajaee Cardiovascular Center between 1396-97. Results Statistical evaluations were performed with Chi Square, T-Test, and Mann-Whitney U tests. It was identified by placing patients on bypass, hemoglobin and hematocrit in the first and second samples, end of bypass, and on ICU that was significantly higher in the experimental group. The number of patients receiving the product and the number of products consumed in the control group were significantly higher. The duration of mechanical ventilation was significantly lower but the ICU stay was not significantly different. Conclusions From these results, it can be concluded that the implementation of RAP retrograde autologous priming can effectively preserve hemoglobin and hematocrit of patients in acceptable range and reduce the use of blood products in patients undergoing bypass. [ABSTRACT FROM AUTHOR]

Background: Sarcoidosis and tuberculosis (TB) are two granulomatous inflammatory diseases with several common symptoms. The aim of the present study was to compare the serum levels of biomarkers including interleukin-4 (IL-4) and IL-13, calcium (Ca), hemoglobin, sedimentation rate, and lymphocyte-to-neutrophil ratio between patients with pulmonary TB, patients with sarcoidosis, and control group. Materials and Methods: This case--control study was performed on patients referred to the Masih Daneshvari Hospital, Tehran, from April 2017 to 2018. In this study, 24 newly diagnosed patients with active pulmonary TB, 34 patients with pulmonary sarcoidosis, and 30 healthy individuals as the control group were enrolled. Demographic data, erythrocyte sedimentation rate (ESR), the ratio of neutrophil to lymphocyte (NLR), serum Ca level, hemoglobin (Hb), and IL-4 and IL-13 were compared between the study groups. Receiver operating characteristic (ROC) curve analysis, sensitivity, and specificity were also calculated using SPSS 16.0 software. Results: The mean age was 47.71 ± 10.88 and 55.25 ± 21.58 years in the sarcoidosis and TB. The mean ESR in sarcoidosis patients was 21.45 ± 13.37 mm/h and 41.4 ± 17 mm/h in the TB group. The percentage of peripheral blood lymphocytes in sarcoidosis and TB patients was 28.02 ± 12.20 and 21.41 ± 12.49, respectively, which was significantly higher among patients with sarcoidosis. NLR was also 2.4 ± 1.6 and 4.4 ± 2.9 in sarcoidosis and TB patients, respectively, which showed a significant difference among the groups. Regarding the evaluation of the level of IL 4 and IL 13 in patients, it is worth noting that IL-4 in patients with sarcoidosis was 90 pg/ml compared to 20 pg/ml for TB patients (P < 0.001). There was no significant difference in the levels of IL-13 in the TB and control groups, which varied between 20 and 80 pg/ml (P = 0.35). However, its value was significantly higher in patients with sarcoidosis (P = 0.01) than in the healthy control group and TB (P = 0.01). The ROC curves showed that the diagnostic cutoff of ESR level, Ca, NLR, and Hb could be valuable due to the area under the curves. The cutpoint of 34 mm/h for ESR had a sensitivity of 86% as well as 80% specificity to distinguish TB from the sarcoidosis. Conclusion: Serum levels of the biomarkers indicated a stronger immunological background in sarcoidosis using NLR, Ca, ESR, and Hb. [ABSTRACT FROM AUTHOR]

The Cystatin C is early predictor for evaluation the kidney functions. The Serum Cystatin C is a cysteine proteinase inhibitor, that the nucleated cells produce it at stable rate. It is filtered through the glomerular filtration membranes of kidneys, and the filtration rate will be unaffected by external factors. A group of recessively inherited hemoglobin disorders called Major Beta-thalassemia and considered the most common genetic disorder all over the world, which could be noticed by the reduction in of β-globin chain synthesis. Objective: To study Serum Cystatin-C estimation as early marker of renal function in relation with other parameters in beta thalassemia patients. Materials and Method: A case-control study was executed on thalassemia patients between February and April 2019 at Al-Zahra'a Teaching Hospital in Najaf/Iraq. Results: the results in this study showed there are significant differences (p≤ 0.05) between major beta thalassemia patients and control group in regarding to hematological parameters. The result of biochemical parameters showed there are variations between patients and control where there were significant statistical increases in our thalassemic patients comparing to the control about Cystatin-C (1.27±0.33and 0.7±0.24 ng\ ml respectively). Conclusion: the cystatin -C is useful marker at major beta thalassemia patients that suffering from renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: The incidence of renal hemorrhage during percutaneous nephrolithotomy (PCNL) is high. We sought to evaluate the effects of tranexamic acid (TXA) on bleeding and hemoglobin levels of patients with staghorn calculi treated with PCNL. Methods: In a double-blind clinical trial, 120 patients with staghorn calculi candidated for PCNL in Alzahra Hospital between January 2014 and November 2017, Isfahan, Iran, were classified into two groups in terms of the stone size (>4 cm and <4 cm). The patients in both groups were then randomly assigned to receive either 1 g of TXA intravenously or normal saline. (The generation of random numbers was done by computer.) Thus, there were four groups of 30 patients each. The transfusion rate, the mean volume of blood loss, the operative duration, and the hemoglobin level were compared between the intervention and control groups for each stone-size category. Statistical analysis was performed using SPSS, version 19. The paired and independent t test and the Pearson coefficient correlation were used, and a P value less than 0.05 was considered statistically significant. Results: The mean volume of blood loss was significantly higher in the control group patients than in those receiving TXA, in both stone-size categories (P=0.00). There was no significant difference in the postoperative hemoglobin level between the intervention and control groups, in both stone-size categories (P=0.26 and P=0.10, respectively). In addition, the mean volume of blood loss increased significantly with an increase in the operative duration (P=0.00). Conclusion: TXA reduced the risk of bleeding during and after PCNL and attenuated the drop in the hemoglobin level in the postoperative period. Longer operative procedures were associated with an increase in the bleeding volume. Trial Registration Number: IRCT20180209038673N1 [ABSTRACT FROM AUTHOR]

Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction–based) criteria. All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09–0.36) and place of residence (OR = 0.41, 95% CI = 0.19–0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities. • Fifty-eight percent of all maternal near miss (MNM) cases were related to women with a history of cesarean section. • Abnormally invasive placenta was the most common cause of sever hemorrhage. • Anemia and living in rural areas were the determinants of severe maternal outcomes. • Delay in providing care and harmful practices were contributed to MNM incidence. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is associated with significant blood loss. Antifibrinolytic agents such as tranexamic acid (TXA) are widely used to manage blood loss during TKA. This study aimed to compare the efficacy of three different administration approaches of TXA in TKA., Methods: In a prospective, multicenter study, 285 patients with end-stage osteoarthritis who underwent TKA between 2020 and 2022 in three orthopedic surgery centers were included in the study. To manage bleeding during TKA, one of the three methods of intravenous administration (IV), intra-articular injection (IA), and combination administration of TXA was performed for the patients. Postoperative blood loss was calculated using blood volume and change in hemoglobin level from preoperative measurement to postoperative day 3., Results: The mean baseline Hemoglobin (Hb) was not significantly different between the three study groups (p > 0.05). The mean postoperative Hb of 12 h, 24 h, and 48 h after the surgery was not significantly different between the three stud groups (p > 0.05). The mean intraoperative blood loss in the combined TXA group was significantly lower compared to the IV and IA groups (0.025). The number of blood transfusions in the three study groups was not statistically significant (p > 0.05). No side effect was recorded in any group, as well., Conclusion: Blood loss in the combination TXA group was significantly less than in the other two groups. Combination TXA can help reduce blood loss after TKA surgery., (© 2023. The Author(s).)