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Abstract Background Breast cancer is one of the most common diseases globally that may have side effects on liver and renal function. Pharmacological treatments to reduce adverse liver and renal effects are still limited. It has been proposed that silymarin may possess hepatoprotective and anti-inflammatory properties. The present trial aims to assess the hepatorenal protective efficacy of silymarin supplementation in cancer patients receiving chemotherapy in an outpatient setting. Method This is a randomized, placebo-controlled clinical trial that recruited female breast cancer patients. Participants were randomly assigned to one placebo group and two intervention groups. The control group received 140 mg of placebo daily, while the two intervention groups received 140 mg silymarin daily. Follow-up assessments were conducted at baseline, 3 weeks, and 6 weeks. At the beginning of the study, the patients were subjected to a computed tomography (CT) scan, and the liver and renal parameters such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), bilirubin, Blood urea nitrogen (BUN) and Creatinine (Cr) were examined through laboratory tests. Results Despite two deaths and three dropouts, 100 patients completed the study. Silymarin showed significant effects on liver enzymes in the levels of ALP and bilirubin (P 0.05). The medication was well-tolerated, with minimal reported side effects (P > 0.05). Discussion The study suggests that silymarin may have hepato-renal protective potential in breast cancer patients and improve patient tolerance to chemotherapy. The data presented on the efficacy and safety of silymarin may provide stronger foundation for further trials and for a possible use in clinical practice. Trial registration information Registration Number: IRCT20201123049474N2, First Trial Registration: 16/08/2021, Access: https://www.irct.behdasht.gov.ir/trial/57641

Background: Cancer has become a significant health challenge in recent decades. The Taxane family is one of the popular chemotherapeutic agents which can cause hepatic injury. The present study was conducted with the aim of evaluating the hepatoprotective effect of Curcumin on cancer patients treated with Taxanes. Method: This controlled randomized clinical trial (RCT) has been conducted on 80 patients with either breast, ovary, or pancreas cancer randomly allocated to the intervention group (n = 37) treated with daily 47.5 mg Curcumin extract or the control group (n = 34) treated with placebo. Hepatic indices, including alanine transaminase, aspartate transaminase, total bilirubin, and alkaline phosphatase, were measured and compared at baseline within three and six weeks after the intervention initiation. Results: The assessments revealed a remarkable increase in all of the indices in both groups by the time (P < 0.05), while these increases were remarkably less among the patients treated with curcumin in comparison with placebo treatment (P < 0.05). The Mean ± standard deviation was 26.3 ± 8.6 and 29.8 ± 10.5 for aspartate transaminase, 25.5 ± 8.3 and 30.2 ± 10.6 for alanine transaminase, 122.9 ± 18.02 and 126.8 ± 16.9 for alkaline phosphatase, 0.88 ± 0.10 and 0.95 ± 0.12 for bilirubin in the intervention and control groups, respectively. Conclusion: Based on the current study's findings, Curcumin could act relatively as a hepatoprotective agent against Taxane; however, further studies are strongly recommended to determine the dosage and consumption instruction of this agent for patients with cancer.

Background: Chemotherapy-induced peripheral neurotoxicity (CIPN) is one of the major complications of chemotherapy regimens commonly used in the treatment of solid and hematologic cancers. Given the high incidence of CIPN in antitumor therapies in patients and limited studies on antioxidants, this study was aimed to investigate the effect of Silybum marianum (SM) on cisplatin-induced peripheral neuropathy. Materials and Methods: This double-blind randomized clinical trial study was performed on 60 cancer patients treated with cisplatin chemotherapy at Seyyed-o-Shohada Hospital of Isfahan during 2019–2020. The patients were divided into two parallel groups as intervention (treated by SM) and placebo, and DN4 (Douleur neuropathique 4 questions) and CIPNAT (chemotherapy-induced peripheral neuropathy assessment tool) were completed for patients in the before and after intervention groups and compared between the two groups. Results: The mean of DN4 score in the before and after study in the intervention group was in 1.76 ± 1.24 and 2.07 ± 2.03, respectively (P = 0.38), and in the control group was 1.41 ± 1.28 ± 3.11 ± 2.86, respectively (P = 0.012). The mean CIPNAT score in the intervention groups was 5.93 ± 3.65 and 4.20 ± 3.23 (P = 0.01), and in the control group was 4.20 ± 4.22 and 4.16 ± 4.03 (P = 0.39). Conclusion: Based on our data, SM is an effective agent in reducing peripheral neuropathy. The use of SM was associated with decreased scores of peripheral neuropathy and was helpful in patients undergoing chemotherapy with cisplatin.

Abstract Background: The Coronavirus disease-2019 (COVID-19) pandemic may profoundly impact on maternal and neonatal health worldwide. However, a few studies have investigated this topic. Objective: This study aimed to investigate the impact of the COVID-19 pandemic on maternal and neonatal health. Materials and Methods: This retrospective cohort study analyzed collected data from March to May 2020, and the same period in 2019, involving 5711 pregnant women referring to comprehensive healthcare centers in Isfahan province health facilities, Iran. Pregnant women and neonates were followed-up until 40 days after the delivery. Demographic characteristics, pre-pregnancy, antenatal care, and post-pregnancy variables were collected. Results: A total of 5711 pregnant women were studied, of whom 3477 (61%) were referred in 2019 (before the COVID-19 pandemic as nonexposed) and 2234 (39%) during the COVID-19 pandemic (as exposed group) in 2020. For those living in cities with a population of > 20,000, the number of antenatal care were lower about 2% compared to nonexposed group (p = 0.01). The number of mothers with a history of the underlying disease who referred to a comprehensive healthcare center during the COVID-19 pandemic (47%) was lower about 6% compared to nonexposed group (41%) (p < 0.001). During the COVID-19 pandemic, the prevalence of hypertension and gestational diabetes mellitus was 5% (n = 109) and 20% (n = 445), which were higher about 2% and 4%, respectively, compared to nonexposed group. The COVID-19 pandemic had no other significant effect on mothers' and neonates' other characteristics than nonexposed group. Conclusion: The COVID-19 pandemic imposes no significant effect on mothers' and neonates' health compared to nonexposed group.

Background: Chemotherapy-induced nausea and vomiting (CINV) is a major side effect seen among cancer patients under chemotherapy. Ginger (Zingiber officinale) and cinnamon (Cinnamomum zeylanicum) are among the traditional antiemetic drugs. The aim of this study was to determine the effect of oral consumption of ginger and cinnamon on CINV. Methods: This study was designed as a double-blind randomized clinical trial. The target population was cancer patients undergoing chemotherapy in medical centers affiliated with Isfahan University of Medical Sciences. Patients were randomly divided into two groups of treatment (Ginger and Cinnamon) and Control. The effect of cinnamon and ginger combination on CINV was measured using the INVR (The index of nausea, vomiting and retching) questionnaire. Using the American Clinical Oncology Guideline, nausea levels from chemotherapy drugs was classified into three categories: high, medium and low. Findings: Seventy-two patients in the control group and 65 patients in the treatment group (ginger and cinnamon) entered the final analysis. Comparisons made between the treatment and control groups was not statistically significant at first, but there was a statistically significant difference between the nausea score of the treatment group and the control group on days two and three as depicted by the standard questionnaire. Conclusion: The combination of ginger and cinnamon is effective in controlling nausea and vomiting caused by chemotherapy. Most of the effect of ginger and cinnamon combination in reducing nausea and vomiting occurred on the second and third day after chemotherapy.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or coronavirus disease (COVID-19) pandemic is the largest infectious crisis in the present century. It has been reported that COVID-19 infection may trigger autoimmune diseases. Herein, we report a 68-year-old male that was diagnosed with thrombotic thrombocytopenic purpura (TTP) following COVID-19 infection. To our knowledge, this is the fourth case of COVID-19-associated TTP. More attention is required regarding the possibility of developing TTP in COVID-19 patients, especially with the presence of decreased consciousness and low levels of hemoglobin and platelet.

Acquired hemophilia (AH) is a potentially life-threatening hemorrhagic disorder. We report the second confirmed case of COVID-19-associated AH in a 45-year-old female which, unfortunately, expired as her treatment failed. She presented to the emergency department with abnormal bleeding and spontaneous hemoptysis about ten days after a removal surgery of her epiglottis tumor. Aggregation tests, such as partial thromboplastin time (PTT), are recommended in patients with COVID-19 infection that have bleeding episodes.

Background: Fatigue, as one of the most common side effects of cancer and its associated treatments, induces a distressing, persistent, and inward feeling. This study aimed to investigate the synergistic effect of the omega-3 supplement as an unconfirmed effect on conventional ginseng treatment with a possible effect on this side effect in cancer patients. Method: This clinical trial was conducted in 2018 on 70 cancer patients referring to outpatient clinics affiliated to Isfahan University of Medical Sciences. Patients were included in the study by the convenience sampling method and were randomly divided into control and intervention groups. Patients in the treatment group received an omega-3 supplement and usual treatment. For patients in the control group, only the usual intervention was administered. Data were collected using the Multidimensional Fatigue Inventory questionnaire. The duration of intervention was 6 weeks. The primary outcome was the improvement of fatigue scores measured by the questionnaire. Result: There was a significant difference in both groups concerning the mean total fatigue score in three times; i.e., 0, 3, and 6 weeks after the intervention (P Conclusion: This study revealed that omega-3 supplement can reduce cancerrelated fatigue in outpatient cancer patients compared with the control group.

Background and Aim: The current study aimed to, first, investigate the frequency of cancer patients who receive complementary and alternative medicine (CAM), separated by the type of the disease, and second, to study their incentives and causes of use. Materials and Methods: Following a cross-sectional design, cancer cases referred to referral centers of cancer in Isfahan province were studied. Data were collected using a researcher-developed checklist that included type of the disease, complementary medicine, and causes of a tendency to use CAM. Results: A total of 256 patients were studied. One hundred and sixty-three patients (63.7%) had a history of receiving CAM. Sixty-five percent of the patients were satisfied with their CAM treatment. Patients with breast cancer had the highest prevalence of CAM use (72.2%), which was more than other types of cancers (P = 0.046). There was no significant association between the frequency of CAM use and the patient characteristics such as age, level of education, marital status, and gender (P > 0.05). Conclusion: It is evident that the majority of patients with cancer are using CAM modulates and are satisfied with it. They want to try every possible way to cure. Physicians should consider the likelihood that their patient is taking CAM and adopt appropriate strategies to address the issue.

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a major complication of many chemotherapeutic agents, including taxanes. Here, we aimed to investigate the effect of zinc on CIPN. Materials and Methods: This is a double-blinded controlled clinical trial that was performed in 2020–2021 in Isfahan on 55 cancer patients. We collected the data regarding CIPN, its severity, presence of abnormal deep-tendon reflexes, paresthesia, restriction in daily activities, and restriction in self-care and pain. Patients were divided into two groups: Patients in the first group were treated with capsules of zinc sulfate 25 mg daily and the control group received placebo. The duration of treatments was 3 months. Patients were visited 6, 9, and 12 weeks after study initiation. Results: There was a statistically significant decrease in the frequency of CIPN in the intervention group (37.03% vs. 14.8%, P < 0.001). The evaluation of the severity of neuropathy and presence of abnormal deep-tendon reflexes also demonstrated significant decrease in the intervention group during the study (P < 0.001 for both), but no significant changes were observed in the placebo group (P > 0.05). The activity limitations and pain severity improved significantly both in the intervention and placebo groups (P < 0.001 for both groups and items). The intervention group, however, had significantly lower frequencies of activity limitation and lower pain severity within compared to the control group during the study (P < 0.001). Conclusion: Zinc supplement therapy resulted in reduced frequency and intensity of CIPN in patients undergoing chemotherapy with taxanes.

Background: Substance abuse in adolescence could affect this period of life, as well as individual rest life. In this research, we studied the attitude of high-school student towards drug abuse, and the effect of some social determinants of heath associated with it. Methods: 3223 high-school students residing Isfahan Province, Iran, in 2015 were included in the study. Data were collected using the researcher-made questionnaire of assessment of knowledge, attitude, and action of urban and rural high-school students in Isfahan Province. Findings: In students’ opinion, momentary tipsiness and depression were the side-effects of drug abuse. Divorce of parents, and seeking pleasure were the most important factors associated with inclination to drugs albeit scored higher by girls. Moreover, girls expressed inability in dealing with daily difficulties as a factor in tendency to drug abuse. Whereas, boys claimed that factors such as too free time, and inadequate recreational facilities were more important. Among social determinants of health, education level of parents, father’s job, and residential area had significant effects on tendency to drug abuse. Conclusion: Besides preventive and educational policies, policy makers and parents should pay attention to improving their children’s self-esteem and self-management abilities, and provide homes as favorable and welcome places for them.

Background: Violence against women as domestic violence is a mental health problem in women, present in all countries. Overlooking this problem could entail irremediable harms to mother and child health. Methods: This cross-sectional study was conducted on 385 married women from Karchagan-Lenjan, Iran, during 2015-2016. Needed information were gathered via using two questionnaires involving violence dimension and measurements on knowledge, attitude, and action of women toward domestic violence and their communication skills, as well. Findings: Mean score (SD) of women’s knowledge toward domestic violence was 7.62 ± 2.90 and was higher than average. No significant difference was seen between mean extent of violence in couples with equal level of education and couples with different levels of education (P = 0.500). Total violence and its components had reverse significant association with total communication skills and verbal skills (P < 0.050). In addition, physical violence among husbands had direct association with number of children and feedback skills and reverse association with husbands’ level of education of and verbal skill. Conclusion: Using communication skills could lower couple contention or, at least, defer it to a better time. Obviously, verbal skill is the most important and effective way in establishing and management of relations. Our findings show that improving the communication skills in women could reduce the violence, especially physical violence, against them.

Background: Germ cell tumors (GCTs) are the most common solid tumors in young men, with a peak incidence at 25-35 years. Approximately 50% of the testicular GCTs are pure seminomas and 50% are non-seminomas. Late relapse of testicular cancer (LRTC) is a rare disease with the incidence rate of 2.6% and is defined as >2 years interval between initial treatment and recurrence. Case Presentation: We report here a patient with nonseminomatous GCT who experienced relapse 27 years after his first diagnosis. He came with gross hematuria and huge abdominal mass. There was a giant retroperitoneal mass with invasion to the left kidney and other organs in computerized tomography. A biopsy was conducted and pathology revealed recurrence of malignant mixed nonseminoma GCT. The tumor was unresetable. Therefore patient was treated with four cycles of chemotherapy. PET scan was conducted after chemotherapy showed residue of tumor thus retroperitoneal lymph node dissection (RPLND) was done. Conclusions: We concluded that with increasing lifespan of cancer patients, follow up of these patients for very late relapse must be conducted lifelong.

Background: Sleep disorder is one of the most common problems in cancer patients involved in chemotherapy stages, which is caused by the side effects of anticancer drugs and the exacerbation of mental disorders. The aim of this study was to evaluate the effectiveness of sleep health education on sleep quality of cancer patients during chemotherapy stages. Materials and Methods: In this clinical trial, 70 cancer patients were selected in the chemotherapy phase and divided into two groups of 35. In the intervention group, two 60-min training sessions on sleep hygiene were educated, solutions of coping with the exacerbation of sleep disturbances were determined, and routine care was provided in the control group. Patients were evaluated for sleep disorders before and 1 and 3 weeks after the intervention by the Pittsburgh questionnaire and then the effect of this intervention compared between the two groups. Results: The mean score of sleep medication consumption in the intervention group was not significantly different between the three times (P = 0.59), but the mean score of total sleep quality disorder and its other dimensions was significantly different between the three time points (P < 0.05). Least significant difference post hoc test showed that the mean total score of sleep quality disorder and its dimensions except using sleep medication 1 week after the intervention was significantly less than before the intervention and 3 weeks after the intervention

Background: Osteoporosis is a serious public health. Since the majority of bone mass occurs during adolescence, primary prevention is important. Probably mother′s participation in health education interventions leads to promote health behaviors in children. Aims: To assess a lifestyle modification intervention focused on mothers and students has an impact on osteoporosis preventive behaviors in adolescent girls. Materials and Methods: It is a randomized field trial in female high schools. 210 girls aged between 11 and 15 were randomly selected. Students in groups A and C and mothers in group B were selected Through the sampling frame. Our lifestyle modification was based on group based education in the public girls′ high schools. Subjects in the intervention groups participated in three educational sessions. Students′ osteoporosis preventive behaviors were measured by using a lifestyle questionnaire consisting of items assessing nutrition, physical activity and sun exposure. Repeated measure ANOVA at baseline, 4 week, 2 months and 6 months and were used to analyze the data. Results: After 1 month, diet and sun exposure scores increased significantly (P < 0.001) but it was higher in group B compared with group A. (About diet P < 0.001 and sun exposure = 0. 001). After 6 months, diet and sun exposure status in the group A approximately decreased to baseline, while in group B, diet components were significantly different compared to baseline (P < 0.001). There was no change in physical activity. Conclusion: Osteoporosis prevention intervention of adolescent can be effective when parents or girls participate in training sessions, but education is associated with better outcomes when focused on mothers.