Interventional studies are necessary to gain new knowledge in medical sciences; they can also be associated with several risks and impose high costs on patients and healthy people, and ethical considerations must be considered, as well. Understanding the ethical challenges and issues of interventional studies is essential. Using placebo, ethical consent, and clinical trials in specific groups are some of these challenges. This systematic review study was conducted to determine ethical considerations in interventional studies with an emphasis on the four ethical principles, including autonomy, non-maleficence principle, beneficence, and justice. Researchers in interventional studies should pay attention to ethics and take the necessary steps in line with these four biological principles.

A 23 year old Gravida 3 Para 1+1 at 26 weeks and four days of amenorrhea presented at our obstetrics and gynecology clinic for assessment following a coincidental scan that revealed a single live intrauterine fetus in cephalic presentation, longitudinal lie with normal cardiac activity, heart rate of 150 beats per minute, normal gross anatomy and estimated fetal weight of 992 grams. Adjacent to it however was a large monoamniotic echocomplex mass of approximately 398 milliliters with a ‘snow storm’ appearance. Patient was asymptomatic at the time of arrival. She had however had occasional episodes of mild per vaginal bleeding about two weeks prior to visiting the clinic which resolved following treatment from a nearby health center at her home where it was managed as threatening abortion. Previous obstetric history was of a molar pregnancy in her second pregnancy about one year ago where a suction evacuation was notably done and patient improved. The first pregnancy was uneventful throughout the prenatal, perinatal and puerperal time.

There is insufficient data about esophageal body dysmotility in patients with refractory gastroesophageal reflux disease (RGERD) and inadequate response to proton pump inhibitors (PPIs) treatment. This study aimed to assess esophageal motility disorder and reflux parameters among these patients by high-resolution manometry (HRM) and intraluminal impedance and pH (MII‐pH) monitoring after stopping PPI therapy. A retrospective study was conducted among 100 RGERD patients admitted to Taleghani Hospital (Tehran, Iran) for one year. More than half of them were males (55%). Their mean age was 47.10±6.92, and 50% of patients had ineffective esophageal motility (IEM). Middle, distal, and proximal esophageal pressure (MEP, DEP, and PEP), lower esophageal sphincter (LES) basal pressure (LESP), integrated relaxation pressure (IRP), distal contractile integral (DCI), large breaks, upper esophageal sphincter basal pressure (UESP), and LES length (LESL) in IEM patients were significantly lower than the patients with normal esophageal motility (P<0.001). Furthermore, there were more patients in the IEM group with long-term and abnormal weakly acid reflux compared with the non-IEM group (P<0.05). It seems that the evaluation of reflux parameters and esophageal motility could lead to additional insights into the pathophysiological mechanisms of RGERD. Nevertheless, further studies are suggested to evaluate the effects of esophageal motility disorders among RGERD patients.

The aim of this study was to evaluate the effect of bupivacaine with dexmedetomidine in comparison with bupivacaine during supraclavicular block with ultrasound guide on the hemodynamics of patients undergoing upper limb orthopedic surgery. Eighty patients (40 patients in each group) who were candidates for upper limb orthopedic surgery randomly received 30 ml of bupivacaine alone (group 1) or 30 ml of bupivacaine with 20 μg of dexmedetomidine (group 2). The supraclavicular nerve block was performed using an ultrasound guide. Patients' hemodynamic data (including mean arterial blood pressure, heart rate per minute, respiration rate per minute, and peripheral blood oxygen saturation), the onset of action, and duration of sensory-motor block were compared between the two groups. The mean arterial blood pressure during surgery in group 2 was lower than in group 1, but the differences were not statistically significant. The onset of sensory and motor block in group 2 was significantly shorter than in group 1 (P=0.0001). The duration of sensory and motor block in group 2 was significantly longer than in group 1 (P=0.0001). During this study, none of the patients had hemodynamic disturbance or surgical complications. The addition of dexmedetomidine to bupivacaine during the supraclavicular block, in addition to hemodynamic stability of the patient during surgery, increases the duration of sensory and motor block.

Autoimmune thyroid diseases are multifactorial conditions caused by genetic and environmental factors. Among environmental factors, infectious agents include viruses, bacteria, and parasites acting as triggers. The current study intended to investigate the association between Helicobacter pylori infection and autoimmune thyroid diseases in a group of Iranian cases with Hashimoto's thyroiditis (HT) and Graves' disease (GD). This study included adult cases newly diagnosed with GD and HT and euthyroid controls. A number of clinical and biochemical factors were evaluated, including tests of thyroid function and serum Helicobacter Ab (IgG), and then inter-group comparisons were performed. Data from 404 patients with HT and 248 cases with GD were analyzed. Also, data from 480 healthy controls were analyzed. For those with HT, GD, and controls, the prevalence of Helicobacter pylori infection was 93.3%, 92.7%, and 88.8%, respectively. The prevalence of H. pylori infection in cases with HT and GD was significantly higher compared to controls. While concerning the prevalence of H. pylori infection, the two groups (HT and GD) were not significantly different. H. pylori antibody level was significantly correlated with FT4, FT3, Anti-TPO, and Anti-Tg in cases with HT. In the group of patients with GD, the H. pylori antibody had a significant positive correlation with Anti-TPO and Anti-Tg. According to the present results, H. pylori is associated with autoimmune thyroid diseases (both Hashimoto's and Graves' diseases).

To investigate the ocular surface status in individuals having long-term occupational sunlight exposure. This study was carried out with a historical cohort design. Long-term occupational sunlight exposure was considered the main exposure. The exposure group included individuals who had direct sunlight exposure in their workplace (124 people with a mean age range of 31.6±6.32), and the non-exposure group was comprised of 182 people (mean age range of 31.6±6.32) who worked indoors and had no long-term exposure to sunlight during work hours. The mean of TBUT in the Sun-exposure group (10.91±6.64 sec.) was significantly lower than the non-exposure one (13.91±9.67 sec.) (P=0.001). 42.9 percent of the members of the non-exposure and 58.9 of the sun-exposure group demonstrated TBUT values lower than 10 seconds. While the mean of OSDI in the exposure group was higher than in the non-exposure group, this difference was not statistically significant. Based on the OSDI results, 51.6 percent of the non-exposure group and 58.9 percent of the exposure group suffered from dry eye. The prevalence of diseases such as Pterygium, blepharitis, and pinguecula in the sun-exposure group was significantly higher than in the non-exposure group (P<0.0001). Based on the results of this study, people who have long-term occupational sunlight exposure tend to have more unstable tear films compared with people who do not have such exposure. In addition, the prevalence of diseases such as Pterygium, blepharitis, and pinguecula is higher among these people.

We aimed to report the five-year results of Trans-epithelial Photorefractive Keratectomy (TPRK) in treating all kinds of refractive errors. In this retrospective cohort study, we quantitatively compared the clinical findings and assessment of optical and refractive parameters, including slit-lamp, corneal topography, Best Corrected Visual Acuity (BCVA), and Uncorrected Distance Visual Acuity (UDVA) in 172 eyes of myopic, hyperopic, and astigmatic patients before and five years after trans-PRK. The average time for post-surgery epithelial healing was 2.97 0.83 days in male and 2.94 0.87 days in female patients; the pain score in a week following the operation was 1.88 0.68 in males and 2.25 0.73 in females. Corneal haze was observed in five patients. No long-term adverse effect was reported. The pre-operative UDVA was 0.84 0.32 in male and 0.87 0.34 in female patients; while the postoperative UDVA was -0.02 0.04 in male and -0.01 0.02 in female patients. There was a highly significant correlation (P<0.001) in all indices except UDVA, which was almost near to being significant (P=0.07). In this survey, the mean safety and index were nearly 1.00. TPRK is a safe and efficient therapeutic procedure to treat all types of refractive errors, including myopia, hyperopia, and astigmatism, with no significant adverse effect. Being touchless and having a short recovery time are two main characteristics of this refractive surgery.

Data on pediatric critical care in Iran are insufficient. This study was performed to determine the outcomes and characteristics of critically ill children admitted to a pediatric intensive care unit (PICU) in Ahvaz, Iran. A retrospective study was conducted among all patients in the PICU of Abuzar Hospital for one year. Their medical documents were reviewed. A total of 400 patients were identified. The average age of patients was 29.94±39.55 months, and 53.8% of them were males. Nearly half of the cases were under age one. The most prevalent causes of PICU admission were respiratory (36.5%), neurological (18.5%), and infection-related diseases (15%). Besides, 55.7% of patients (n=223) had no history of underlying health problems. Admissions were more frequent in winter (n=125; 31.3%) and spring (n=101; 25.3%). The mortality rate and the mean hospital length of stay (LOS) were 15.5% and 10.79±6.39 days, respectively. In addition, 231 patients had an abnormal respiratory rate and a quarter of them (n=97) required ventilation support. Moreover, 377 and 82 patients were malnourished and severely underweight, respectively. A significant association was found between the mortality of patients and malnutrition, as well as having consanguineous parents (P<0.001). The death rate was significantly higher in patients with infectious disease than non-infectious, as well as in long-stay PICU patients than in short-stay patients (P<0.05). Additional studies are required to find factors contributing to the disease burden among PICU patients in Iran to develop appropriate therapeutic strategies and improve the outcomes of pediatric patients.

Acute necrotizing encephalopathy (ANE) is an infrequent disease in childhood with Specific clinical complications. To date, the highest incidence of this disease has been reported in East Asian children. The clinical features of the disease include convulsions, frequent vomiting, and coma. Most of these patients die within days or cause severe neurological complications. The disease is characterized by symmetric and necrotic multifunctional lesions in the thalami and brainstem. We reported a 5-year-old girl infant from Besat Hospital, Sanandaj, Kurdistan, located in west of Iran.

Phlebosclerosis is defined as the fibrous degeneration of the venous wall, though in history, it has been defined from endophlebitis to hyalinzation of the intima of the venous wall, the actual pathology is obscure. We present a case series of three different cases from three different decades of life, 5^th, 6^th, 7^th  respectively with varied co-morbities, in which we encountered phlebosclerosis , while harvesting GSV for CABG.: To author’s knowledge, this is the first ever indigenous study on phlebosclerosis of GSV, the study would give a excerpt into the continuum on the natural history of the disease. The literature is reviewed and the case is presented.