A systematic review and meta-analysis was conducted to determine the association between exposure to maternal diabetes and ADHD in the offspring. Major electronic databases, including Web of Science, PubMed, Scopus, Embase, and Proquest, were searched from inception until December 2018. The New Castle-Ottawa scale was used to assess the quality of the included studies. A fixed effects model was applied for analysis. Seven studies including a total of 5,658,871 individuals were retained. A significant association was found between maternal diabetes and ADHD [OR=1.23, 95% CI: 1.117, 1.345]. There was a significant heterogeneity (I^2=77.7, P<0.0001), while Egger’s and Begg’s test were not significant. This study showed a significant relationship between maternal diabetes and ADHD; however, more well-designed studies are needed to confirm the results.

The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P< 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (>7 days) group. This difference was not statistically significant (P> 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.

Herein we investigated mutations in the ABCA4 gene in an Iranian patient with Stargardt disease using whole exome sequencing (WES). We evaluated genetic alterations in a 13-year-old Iranian girl with Stargardt disease and her family using WES. The target sequences for the proband and her parents were then amplified through polymerase chain reaction (PCR) and the obtained products were screened for mutations in ABCA4 gene by Sanger chain terminating dideoxy nucleotide sequencing. Two novel potentially pathogenic mutations in compound heterozygous state (c.2713del p.E905Rfs*27 and c.5172G>A p.W1724X) were identified in ABCA4 gene which may contribute to the proband’s Stargardt disease phenotype. In general, the WES successfully identified novel causal mutations in ABCA4 gene which may be used for genetic counseling, prenatal diagnosis (PND), and preimplantation genetic diagnosis (PGD) of Stargardt disease.

The aim of this study was to compare the post-operation analgesic effects of patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients who were undergoing esophageal cancer surgery. This was a randomized clinical trial. 80 patients undergone esophagostomy were randomly divided into two groups: 40 patients in the epidural PCA and 40 patients in the intravenous PCA group were evaluated. Post-operation pain score was assessed using the universal pain assessment tool (UPAT) in both groups at 24 and 48 hours after surgery. Secondary outcomes included AKI, MI, CVA, pulmonary complications, ICU stay and three months survival. Mean pain scores were similar in the two groups (P>0.05). There was no significant difference between the two groups for rescue treatment, three months’ survival, CVA, MI and AKI. However, ICU stay (P=0.008) and pulmonary complications (P=0.05) were greater in PCIA group. The results indicate that none of the PCEA and PCIA methods have any superiority in terms of pain control and the incidence of analgesic-related side effect complications after surgery in patients undergoing esophagostomy and confirm sufficient analgesia by both.

Osteoarthritis (OA) is the most common type of arthritis and although there is no definitive cure for it, there are treatments for symptom management. The present study was conducted to evaluate the effects of silicon dioxide (SiO2) on clinical symptoms of knee OA and compare it with avocado soybean unsaponifiable (ASU) and placebo. This study is a double-blind randomized clinical trial on 104 patients with knee OA referred to Rheumatology Clinic, Rasoul Akram Hospital, Tehran. Patients were randomly divided into three groups, including patients treated with ASU, SiO2, and placebo for 3 months. Subsequent referral was performed at weeks 4, 8, and 12, and the stiffness, physical function, and pain scores were recorded based on the WOMAC questionnaire. In this study, the effect of treatment of placebo and SiO2 and ASU in patients with knee OA based on WOMAC questionnaire showed a significant reduction in terms of pain, joint stiffness, physical function, and total scores of WOMAC in the cases of the SiO2 group compared with the other two groups. The findings of this study showed that the therapeutic effects of SiO2 in patients with knee OA in terms of pain and stiffness and physical function scores were more than the ASU and placebo groups.

In order to decrease medical errors and improve organized, targeted education pre- and post-graduation, we intended to detect 10 most important concepts that neuro-otologists believe family physicians and general practitioners must know. A multi-center study based on Delphi’s method was designed and conducted in three stages. Of 31 topics gathered by expert panel, 10 top priorities were ranked based on 50 neuro-otologists’ opinion over the country. Early diagnosis and management of sudden sensorineural hearing loss, foreign body removal from external ear canal, proper management of otitis extern, and management of emergency situations in chronic otitis media gained the highest scores among all. Also, some topics, such as managing serous and acute otitis media, differentiating peripheral vs. central vertigos, and early hearing screening at birth were among top topics, contrary to others, such as surgery in only hearing ears, or hearing losses after COM surgeries. Almost all of the top-ranked topics are among critical/organ saving, or most prevalent medical concerns in all of the world. Sudden deafness, complicated COM, and mis-diagnosing vertigo may be organ/life threatening, while foreign bodies or inflammations of external ear, acute or serous otitis media, and congenital hearing loss are among the most prevalent medical problems worldwide, with numerous malpractices in their diagnosis and management. Regarding educational and practical priorities should be considered a basic step in neurotology field, and targeted programming policies.

 Immune system immaturity in newborns exposes them to infections, among which bloodstream infection is of great importance due to high mortality and morbidity and treatment costs. The aim of the present study was to evaluate common pathogens in blood culture positive cases and its determinants. This study was conducted in two phases, including a cross-sectional phase to collect the cases of definitive septicemia and a case-control phase on neonates admitted to the Neonatal Intensive Care Unit of Vali-e-Asr Hospital with clinical suspicion of sepsis during 2015-2019. The eligible cases were selected based on the study criteria. After extracting descriptive statistics, to evaluate causal relationships, culture-positive and culture negative cases were compared in terms of neonatal disease in the second phase. SPSS-22 was used for data analysis. The most common bacterial families were Staphylococcus (34.30%), Acinetobacter (10.46%), and Klebsiella (7.55%), among which coagulase negative Staphylococcus was the most common organism (13.08%). The most common antibiotics prescribed were ampicillin (75.1%), amikacin (58%), and gentamycin (44.8%). Factors that had a significant association were the occurrence of septicemia were gestational hypertension, premature rupture of membranes, conjunctivitis, TORCH infections, and low gestational age. The results of this study will be helpful in anticipation and management of neonatal septicemia through shedding light on some determinants of common blood culture pathogens like infections and obstetric complications in NICU admitted neonates.  

The widespread inappropriate use of intravenous (IV) pantoprazole, due to its high cost, is a substantial issue. To improve its rational use, an order entry form (OEF) based on the institutional guideline, was implemented. Physicians were required to fill an OEF upon administration of IV pantoprazole. We aimed to evaluate the compliance of physicians as well as the accuracy of filled OEFs six months after the implementation. The study was conducted in a tertiary care teaching hospital in Tehran. Chart review was performed for all patients with an IV pantoprazole order. IV pantoprazole OEFs received by the hospital pharmacy for these patients were evaluated in terms of quantity and quality (e.g., completeness, accuracy of filled items, etc.). Only for 270 (62%) patients, OEFs were received by the hospital pharmacy. Indications were specified in 199 (73.5%) forms, and their agreement with the forms filled by the researcher was 37.8%. The most frequent indication specified in OEFs was stress ulcer prophylaxis (40.7%). IV pantoprazole administration was rational only in 15.9% of cases. The emergency ward had the highest frequency of orders (57.9%), while having the lowest fill rate (56.7%) among the wards with the highest number of orders. The disagreement between the researcher and the OEFs regarding the need for IV medication was 39.5%. This study demonstrated that the compliance of physicians with the accurate completion of OEFs was suboptimal. It seems that for long-lasting changes in IV pantoprazole utilization patterns, barriers should be determined, and additional methods such as ongoing educational seminars or feedback might be needed along with OEF.

We describe a case of prolonged intrauterine fetal bone retention following a neglected pregnancy. A 43-year-old rural woman had one year history of malodorous vaginal discharge. She underwent medical treatment with broad spectrum antibiotics. Four days following the onset of antibiotic therapy, cystoscopy and hysteroscopy were done. Incredibly, some bony-like pieces were extracted by instrument from endocervical canal. Intrauterine retention of fetal bones, although rare, should be considered as a possibility in cases with unexplained abdominal pain, dysmenorrhea, dyspareunia, and long period infertility. Hysteroscopy is the best modality for diagnosis and may be enough for management of the condition in many cases. However, in complicated cases, hysterectomy would be inevitable.

Introduction: The COVID-19 has recently become pandemic. Early diagnosis and the transmission chain cutting off are critical keys to control this disease and stop its spread. In this case report, the significance of proper and on-time diagnosis is discussed. Misdiagnosis of COVID-19 may lead to delay in early diagnosis of the disease.
Case Presentation: A 78-year-old man with chief complaint of dark stool and constipation was admitted. Based on the preliminary complaints of the patient, the emergency medical specialist transferred him to the internal caregiving service, but according to radiological findings and his positive Real time PCR test, COVID-19 was final diagnosis.
Conclusion: Healthcare planners and policymakers should prepare precise clinical guidelines that are compatible with domestic conditions of the country to improve the ability of health care providers for diagnosing patients with COVID-19 to promote controlling this condition.