Background: Vesicoureteral reflux (VUR) is one of the most common underlying urologic abnormalities in children with acute febrile urinary tract infection (UTI). Therefore, evaluating VUR in all patients with acute pyelonephritis (APN) is necessary to prevent further complications. Objectives: The purpose of this study was to investigate the value of laboratory and imaging findings in children with acute febrile UTI in determining the need for cystographic examinations for VUR. Methods: A total of 424 children with their first febrile UTI were evaluated in two groups: Those with VUR (n = 204) and those without VUR (n = 220). Patients with secondary VUR were excluded from the study. Variables such as acute phase reactants, serum creatinine (Cr), and urine culture were obtained at the time of admission and before antibiotic treatment. Results: Vesicoureteral reflux was significantly more common in males (P = 0.001), in those with higher serum Cr at admission (P < 0.001), in patients with abnormal renal bladder ultrasound (P < 0.001), and in cases with the growth of non-Escherichia coli organisms compared to those without VUR. Serum Cr and abnormal ultrasound showed a significant correlation with VUR in multivariate analysis. Additionally, serum Cr and abnormal ultrasound were moderately accurate predictors of VUR, with moderate sensitivity and specificity. Conclusions: Investigation of primary VUR among children with acute febrile UTI is recommended for those with increased serum Cr and abnormal renal bladder ultrasonography.

Background: Bacillary dysentery is an invasive bacterial gastroenteritis that damages the colon epithelium and leads to bloody diarrhea. Enteroinvasive Escherichia coli (EIEC) and Shigella flexneri are two major etiologic agents of the disease. The virF gene is a transcriptional regulator of the virulence genes involved in the invasion of these bacteria. Previous studies have shown that sub-minimum inhibitory concentrations (sub-MICs) of antibiotics have significant effects on bacterial virulence. Objectives: This study aimed to evaluate the effects of sub-MICs of ciprofloxacin and azithromycin on S. flexneri and EIEC. Methods: Prototype strains of both bacteria were treated with sub-MICs of 1/2, 1/4, and 1/8 of ciprofloxacin and azithromycin antibiotics. Changes in the expression of the virF gene in antibiotic-treated samples compared to control samples were analyzed using relative real-time polymerase chain reaction (PCR). Results: The mean expression of the virF gene in all sub-MICs of ciprofloxacin was increased in both S. flexneri and EIEC, while a down-regulation was observed in sub-MICs of azithromycin. These gene expression changes were dose-dependent. Conclusions: The results demonstrated that the virulence of S. flexneri and EIEC is affected by sub-MICs of azithromycin and ciprofloxacin. Given that azithromycin, unlike ciprofloxacin, reduces the severity of infection at sub-MICs, it is a more appropriate choice with a lower risk for treating acute infections caused by these bacteria.

Background: There are ongoing controversies regarding pregnancy outcomes during the COVID-19 era. Objectives: This observational study with a retrospective design was conducted to investigate the maternal and neonatal impacts of COVID-19 on pregnancy outcomes. Methods: An observational study with a retrospective design was carried out using census sampling from February 2020 to July 2021. The study population included pregnant women who were referred to Asalian Hospital in Khorramabad city, western Iran. A total of 769 mothers (107 with COVID-19 and 662 without COVID-19) were included in the study. Results: The most common symptoms reported by infected mothers were body pain/myalgia (68, 72.3%), fatigue (57, 60.6%), headache (47, 50%), and shivering (46, 48.9%). After adjusting for covariates, the risk of caesarean section (CS) in pregnant women with COVID-19 was found to be 3.2 times higher (95% confidence interval: 1.90 - 5.50). In contrast, the risks of newborn hospitalization, prematurity, low APGAR scores, respiratory distress, and smaller head circumference were higher among newborns of non-COVID-19-infected mothers than those of COVID-19-infected mothers (P < 0.05). Conclusions: While it is generally expected that COVID-19-infected mothers would experience adverse maternal and neonatal outcomes, this retrospective study demonstrated that COVID-19 infection does not result in adverse outcomes for mothers or newborns, apart from a higher rate of CS.

Background: In 2020, COVID-19 was a major cause of absenteeism. Objectives: To investigate the factors affecting the time taken to return to work after COVID-19 hospitalization. Methods: This was a cross-sectional study conducted on 320 working individuals (295 men and 25 women) hospitalized in Yazd province, Iran, due to COVID-19 between September 2020 and March 2021. All patients who met the inclusion criteria and provided consent were enrolled in the study via census. The inclusion criteria were: A definite or probable diagnosis of COVID-19 and hospitalization for no reason other than COVID-19. The required information was collected through phone interviews using a researcher-developed questionnaire that included demographic, occupational, recent COVID-19 infection, and return-to-work information. Data were analyzed using SPSS software. Results: The average duration of absenteeism was 31.67 ± 33.47 days. Univariate regression analysis revealed a significant relationship between absenteeism lasting more than 21 days and several factors: Age (P = 0.005), gender (P = 0.044), marital status (P = 0.005), number of dependents (P < 0.001), diabetes (P = 0.004), BMI (P = 0.031), job experience (P < 0.001), type of employment (P = 0.008), workplace respiratory exposures (P = 0.042), lower respiratory symptoms (P = 0.024), duration of hospitalization and medication use (P < 0.001), pulmonary complications (P < 0.001), and mental complications (P = 0.004). After adjusting for confounding factors, only three factors were significantly associated with a delay in return to work of more than 21 days: Duration of medication use (P < 0.001), presence of pulmonary complications (P = 0.014), and presence of psychological complications (P = 0.040). Conclusions: The severity of the disease, as indicated by the duration of medication use for COVID-19 after discharge, and the presence of pulmonary and psychological complications, directly influenced the return to work after COVID-19.

Background: At the onset of the COVID-19 pandemic, a misunderstanding emerged, suggesting that the consumption of opioid combinations might have a protective effect against COVID-19. Objectives: To identify prognostic factors associated with in-hospital mortality among confirmed COVID-19 patients with a history of opioid combination consumption in southern Iran. Methods: This retrospective cross-sectional study, conducted between September 2020 and March 2021, included patients over 14 years of age with a confirmed diagnosis of COVID-19 who were admitted to Shahid Faghihi Hospital in southern Iran (affiliated with Shiraz University of Medical Sciences). Patients with incomplete or unreadable medical records were excluded. Data were extracted from medical files and recorded in a structured data collection form comprising three main sections: (1) Demographic characteristics (e.g., age, gender, comorbidities, smoking status), (2) clinical and paraclinical findings, and (3) patient outcomes. Statistical analysis was subsequently performed. Results: Of 1,048 patients with confirmed COVID-19, 98 (8.55%) reported a history of opioid combination consumption. The mean ± SD age was 61.40 ± 14.50 years, and 81 (82.7%) were male. Thirty patients (30.6%) died in the hospital (P < 0.001). A comparison of survivors and non-survivors revealed that the mean age was significantly higher in non-survivors (P = 0.004). Non-survivors were more frequently admitted to the ICU (P = 0.001), and their mean length of ICU stay was significantly longer (P = 0.03). Multiple logistic regression analysis identified C-reactive protein (CRP) (OR = 0.92, P = 0.02) as the only independent predictor of mortality among opioid combination users with confirmed COVID-19. Conclusions: Among confirmed COVID-19 patients with a history of opioid combination consumption, the CRP level was the sole independent predictor of in-hospital mortality.

Background: Prophylactic antibiotics can reduce post-surgical infection rates, but their improper use in surgery remains a significant concern. This misuse leads to adverse drug reactions, increased bacterial resistance, and unnecessary hospital costs. Objectives: This study aimed to examine and compare prophylactic antibiotic prescribing practices in general surgery departments at two Tehran university hospitals, in relation to established guidelines. Methods: A cross-sectional study was conducted on 194 surgical patients. Data collection included demographic details, surgery type, and antibiotic prophylaxis protocols, covering medication type, dosage, pre-surgical timing, and prophylaxis duration. Results: The study included 27.8% clean surgeries and 72.2% clean-contaminated surgeries. Cefazolin was the primary antibiotic prescribed. According to the American Society of Health-System Pharmacists (ASHP) treatment guidelines, 10% of patients received antibiotics without proper indication. Among the 90 cases requiring antibiotic prophylaxis, appropriate antibiotic selection occurred in 39.0% of cases at Rasul Akram Hospital and 41.5% at Firouzgar Hospital. In these cases, errors were noted in dosing (79.8%), pre-operative timing (97.4%), and administration protocol (100%). Only 33% of cases followed the optimal prophylaxis duration. Conclusions: These hospitals require an evidence-based antibiotic prescription program that adheres to clinical guidelines and includes close monitoring of implementation. Regular training and review of clinical guidelines are essential for all healthcare professionals.

Background: We aimed to evaluate calcium (Ca) metabolism disorders in patients with COVID-19, a novel virus with numerous unknown aspects and potential complications. This study was conducted due to the scarcity of evidence on this subject and the crucial importance of conducting a comprehensive assessment. Objectives: We hypothesized that this research would shed light on this previously unexplored phenomenon. Methods: This study was a descriptive cross-sectional study conducted on COVID-19 patients admitted to Afzalipur Kerman Medical Center, Iran, in 2021. Data collection involved demographic characteristics and laboratory results. A 5 cc blood sample was collected in a clot test tube to perform total Ca tests using the photometric method (Arsenazo III kit), ionized Ca tests via the ISE method, magnesium measurements with the photometric method using the Xylidyl blue kit, iPTH (intact parathyroid hormone) assessments, and 25-OH-VITD3 measurements using the ELISA technique with the Monobind kit. Results: The present study included 162 participants, comprising 59% males and 41% females, with an average age of 49 years. Among the patients, the most prevalent Ca metabolism disorders were low vitamin D levels, including both deficiency and insufficiency (59%), as well as elevated ionized Ca levels (43%). Conversely, the least common Ca metabolism disorders in these patients were hyperparathyroidism (7%) and excessive Ca adjustment (8%). Conclusions: The findings suggest the possibility of Ca metabolism disorders, particularly hypocalcemia, in COVID-19 patients. Given the nature of this study, we recommend conducting longitudinal and more comprehensive research in this field to investigate contributing factors in more detail and establish a cause-and-effect relationship.

Background: The coronavirus disease 2019 (COVID-19) has become one of the deadliest pandemics in recent history. Despite the introduction of preventive measures such as physical distancing, wearing masks, remote work, isolation, and quarantine to slow the spread, these behavioral measures have had undesirable consequences, including negative psychological effects, deep depression, and other mental health issues. The development of a safe and effective vaccine emerged as the most promising strategy for combating COVID-19. Today, vaccination remains one of the most effective tools to fight against COVID-19. Objectives: The aim of this study was to analyze the clinical and laboratory differences between vaccinated and unvaccinated patients hospitalized for pneumonia caused by COVID-19. Methods: The study included patients admitted to the clinic with COVID-19 between January 2021 and October 2021. Demographics, clinical features, and treatment outcomes were recorded. Additionally, the vaccination status of patients against COVID-19 was documented. The cases were divided into two groups: Those who had received the COVID-19 vaccine and those who had not. Complete vaccination was defined as receiving two doses (0.5 mL) intramuscularly with the last dose administered at least 14 days prior or receiving two doses (0.3 mL) intramuscularly with the last dose administered at least 21 days prior, and no more than 6 months after the last dose. The vaccines included in the study were Pfizer, QazVac, Sinopharm/Beijing, Sinovac, and Sputnik V. Results: In total, 510 cases were included in the study, divided into two groups based on vaccination status: 367 unvaccinated cases and 143 vaccinated cases. The unvaccinated group had a longer duration of hospitalization than the vaccinated group (9 days vs. 7 days, respectively) (P < 0.001). Although no differences were found between the two groups regarding the nature of the radiological lesions, the number of affected areas was significantly greater in the unvaccinated group (P < 0.05). There was no statistically significant difference in the number of complications between the two groups (97.9% in the vaccinated group, n = 140/143; 99.2% in the unvaccinated group, n = 364/367). In terms of mortality, 9.8% (14/143) of the vaccinated group died, compared to 21.3% (78/367) in the unvaccinated group, with a statistically significant difference (P = 0.002). When assessing the SPO2 index at admission, statistically significant differences were observed (P < 0.001). Biochemical parameters such as urea, albumin, glucose, and creatinine were significantly higher in unvaccinated patients (urea: 4.2 ± 19.3; creatinine: 9.8 ± 18.5). Serum levels of C-reactive protein (CRP) and procalcitonin (PRK) were significantly higher in the vaccinated cases. Interleukin-6 (P < 0.001), troponin (P < 0.001), ferritin (P = 0.002), and D-dimer (P < 0.001) were significantly elevated in the unvaccinated group. Conclusions: Vaccinated patients infected with COVID-19 had shorter hospital stays and less severe radiological lesions. The levels of severe COVID-19 predictors such as CRP, IL-6, D-dimer, and ferritin were statistically significant in the unvaccinated group. The mortality rate was higher in the unvaccinated group compared to the vaccinated group. Vaccination appears to be highly effective in mitigating the effects of COVID-19 in patients with chronic comorbidities and significantly reduces mortality in these patients.

Background: Atherosclerosis and periodontitis are chronic inflammatory diseases characterized by inflammation and tissue destruction. Porphyromonas gingivalis, a key pathogen in periodontal disease, is implicated in initiating inflammation and tissue damage. Objectives: Given the potential link between periodontitis and the development of atherosclerotic plaques, this study aimed to investigate the presence of P. gingivalis DNA in subgingival and atherosclerotic plaques obtained from cadavers at the Tehran Forensic Medicine Center. Methods: In this cross-sectional study, cadavers with a postmortem interval of 6 hours and atherosclerotic plaques in their coronary arteries, along with subgingival plaques exhibiting pocket depths exceeding 5 mm, were examined. Subgingival plaque samples were collected from the deepest sites, while atherosclerotic plaque samples were harvested. Real-time PCR was employed to detect the presence of P. gingivalis in all samples, and the McNemar test was used for data analysis. Results: A total of 25 cadavers were included in the analysis, and both subgingival and atherosclerotic plaque samples were assessed. P. gingivalis DNA was identified in 40% of subgingival plaque samples and 16% of atherosclerotic plaque samples. Moreover, all positive atherosclerotic plaque samples also tested positive for P. gingivalis in the subgingival plaque. McNemar's analysis revealed a statistically significant difference between the subgingival and atherosclerotic samples (P-value = 0.03). Additionally, a correlation coefficient of 0.53 was obtained. Conclusions: While the study has certain limitations, the findings indicate a significant association between the presence of P. gingivalis in subgingival and coronary atherosclerotic plaques. Further investigations are warranted to elucidate the precise role of this periopathogen in atherosclerotic plaque formation.