aliashraf mozafari

The prevalence of abdominal obesity appears to vary depending on the mode of delivery. Abdominal obesity is the most common manifestation of metabolic syndrome and plays a significant role in diagnosing metabolic disorders.

This study aimed to determine whether the mode of childbirth is associated with metabolic syndrome (MetS).

A total of 350 women who had either an elective cesarean section (CS) or natural vaginal delivery (NVD) at least three years ago were included in this cross-sectional study. The sample was recruited from the integrated health system (Sib) affiliated with Ilam University of Medical Sciences in southwest Iran, 2020 - 2021, using cluster randomization. Metabolic syndrome was assessed according to the 2005 revised NCEP ATP III criteria. Descriptive data were presented as means (standard deviations, SD) or frequencies (%). A t -test was used for comparison between groups, and logistic regression analysis was employed to estimate odds ratios (ORs).

Metabolic syndrome was found in 18.29% of women in the NVD group and 30.29% in the elective CS group. Multivariate logistic analysis revealed that breastfeeding duration (P < 0.001) and NVD (P = 0.04) were significantly associated with a decreased likelihood of MetS among mothers. Each additional month of breastfeeding was shown to reduce the likelihood of MetS by 30%. The results also demonstrated that NVD had a protective effect against MetS (Adjusted Odds Ratio (OR): 0.57, 95% CI: 0.34 - 0.97, P = 0.04) after adjusting for age and breastfeeding duration.

Women with a history of CS were found to have a higher prevalence of MetS than those in the NVD group. This suggests that the mode of delivery may play a role in the development of MetS after childbirth. Therefore, obstetricians and midwives should consider the potential risk of disorders such as MetS when deciding on elective cesarean sections.

Effective performance in online education increasingly impacts the quality of classes and, consequently, student learning outcomes. This study aims to compare satisfaction levels and learning rates between online and face-to-face methods of teaching medical physiology.

This cross-sectional descriptive-analytical study involved 79 medical students divided into two groups. The first group received instruction on heart physiology (5 weeks, one session per week) online via the Navid system, while the second group received face-to-face instruction. At the study's conclusion, both groups underwent the same test to assess learning outcomes, and satisfaction with the teaching methods was evaluated through a questionnaire. Data analysis was conducted using Stata 14 statistical software, employing logistic regression and linear regression models.

The two groups differed in terms of the course studied, student nativeness, and satisfaction levels with the educational method. Satisfaction with online education was reported at 69%, compared to 65% for the face-to-face method. The average learning score for students in the online group was 12.93±0.12, while in the face-to-face group, it was 13.48±0.47. However, the linear regression model revealed no significant relationship between students' scores and specific educational methods (p=0.32). Significant relationships were observed between age, nativeness, and dormitory accommodation with satisfaction levels in online education. Conversely, none of the variables showed a significant relationship with satisfaction levels in face-to-face education.

 Both e-learning and face-to-face methods demonstrated relatively similar effects on students' learning outcomes. However, satisfaction levels with online education appear to be influenced by variables such as age, nativeness, and dormitory accommodation.

Aluminum Phosphide (ALP) is an effective, cheap, and highly toxic pesticide. ALP poisoning can have destructive effects on the human body, such as the heart, lungs, gastrointestinal tract, kidneys, and central nervous system, although all organs can be involved. We describe a 53-year-old Iranian Kurdish man with Hemolytic Uremic Syndrome (HUS) and Acute Kidney Injury (AKI). Supportive treatments such as hemodialysis and plasmapheresis were performed. After 23 days of hospitalization, the patient fully recovered and was discharged. Thrombotic microangiopathy such as HUS should be considered in patients with ALP toxicity that has a genetic defect in complement proteins. Combined use of hemodialysis and plasmapheresis improve outcomes in these patients.

Methadone poisoning intentionally or accidentally leads to a high rate of treatment burden and cost and deaths. The evaluation of the factors affecting the severity of poisoning can reduce recovery time, costs, and potential risks.

This study aimed to investigate the effect of intravenous vitamin C (ascorbic acid) administration on serum level and urinary excretion of methadone.

In this single-blind study, 54 patients who were diagnosed with methadone poisoning were divided into three groups. The two intervention groups received different doses of vitamin C, including 12 and 24 g, and the control group received normal saline. The serummethadone level and urine pH weremeasured at the time of arrival and 24 hours after admission. The data were analyzed using repeated measure analysis of variance (ANOVA) in STATA version 12.

In this study, 18 patients were placed in each group. The three groups were not significantly different in basic variables, such as age, gender, and methadone dosage. Between and within-group comparison showed a significant decrease in the serum methadone levels over time after adjusting age, gender and methadone dosage (P < 0.05). Post-hoc analyses revealed a significant difference in methadone reduction between 12 g of vitamin C and control groups (P = 0.04), and there was no significant difference between the control and 24 g of vitamin C groups (P > 0.05). However, between and within-group comparisons showed no significant difference between the three groups in terms of urine pH (P > 0.05). In addition, interaction was observed between intervention and time on serum methadone levels (P < 0.001) and urine pH (P = 0.04) variables.

Consuming 12 g of vitamin C further reduced the serum methadone level in patients with methadone poisoning. There was no effect on methadone urinary excretion in patients.

COVID-19 usually complicates respiratory failure; microvascular, macrovascular, and renal complications are common. Both micro and macrovascular complications are associated with multi-organ dysfunction and in-hospital mortality. Thrombotic microangiopathy (TMA) causes microvascular thromboses associated with organ failure, including acute kidney injury (AKI).

This Retrospective Cohort study included 100 COVID-19 patients with thrombocytopenia, followed up in a university hospital’s intensive care unit (ICU). The primary endpoints were in-hospital mortality or discharge from the hospital and assessing the occurrence of TMA and AKI during the hospitalization. The effect of thrombotic microangiopathy and acute kidney injury on mortality was investigated using logistic regression models in Stata software version 12.1.

The TMA and AKI were associated with in-hospital mortality in COVID-19 patients presenting with thrombocytopenia in multivariate regression analysis, adjusted for other variables. The effect of AKI on mortality was obtained (adjusted OR 4.09, 95% CI: 1.33–12.53, p = 0.01). Moreover, the odds of mortality due to TMA were ten-fold higher in the patients who had TMA than those who did not (adjusted OR 10.26, 95% CI: 1.26–83.76, p = 0.03).

We outlined TMA in COVID-19 patients, which could be responsible for kidney injury and mortality in critically COVID-19 patients.

 The COVID-19 pandemic emerged in late 2019 with increased infection and mortality rates. Even with observing safety measures, medical staff have to deal with a high level of mental and physical pressure during an epidemic, and they might demonstrate diverse behaviors rooted in their experiences and emotions toward the situation. The paper examines different experiences and emotions of medical staff dealing with COVID-19 in Ilam, Iran.

A cross-sectional study was carried out with the participation of 200 care providers in 2020. Data was gathered using two questionnaires: the scale of positive and negative emotions (SPANE) and the positive and negative affect scale (PANAS). Data analyses were done in STATA12 using linear regression models.

The mean score of positive emotion in ICU, general, maternity, and administrative wards in women were 32±6.23, 34.07±6.74, 35.35±9.24, and 35.61±6.91 respectively. The mean scores of Negative emotions in the Maternity ward and administrative departments were higher than in the ICU and CCU wards (P=0.05). The midwives’ mean negative emotions score was lower than the physician’s (P value<0.05). Average levels increased by about 4.41 scores in negative experiences for individuals with a work experience higher than 25 years compared to those with work experience less than ten years (P=0.03).

Factors such as type of work, workplace, and work experience that affect care providers’ positive and negative experiences and emotions should be considered in staffing arrangements and their expectations.

Depression is a common disorder in rheumatoid arthritis (RA) patients and can affect clinical outcomes. This study was conducted to determine the prevalence of depression and its relationship with disease activity in RA patients.

In this cross-sectional study, 144 patients with RA were recruited from the Rheumatology Outpatients Clinic, Mostafa Khomeini Hospital Ilam, and were examined for disease activity and depression symptoms. Disease activity was assessed by DAS28 using laboratory tests and physical examination. The Beck self-report questionnaire was used for measuring depression disorder. Data were analyzed using the linear regression models in STATA 14 software.

The prevalence of depression in the sample was 61%. Multivariate analyses showed that patients with severe disease activity faced a significantly greater risk of depression compared to those with mild disease activity. Average levels increased by about 12.43 points in depression for patients with severe disease activity compared to those with mild disease activity. This association was statistically significant after adjusting for the model's other predictors (P<0.001). Furthermore, predicted models showed that the probability of depression increased with age and disease duration in patients with severe activity.

Considering the relationship between depression and severe RA disease activity, the need to screen RA patients in terms of depression disorder and pay attention to comprehensive mental and physical care and cure for better clinical outcomes seems necessary.

Severe disease activity in RA may have been influenced by a psychological phenomenon such as depression; therefore, it was suggested that depression, as one of the diseases worsening the RA symptoms, should be screened and evaluated. It was also recommended that a comprehensive and multidisciplinary approach should be adopted by seeking assistance from psychiatric and psychological specialists in RA disease management.

In 2019, a new disease called Covid-19 was identified in Wuhan, China. Anyone can get this disease at any age and become seriously ill, or even die from it. This study aimed to determine the factors affecting the re-admission of coronary patients.

In this study, 2411 Covid-19 patients referring to Shahid Mostafa Khomeini Hospital in Ilam, Iran were included. Variables such as gender, age, death, body mass index, headache, vomiting, having cold, cough, muscle pain, underlying disease, fever, hemoglobin, blood platelets, glucose as well as ALT, AST, and LDH enzymes were examined. SPSS software was used to fit the model of multiple logistic regressions in soft.

Majority of the patients (54.5%) were males. The average age of readmitted patients was 63 years, and 23% of these patients died. The results of logistic regression test showed the variables of age (OR=1.02, P=0.029), sex (OR=0.637, P=0.047), underlying disease (OR=2.36, P=<0.001), hemoglobin (OR=0.91, P=0.04), blood platelet count (OR=0.99, P<0.001), vomiting or nausea (OR=0.48, P=0.03), and muscle pain (OR=0.61, P=0.04). Effective factors were also identified.

It was concluded that having a comorbid disease and old age increased the chances of re-admission. Moreover, it was scientifically confirmed that an increase in age along with having an underlying disease significantly contributed to re-admission of patients with Covid-19.

The maximum effectiveness of the treatment of Covid-19 patients was confirmed by this study and, therefore, it was recommended that re-hospitalization should be avoided in order to avoid additional treatment costs and waste of resources.

An epidemic of infectious diseases such as COVID‑19 can affect mental health, which may be associated with suicidal behaviors. This study was conducted based on the systematic review and meta‑analysis methods for evaluating the prevalence of suicide ideation during COVID‑19. This study used Preferred Systematic Review Reporting System and Meta‑ Analysis guideline and valid keywords. The articles related to the prevalence of suicide ideation during COVID‑19 pandemic were obtained by searching among different databases including Scopus, Web of science, PubMed, ISC, Google scholar, SID, and Magiran. All of the articles published from the beginning of January 2020 to the end of May 2021 were reviewed. Among 478 articles screened, 377 articles were related to the studied topic, among which 38 articles were selected after assessing the title and abstract of which for reviewing the full text and finally 18 studies were included in the meta‑analysis. Based on the results, the prevalence of suicide ideation and attempt among all studies were equal to 13% (95% confidence interval = 0.11‑0.15, I2 = 99.7%, P = 0.00) and 1% (95% confidence interval = 0.00‑0.01, I2 = 95.5%, P = 0.00), respectively. Based on the results, the prevalence of suicide attempt and ideation is possible during the COVID‑19 pandemic. Therefore, health officials should pay attention to mental health issues in addition to the protective measures for preventing or reducing the infection with COVID‑19. The increase of psychological consequences is probably related to the effect of lifestyle changes which associates with the spread of the disease. In the current meta‑analysis performed, the prevalence of suicidal ideation and suicidal attempt was examined during the COVID‑19 pandemic period and compared to the previous period without COVID‑19. The effect of COVID‑19 on suicidal ideation and suicidal attempt has never been studied.

 Depression is a common disorder in rheumatoid arthritis (RA) patients and can affect clinical outcomes. This study was conducted to determine the prevalence of depression and its relationship with disease activity in RA patients.

In this cross-sectional study, 144 patients with RA were recruited from the Rheumatology Outpatients Clinic, Mostafa Khomeini Hospital Ilam, and were examined for disease activity and depression symptoms. Disease activity was assessed by DAS28 using laboratory tests and physical examination. The Beck self-report questionnaire was used for measuring depression disorder. Data were analyzed using the linear regression models in STATA 14 software.

The prevalence of depression in the sample was 61%. Multivariate analyses showed that patients with severe disease activity faced a significantly greater risk of depression compared to those with mild disease activity. Average levels increased by about 12.43 points in depression for patients with severe disease activity compared to those with mild disease activity. This association was statistically significant after adjusting for the model's other predictors (P<0.001). Furthermore, predicted models showed that the probability of depression increased with age and disease duration in patients with severe activity.

Considering the relationship between depression and severe RA disease activity, the need to screen RA patients in terms of depression disorder and pay attention to comprehensive mental and physical care and cure for better clinical outcomes seems necessary.

 Severe disease activity in RA may have been influenced by a psychological phenomenon such as depression; therefore, it was suggested that depression, as one of the diseases worsening the RA symptoms, should be screened and evaluated. It was also recommended that a comprehensive and multidisciplinary approach should be adopted by seeking assistance from psychiatric and psychological specialists in RA disease management.

 In 2019, a new disease called Covid-19 was identified in Wuhan, China. Anyone can get this disease at any age and become seriously ill, or even die from it. This study aimed to determine the factors affecting the re-admission of coronary patients.

 In this study, 2411 Covid-19 patients referring to Shahid Mostafa Khomeini Hospital in Ilam, Iran were included. Variables such as gender, age, death, body mass index, headache, vomiting, having cold, cough, muscle pain, underlying disease, fever, hemoglobin, blood platelets, glucose as well as ALT, AST, and LDH enzymes were examined. SPSS software was used to fit the model of multiple logistic regressions in soft.

 Majority of the patients (54.5%) were males. The average age of readmitted patients was 63 years, and 23% of these patients died. The results of logistic regression test showed the variables of age (OR=1.02, P=0.029), sex (OR=0.637, P=0.047), underlying disease (OR=2.36, P=<0.001), hemoglobin (OR=0.91, P=0.04), blood platelet count (OR=0.99, P<0.001), vomiting or nausea (OR=0.48, P=0.03), and muscle pain (OR=0.61, P=0.04). Effective factors were also identified.

 It was concluded that having a comorbid disease and old age increased the chances of re-admission. Moreover, it was scientifically confirmed that an increase in age along with having an underlying disease significantly contributed to re-admission of patients with Covid-19.

 The maximum effectiveness of the treatment of Covid-19 patients was confirmed by this study and, therefore, it was recommended that re-hospitalization should be avoided in order to avoid additional treatment costs and waste of resources.

 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.

 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.

 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.

 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.

Patients with cancer are potentially vulnerable to COVID-19 infection due to the immune-compromised state of cancer or its treatment complications.

This study compared the COVID-19 mortality rate in cancer patients with and without a history of chemotherapy.

This registry-based cohort study launched from March 2020 to March 2021 contains 2350 records in which 64 COVID-19 patients with cancer were included, of which 27 patients underwent the chemotherapy plan within eight weeks before confirmed COVID-19. In addition, age and sex were matched in patients without a history of cancer as a control group. Two groups of cancer patients with and without a history of chemotherapy compared to the control group using cox proportional hazard regression models in Stata.10 software.

Patients with cancer had a higher hazard for in-hospital mortality from COVID-19 infection (adjusted HR; 2.27, 95% CI: 1.25 - 4.13, P = 0.007) after adjusting for age, sex, body mass index (BMI), and co-morbidities. Our result showed no significant association between chemotherapy and control groups (adjusted HR; 1.65, 95% CI: 0.60 - 4.56, P = 0.33).

Patients with cancer faced a risk of mortality from COVID-19 two times higher than those without cancer. However, chemotherapy did not increase the mortality following COVID-19 infection.

Anemia often worsens the severity of respiratory illnesses, and few studies have so far elucidated the impact of anemia on COVID-19 infection. This study aimed to evaluate the effect of anemia at admission on the overall survival of COVID-19 patients using AFT models.

This registry-based, single-center retrospective cohort study was conducted in a university hospital in Ilam, the southwest of Iran, between March 2020 and September 2021. AFT models were applied to set the data of 2,441 COVID-19 patients. Performance of AFT models was assessed using AIC and Cox-Snell residual. On-admission anemia was defined as Hb concentration <120 g/l in men, <110 g/l in women, and <100 g/l in pregnant women.

The median in-hospital survival times for anemic and non-anemic patients were 27 and 31 days, respectively. Based on the AIC and Cox-Snell residual graph, the Weibull model had the lowest AIC and it was the best fitted model to the data set among AFT models. In the adjusted model, the results of the Weibull model suggested that the anemia (adjusted TR: 1.04; 95% CI: 1.00-1.08; p = 0.03) was the accelerated factor for progression to death in COVID-19 patients. Each unit of increase in hemoglobin in COVID-19 patients enhanced the survival rate by 4%.

Anemia is an independent risk factor associated with the risk of mortality from COVID-19 infection. Therefore, healthcare professionals should be more sensitive to the Hb level of COVID-19 patients upon admission.

 Individuals with opioid use disorder are a marginalized population in any society. They commonly have a weaker immune system, greater stress vulnerability, poorer health, more high-risk behaviors, and less access to healthcare services compared to the general population, which can expose them to a risk of severe COVID-19 complications. This study aimed to evaluate the effects of opioid use disorder on mortality in patients with SARS-CoV-2.

 This registry-based retrospective cohort study was conducted on 2362 consecutive inpatients with a confirmed diagnosis of SARS-CoV-2 between March 5, 2020 and March 21, 2021, presenting to a university hospital in Ilam in the southwest of Iran. Forty-five patients with opioid use disorder were identified in this study and matched to 100 patients without opium addiction. All patients with a history of opium addiction were included in the study group, and age- and sex-matched patients without opioid use disorder were randomly recruited as the controls. After adjusting for the effects of age and comorbidities, data were analyzed in STATA version 10, using logistic regression models.

 The mortality of patients with opioid use disorder increased following COVID-19 (adjusted OR: 6.59; 95% CI: 1.84–23.59; P=0.004). Hypertension (adjusted OR: 8.17; 95% CI: 2.21–30.15; P=0.002) and advancing age (OR: 1.06; 95% CI: 1.01–1.11; P=0.01) were significantly associated with increased COVID-19 mortality.

 Based on the present findings, opioid use disorder is a possible risk factor for mortality following COVID-19. The findings of the present study can be applied in the implementation of preventive measures and policies and prioritization of COVID-19 vaccination. However, further relevant research is recommended.

Electrolyte imbalances are common in COVID-19 infection and are associated with poor outcomes in hospitalized patients.

This study examined whether serum phosphate imbalances at admission are associated with mortality in hospitalized COVID-19 patients.

In this registry-based single-center retrospective cohort study, 1349 inpatients with COVID-19 were included from March 2020 to March 2021 in an academic hospital in Ilam (southwest Iran). The Cox proportional hazard (PH) regression model was applied to the data set of COVID-19.

The in-hospital median survival time for patients with low, normal, and high serum phosphate levels was 14, 25, and 8 days, respectively. In a multivariate model, adjusted for the other variables, patients with hypophosphatemia (adjusted hazard ratio [HR], 2.53; 95% CI, 1.15 - 5.58; P = 0.02) and hyperphosphatemia (adjusted HR, 1.77; 95% CI, 1.00 - 3.14; P = 0.05) had an increased mortality hazard compared with those who had normal levels of serum phosphate.

Our results demonstrate a strong effect of hypophosphatemia and hyperphosphatemia with increased in-hospital mortality in COVID-19 patients. Intensive medical care and more attention must be paid to COVID-19 patients with serum phosphate imbalances at admission.

Decrease in Bone Mineral Density (BMD) is one of the complications of kidney transplantation in which many factors are involved. The results of studies are different and contradictory.

to investigate the prevalence and related factors influencing BMD in renal transplant recipients.

all kidney recipients (69 patients) referring to the Shahid Mostafa Khomeini Hospital, Ilam, Southwest of Iran, were included between 2016 and 2018. BMD of the lumbar spine and femoral neck was performed using dual-energy X-ray absorptiometry (DEXA). According to Z- score and T- score, patients were divided into two groups: fewer than 50 and over 50 age years. All demographic, background variables and laboratory parameters were evaluated. Descriptive statistics and Binary and multinomial logistic regression were used to analyze.

The overall prevalence of osteoporosis in the femur and lumbar spine was 38% and 32%, respectively. In patients under 50 years, Osteoporosis in the femur showed a significant relationship with vitamin D level and gender. In patients over 50 years, increased age and length of prednisolone consumption were associated with an increased risk of osteoporosis and osteopenia in the femoral neck (P <0.05). Moreover, the length of use of prednisolone was associated with osteoporosis in the lumbar spine (RRR=1.02; p <0.05).

various factors such as prednisolone consumption affect BMD reduction in renal transplant recipients. Regular monitoring of BMD, reducing prednisolone dose as much as possible, training on effective supplements, and other preventive and supportive measures can be helpful and necessary.

Suicide is one of the most important health problems in the world. Financial, academic, social, and environmental difficulties along with genetic, physical, and mental disorders affect suicide attempts. This study aimed to find risk factors for completed suicide in Ilam province according to the suicide registry in Ilam province.

This was a prospective study and was performed based on suicide case registration data, pre-determined checklist data, and death registration data in Ilam province from March 2019 to September 2020. Logistic regression models and the Chi-square test were used to determine the relationship between completed suicide and its risk factors.

Among 1,410 attempted suicides, 66 (4.7 %) were executed. Rate of completed suicides was higher in men (6.5%) compared to women (4.5%), (p = 0.005), age groups over 65 years (P < 0.001), retirees and farmers (P = 0.009), illiterate people (P < 0.001), villagers (P = 0.02), people motivated due to physical problems (P = 0.016), suicide by physical methods (P < 0.001) and self-immolation (P < 0.001). Logistic regression showed that incidence of completed suicide was significantly higher in the age group over 65 years, illiterate people, people using physical methods, villagers, and men. Multivariate logistic regression also showed that men and individuals using physical methods of suicide were significantly more successful in suicide.

Men, the elderly, illiterates, villagers, and people who used physical suicide methods were in high-risk groups. Despite lower prevalence of suicide, a higher rate of completed suicide was demonstrated. To decrease completed suicide rates, we must pay attention to these groups.

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by synovitis, inflammation, and joint destruction that if not well controlled can destroy cartilage, bone, ligaments and tendons, and in some cases cause disability. The aim of this study was to evaluate the possible role of the ratio of neutrophil-lymphocyte (NLR) as an inflammatory marker in determining the severity of RA (Disease Activity Score 28 [DAS28]).

Fifty patients with RA attending the rheumatology clinic in Ilam Shahid Mostafa Khomeini Hospital, Iran, were examined for disease activity using physical and laboratory tests. NLR and disease severity were determined based on DAS28.

The disease activity, including remission and mild/moderate were seen in 34% (DAS28<2.6) and 66% (DAS28 2.6), respectively. The patients were 86% women and 14% men. Mean ages of patients with mild/moderate and remission RA were 51.30 and 36.82 years, respectively. The mean NLR was 1.80 in patients with remission RA and 1.93 in those with mild/moderate RA and no significant relationship was found in NLR between these two groups (P=0.99). There was a significant relationship between DAS28 and erythrocyte sedimentation rate (ESR) (P=0.02), and a weak relationship between DAS28 and age, gender, and medication (P≥0.1).

According to the results, perhaps ESR rather than NLR could be a prognostic factor for determining disease activity levels in RA patients with DAS28 <3.2.

Context: 

Acetylcysteine is an effective treatment for acetaminophen poisoning. The preparation and dose calculation of acetylcysteine is associated with medical errors. The prevalence of this error is 34% globally.

Case report:

 A 15-year-old girl took an overdose of acetaminophen in a suicide attempt. Acetylcysteine intravenous was ordered. Due to the medication error by the nurse, she received a 10-fold overdose of intravenous acetylcysteine in both initial loading dose and maintenance dose, at first day. On the second day, the patient showed abdominal pain, nausea, vomiting, and elevated liver enzymes. Her hemoglobin, hematocrit, and platelet quickly decreased. Subsequently, she developed oliguria, anuria, and rising serum creatinine levels. The patient was diagnosed with uremic hemolytic syndrome. She underwent hemodialysis and was treated with plasmapheresis, blood transfusions, and platelets.

 The effects of acetaminophen poisoning and acetylcysteine overdose may be much more severe and have a greater impact on patient survival than each poisoning alone. Timely and accurate treatment measures can help prevent long-term side effects.

 Suicidal behavior in children under 10 years of age is a warning and a matter of concern. It can be an important indicator for evaluating the mental health of individuals in the community. 

This study reported an 8-year-old boy who had three failed suicide attempts by hanging. The psychiatric assessment revealed that he had major depressive disorder which had not been diagnosed.

 Evaluation of his behavior by using the Child Behavior Checklist completed by his parents showed that he had the highest scores in aggressive behavior, attention problems, rule-breaking behavior, and anxious/depressed subscales. Lack of parental attention to meeting the needs and creating a supportive environment may have led to behavioral-emotional disorders and risky behaviors such as suicide in the boy.

Postpartum depression (PPD) is a mood disorder that can affect women after childbirth and this disorder can strike fathers as well as mothers.  The study reports a 28-year-old man who attempted suicide three times following his wife delivery and newborn baby boy. Psychiatric assessment showed that the man revealed major depression following childbirth. So effective mental disorders screening and health care services must be provided for fathers as well as mothers and children.

Disasters have many health consequences such as suicide ideation as one of the relatively common psychological consequences after natural disasters, especially earthquakes. This study aimed to determine the prevalence of post-earthquake suicidal ideation in affected people.

Related keywords of this systematic review and meta-analysis in English and their Persian equivalents were searched in the data resources including Google Scholar, SID, Magiran, Scopus, PubMed, and Web of Science from Jan 2014 to May 2019. The STROBE checklist was used to evaluate the quality of the articles. The I2 index was used to determine the heterogeneity and the random-effects model was used in meta-analysis. Statistical analysis was conducted in the STATA software version 14.

Overall, 14347 subjects including 6662 males and 7715 females with the mean age of 23.88 ± 15.81yr old were assessed. The prevalence of post-earthquake suicidal ideation was 20.34% (95% CI: 13.60-27.08, P<0.001, I2=99.1). The prevalence of suicidal ideation showed a decreasing trend based on the year of the study and the duration of post-earthquake follow-up.

Although the prevalence of post-earthquake suicidal ideation showed a decreasing trend, the probability of incidence of these thoughts in the long-term is still noticeable. Therefore, implementing a surveillance system is recommended to monitor the mental health status of earthquakes survivors for the possibility of suicidal thoughts in the short and long term recovery phase.