Objective: To compare effect of intrathecal meperidine, tramadol, magnesium sulfate, and dexmedetomidine on the prevention of postspinal anesthesia shivering and adverse events in hip fracture repair patients. Methods: In a randomized, double-blind trial, 132 patients with American Society of Anesthesiology (ASA) I and II spinal anesthesia who needed hip fracture surgery were enrolled. Patients were stratified into 4 intervention groups based on a randomized block pattern: meperidine, tramadol, magnesium sulfate, and dexmedetomidine. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation, as well as the severity of shivering, core body temperature, Ramsay sedation score, adverse events, meperidine consumption were recorded and compared. Results: There was no statistically significant difference in the normal hemodynamic parameters, temperature, duration of surgery, meperidine consumption, and adverse events such as dizziness, hypotension, nausea, and bradycardia among groups (P>0.05). Compared to other groups, severity of shivering was the lower in the dexmedetomidine group 6 and 8 h after surgery. The Ramsay sedation scores were higher in the dexmedetomidine and meperidine groups 4 h after surgery (P=0.020). Conclusion: Dexmedetomidine acts better than the other three adjuvants in reducing complications such as shivering. Overall, these four adjuvants are helpful to prevent postoperative shivering and could be put forward as promising local anesthetics in spinal anesthesia, based on anesthesiologists’ discretion and patients’ general conditions. Clinical registration: The study was approved by the Research and Ethics Committee at the Valiasr Hospital (Arak, Iran) with the clinical trial code of IRCT20141209020258N153.

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Thrombotic complications appear to be a major predictor of death in COVID-19 patients, and multiple studies have shown that anticoagulants can help to improve the outcome. The Food and Drug Administration’s acceptance of non-vitamin K antagonist oral anticoagulants (NOACs) has sparked much excitement about their potential as a replacement for existing oral anticoagulants. NOACs target a single clotting factor, often activated factor X or thrombin, and involve the coagulation factor Xa inhibitors including apixaban, edoxaban, and rivaroxaban, and the thrombin inhibitor dabigatran. COVID-19 is an infectious disease that causes thrombotic events by inducing a pro-inflammatory and prothrombotic condition. This article provides a comprehensive overview of the mechanism behind enhanced thrombogenicity accompanying COVID-19, the clinical range of NOACs, and the role of NOACs in treatment of COVID-19 based on recent investigations and clinical trials.

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Rationale: Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal (GI) bleeding. GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock. Patient’s Concern: A 33-year-old man with confusion and hypotension (blood pressure: 70/40 mmHg and pulse rate: 140/min) was brought by emergency medical services from home to the emergency department without any companion. The patient was in undifferentiated shock. His hypotension was assessed with inferior vena cava (IVC) size and collapsibility, and rapid ultrasound in shock and hypotension (RUSH) protocol was used to investigate the cause of his shock. Following the RUSH protocol when scanning the IVC, parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid. After seeing these particles, we suspected GI bleeding. Diagnosis: Endoscopy confirmed GI bleeding. Interventions: After placing an orogastric tube and suction, about 2 L of coffee-ground fluid with clots was removed. We started intravenous proton-pump inhibitors 80 mg bolus, followed by a continuous infusion of 8 mg/h. The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension. Outcomes: After being admitted to the GI ward and treated for three days, the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic. Lessons: The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock. The components of the RUSH exam are the heart (H), IVC (I), Morrison’s/FAST abdominal views with the aorta (MA), and pulmonary and pipes scanning (P), and can be memorized with the mnemonic: HI-MAP. We would like to introduce a new mnemonic: Hi-MAPS, adding stomach (S) to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

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Objective: To report the maternal death due to COVID-19. Methods: A total of 14 maternal deaths due to severe and critical COVID-19 who were referred to the obstetric department of Nekouie-Forghani-Hedayati Hospital, Qom, Iran from December 2019 to May 2022 were collected. The clinical manifestations and maternal and perinatal outcomes were analyzed. Results: Dexamethasone was used in 7 cases, while remdesivir was used in 5 cases. Acute respiratory distress syndrome, multiple organ failure, and sepsis were the main cause of mother death. The pregnancy in 8 cases were terminated by caesarean and only one neonatal death was reported from a mother at 13th week of gestational age, while all other fetus delivered were healthy and alive. Conclusions: COVID-19 in pregnancy is an emergency. Critical appraisal is needed to detect the other comorbidities and positive PCR test by throat swap should be performed as soon as possible.

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Objective: To uncover the impact of centralization of COVID-19 and perceived control of COVID-19 on society during the pandemic. Methods: We recruited a total of 1 041 people in this cross-sectional study. The data were collected using a questionnaire booklet covering demographics, a COVID-19-related information form, the Centrality of Event Scale, and the Perception of Control of COVID-19 Scale. We utilized independent samples t-test, chi-square test, and one-way analysis of variance to analyze the data. Results: 1041 questionnaires were collected and no questionnaire were excluded from our study. Slightly more than half of the participants (51.2%) stated that social isolation impaired public mental health, while 30.1% reported adverse impacts of the pandemic on their sleep quality. Participants with changes to their sleep patterns were found to centralize COVID-19 more. Moreover, measures against COVID-19 and constant announcements of the daily number of cases in the media brought both positive and negative effects on people and further contributed to the participants’ centralization of COVID-19. Individuals with low centralization scores were concluded to perceive COVID-19 as a minor disease. Healthcare professionals without a relative diagnosed with COVID-19 and those satisfied with treatment opportunities had a higher perceived control of COVID-19, while those who were not interested in statistical data on COVID-19 and who had difficulty complying with the rules had a lower perceived control of COVID-19. Besides, poorer perceived control of COVID-19 was found to adversely affect sleep quality. Furthermore, healthcare professionals scored higher on the inevitability subscale of the Perception of Control of COVID-19 Scale. Finally, among the participants, most COVID-19 survivors thought COVID-19 to be an avoidable disease. Conclusion: In addition to its physical impacts, COVID-19 adversely impacts on mental health, and these effects are closely linked to a society’s centralization of COVID-19 and perceived control of COVID-19.

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Objective: To investigate the clinical symptoms of coronavirus disease 2019 (COVID-19) patients with and without B.1.1.7 mutation. Methods: This retrospective observational study included COVID-19 patients who were divided into two groups, the mutation and the non-mutation group. Demographics characteristics, clinical characteristics, laboratory parameters, and mortality rates were recorded and compared between the two groups. Results: A total of 196 patients were included in the study. The relationship between the mutant virus status and sex, age, comorbidity, survival status, and disease severity was not significant (P>0.05). No significant differences were found in duration of hospitalization between the mutation and the non-mutation group (P>0.05). However, there was a statistically significant difference between patients with and without mutant viruses in hemoglobin, mean platelet volume, procalcitonin, low density lipoprotein, ironbinding capacity, potassium, calcium, C-reactive protein, folate, creatine kinase myocardial band, D-dimer, and international normalized ratio (P<0.05). Conclusions: No significant difference is found in mortality rate, disease severity or duration of hospitalization between the patients with and without variant B.1.1.7. Careful monitoring of COVID-19 patients is required for all variants.

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Rationale: Acute iron poisoning is commonly seen in a pediatric population caused by accidental ingestion of iron syrups. We describe a case of iron poisoning who presented to the hospital following intentional near-fatal ingestion of ferrous sulfate. Patient’s Concern: A 14-years-old previously healthy female patient presented to the emergency department with a history of an intentional overdose of 80 ferrous sulfate tablets. Diagnosis: Ferrous sulfate poisoning. Interventions: The patient developed acute fulminant liver failure 24 h after of the overdose. She was managed conservatively, mainly with deferoxamine and N-acetylcysteine while awaiting transfer to a liver transplant facility. Outcomes: The patient responded well to medical therapy and was discharged on the 9th day of intensive care unit admission. Lessons: This case highlights the patient’s successful recovery with prompt conservative therapy. Severe iron toxicity can be treated with early use of deferoxamine and N-acetylcysteine where a liver transplant facility is not available.

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