Inflammation is a multifaceted cellular and molecular response triggered by injury, infection, or various pathological conditions. Serving as a protective defense mechanism, the inflammatory response involves clinical signs like redness, swelling, pain, and increased body temperature. Immune cells, notably neutrophils and macrophages, play key roles in orchestrating this response. The delicate balance between proinflammatory and anti-inflammatory mediators, including cytokines and chemokines, regulates the inflammatory cascade. While acute inflammation is crucial for tissue repair, chronic inflammation may indicate an imbalance, contributing to conditions like autoimmune diseases. Understanding these mechanisms is vital for developing therapeutic strategies and managing chronic diseases.

Objective: To investigate cardiovascular risk factors affecting COVID-19 outcomes in a tertiary referral hospital. Methods: This prospective cohort study analyzed 269 participants with COVID-19. The primary outcomes were ICU admission, prolonged hospital stay duration, and in-hospital death. The secondary outcomes included death, chronic symptoms, and NYHA functional class during follow-up periods. Results: A total of 412 patients with COVID-19 symptoms were enrolled in the study, and out of which 269 patients had complete medical records and positive SARS-CoV-2 PCR test results, fulfilling the study criteria were analyzed. The patients were divided into two groups, with cardiovascular comorbidities (group A, n=122), such as established cardiovascular disease, diabetes mellitus, and hypertension, and without cardiovascular comorbidities (group B, n=147). Binary logistic regression analysis showed that patients with underlying hypertension, diabetes, and established cardiovascular disease had a 1.55 (95% CI: 1.28-2.26), 1.62 (95% CI: 1.34-2.13), and 1.63 (95% CI: 1.07-5.34)-fold risk of mortality, respectively in the adjusted model. Conclusions: Hospitalized COVID-19 patients with predisposing cardiovascular risk factors are more susceptible to develop worse outcomes. More attention should be paid to the management and follow-up of these patients.

Objective: To explore correlation of neutrophil-to-lymphocyte ratio (NLR) to severity of coronary artery disease (CAD) and in-hospital clinical outcomes in patients with acute coronary syndrome (ACS). Methods: In this prospective and observational study, we recruited 500 patients with ACS. For all the eligible patients, demographic details were collected, and laboratory parameters were evaluated. The CAD severity was evaluated in terms of the number of involved vessels. The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed. Results: 77.2% of Patients was male, and 52% of the patients aged between 55-70 years. Based on the type of ACS, 396 out of 500 patients had ST-elevation myocardial infarction. An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among class Ⅳ patients. The mean NLR value among the non-survivors were higher compared to the survivors (9.52±5.72 vs. 4.76±2.36; P<0.01). Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0% and a specificity of 77.3%. Conclusions: The NLR can be used as an independent prognostic marker in ACS. An elevated NLR value serves as a reliable predictor for short-term complications, notably in-hospital mortality.

Objective: To determine the temporal trend and epidemiology of animal bite cases in Gerash City, Iran. Methods: This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City. The collected data were analyzed using Chi-square test. Results: The mean age of victims was (30.9±17.5) years. 80.54% Of victims were male, 39.70% were self-employed, and 64.60% were adults (≥18 years). Most cases of bites occurred in 2019 (91 cases), 2020 (74 cases) and 2021 (87 cases), and most of the bites were related to the upper limbs (62.70%). Most of the wounds were superficial (78%), most of the biting animals were domestic animals (91.74%), and most of the victims had Iranian nationality (97.62%). Conclusions: Given the increasing trend of animal bites in Gerash City, health authorities should carry out basic measures such as education and awareness among the public, especially at-risk groups such as adult males. Additionally, since most cases of bites are due to dogs, it seems necessary to plan for vaccination of dogs, especially those with owners.

Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type. Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes. Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01). Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

Objective: To investigate the clinical profile and risk factors of symptomatic and asymptomatic hypoglycemia in neonates admitted to a neonatal intensive care unit in a tertiary care center. Methods: The prospective observational study was conducted in a tertiary care center in the Specialty Department of Pediatric. 196 Newborn babies with blood glucose levels < 45 mg/dL were examined with a simple random sampling method between December 2019 and November 2021. Maternal and neonatal risk factors and clinical signs were recorded and compared between symptomatic and asymptomatic cases. Results: The proportion of symptomatic hypoglycemia neonates born to gestational diabetes mellitus mothers was significantly higher (23.4% vs. 8.4%)(P<0.05). Small for gestational age, low birth weight, respiratory distress syndrome, hypothermia, and endocrine disorders were risk factors. The death rate in asymptomatic hypoglycemia neonates was significantly higher (58% vs. 39%) (P<0.05). Conclusions: The study indicates that maternal gestational diabetes mellitus is associated with symptomatic hypoglycemia and asymptomatic hypoglycemia is associated with neonatal mortality. It is important to take vigilance and timely interventions to address associated symptoms, particularly poor feeding, in the management of neonatal hypoglycemia.

Rationale: Acute otitis media is a common disease in early childhood, and is usually caused by Streptococcus pneumoniae ( S. pneumoniae). Acute mastoiditis is a complication of acute otitis media and can involve not only the mucoperiosteum of the middle ear but can also spread to the periosteum by destroying the mastoid bone (acute coalescent mastoiditis). In addition, the infection can extend through the surrounding bones or the emissary veins beyond the mastoid’s air cells, leading to subperiosteal abscesses.
Patient’s Concern: A 16-month-old female patient was hospitalized due to the purulent discharge of the left ear and the symptoms of right mastoiditis (swelling and redness of the skin).
Diagnosis: Bilateral acute coalescent mastoiditis caused by S. pneumoniae infection. The computer tomography revealed bilateral bone destruction of the mastoid and abscesses found behind the auricle on both sides.
Interventions: The patient underwent intravenous antibiotic therapy and surgical treatment.
Outcomes: The patient was discharged 14 days after hospitalization with an improved condition.
Lessons: Improperly treated acute coalescent mastoiditis can lead to extracranial and intracranial complications, sometimes serious and even life-threatening. Complications are prevalent in children under 2 years, in whom the disease progresses more rapidly and severely. The vaccination with a 13-valent vaccine may not result in sufficient immunity against S. pneumoniae, a predominant pathogen in children affected by acute coalescent mastoiditis.

Rationale: Multi-organ failure is a symptom of paraquat poisoning, resulting in high mortality and morbidity rates. Though paraquat is widely available, poisoning through inhalation is rare. Patient’s Concern: A 37-year-old male reported to the emergency department with complaints of vomiting after an alleged history of inhalation of paraquat while at work. Diagnosis: Paraquat poisoning. Interventions: Supportive management along with multiple sessions of hemodialysis. Outcomes: Renal complications caused by paraquat were improved after multiple sessions of hemodialysis. However, the patient developed respiratory complications and later due to persistent hypoxemia and non-responsive to supportive therapy, he succumbed to his illness. Lessons: Acute kidney injury is a complication of paraquat poisoning. However, kidney involvement with the inhalational mode is rare. It is caused by reduction and oxidation cycles, as well as the formation of reactive oxygen species, necessitating hemodialysis as the treatment. Without a clear history, a specific clinical trait, or a diagnostic test, diagnosis can be difficult. Our case thus highlights the inhaled paraquat poisoning, presenting with acute kidney injury with late respiratory impairment as a consequence.

Meigs syndrome (MS) is characterized by a benign ovarian tumor (fibroma), hydrothorax on the right side, and ascites; which can be resolved permanently after surgery. Available literature reveals that most MS surgeries were performed under general anesthesia (GA)[1]. However, GA poses major risks to the patient. Considering the high risk of gastric content regurgitation, poor general condition or dyselectrolytemia may lead to delayed arousal, and associated multi-organ dysfunction. Intraoperative mechanical ventilation is also difficult due to ascites and hydrothorax (reduced cardiac output, impaired ventilation-perfusion in lungs causing hypoxia and hypercapnia)[1,2]. In this letter, we report a case of MS tumor resection under the subarachnoid block (SAB) to mitigate these issues and also review the complications associated with both techniques.