Tehran University Medical Journal

Wound healing and reduction of its recovery time is one of the most important issues in medicine. Wound is defined as disruption of anatomy and function of normal skin. This injury could be the result of physical elements such as  surgical incision, hit or pressure cut of the skin and gunshot wound. Chemical or caustic burn is another category of wound causes that can be induced by acid or base contact irritation. Healing is a process of cellular and extracellular matrix interactions that occur in the damaged tissue. Wound healing consists of several stages including hemostasis, inflammatory phase, proliferative phase and new tissue formation which reconstructs by new collagen formation. Wounds are divided into acute and chronic types based on their healing time. Acute wounds have sudden onset and in normal individuals usually have healing process of less than 4 weeks without any residual side effects. In contrast, chronic wounds have gradual onset. Their inflammatory phase is prolonged and the healing process is stopped due to some background factors like diabetes, ischemia or local pressure. If the healing process lasts more than 4 weeks it will be classified as chronic wound. Despite major advances in the treatment of wounds, still finding effective modalities for healing wounds in the shortest possible time with the fewest side effects is a current challenge. In this review different phases of wound healing and clinical types of wound such as venous leg ulcer, diabetic foot ulcer and pressure ulcer are discussed. Also acute wound models (i.e burn wounds or incisional wound) and chronic wound models (such as venous leg ulcers, diabetic foot ulcer, pressure ulcers or bedsore) in laboratory animals are presented. This summary can be considered as a preliminary step to facilitate designing of more targeted and applied research in this area.

Background: Bronchiolitis is one of the most common diseases of the lower respiratory tract in infants. Vitamin D has been shown to be protective against lower respiratory infections; however, there are limited and contradictory results in relation to serum vitamin D level and the incidence of bronchiolitis in children. The aim of this study was to compare serum levels of this vitamin in healthy infants and infants with acute bronchiolitis.
Methods: This case-control study conducted at Abuzar hospital in Ahvaz city, during October to March of 2014. Three groups of 45 eligible infants including control, low and high intensity of bronchiolitis enrolled to study. The severity of bronchiolitis classified according to scores derived from the respiratory distress assessment index. One to eight scores considered as low intensity and 9 to 17 scores considered as high intensity of bronchiolitis. Subsequently, 3 ml of venous blood sample were taken from them and the serum levels of 25(OH)D were measured by using an enzymatic kit.
Results: 60 (44.4%) infants were girls. The mean age of the control, low and high intensity of bronchiolitis groups were 11.2±5.2, 10±5.8 and 9.8±4.7 months, respectively (P=0.1). The mean of 25(OH)D concentrations in the control, low and high intensity bronchiolitis groups were 28.3±19.4, 17.7±11.7 and 13.6±5.7 nm/l, respectively. There was a significant difference in levels of 25(OH)D between the control-low intensity bronchiolitis groups (P=0.001) and the control-high intensity bronchiolitis groups (P=0.002), this difference was not significant between the two groups of bronchiolitis. There was a direct and significant correlation between serum level of 25(OH)D and age (r=0.2, P=0.005), breast milk consumption (r=0.3, P=0.001), and vitamin D supplementation (r=0.6, P=0.000).
Conclusion: In the present study, levels of 25(OH)D were significantly lower in infants with bronchiolitis than control group. In addition, 25(OH)D levels did not affect the severity of bronchiolitis.

Background: Acute leukemia is one of the most common types of childhood malignancies and one fourth of malignancies in this age group is acute leukemia. Acute leukemia may be myeloid or lymphoid. Acute lymphoblastic leukemia is characterized with abnormal proliferation of lymphoid cells and symptoms related to this are acute and if disease is not treated appropriately, it progresses rapidly and end up to death. Diagnosis of these types of malignancies is easily made with evaluation of bone marrow and peripheral blood cells by an expert hematologist. One of the primary sites of leukemic involvement in childhood is oral cavity which is caused by infiltration of leukemic cells in this area. This causes signs and symptoms, for instance, oral lesions gingival hemorrhage and swelling.
Case presentation: We present a 13-year-old girl who was referred to local physician due to toothache and gingival lesions. Some medications were prescribed for her without any improvement. Then excision of this painful gingival lesion was done and diagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and start of appropriate medical therapy, patient developed many different complications of acute lymphoblastic leukemia and its related therapies. What make this presented case as an outstanding and interesting one is the mentioned complications which were more significant with multiple organ involvement in comparison with similar cases. These complications were treated by appropriate managements.
Conclusion: With new advance in treatment of ALL, survival rate of patients is increased but unfortunately morbidity rate is significant. These complications may be managed by appropriate therapies and close follow-up.

Background: Acute myeloid leukemia (AML) is blood and bone marrow malignancy. Low-density oxidative lipoprotein (oxLDL) is a pro-inflammatory factor that has free radicals in its structure. OxLDL levels are also rising in diseases such as diabetes, cardiovascular disease, and some cancers. Studies have shown that oxLDL and dyslipidemia are more common in patients with various cancers. This study aimed to evaluate the level of blood lipids and oxLDL in these patients with acute myeloid leukemia.
Methods: In a descriptive study, 36 patients who were diagnosed with acute myeloid leukemia from April 2016 to March 2017 were enrolled. This study was done in Shahid Ghazi Blood Department of Imam Reza Hospital, Tabriz University of Medical Sciences, Iran. Basic information including age, sex, type of disease, cause for referrals of the patients were collected. After obtaining informed consent from patients and 12 hours of fasting, 5 cc blood samples were sent to the Central Laboratory of Shahid Ghazi Hospital to measure the level of blood lipids including cholesterol, triglyceride, low density lipoprotein, high density lipoprotein (HDL), and oxLDL levels. Blood lipid and oxLDL levels were measured by automatic analyzer (Abbott Laboratories, Abbott Park, IL, USA) (ELISA method).
Results: 23 patients (54.8%) were male and 19 (45.2%) were female. The mean age of the patients was 44.06±14.48 years. The lowest age was 25 and the highest was 80 years. In the study, the mean serum cholesterol level was 147.64±42.28 mg/dl, the blood triglyceride was 183.28±79.34 mg/dl, the LDL was 84.89±26.35, and the HDL 29±14.51, the mean oxLDL was 1482.5±6031.85 ng/ml.
Conclusion: The results of this study indicate that dyslipidemia in patients with acute myeloid leukemia has not been evident. Concerning oxLDL, an oxidative stress factor involved in acute myeloid leukemia requires further investigation and studies.

Background: Acute myeloid leukemia (AML) is a malignant hematological disorder which has numerous manifestations at the initial step such as infections and hemorrhagic signs. This is the first report in which the diagnosis of AML was made after managing of Bartholin gland site swelling and pain as the chief complaint of a patient.
Case presentation: Herein, we present a young girl who was referred to us in our tertiary level hospital, Firoozgar Hospital, Tehran, Iran, in october, 2017 just with pain and swelling of the left Bartholin gland. At first, it was suspected to be a cyst or abscess of Bartholin gland, she did not have any history or symptoms of infection on comprehensive physical examinations such as pneumonia, meningitis, Nevertheless, the ultimate diagnosis of AML was made after generalized and precise systemic examination and laboratory findings were done. According to the guidelines for the treatment of AML, systemic chemotherapy with multiple drugs was given immediately but unfortunately, she died due to severe septicemia which was resistant to broad-spectrum antibiotics and disseminated intravascular coagulation.
Conclusion: Based on our searching, this is the first case. Because we expected other more common symptoms of acute lukemia, systematic and precise generalized examination must be performed gently in all of the patients even in women just with genital symptoms as their chief compliant for instance, pain and swelling of Bartholin gland. Finally, not focusing just on the perineal site and detailed examination for all parts of the body may reveal an accurate diagnosis of the main underlying disease.

Background: Acute myeloid leukemia (AML) is characterized by the proliferation of myeloid precursors and abnormal differentiation of hematopoietic stem cells, which results in the accumulation of immature cells in the bone marrow (BM). The accumulation of these cells in the bone marrow causes molecular and cellular changes in the microenvironment of the bone marrow. The adiponectin hormone originates from adipose tissue of the bone marrow, which in addition to effective functions in cellular metabolism, suppresses cancer through various mechanisms, including inhibition of metastasis, angiogenesis, and proliferation. In the bone marrow sample, patients with acute myeloid leukemia are associated with different subtypes of the disease.
Methods: In this basic-fundamental research, a total of 40 BM samples from de novo AML patients and 15 BM samples from healthy volunteers as the healthy group referred to the Stem Cell Transplantation Laboratory and Cell Therapy of Taleghani Hospital and with assisting the Research Center, Shahid Beheshti University of Medical Sciences, Tehran, from March 2015 to February 2017, were entered into the study. Then used the Real-time polymerase chain reaction (RT-PCR) method for diagnosis level of adiponectin gene expression in BM samples patients and the healthy group.
Results: The results of the present study showed that the level of adiponectin gene expression in the BM sample of patients was significantly decreased in comparison with the healthy group (P=0.002). While, there was no significant difference (P<0.05) in adiponectin gene expression in AML subtypes myeloblastic, promyelocytic, and myelomonocytic/monocytic.
Conclusion: The results of this study indicate that there was a decrease in adiponectin gene expression in the bone marrow of acute myeloid leukemia patients compared to healthy controls. This decrease in adiponectin expression may be due to myeloid hyperplasia and a decrease in bone marrow adipocytes. In fact, The nutritional, metabolic, and mechanical stresses associated with myeloid cells accumulation cause alterations in bone marrow microenvironment structure and destruction of bone marrow adipose tissue. Therefore, reduced adiponectin gene expression in AML patients is one of the key indicators of bone ‎marrow microenvironmental changes in AML patients.‎‎

Background: Early diagnosis and proper treatment of patient with acute coronary syndrome (ACS) and ischemic heart disease are important in determining prognosis, preventing adverse effects, and may even save lives. In this study, the level of pregnancy-associated plasma protein-A (PAPP-A) in ACS patients was compared with the control group, in addition to cardiac Troponin (cTn) and creatine kinase-myocardial band (CK-MB) markers.
Methods: In this cross-sectional study, 116 patients with ACS were selected by convenience sampling method among patients referring to the emergency department of Farshchian Heart Center, Hamadan University of Medical Science in Iran, from June 2017 to May 2018, and then were compared with 116 healthy persons (control group) in term of PAPP-A, CK-MB and serum cTn biomarkers.
Results: The mean and standard deviation of PAPP-A in acute coronary syndrome (ACS) and control group were 93.85±27.56 and 89.63±7.29, respectively. There was no significant statistical difference between patients with ACS and control group. However, the level of PAPP-A in ST segment elevated myocardial infarction patients (STE-MI) was significantly higher than those with unstable angina (UA) and non-ST segment elevated myocardial infarction (NSTE-MI) (P<0.001). The mean and standard deviation of PAPP-A in patients with acute coronary syndrome with positive and negative troponin results was 99.42±27.52 and 90.69±18.79, respectively (P=0.021). The correlation coefficient between serum PAPP-A and creatine kinase-MB obtained 0.070 (P=0.292).
Conclusion: In patients with ACS, in addition to the increase in cardiac troponin markers (cTn), the serum level of pregnancy-associated plasma protein A (PAPP-A) also increases significantly. Therefore in addition to measuring serum cardiac troponin levels, evaluation and measurement of PAPP-A can also be used to diagnose and management of ACS.

Background: Opioid poisoning is the most common type of poisoning in intensive care units (ICUs). This group usually includes patients who have been drug abusers for a long time and now require hospitalization either because of acute overdose or due to side effects of routine opioid use. This study aimed to compare the severity and prognosis of patients using common mortality predictors Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score (SAPS II), Acute Physiology And Chronic Health Evaluation (APACHE II, APACHE IV) on different days of hospitalization.
Methods: This cross-sectional study was performed on all patients with opioid poisoning admitted to the ICU, Imam Reza Hospital, Mashhad, Iran, from the beginning of April 2016 to March 2017 (Persian Calendar). For all poisoned patients enrolled in the study, the four mortality predicting tools were filled daily in the first three days of hospitalization and then every other day until discharge from the ICU or patient's death.

Background: Urinary tract infection (UTI) is one of the most important pediatric health problems, which is occasionally associated with irreversible renal damage. Dimercapto-succinic acid (DMSA) scan is a diagnostic standard for the renal scar. Doppler ultrasonography (D.S) has been considered as a less invasive method. The purpose of this study was to determine the sensitivity and specificity of D.S in the diagnosis of renal scarring in children with a history of acute pyelonephritis (APN).
Methods: The present cross-sectional study was conducted on 120 children with APN, aged six months to twelve years in the University Pediatric Hospital of Qazvin, Iran, between August 2017 and August 2018. DMSA scan was performed in the acute phase of pyelonephritis for all patients. Half of the children with acute pyelonephritis had decreased radionuclide uptake in the first DMSA scan of whom thirty patients had kidney scarring in the second scan, six months later. Then renal vascular D.S was performed for these patients. Simultaneously, twenty children with a normal DMSA scan, assigned for D.S.
Results: The mean age of children was 5.30(3.50-11.8), and 4.80(2.50-10.09) in the scar and control group. Most of the patients in both groups were female, 25(83.8%) in renal scar, and 15(75.0%) in control. The scar group showed a greater rate of vesicoureteral reflux, 17(56.6%), of whom 11(36.7%) were bilateral. Among 30 patients with a renal scar, 2(6.7%) had first-time acute pyelonephritis, 11(36.7%) had second, and 17(56.7%) had more than two attacks of pyelonephritis. The frequency of renal scarring was 25% based on DMSA scan and 14% based on D.S. Accordingly, the sensitivity and specificity of D.S in the detection of renal scarring in children with APN was 23.3% and 100%.

  SARS-CoV-2 emerging from Wuhan, China is a member of the Coronaviridae family, which has so far infected and killed many people. The SARS-CoV-2 pandemic affected various aspects of life in Iran and Worldwide, and governments have imposed quarantines and travel bans on an unprecedented scale. The virus causes COVID-19, which can spread through close contact with the infected person, contaminated equipment, and suspended air droplets. The most common symptoms of the disease include fever, cough, shortness of breath, gastrointestinal symptoms, and diarrhea. In severe cases, the lung infection can occur, which causes Severe Acute Respiratory Syndrome that leads to ICU admission and even death.
  Besides, this infection can cause gastrointestinal, neurological, and renal impairments. Not merely, this new coronavirus has infected many more people worldwide in comparison to MERS and SARS, but also it has killed more people. Patients with underlying diseases such as hypertension, diabetes, respiratory problems, kidney disease, heart disease and Immunodeficiency are at higher risk of infection and potential death. Also, the risk of death and complication increases in older adults, while most of the infected children are asymptomatic. Some infected people may have mild or no symptoms but can still transmit the disease and spread it to others.
To diagnose COVID-19, serology tests, and level of ESR, CRP and other acute-phase reactants are helpful, whereas molecular tests, such as RT-PCR tests, that detect the virus’s genetic material are still the golden standard. Also, CT scan detects lung involvement; Ground-glass opacification, especially in lower lobes and subpleural region, is the most common CT characteristic, although it is not specific for COVID-19. Because the disease is difficult to diagnose, hard to prevent and challenging to treat, it has become a major concern for many countries. This review aims to gather existing information in the fields of virology, molecular pathogenesis, disease symptoms, epidemiology, clinical presentations, diagnosis, treatment, and the spread of the disease. This study also provides evidence-based prevention and treatment strategies for health policymakers, doctors, nurses, and practitioners in the field of public health, including researchers and students.

Background: Acute coronary syndrome (ACS) is one of the causes of disability and death. Levels of Uric acid, blood glucose, and dyslipidemia are the risk factors for the disease, but their role in electrocardiographic changes has not been studied. Based on this, this study aimed to investigate the relationship between some demographic and clinical characteristics with electrocardiographic changes.
Methods: This cross-sectional study was performed on 484 patients with Acute Coronary Syndrome admitted to Shahroud Imam Hossein Hospital from the beginning of January to the end of June 2018. In this study, the relationship between demographic, clinical and laboratory variables in patients with the acute coronary syndrome with STE, STD, Dynamic changes and inverted T waves were investigated. The required information was extracted from the Patients' records using the researcher-made checklist. Statistical analysis of data was conducted by using descriptive tests for estimating mean and frequency and statistical-analytical tests including chi-square and ANOVA were performed by SPSS software version 22.
Results: The results show that the proportion of STD deviations in women with ACS was 12.6% higher than in men, but the proportion of STE and Dynamic changes in men was 10.4% and 12.2% higher than women, respectively. The proportion of STD, STE, inverted T and Dynamic changes in people with hyperlipidemia was 67.8%, 77.6%, 64.7% and 75.8%, respectively. The proportion of STD, STE, inverted T and Dynamic changes in patients with hypertension were 0.12%, 5.1%, 11.2%, and 19.1%, respectively that there was a difference with patients without high blood pressure. Between addiction, fasting blood sugar and LDL with STD; Between History of heart disease, history of angiography, hypertension, creatinine and WBC with STE; and between creatinine and fasting blood sugar statistically significant differences were observed.

Background: Otitis is the most common infectious disease of the ear with internal and external cranial complications. If the infection is in the middle ear, it causes otitis media. If the infection is in the external ear, it’s along with otitis externa (OE). Different types of otitis media include acute otitis media (AOM), chronic otitis media (COM) and Otitis media with effusion (OME). This study aimed to investigate the different types of otitis and its symptoms.
Methods: This cross-sectional study was conducted from March 2019 to February 2020 for 200 patients who have been referred to the ENT center of Shafa hospital, Kerman, Iran. Sampling was conducted with ease and no need for specified sampling distribution. The type of otitis was written in a questionnaire by the physician after the examination. The present research investigated types of otitis along with its symptoms. Also, their demographic information was determined.

Results: After treatment in placebo group the level of LDL-C (median 0.90 mg/dl to 0.82, P=0.008) and HDL-C (median 0.40 mg/dl to 0.35, P=0.090) were decreased, while in the empagliflozin group the levels of LDL-C (median 0.87 mg/dl to 0.96, P=0.875) and HDL-C (median 0.38 mg/dl to 0.48), P=0.007) increased. Treatment with Empagliflozin and placebo had no significant effect on changing the levels of total cholesterol, TG and eGFR (P>0.05). The weight loss and FBS reduction in the empagliflozin group were significantly higher than placebo (P=0.001 and P=0.048, respectively).

Background: Since numerous chemotherapy regimens for the treatment of patients suffering from acute lymphoid leukemia (ALL) have been recently developed, having basic information about the previous results of using the Hyper-CVAD regimen in order to compare with other common chemotherapy regimens is essential. The aim of this study was to evaluate demographic, clinical and outcome of ALL patients receiving Hyper-CVAD regimen.
Methods: In this retrospective study, nighty eligible ALL patients treated with the Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran during April 2016 till April 2019 were considered. We evaluated the demographic variables, pathological data and other clinical factors by an information sheet designed by main investigator. The main purpose of this study was to evaluate overall survival, progression-free survival, and overall response rate of patients along with patients’ clinical characteristics and other relevant factors using Kaplan-Meier or Cox-regression and other statistical analyses. 

Results: The mean overall survival and the median survival of patients were 44.8±2.93 and 36.7±7.47 months; respectively. Also the mean progression free survival of patients was 44.44±3.30 months. More than 84.4% of patients encountered complete remission (CR) after receiving Hyper-CVAD regimen. Reaching to CR had positive significant effects on patients’ overall survival and median survival. However, the bone marrow transplantation variable alone did not affect the patients’ overall survival. The variables such as being B/T Cell ALL, Philadelphia, myeloid marker, and central nervous system involvement did not affect the overall survival of patients but the relapse index indicated the significant effects. The median survival time is higher in patients with no relapse episode. None of the initial lab data had any significant effects on patients’ overall survival. Conclusion: For the first time in Iran, we have obtained the mean survival outcome of ALL patients after applying the Hyper-CVAD regimen. According to the results, the mean overall survival, progression free survival and other survival items in Iranian patients suffering from ALL and receiving Hyper-CVAD regimen were in consistent with previous studies in the world.

Left ventricular thrombosis (LVT) is a very serious condition and life-threatening complication that usually occurs after acute occlusion of the left anterior descending (LAD) coronary artery followed by acute myocardial infarction with ST-segment elevation (STEMI), which leads to significant regional wall motion abnormality (RWMA). It should be noted that its diagnosis, treatment, and management are challenging now and depend on various factors such as the type of thrombus, time of percutaneous coronary intervention (PCI), and underlying disease. The preferred diagnostic method is cardiovascular magnetic resonance imaging (CMR), but transthoracic echocardiography (TTE) is routinely used for diagnostic and screening purposes also follow-up of response to treatment. It is worth mentioning that when the diagnosis of left ventricular thrombus is not clear with conventional echocardiography, contrast echocardiography is used for more resolution and detailed information. Left ventricular thrombosis can appear in both acute and chronic forms and lead to significant complications, the most important of them are stroke and systemic arterial embolism (SE). According to previous studies, vitamin K antagonist (warfarin) by keeping INR within the therapeutic range currently used to treat left ventricular thrombosis. Although the use of direct oral anticoagulants (DOAC) has brought excellent outcomes, but due to the lack of large clinical trials, the routine use of these agents is controversial, and only in case of warfarin intolerance or contraindications, DOACs can be used as an alternative. Generally, the best way to prevent left ventricular thrombosis is primary percutaneous coronary angioplasty (primary PCI) which preserves left ventricular function. Depending on the sensitivity of the diagnostic method, thrombus will likely resolve in >50% of patients by six months after the MI. On the other hand, in rare cases, surgery is indicated if a thrombosis remains despite the medical treatment especially if it is accompanied by a left ventricular aneurysm. The purpose of this narrative review is to evaluate the latest evidence in the field of left ventricular thrombosis management and to adopt the best approach for these patients.

Background: Noninvasive ventilation (NIV) has been used as one of the most promising methods to treat hypoxic respiratory failure in COVID-19.
Methods: In this study, the clinical outcomes of 80 patients with acute respiratory failure caused by COVID-19 were evaluated. The disease was confirmed in two methods: clinical and radiographic confirmation of disease in patients with an acute respiratory infection (highly suspected) or in some cases with a positive PCR test. The rate of discharge from the ICU without the need for intubation was evaluated as the primary outcome and based on that, the patients were divided into two groups: NIV failure and NIV success. Mortality rate, length of stay in ICU, frequency of intubated patients and laboratory factors of patients as secondary outcomes in two groups were compared.
Results: Regarding the outcome of death and discharge, there was a statistically significant difference between the two groups. Therefore, all patients with corona who were admitted to ICU and received NIV and were intubated due to non-responsiveness to NIV died and the patients were discharged from the hospital without intubation. All the patients investigated in this study, had received antiviral, antibiotic, and glucocorticoid treatment during hospitalization. In this study, the patients who were in the NIV success group and were not intubated had a lower mean age compared to the group without NIV success (54 vs. 67 years, respectively). The number of white blood cells in the NIV success group was 3945.28±10011.21 and in the group without NIV success was 9242.38±17296.16, which was statistically significant (P=0.004). The number of blood neutrophils in the successful and unsuccessful NIV groups was 12.19±83.04 and 4.31±89.49, respectively (P=0.034). The mean APACHEII score in patients in the NIV success group (11.07±5.05) was significantly lower than the group without NIV success (20.16±4.96).

Conclusion: Mortality was higher in the intubated group than in the NIV group. The combination of APACHEII score and respiratory rate one hour after receiving NIV can predict success with NIV.

Background: The purpose of this study was to evaluate the adherence to the ESC 2020 guideline for the management of NSTE-ACS patients admitted to Shahid Chamran Cardiology Hospital affiliated to Isfahan University of Medical Sciences in 2021.
Methods: In this retrospective study which was done during April 2021 to September 2021 we reviewed the hospital documents of 239 NSTE-ACS patients, in regard to prescribed medication during the admission period in Shahid Chamran Heart Center. Guideline-adherence was evaluated according to ESC2020 guideline. Totally 18 items were evaluated including Antiplatelet (Clopidogrel, Ticagrelor, and Prasugrel) Anticoagulant (Heparin or Enoxaparin), PPI, Statin, Beta blocker, and RAAS blockers (including ACEI/ARB or MRA). In each section the selected drug and the administered dose were compared with the guideline and the guideline adherence for each part was expressed as percent.

Results: Almost complete guideline adherence was described for 12 out of 18 reviewed items (77%). However, guideline adherence in relation to the type of medicine chosen as an antiplatelet was reported to be very low, and only 1.2% of the cases received ticagrelor or prasugrel which are the guideline recommended antiplatelet agent. Additionally, most of the administered GP2b3a antagonist agents such as eptifibatide were not in accordance with the guideline (Guideline adherence 39.74%). Also, the choice of the anticoagulant agent was among the items with low guideline adherence (29.76%) and the cross-over between anticoagulants (changing heparin to enoxaparin or vice versa) which has been inhibited by the guideline was seen with high incidence in this center (78 cases). Conclusion: The present study showed relatively high guideline adherence in the most aspects of medical management. However, compliance was reported to be low in relation to the antiplatelet selection, the choice of the anticoagulant agent, and the indication for GP2b3a antagonist use, which maybe due to the higher cost of recommended agents, and shortage of some medications and dosage forms in Iran.

Background: Studies of viral pandemics in the past, as well as studies of patients with sepsis, have shown that there is a direct relationship between the occurrence of AKI with disease severity and mortality, prognosis and outcomes. Considering that the COVID-19 disease is a novel pandemic and there is not enough information on the occurrence of AKI with COVID outcomes and its consequences, especially in Iran, it is necessary to conduct research in this field.
Methods: This is a retrospective study on 310 Covid patients hospitalized in the internal medicine, critical care and infectious disease ward of Birjand Valiasr Hospital from 20 March 2020 until 20 March 2021. Data were collected from the hospital's health information unit. The information was collected including demographics, underlying diseases, vital signs, laboratory information, and imaging and type of respiratory support. Finally, data was analyzed by SPSS V.22.

Results: 310 patients with an average age of 51.9 ± 17.4 participated in this study, 58.4% of them were male. The prevalence of acute kidney injury in patients was 7.4%. There was a significant relationship between acute kidney injury and the COVID severity, so that the COVID severity increases with the occurrence of acute kidney injury. There was a significant relationship between COVID outcomes and acute kidney injury, so that a higher mortality rate was observed in patients with acute kidney injury. No significant relationship was found between the occurrence of acute kidney injury and the score of pulmonary involvement. Patients with hypertension were more tent to experience acute kidney injury. Also, patients with acute kidney injury have more leukocytosis compared to patients without acute kidney injury. In this study, no significant relationship was observed between lymphocyte count and acute kidney injury. This study showed that the level of serum CRP and BUN are significantly higher in patients with acute kidney injury.

Results: In this study, the results showed that out of 100 patients, most of the participants were male (58%)58 and the rest were female, and the average age was 63.71±17.3 years, and 86% were in the age range of 18-80 years, which was the appropriate age to receive or thrombolytics. and the rest were over 80 years old. The fastest visit time was 25 minutes and the latest was 10080 minutes (168 hours). Among these 40 people, only four people (40%) were in the golden time period of thrombolytic drug, i.e. Three hours from the onset of symptoms to the final evaluation. Among the four people who were placed in the golden time, in 50% of the cases there was a history of taking anticoagulants, in 25% a history of head injury, in 50% of the blood sugar less than 50 and finally 1 person (25% of the people placed in the golden time) that is, 1% of all patients were eligible to receive rtPA. About 24% of patients had NIHSS<4 and 2% had NIHSS>25, and the average number obtained was 10. Conclusion: The most important obstacle in the timely initiation of thrombolytic therapy is the delay in visiting the emergency room. Therefore, public education in order to improve the level of general awareness of the society can be effective in reducing this time delay.