: Chronic kidney disease (CKD) is a global public health problem. Pain is one of the most generally experienced symptoms by CKD patients. Pain management is a key clinical activity; nonetheless, insufficient pain management by health professionals keeps it up. Opioids as pain relievers are a class of naturally-derived and synthetic medications. They act through interactions with receptors in peripheral nerves. Numerous pharmacokinetic alterations happen with aging that influence drug disposition, metabolism, and quality of life. Acetaminophen alone, or combined with low-potency opioid does is regarded as the safest pain-relieving choice for CKD. Morphine and codeine are probably eluded in renal impairment patients and used with excessive carefulness. Tramadol, oxycodone, and hydromorphone can be used by patient monitoring, while methadone, transdermal fentanyl, and buprenorphine seem to be safe to use in older non-dialysis patients with renal impairment. Consistent with the available literature, the main aim of this review was to explore the occurrence of chronic pain and its opioid treatment in CKD patients. Ac-cording to this review, more and well-made randomized controlled trials are necessary to find appropriate opioid doses and explore the occurrence of side effects.

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Background Traumatic brain injury (TBI) causes mortality and long-term disability among young adults and imposes a notable cost on the healthcare system. In addition to the first physical hit, secondary injury, which is associated with increased intracranial pressure (ICP), is defined as biochemical, cellular, and physiological changes after the physical injury. Mannitol and Hypertonic saline (HTS) are the treatment bases for elevated ICP in TBI. This systematic review and meta-analysis evaluates the effectiveness of HTS in the management of patients with TBI. Methods This study was conducted following the Joanna Briggs Institute (JBI) methods and PRISMA statement. A systematic search was performed through six databases in February 2022, to find studies that evaluated the effects of HTS, on increased ICP. Meta-analysis was performed using comprehensive meta-analysis (CMA). Results Out of 1321 results, 8 studies were included in the systematic review, and 3 of them were included in the quantitative synthesis. The results of the meta-analysis reached a 35.9% (95% CI 15.0–56.9) reduction in ICP in TBI patients receiving HTS, with no significant risk of publication bias (t-value = 0.38, df = 2, p-value = 0.73). The most common source of bias in our included studies was the transparency of blinding methods for both patients and outcome assessors. Conclusion HTS can significantly reduce the ICP, which may prevent secondary injury. Also, based on the available evidence, HTS has relatively similar efficacy to Mannitol, which is considered the gold standard therapy for TBI, in boosting patients' neurological condition and reducing mortality rates.

Background and Objectives Every year, about three hundred thousands of infant deaths occur because of congenital anomalies. Some continue to live with various types of disabilities. Low and middle income countries have higher rate of congenital anomalies. It is estimated more than 100,000 cases of birth defcets occure annualy in Iran where 70 percent are preventable. There is no long term investigation on the epidemiology and secular trend of congenital anomalies in Iran. The aim of this study was to document the time trend and epidemiological features of congenital anomalies in the northwest of Iran using the Tabriz Registry of Congenital Anomalies (TRoCA) programme. Material and Methods A total of 297,734 births were registered in the region by TRoCA registry during the study period to estimate the occurrence of total and selected groups of congenital anomalies based on the standard coding system of the International Classification of Diseases (ICD). Total prevalence was calculated by dividing the numerator (registered cases of congenital anomalies in the TRoCA region) by the relevant denominator (total live and stillbirths in the TRoCA region) for the same period of time. Results An overall prevalence rate of 262.9 (CI95%:257.2–268.7) was estimated in the region. Anomalies of genito-urinary tract (59.2 per 10 000 births, 95% CI: 56.5–62.0), limb defects (46.3 per 10 000 births, 95% CI: 43.9.5–48.8), nervous system anomalies (39.4 per 10 000 births, 95% CI: 37.2–41.7), gastrointestinal anomalies (27.8 per 10 000 births, 95% CI: 25.9–29.7) and congenital heart diseases (37.1 per 10 000 births, 95% CI: 34.9–39.3) were accounted for 80 percent of birth defects. Total prevalence of anomalies was more than tripled in the region over the past two decades. More cases were observed in males, and those with consanguineous marriage. Conclusion The increasing trend of the occurrence of congenital anomalies indicates that appropriate care programmes and more effective prenatal screening procedures need to be implemented in the region. Extended Abstract Background and Objectives Congenital anomalies, also called birth defects, are defined as structural or functional anomalies that may be identified before or at birth, or later in life. Every year, more than three hundred thousands of infant deaths occur because of congenital anomalies. Some continue to live with various types of disabilities. Low and middle income countries have higher rate of congenital anomalies. There is no long term investigation on the epidemiology and secular trend of congenital anomalies in Iran, and various prevalence rates of congenital anomalies have been reported for different parts of the country. The aim of this study was to document the time trend and epidemiological features of congenital anomalies in the northwest of Iran between 2000 and 2020, using the Tabriz Registry of Congenital Anomalies (TRoCA) programme. Material and Methods This study was carried out on the births registered by TRoCA in the region between 2000 and 2020 to estimate the occurrence of selected groups of congenital anomalies based on the standard coding system of the International Classification of Diseases (ICD). All infants born in three main hospitals involved in the programme are routinely examined for general health status, maturity and congenital anomalies by a clinical practitioner (gynaecologist, obstetrician, neonatologist or paediatrician) and then followed up until hospital discharge. "Passive" method for data collection was used. The registrar for data documentation were midwives. A medical coder coded the defects. Congenital anomalies for the purposes of this programme were defined based on the standard coding of ICD under one of the following main headings according to the primary diagnosis of anomaly: nervous system anomalies; genito-urinary tract, and kidney; anomalies of limb; chromosomal anomalies; cleft lip with/without palate; congenital heart disease; musculoskeletal and connective tissue anomalies; digestive system anomalies; eye and ear anomalies and other defects. Total prevalence was calculated by dividing the numerator (registered cases of congenital anomalies in the TRoCA region) by the relevant denominator (total live and stillbirths in the TRoCA region) for the same period of time. TRoCA activities have been approved by the Ethics Committee of the Tabriz University of Medical Sciences. Confidentiality and privacy are strictly considered in every part of the data gathering, processing, registration, access and reports. Results A total of 297,734 births were registered in the region by TRoCA registry during the study period to estimate the occurrence of selected groups of congenital anomalies based on the standard coding system of the International Classification of Diseases (ICD). Most of the infants born with birth defects were male (61.3 percent). The majority of infants were born live (89.6 percent). Although familial marriage was not reported in 60.4 percent of the families with an affected child, first cousin marriage was observed in 12.5 percent of the cases. Main type of delivery in infants born with congenital anomalies was caesarean section delivery which included 49.4 percent of births. An overall prevalence rate of congenital anomalies was estimated as 262.9 (CI95%:257.2–268.7). Anomalies of genito-urinary tract (59.2 per 10 000 births, 95% CI: 56.5–62.0), limb defects (46.3 per 10 000 births, 95% CI: 43.9.5–48.8), nervous system anomalies (39.4 per 10 000 births, 95% CI: 37.2–41.7), gastrointestinal anomalies (27.8 per 10 000 births, 95% CI: 25.9–29.7) and congenital heart diseases (37.1 per 10 000 births, 95% CI: 34.9–39.3) were accounted for 80 percent of birth defects. The lowest prevalence rates were reported for musculoskeletal and connective tissue, cleft lip with/without palate, chromosomal, eye and ear anomalies all of which collectively accounted for less than 20 per 10 000 births. Total prevalence of anomalies was more than tripled in the region over the past two decades. With the control of infectious diseases and malnutrition, congenital anomalies are now making a proportionally greater contribution to ill health in childhood in many countries. According to the findings if this study, the prevalence and occurrence pattern of birth defects in a long period of time may be useful in identifying clues to the etiology of birth defects. The results may prove useful in genetic consultation, and in planning and evaluating the strategies for primary prevention of congenital anomalies, particularly in high-risk populations. Practical Implications of Research As a small registry of congenital anomalies in a developing country, our experiences might be of interest and useful to medical practitioners, policymakers of birth defects control programs, and those willing to set up a monitoring system of congenital anomalies in similar areas. Ethical Considerations This study was approved by the Ethics Committee of Tabriz University of Medical Science (IR.TBZMED.REC.1399.525). Confidentiality and privacy were observed at every stage of the program, including data gathering, data access, data analysis and reporting. Conflict of Interest Authors declare no conflict of interest. Aknowledgment The authors wish to thank the Iranian Ministry of Health and Medical Education, Tabriz University of Medical Science, and all those financially supporting the study, participating at the program, including parents and children (thesis no. 65711).