Background:Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients.Objectives:We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it.Patients and Methods:In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant.Results:A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m2 were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower vitamin D, higher Child score, and less GFRc.Conclusions:Abnormal DEXA was highly prevalent among patients with cirrhosis. The risk of this finding was increased by lower vitamin D levels, advanced disease, and impaired renal function.

Background: Hyperglycemia during coronary artery bypass graft surgery (CABG) strongly predicts intra- and post-operative adverse consequences. Objectives: This study aimed to evaluate the quality of glycemic management during CABG in an academic center regarding peripheral blood and coronary sinus values. Methods: This prospective descriptive study encompassed 55 eligible patients undergoing on-pump CABG surgery in 2020. Peripheral blood glucose (BG) was measured four times, before anesthesia induction (T0), before cardiopulmonary bypass pump (CPB) (T1), during CPB (T2), at the end of CPB (T3), and at the end of surgery (T4). The surgeon also took a sample of the coronary sinus BG. Results: The BG variations from T0 to T4 were statistically significant (P < 0.0001). The higher values detected in the ASA class III compared to ASA classes II were statistically significant at T1 (P = 0.01) and T2 (P = 0.025): patients with the higher BMI showed the higher levels of BG. In this regard, the differences were significant at T0 (P = 0.0001), T2 (P = 0.004), and T3 (P = 0.015). Regarding coronary sinus, the mean BG was 222.18 ± 75.74 mg/dL. It was also observed that the ASA class III (P = 0.001), longer duration of CPB (P = 0.021), higher IV fluid volume administrated during surgery (P = 0.023), higher BMI (P = 0.0001), and less urine volume at the end of surgery (P = 0.049) were significantly associated with the higher BG of the coronary sinus. Conclusions: The existing glycemic management protocols on the CABG patients were acceptable in our hospital. However, the BG level of the coronary sinus was higher than the peripheral one.

Introduction: Dialysis quality is an important factor in reducing inability and mortality in chronic kidney failure patients and can enhance their life quality and social activity. Objectives: The aim of this investigation was to examine the efficacy of dialysis based on urea reduction rate (URR) and the associated factors in hemodialysis patients due to the lack of clarity on the adequacy of dialysis. Patients and Methods: This multicenter cross-sectional study was conducted on 344 hemodialysis patients over 18 years and referred to seven dialysis centers in Guilan, Iran. The adequacy of dialysis was obtained using URR (>65%) criteria. Results: The mean URR of studied patients was 63 ±10.4%. The desirable dialysis adequacy was reached in 45.9% of the patients. There was a significant negative association between URR and BMI (r= -0.155, P =0.005). Patients who had normal calcium levels had significantly higher URR adequacy than patients with abnormal calcium levels ( P <0.001). The URR criterion was contrariwise associated to blood pressure before and after dialysis ( P <0.05). There was a significant association between the length of the time, patients underwent dialysis (in year) and URR (R=125, P =0.023). Conclusion: This study indicated that URR is a desirable criterion for dialysis adequacy, which was associated with blood pressure, serum calcium level and body mass index (BMI). These findings suggest providing treatment strategies based on these findings to enhance the effect of dialysis adequacy.

Aim: We aimed to investigate the associated risk factors of deep vein thrombosis (DVT) among COVID-19 patients. Materials & methods: In this cross-sectional study the demographical data and clinical characteristics of 382 COVID-19 patients were collected and analyzed. Results: The DVT was observed in 53 patients (14.1%). The rate of death was significantly associated with the incidence of DVT, 48.1 versus 32.2% in non-DVT cases; p = 0.034). Also, BMI (p = 0.0001), renal failure (p = 0.001), lower-limb edema (p = 0.0001) and intubation (p = 0.004) were associated with the risk of DVT. Conclusion: COVID-19 patients with a higher BMI, renal failure, lower-limb edema and need for intubation were at a higher risk of DVT.