<b><i>Introduction:</i></b> Kidney involvement, ranging from mild hematuria and proteinuria to acute kidney injury (AKI) in patients with coronavirus disease-2019 (COVID-19), is a recent finding with various incidence rates reported among hospitalized patients with COVID-19. Given the various AKI rates and their associated risk factors, lack of AKI recovery in the majority of patients hospitalized with COVID-19, and limited data regarding AKI in patients with COVID-19 in Iran, we aim to investigate the potential risk factors for AKI development and its incidence in patients hospitalized with COVID-19. <b><i>Methods:</i></b> In this retrospective cohort study, we enrolled adult patients referred to the Sina Hospital, Iran, from February 20 to May 14, 2020, with either a positive PCR test or a highly susceptible chest computed tomography features consistent with COVID-19 diagnosis. AKI was defined according to the kidney disease improving global outcomes criteria, and patients were stratified based on their AKI staging. We evaluated the risk indicators associated with AKI during hospitalization besides in-hospital outcomes and recovery rate at the time of discharge. <b><i>Results:</i></b> We evaluated 516 patients with a mean age of 57.6 ± 16.1 years and a male-to-female ratio of 1.69 who were admitted with the COVID-19 diagnosis. AKI development was observed among 194 (37.6%) patients, comprising 61.9% patients in stage 1, 18.0% in stage 2, and 20.1% in stage 3. Out of all patients, AKI occurred in 58 (11.2%) patients during the hospital course, and 136 (26.3%) patients arrived with AKI upon admission. AKI development was positively associated with all of the in-hospital outcomes, including intensive care unit admissions, need for invasive ventilation, acute respiratory distress syndrome (ARDS), acute cardiac injury, acute liver injury, multiorgan damage, and mortality. Patients with stage 3 AKI showed a significantly higher mortality rate, ARDS, and need for invasive ventilation than other stages. After multivariable analysis, male sex (odds ratio [OR]: 11.27), chronic kidney disease (CKD) (OR: 6.89), history of hypertension (OR: 1.69), disease severity (OR: 2.27), and high urea levels (OR: 1.04) on admission were independent risk indicators of AKI development. Among 117 (28.1%) patients who experienced AKI and survived, only 33 (28.2%) patients made a recovery from the AKI, and 84 (71.8%) patients did not exhibit full recovery at the time of discharge. <b><i>Discussion/Conclusion:</i></b> We found that male sex, history of CKD, hypertension, disease severity, and high serum urea were independent risk factors associated with AKI in patients with COVID-19. Also, higher stages of AKI were associated with increased risk of mortality and in-hospital complications. Our results indicate a necessity for more precise care and monitoring for AKI during hospitalization in patients with COVID-19, and lack of AKI recovery at the time of discharge is a common complication in such patients.

BackgroundThe proliferative activity as well as apoptosis has been suggested to play a role in the pathogenesis of lupus nephritis (LN). The aim of the study was to investigate the coexpression of Ki-67-triggered marked proliferation and P53-induced apoptosis in renal biopsy of childhood lupus nephritis (cLN) and to compare the coexpression of proliferative and apoptotic indices between different subgroups and clinicopathologic patterns of renal disease.MethodsRenal biopsy specimens of 33 children with lupus nephritis (LN) and 10 healthy subjects were retrospectively evaluated. The type of LN and activity and chronicity indices were determined. Ki-67 and P53 immunostaining were performed. The coexpression of Ki-67 and P53 was compared among different subgroups of LN and correlated with disease activity index, serum creatinine, proteinuria, anticardiolipin antibodies, and complement levels. Histopathological examination of LN was classified based on the International Society of Nephrology/Renal Pathology. Histological LN activity was measured by the National Institutes of Health activity index (NIH-AI).ResultsIn comparison with the healthy control group, the coexpression of Ki-67and P53 was greater in cLN (particularly in classes II, III, and IV) than in normal renal tissue. The coexpression of Ki-67and P53 shows a positive correlation with subclasses II, III, and IV of LN (P<0.02) and LN activity index (P<0.03). Moreover, the positive correlation was found between the coexpression of Ki-67 and P53 with erythrocyte sedimentation rate (P<0.02), D-dimer (P<0.03), serum creatinine (P<0.03), proteinuria (P<0.04), and anticardiolipin antibodies (P<0.05) significantly. Unexpectedly, adverse correlation between the coexpression of Ki-67 and P53 with serum C3 (P<0.02) and C4 complement (P<0.03) was significant.ConclusionOur data showed that the coexpression of Ki-67-induced marked proliferation and P53-induced apoptosis in proliferative and active phases of cLN could reflect a valuable marker for treatment and remission in cLN patients before reaching the end stage of renal disease.

Background Asthenozoospermia is a usual male infertility factor, characterized by decreased semen quality. It has been revealed that antioxidants improve sperm function, enhance endogenous antioxidant activities, and protect spermatozoa against oxidative damage during cryopreservation. This aimed to evaluate the effects of vitamin D on sperm kinematics and apoptosis in the semen of bulls with normozoospermia and asthenozoospermia after the freeze-thaw process. For this purpose, 32 semen samples of four Holstein bulls (normozoospermic, progressive motility > 70 %) and 32 semen samples of four bull (asthenozoospermic progressive motility < 40 %) were collected and pooled separately (normozoospermic and asthenozoospermic). Samples were then diluted into four equal aliquots of extender containing different vitamin D concentrations (0, 5, 10, and 50 ng/mL) and aspirated into a 0.5 mL straw. Results The percentages of sperm progressive motility and viability were significantly higher (P < 0.05) in 50 ng/mL of vitamin D in normozoospermic group. Sperm kinematics parameters including curvilinear velocity (VCL), straight-line velocity (VSL), and average path velocity (VAP) were significantly higher in the high dose (50 ng/mL) vitamin D-treated group compared to the low dose vitamin D-treated group (5ng/mL) in normozoospermic bull semen samples. The supplementation of the semen extender with different concentrations of vitamin D could not increase the rate of acrosome integrity in normozoospermic bulls compared to the control group (P < 0.05). In the asthenozoospermic group, 10 ng/mL vitamin D-treated group could increase the rate of plasma membrane integrity compared to 5 ng/mL vitamin D-treated group (P < 0.05). The percentages of early-apoptosis (P = 0.049) and late-apoptosis (P = 0.005) were significantly higher in the asthenozoospermic than the normozoospermic group. Conclusions The present study revealed that a high dose (50 ng/mL) of vitamin D protected normozoospermic bulls’ sperms from the freezing procedure and lead to higher quality of frozen-thawed bull sperm.

BackgroundAnemia is a common complication of chronic renal failure due to reduce erythropoietin production by kidneys. Anemia treated with recombinant human erythropoietin (rHu-EPO). Pure red cell aplasia (PRCA) due to antibody productionagainst rHu-EPO is a rare but major complication of this drug. ObjectivesThe aim of this study was to determine the prevalence of PRCA due to antibodies in dialysis patients with resistant anemia who received erythropoietin. Patients and MethodsWe studied 128 under maintenance hemodialysis patients more than 3 month in Kashan. In patients with anemia who received erythropoietin with dose requirements based on weight and anemia and without any another cause for anemia, evaluate for PRCA and anti-rHu-EPO antibody level were measured by ELISA. ResultsIn this research, 75 patients (58.6%) were male and 53 patients (41.4%) were female. The mean age of the patients was 59.05 ± 16.66 years. The result of analysis showed that 55 (43%) patients had anemia with hemoglobin level less than 10 mg/dL. Only 3 patients had PRCA and antibodies against erythropoietin in serum. There were no correlation between age, gender, cause of renal failure, hemodialysis duration, hemoglobin level, rHu-EPO dose and levels of anti-rHu-EPO antibody serum value. ConclusionsThe result of this study indicated that administration of rHu-EPO in dialysis patients afflicted to kidney failure may cause PRCA especially through intravenous injection. However, this change is not statistically significant.

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IntroductionPrimitive neuroectodermal tumors (PNET) form a group of tumors defined by their appearance that are thought to develop from primitive (undifferentiated) nerve cells in the brain. They are rare tumors and their incidence is not well defined.Case presentationAn 18-month-old male presenting with typical Cushingoid appearance (moon face, central obesity, hirsutism and growth arrest) was admitted for evaluation of endocrine problems. Subsequent laboratory studies revealed markedly elevated adrenocorticotropic (ACTH) and cortisol levels, as well as a hypokalemic metabolic alkalosis, these data are consistent with the diagnosis of Cushing's disease. He was treated with metyrapone to control hypercortisolemia. One month and a half later, a mass was detected in the abdomen by ultrasonography. An abdominal Computed tomography confirmed a large heterogeneous retroperitoneal mass with a significant amount of extension into surrounding structures which was removed by laparoscopic abdominal surgery. The patient's symptoms completely resolved and the ACTH and cortisol levels were also greatly reduced. Histologically, the tumor tissue consistent with the diagnosis of the retroperitoneal primitive neuroectodermal tumor which was confirmed immunohistochemically. This case demonstrates the successful diagnosis and treatment of a rare neoplasm.ConclusionThis is the first rare case with ectopic ACTH syndrome caused by the peripheral primitive neuroectodermal tumor.

Objective: Acetabular fractures are common injuries in Iran. We assess the functional outcome of open reduction and internal fixation management of displaced Complex acetabular fractures. Materials and Methods: We analyzed a case series of patients with open reduction and internal fixation (ORIF) for complex acetabular fractures. Two hundred patients (132 men, 68 women) in four age groups including with a mean age of 43.39 ± 6.18 years (range 20 -59 years) and a mean follow-up of 82.34 ± 12.48 months (range 18 -109 months) met the inclusion criteria. Functional outcome at final follow-up was graded assessed according to Harris score. Factors affecting were defined. Results: Anatomic reduction was achieved in 192 hips, imperfect in 8 and poor in none. Radiological outcome revealed excellent results in 128 (64%) hips, good in eight, fair in five and none in poor. Harris score were excellent in 139 (69.5%) hips, good in 43 (21.5%) and fair in 18 (9%) and poor in none. The anatomical reduction results had a favorable final functional outcome. (0.003) However, BMI (P < 0.004), fracture pattern (P < 0.004), displaced acetabular fractures (P < 0.005), associated injuries in lower extremity (P < 0.005), finally post-surgery complications (P < 0.001) and adequate physical therapy 364anatomic postoperative reduction. Also experience of specialist, on time surgery and good recovery lead to receiving excellent functional outcome with at least complications.