Combined botulinum toxin A injection with a topical application of diltiazem could be as effective as partial lateral internal sphincterotomy in the treatment of chronic anal fissure in patients who have chronic anal fissure for ≤12 months. However, in chronic anal fissures of longer duration, partial lateral internal sphincterotomy is associated with a significantly higher cure rate.

Background: In Covid-19 infection, leukopenia, inflammation, and elevated liver enzymes are found in most patients. Also, vitamin D deficiency attenuate the immune system and predispose a person more susceptible to infection. In this context, we aimed to evaluate vitamin D, Electrolytes, Complete blood count, Liver enzymes, Urea, Creatinine, Albumin, CRP and ESR levels in patients with Covid-19. Methods: We conducted a cross-sectional study on 118 patients with Covid-19 who were hospitalized from 2020/2/19 to 2020/4/3 in ICU. Serum levels of electrolytes, liver enzymes, blood factors, urea, creatinine, CRP and ESR as well as anthropometric parameters and serum vitamin D concentration were measured. Results: A total of 118 patients (80 male and 38 female) was enrolled in the study (65.05±15.75 years). Only 5.08% of patients had no risk factors and 55.9% had ≥ 2 risk factors. Diabetes (44.1%) and obesity (23.7%) were more common among patients. Laboratory finding showed that 80.50% of patients had hyponatremia, but other electrolytes included K, Mg, Ca and P were normal in majority of participants as well as CBC, Cr, Urea, Alb, ALT and ALKP. The AST concentration increased in most patients (66.94%). All patients had high levels of inflammatory factors such as CRP and ESR. The mean of 25-hydroxy-vitamin D levels in participants (25.95 ± 14.56 ng/mL) was lower than its levels in general papulation. However, it was not statistically significant (P= 0.88). A significant negative correlation found between vitamin D and ALT (P= 0.02, -0.21) as well as vitamin D and CRP (P= 0.05, -0.17). Conclusion: Regarding to the regulatory role of vitamin D in immune system and low levels of vitamin D in Covid-19 infected patients, the evaluation of vitamin D levels and prescribe supplements if necessary is suggested.

Evidence shows that there has been an increasing incidence of melanoma cancer in Iran, especially among the young population, which has led to increased mortality, disability and disablement, mostly due to the complications of disease and treatment. New treatments such as targeted therapy are extremely costly, and their results are not clear. The objective of this study is to review different current guidelines for the management of cutaneous melanoma cancer and discuss the differences in the various phases of patient assessment (prevention, risk factors, genetic assessment, clinical diagnosis, biopsy, staging, treatment and follow-up, pediatric melanoma, melanoma during pregnancy, and the necessity of social and mental support for melanoma patients). Then, based on the results, we will prepare a national guideline for the management of cutaneous melanoma in accordance with the prevailing conditions in Iran.