Background We performed a multicenter, randomized open-label trial in patients with moderate to severe Covid-19 treated with a range of possible treatment regimens. Methods: Patients were randomly assigned to one of three regimen groups at a ratio of 1:1:1. The primary outcome of this study was admission to the intensive care unit. Secondary outcomes were intubation, in-hospital mortality, time to clinical recovery, and length of hospital stay (LOS). Between April 13 and August 9, 2020, a total of 336 patients were randomly assigned to receive one of the 3 treatment regimens including group I (hydroxychloroquine stat, prednisolone, azithromycin and naproxen; 120 patients), group II (hydroxychloroquine stat, azithromycin and naproxen; 116 patients), and group III (hydroxychloroquine and lopinavir/ritonavir (116 patients). The mean LOS in patients receiving prednisolone was 5.5 in the modified intention-to-treat (mITT) population and 4.4 days in the per-protocol (PP) population compared with 6.4 days (mITT population) and 5.8 days (PP population) in patients treated with Lopinavir/Ritonavir. Results The mean LOS was significantly lower in the mITT and PP populations who received prednisolone compared with populations treated with Lopinavir/Ritonavir (p = 0.028; p = 0.0007). We observed no significant differences in the number of deaths, ICU admission, and need for mechanical ventilation between the Modified ITT and per-protocol populations treated with prednisolone and Lopinavir/Ritonavir, although these outcomes were better in the arm treated with prednisolone. The time to clinical recovery was similar in the modified ITT and per-protocol populations treated with prednisolone, lopinavir/ritonavir, and azithromycin (P = 0.335; P = 0.055; p = 0.291; p = 0.098). Conclusion The results of the present study show that therapeutic regimen (regimen I) with low dose prednisolone was superior to other regimens in shortening the length of hospital stay in patients with moderate to severe COVID-19. The steroid sparing effect may be utilized to increase the effectiveness of corticosteroids in the management of diabetic patients by decreasing the dosage.

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Introduction: Hemodialysis patients should receive hemodialysis three times per week and 140- 160 times annually. The financial and temporal costs of continuing travel to hemodialysis centers affect the type of vascular access, treatment coherence, geographical distribution and mortality of patients. Objectives: In this study, the spatial distribution and geographical accessibility of patients to the hemodialysis center and its effect on mortality and vascular access have been investigated. Patients and Methods: This descriptive-analytic study was conducted on 315 patients with chronic renal failure undergoing hemodialysis in Bou-Ali hospital of Ardabil. Accessibility to the hemodialysis center was determined by calculating the time spent from the residence to the treatment center and analyzed by ArcGIS-10. In this study, accessibility was considered in less than 10 minutes. Logistic regression was used to investigate the relationship between spatial accessibility and mortality and vascular access. To verify the correlation between different variables, Pearson’s correlation, Phi and Cramer’s V, and Eta tests were applied. Results: Among 315 patients, 161 patients (51.1%) were male and 277 (87.9%) patients were married. The mean age of patients was 62.7 ± 16.6 years. There were 170 illiterate patients (54%), 275 patients living in urban area (87.3%) and 132 patients as housewife (41.9%). Hospital records, showed 186 patients with arteriovenous fistula (AVF) (59%), 113 patients with central venous catheter (35.9%), since in 16 patients type of vascular access (5.1%) was not mentioned. Twenty patients (6.3%) died due to end-stage renal disease (ESRD), of which 11 were female. Additionally, eight patients (2.5%) were forced to migrate to nearby areas due to inappropriate accessibility to the hemodialysis services. The results showed a negative correlation between proximity to hemodialysis center and the prevalence of hemodialysis in women and men and the number of population in each time period. The spatial accessibility to the hemodialysis center did not correlate with the patient’s mortality and type of vascular access. Conclusion: Due to the high prevalence of hemodialysis patients in the vicinity of the hemodialysis center, there is a concern that ESRD patients in rural or remote areas are not properly diagnosed or died without referral to health centers. It can be declared that one of the main reasons for the low-prevalence in remote areas is the issue of spatial accessibility. The results of this study indicated the need for further studies on the prevalence and identification of ESRD in rural areas and the causes of the disease, in order to clarify the issue’s dimensions.

Background Pruritus is one of the most common problems in patients with chronic renal failure. Of all patients with end‐stage renal disease (ESRD), 60–80% report pruritus during their life. Aim To compare the effect of gabapentin (GBP) and hydroxyzine (HYDZ) in treating pruritus in patients on dialysis. Methods In a double‐blind, randomized, crossover clinical trial, 32 patients on dialysis who reported pruritus were assigned randomly to receive either GBP or HYDZ for 6 weeks; the first group received GBP 100 mg/day orally and the second group received HYDZ 25 mg/day orally for 6 weeks. After this 6‐week period (Period 1) there was a washout period of 2 weeks then patients were crossed over to the other drug (the first group receiving HYDZ and second group receiving GBP) and followed up for a further 6 weeks (Period 2). A visual analogue scale was used to measure pruritus intensity in the groups before and after the first and second period. Results In Period 1, pruritus severity decreased from 7.1 ± 1.46 at baseline to 2.17 ± 1.82 at 6 weeks in the GBP group (P = 0.001) and from 6.83 ± 2.11 to 2.86 ± 1.67 in the HYDZ group (P = 0.001). In Period 2, pruritus severity decreased from 5.1 ± 1.61 at baseline to 1.56 ± 0.82 at 6 weeks in the GBP group (P < 0.01) and from 5.23 ± 2.11 to 2.1 ± 1.87 in the HYDZ group (P = 0.001). Conclusion Results showed that both HYDZ and GBP significantly improved and controlled pruritus in patients on dialysis, with no significant difference observed between the two drugs.

Introduction: Hemodialysis patients usually demonstrate lower immune response to hepatitis B vaccine compared to non-uremic population. Objectives: The present study aimed to determine the level of response to hepatitis B vaccination in patients under hemodialysis. Patients and Methods: This study was conducted on 172 live patients receiving hemodialysis in the dialysis department of Buali hospital in Ardabil, Iran (2015). To analyze their response to the vaccine, their vaccination titers were investigated. Before vaccination, the serological markers of hepatitis B and C were checked in all of the patients. Those for whom HBsAg and HBsAb results were negative and had not received the vaccinein the past entered the study. The patients received a double dose of hepatitis B vaccine at 0, 1, and 6 months after the beginning of dialysis. The response to the vaccine was investigated by measuring the level of patients’ hepatitis B antibody one month after receiving the last dose of the vaccine. Results: Seventy patients (40% of the total) displayed a proper immune response to the vaccine, 34 patients (19.8%) were without, and 68 patients (39.5%) were identified to have poor response. The results of Pearson’s correlation test indicated that there is a negative correlation between the patients’ age and their response to the vaccine. Conclusion: The results of this study indicated that higher age is one of the factors that reduce the effectiveness of hepatitis B vaccine in hemodialysis patients.