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Background and Objective: Liver enzyme tests are usually normal or slightly increased during pregnancy. Abnormal liver enzyme tests are seen in 3% of pregnancies and should be evaluated immediately. Early detection and timely treatment is the key to successful treatment. This study was carried out to determine the prevalence of abnormal liver enzymes and pregnancy outcome in women admitted to Sayyad-e-Shirazi hospital in Gorgan-north of Iran.
Methods: This descriptive, cross-sectional study was carried out on 73 hospitalized pregnant women out of 6680 pregnant women in the Sayyad Shirazi hospital, in north of Iran during April to September 2015. Clinical information was including laboratory tests, final diagnosis and complications postpartum of 73 women with impaired liver enzymes.
Results: The most common cause of abnormal liver enzymes were pre-eclampsia in pregnant women (16 patients 21.9%) which occured in the third trimester. HELLP syndrome was observed in 9 (12.3%) of patients which occurred in the third trimester. Also in 3 cases (4.1%) eclampsia was reported in the third trimester.
Conclusion: Due to the high incidence of pre-eclampsia and HELLP syndrome in women with impaired liver enzymes, careful examination of patients, especially in the third trimester of pregnancy is essential.

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Background and Objective: Multiwall carbon nanotubes nowadays have multiple uses in the field of drug and gene delivery and other biological fields, and it is necessary to study their potential toxicity on organisms due to unique properties of these nanostructures. This study was conducted to determine the toxicity of multi-wall carbon nanotubes functionalized with carboxylic groups on the function and structure of the rats liver tissue.
Methods: In this experimental study, 50 mature female Wistar Rats were randomly allocated into five groups including the control group of normal saline and Tween and treatment groups 2.5, 5, 10, 20 mg/kg/bw concentrations of multi-wall carbon nanotubes functionalized with carboxylic group with diameter less than 8 nm and length 30 micrometers that was received in 8 steps, intraperitoneally. Blood sampling was performed in two steps (The first stage was one day after the last injection and the second stage was 20 days after the last injection). The level of activity of the aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) enzymes and the amount of malondialdehyde were measured in serum. By preparing the tissue sections of the liver, a number of rats in each group (after 20 days from the last injection) with hematoxylin-eosin staining, the tissue structure of the liver was examined by optical microscopy. Animals were weighed before and after treatment.
Results: In the first stage, only the mean of AST activity at 5 mg/kg/bw concentration was significantly increased (P<0.05). In the second stage, ALP activity was significantly reduced (P<0.05) in all doses higher than 2.5 mg/kg/bw and the activity of AST and ALT in doses of 5 and 10 mg/kg/bw was significantly reduced (P<0.05) and in the dose of 2.5 mg/kg/bw was significantly increased (P<0.05). Histologic studies revealed disturbances such as degeneration of the vein wall of the lobular center, degeneration of the nucleus and hepatocyte lysis with severe atrophy, irregularity and dilatation of the sinusoids and accumulation of inflammatory cells in the treatment groups in dose-dependent manner. Based on the above findings the most disturbances were related to the 20 mg/kg/bw concentration.
Conclusion: It seems that multi-wall carbon nanotubes functionalized with carboxylic group, even in small amounts (2.5 and 5 mg/kg/bw) after 20 days, are toxic on the liver and cause liver tissue and function impairment.

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Background and Objective: The diazinon insecticide is a strong acetylcholinesterase controller at the nerve terminals. This study was conducted to determine the effect of diazinon on functional tests and tissue alterations in rat liver.
Methods: In this experimental study, 40 adult male Wistar rats were allocated into 5 groups including the first, second and third experimental groups were received 50, 100 and 150 mg/kg/bw of diazinon, respectively, orally during 21 days. The control group did not receive any medication and the sham group received solvent. At the end of study, blood samples were obtained from animals and Alanine transaminase (ALT), Aspartate transaminase (AST), Alkaline phosphatase (ALP) hepatic enzymes, total protein, albumin and bilirubin were measured. After anesthesia the liver of animals were removed and evaluated by hematoxylin eosin histological staining methods.
Results: The level of AST and ALT enzymes in the experimental groups receiving 100 and 150 mg/kg/bw doses of diazinon significantly increased in compared to the control group (p<0.05). The level of ALP of animals in all groups receiving diazinon was significantly higher than the control group (P<0.05). Total protein level significantly reduced in all groups receiving diazinon compared to the control group (P<0.05). The level of albumin in the experimental group receiving 150 mg/kg/bw dose of diazinon significantly reduced in comparision with controls. In the experimental groups, tissue samples showed more necrosis with increasing doses of diazinon.
Conclusion: Diazinon increases level of liver enzymes and decreased total protein and albumin level and causes the histological alterations in rat liver.

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Background and Objective: Hyperlipidemia and high level of serum total cholesterol are risk factors contributing to prevalence and severity of cardiovascular complications like coronary heart diseases. Lamiaceae plants have terpenoids and flavonoids can reduce triglyceride and cholesterol, therefore. This study was done to evaluate the effect of feeding with essential oil of Thymus deanensis Celak. on lipid profile, blood urea and liver enzymes in hyperchlostrolemic male Wistar rats.

Methods: This experimental study was performed on 36 male Wistar rats. Animals were randomly divided into 6 groups (there were 6 rats in each groups). The groups including control, sham, two groups receiving 200 and 500 ppm Thymus deanensis essential oil and hyperchlostrolemia groups treated with doses of 200 and 500 ppm of Thymus deanensis essential oil. Hyperchlostrolemia was induced by giving high cholesterol (2%) and sweet almond oil (97.5%) diet. The animals were treated for 32 days with essential oil of the thyme. At the end of the 32-day trial, blood sampling was performed. Total cholesterol, triglyceride, urea and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) liver enzymes were measured.

Results: The level of ALT and AST in hypercholesterolemia rats were significantly increased in comparison with the control group (P˂0.05). Thymus daenensis essential oil significantly reduced level of triglycerides and cholesterol (P˂0.05). The high dose of Thymus daenensis (500 ppm) essential oil more than a low dose (200 ppm) significantly reduced the level of cholesterol and triglyceride (P˂0.05). Blood urea nitrogen significantly increased in hypercholesterolemia group in compare to control group (P˂0.05). After the administration of essential oil with a minimum and maximum dose in hypercholesterolemia rats, the level of urea in the blood significantly decreased (P˂0.05). The level of ALT and AST in hypercholesterolemia rats significantly increased in comparison with the control group (P˂0.05). AST level significantly reduced in the groups of rats which received minimal and maximal doses compared to the group hypercholesterolemia (P˂0.05).

Conclusion: By lowering blood lipids, urea and liver enzymes after the use of essential oils, it seems that the Thymus daenensis dose-dependent is effective in improving liver function, kidney and high level of  lipid.

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Background and Objective: Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic hepatic diseases which may be associated with cardiovascular disease. This study aimed to consider the effect of combined therapy with resveratrol supplementation and interval exercise training on heart cells apoptosis in rats with NAFLD using TUNEL assay.
Methods: This experimental study was done on 35 Wistar rats. Animals were randomly allocated into five groups including control (healthy) and four NAFLD groups, including patient, resveratrol, interval exercise, and resveratrol + interval exercise. A TUNEL assay kit was applied for the detection of apoptosis in heart tissue.
Results: The patient group had significantly higher percentage of heart apoptotic cells (24.38±0.69%) compared to the other groups (P<0.05), while the resveratrol + interval exercise (9.02±0.49%) and resveratrol (9.47±0.83%) groups showed significantly lower mean levels of heart apoptotic cells compared to the patient and interval exercise (P<0.05) groups. There was no significant difference in mean of apoptotic cells between resveratrol and resveratrol + interval exercise groups. The mean of apoptotic cells in interval exercise group was 11.39±0.28%.
Conclusion: Nonalcoholic fatty liver disease is considerably associated with heart cells apoptosis. Resveratrol supplementation especially combined with interval exercise significantly reduces apoptotic cells in heart tissue.

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Background and Objective: Cancer can cause many problems in all aspects of the physical, mental, social, economic and family life of the elderly patients. This study was done to determine the supportive care needs of the elderly people with cancer in north of Iran.
Methods: This descriptive- analytical study was carried out on 248 elderly patients with cancer whom referred to governmental and private medical centers in Gorgan, Northern Iran during 2018. Data were collected by a valid and reliable questionnaire "Supportive Care Needs Survey-SCNS" consisted of five domains of physical needs and daily functioning, health system and information, supportive and care, mental, and sexual chracteristics.
Results: There was a significant relationship between physical activity and daily functioning, sexual domain, support and care, health and information system with gender (P<0.05). Female seniors were more in need of assistance in the areas of physical and daily functioning, and male seniors in the areas of sex, support and care, health systems, and information.
Conclusion: This study showed that unmet needs in the elderly with cancer are particularly high in physical and functional areas.

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Background and Objective: Copper oxide nanoparticles, in addition to useful applications, may have adverse effects on the organisms.This study was done to determine the effect of copper oxide nanoparticles on liver toxicity, enzymes changes and liver histological structure of rats.
Methods: In this experimental study, 40 Wistar male rats were randomly allocated into 4 groups. During 10 days, five times (one day interval), 3 groups of rats were received 10, 20 and 30 mg/kg of copper oxide nanoparticles with a diameter of less than 50 nm and purity of 99% and a surface of 80 m²/g intraperitoneally, respectively. One group was considered as the control group. Activity of Lactate dehydrogenase (LDH), Alkaline phosphatase (ALP), Aspartate transaminase (AST) and Alanine aminotransferase (ALT) enzymes were tested in two stages (one day and 15 days after treatment). Also, liver tissue sections were prepared and stained with hematoxylin-eosin.
Results: No significant alterations of AST enzyme activity were not seen between different groups in two stages. The activity of ALT, ALP, and LDH enzymes in the first stage showed a significant increase in all treatment groups compared to control and returned to normal after 15 days. Rat's weight changes were not statistically significant between different groups. Histological studies revealed multiple tissue injuries in dose-dependent in treatment groups which included mild and severe hyperemia, hepatocytes degeneration, hyperplasia and inflammation.
Conclusion: Injection of low doses of copper oxide nanoparticles, after 15 days, although changes in enzyme activity return to normal, but significant disturbances observes in the structure of the liver tissue.

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Background and Objective: Sodium levothyroxine is one of the common medicines used for treatment of hypothyroidism and thyroid cancer. The study was done to determine the effect of sodium levothyroxine on knee articular cartilage tidemark integrity, plateau tibia cartilage thickness (calcified and non-calcified) and liver enzymes in induced hypothyroidism rats.
Methods: In this experimental study, 50 adult female BALB/c mice, weighting 25-30 grams were randomly allocated into one control and four experimental groups. Animals in control did not receive any medicine. Animals in the second group were received different increasing doses of sodium levothyroxine daily for 8 weeks. Animals in the third group were received constantly high dose of levothyroxine daily for 8 weeks. In the fourth group, the animals became hypothyroid with propylthiouracil (PTU). In the fifth group, animals with hypothyroidism were received sodium levothyroxine by gavage same as group 2. After 8 weeks serum samples were taken to determine ALT, AST and ALP. The plateau tibia cartilage stained with hematoxylin-eosin. Histologic changes evaluated by light microscopy. Using a light microscope equipped with camera, the samples were photographed and using a computer equipped with axiovision software. Cartilage (calcified and non-calcified) thickness measured in micrometer. The integrity of tidemark line on hematoxylin-eosin staining also evaluated.
Results: The results of the present study showed separation, disruption and destruction in tidemark line in group 3 (the group with high dosage of sodium levothyroxine from the beginning of the treatment). The total cartilage and non-calcified part thickness in groups 3, 4, 5 were reduced and in group 3 showed significant reduction (P<0.05). Calcified cartilage thickness in all groups were reduced and in group 3 showed significant reduction (P<0.05). ALT level decreased in all groups compared to control group but only in the second and third groups, the decrease of ALT was significant (P<0.05). AST serum level in all groups significantly increased in compared to control group (P<0.05). ALP serum level in all groups increased compared to the control group, but this increase was significant only in the groups 4, 5.
Conclusion: Consumption of sodium levothyroxine with constantly high dose can cause severe alteration in knee joint cartilage in hypothyroidism rats.

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Background and Objective: Lead is one of the most toxic environmental pollutants, which is very dangerous for living creatures, including humans. Therefore, the use of various compounds such as nanochitin to remove lead from aquatic environments has been considered in recent years. This study was performed to determine the effect of nanochitin on the Tissue absorption rate of lead acetate in the liver of rats.
Methods: This experimental study was performed on 15 Wistar rats with a weight of 150-180 grams and an age of 8-10 weeks. The animals were allocated into three groups including control group, the lead group, and the nanochitin and lead simultaneously group. Animals were received lead and nanochitin by gavage for six weeks. Then liver tissue was removed and lead concentration was measured with an atomic absorption device. Liver tissue was prepared for hematoxylin-eosin staining and then examined under an optical microscope.
Results: The mean lead concentration in the liver tissue of the control, lead and the nanochitin and lead simultaneously groups were 8.1±0.45, 45.41±4.73, and 17.06±0.83 mic/g, respectively. The concentration of lead in the lead group increased significantly compared to the control group (P<0.05). Also, the hepatic concentration of lead in the nanochitin and lead simultaneously group significantly reduced in compared to lead group (P<0.05). Histopathological studies showed a reduction in tissue lesions including degeneration and necrosis of liver hepatocytes, hypertension, and severe congestion in liver tissue in the nanochitin and lead simultaneously group in compared to lead group.
Conclusion: Nanochitin without adverse effects on liver tissue can increase the removal and inhibit the absorption of lead in rats liver tissue.

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Background and Objective: Perinatal mortality rate (PMR) is one of the main indicators in evaluation of health community and healthcare systems. This study was performed to determine the perinatal mortality rate in the referral third level of maternal and infant care center affiliated to Babol University of Medical Sciences.
Methods: This descriptive-analytical study was performed on by cross-sectional method and 19234 births (9751 male and 9483 female) from 22 weeks gestation to 29 days after delivery Ayatollah Rouhani Hospital in Babol, northern Iran during 2011-18. Data on the cause of neonatal death, maternal age, type of delivery, malformations, maternal underlying disease, maternal pregnancy-related conditions, and diseases at the time of death in neonate were collected from website of the Ministry of Health. Then each of the indicators was calculated per 1000 live births.
Results: In this study, the PMR was calculated per 1000 live births which was 29.01 (boys 16.17 and girls 12.84). The portion of vaginal delivery was 9.67 and cesarean section was 19.34. Out of 558 perinatal deaths, 59.9% died due to intrauterine death with an index of 17.37 and 40.1% of deaths were due to infant death with an index of 11.63. Most neonatal deaths (74%) occurred within the first 24 hours of birth and in terms of gestational age 86.02% were <37 weeks of gestation with an index of 24.95, and low birth weight were 83.8% with an index of 24.31. Underlying disease was found in 25.6% of mothers and pregnancy-related conditions in 74.4% of cases. Fetal distress in 14.4% with an index of 4.20 was the most common disease associated with infant death or cause of death in preterm infants. Other causes of perinatal death were specific disorders of perinatal origin, birth defects, chromosomal abnormalities, and accidents were 10.09, 4.06, and 0.58 per 1000 live births, respectively.
Conclusion: The most and important factors of prenatal mortality wrer prematurity and low birth weight that major causes include maternal pregnancy-related conditions and maternal underlying disease, Therefore, emphasis on adequate prenatal care, identification and follow-up of mothers with underlying diseases can be effective in reducing perinatal mortality.

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Background and Objective: Physical activity and the use of herbal supplements can affect liver enzymes. Nano-curcumin is an effective ingredient (deferulovl methane) in turmeric with antioxidant, antibacterial, antifungal, antiviral, anti-inflammatory and anti-proliferative properties and can play an important role in preventing liver fibrosis. This study was performed to determine the effect of 6 weeks of high intensity interval training (HIIT) with Nano-curcumin supplementation on liver enzyme levels in overweight female students.
Methods: This clinical trial study was performed on 48 overweight female students of Shahid Chamran University of Ahvaz, Iran with an average age of 21.7±1.32 years and a BMI equals 27.8±2.46kg/m² during 2018. Participants were randomly divided into 4 groups: control, Nano-curcumin supplementation (One 80 mg capsule daily), training and training combined with nano-curcumin supplementation (one 80 mg capsule daily). Training groups performed an exercise protocol of HIIT training with maximum heart rate for 6 weeks (three sessions per week). Blood samples were obtained to liver enzymes measurement (ALT, AST and ALP) before and after the intervention period.
Results: Performing six weeks of high intensity interval training along with taking nano-curcumin supplemen led to a significant reduction in serum level of AST and ALT compared to control group (P<0.05). In the supplement-training group, a significant decrease was observed in serum levels of ALT and AST compared to pre-test (P<0.05). But no statistically significant changes were observed in ALP serum level.
Conclusion: It seems taking nano-curcumin supplement along with high intensity interval training have a favorable effects on improving some of the liver characteristics of overweight female students.

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Background and Objective: The liver is the main organ involved in the metabolism of various drugs and toxins. Thus, it is highly vulnerable to damage caused by drugs and toxins. Alpinia officinarum belongs to the Ginger family and has been used in traditional Iranian medicine for its therapeutic effects on the digestive system, including strengthening the function of the stomach and organs, improving digestion and reducing bloating. In addition, the plant has anti-hyperlipidemic, anti-inflammatory, antiviral, antibacterial, anticancer and antioxidant properties. This study investigated the hepatotoxic effects of Alpinia officinarum rhizomes aqueous extract in male Wistar rats.
Methods: This experimental study was performed on 35 male Wistar rats that were randomly allocated into 5 groups of 7. Four groups received 100, 200, 400 and 800 mg/kg of the extract for 28 days, while a group did not receive the extract (control group). Tissue sections (5 microns) were stained by hematoxylin and eosin at the pharmacology laboratory of Golestan University of Medical Sciences. The groups were examined for liver tissue pathology, and the level of liver enzymes including aspartate aminotransferase (AST), alanine transaminase (ALT) and alkaline phosphatase (ALP) was measured by Pars Azmoun ELISA kit.
Results: Administration of the aqueous extract of Alpinia officinarum rhizome for 28 days by gavage increased the level of AST, ALT and ALP in the serum of rats. Tissue damage was observed in most groups receiving the extract.
Conclusion: The results show that consumption of the aqueous extract of Alpinia officinarum rhizome at a dose of more than 100 mg/kg can cause liver damage and is lethal at a dose of 800 mg/kg.
 

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Background and Objective: Spirulina (Spirulina platensis) has numerous nutritional and therapeutic benefits. This experimental study aimed to investigate the effect of spirulina on changes in the levels of liver enzymes of male BALB/c mice exposed to a high dose of acetaminophen.
Methods: In this experimental study, 42 adult male BALB/c mice were divided into seven groups of six. The toxic dose of acetaminophen 600 mg/kg body weight was considered. The control group received only a standard diet and water. The sham group was gavaged with saline solution. The third to seventh groups were treated as: acetaminophen; spirulina 600 mg/kg/bw, spirulina 300 mg/kg/bw, spirulina 600 mg/kg/bw + acetaminophen, and spirulina 300 mg/kg/bw + acetaminophen, respectively. In all groups, mice were treated with acetaminophen and spirulina powder by gavage for 14 consecutive days. Twenty-four hours after receiving the last dose of medication and deprivation of food (the animals still had access to water), the animals were anesthetized and blood samples were taken from the heart. Activity of liver enzymes including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) was measured by spectrophotometry. Protein concentration was determined by the Lowry method. Catalase activity was assessed using hydrogen peroxide. The amount of malondialdehyde was measured and the total antioxidant capacity was determined by FRAP method by reducing ferric to ferro ions.
Results: The levels of serum transaminases (ALT, AST, ALP) as well as the level of total antioxidant capacity and malondialdehyde of the acetaminophen-treated group increased significantly compared to the control group (P<0.05). The levels of these enzymes in the group treated with S. platensis 300 mg/kg/bw + acetaminophen decreased significantly compared to the group treated with acetaminophen (P<0.05). Catalase activity in the acetaminophen group was significantly decreased compared to the control group (P<0.05).In the group of S. platensis 300 mg/kg/bw + acetaminophen, catalase activity increased significantly compared to the acetaminophen group (P<0.05). The results of experiments in two groups of spirulina and acetaminophen showed that the active ingredients of the algae at a dose of 300 worked better than 600 mg per kg of body weight in response to oxidative stress.
Conclusion: Consuming 300 mg/kg of S. platensis along with a near toxic dose of acetaminophen increases resistance to oxidative stress and injuries caused by drug poisoning by affecting the activity of enzymes and the antioxidant defense system.
 

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Background and Objective: Vincristine is an important anticancer drug, which is highly toxic to the liver. It is a naturally occurring polyphenol found in many plants. Some studies have shown the anti-inflammatory and antioxidant effects of resveratrol. This study was conducted to determine the hepatoprotective and antioxidant effects of resveratrol against vincristine-induced toxicity in mice.
Methods: In this experimental study, 32 female NMRI mice weighing 25-30 grams were randomly divided into four groups (n=8): control, vincristine, vincristine + resveratrol, and resveratrol. The animals received vincristine intraperitoneally at a dose of 3 mg/kg/bw once a week for four weeks. They also received resveratrol at a dose of 30 mg/kg for 28 days through gastric gavage. At the end of the study, the activity of alanine transaminase (ALT) and aspartate transaminase (AST) were measured. The level of antioxidant enzymes including superoxide dismutase (SOD), glutathione peroxidase (GPX), malondialdehyde (MDA) as well as total antioxidant capacity (TAC) was measured in the liver tissue of mice.
Results: The activities of ALT, AST, SOD, and GPX decreased in the vincristine group compared to the control group, while MDA level increased significantly (P˂0.05). Treatment with resveratrol in the vincristine + resveratrol group improved the evaluated parameters compared to the vincristine group (P˂0.05).
Conclusion: Resveratrol has protective and antioxidant effects against vincristine-induced oxidative damage in the liver of mice.
 

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Background and Objective: Vaginal delivery is a natural physiological process that can be a critical experience for women. One of the factors involved in avoiding vaginal delivery is childbirth self-efficacy. Self-efficacy affects all aspects of behavior and emotional activities, including attachment. This study aimed to determine the relationship between childbirth self-efficacy and maternal attachment to the fetus in nulliparous pregnant women.
Methods: This descriptive-analytical study was conducted on 323 nulliparous pregnant women who attended health centers in Zahedan city from 2020-2021. Data were collected using participants’ demographic questionnaire, Lowe’s childbirth self-efficacy questionnaire, and Cranely’s maternal attachment to the fetus questionnaire.
Results: Maternal attachment style to the fetus showed a significant direct correlation with childbirth self-efficacy. Maternal attachment style to the fetus predicted childbirth self-efficacy (P=0.003, r=0.16), explaining 2.7% of the variance of childbirth self-efficacy.
Conclusion: The results suggest that helping mothers accept their motherly role and improving maternal attachment to the fetus can increase childbirth self-efficacy. Educational programs during pregnancy should include training related to strengthening maternal attachment to the fetus. As women with high childbirth self-efficacy have a greater ability to perform vaginal delivery, it may increase their desire for vaginal delivery.
 

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Background and Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a significant threat to both healthy individuals and those with chronic diseases, including liver cirrhosis. This study aimed to evaluate the clinical and laboratory manifestations and treatment outcomes of patients with liver cirrhosis who were infected with COVID-19.
Methods: This retrospective descriptive study was conducted on 9 patients (4 women and 5 men) with liver cirrhosis infected with COVID-19 hospitalized at Shahid Sayyad Shirazi Educational and Therapeutic Center in Gorgan, Iran during 2019-20. COVID-19 infection was diagnosed by a positive polymerase chain reaction (PCR) test. The Child-Pugh score was used to classify the severity of liver disease. Demographic and clinical data, including initial symptoms and complaints, laboratory results, need for intensive care unit (ICU) admission, length of hospital stay, and treatment outcomes, were extracted from patients’ medical records.
Results: The severity of liver disease was classified as Class B in 7 patients. Comorbidities included cardiovascular diseases and hypertension in 2 patients each, as well as diabetes and asthma in one patient each. Clinical manifestations at the time of COVID-19 diagnosis included ascites in 6 patients; fever in 5 patients; respiratory distress and anorexia in 4 patients each; cough, oxygen saturation less than 93%, and muscle pain in 3 patients each; nausea and vomiting in 2 patients; and abdominal pain and decreased level of consciousness in one patient each. Albumin levels were less than 4 g/dL in all patients. Hemoglobin was less than 12 g/dL in 7 patients. Thrombocytopenia was observed in 8 patients, leukocytosis in one patient, and leukopenia and pancytopenia in 4 patients each. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were higher than 40 U/L in 6 and 5 patients, respectively. Only one patient died, a 60-year-old woman with a history of fatty liver disease, cardiovascular disease, and uncontrolled Class C cirrhosis.
Conclusion: The most common clinical manifestations in patients with liver cirrhosis infected with COVID-19 consisted of ascites, fever, respiratory distress, and anorexia, and the most common laboratory manifestations were hypoalbuminemia and thrombocytopenia.

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Background and Objective: Ketamine, a derivative of phencyclidine, is utilized as an anesthetic agent in surgical procedures. Like other medications, it can be associated with various adverse effects on different organs in the body. This study was conducted to determine the effect of injectable ketamine on the histopathological changes in the liver in neonates born to pregnant rats subjected to short-term and long-term anesthesia.
Methods: In this experimental study, 15 pregnant female Wistar rats were randomly divided into 3 groups of 5 each: A control group, a short-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 25 mg/kg/bw), three times per week for 4 weeks), and a long-term anesthesia group (receiving an intraperitoneal injection of ketamine at a dosage of 75 mg/kg/bw, once per week for 4 weeks). Following parturition and during the lactation period, when the neonatal rats reached two weeks of age, they were initially anesthetized and sacrificed for tissue sampling via intraperitoneal injection of 7 units of ketamine and 3 units of xylazine. Tissue samples, with a thickness of 5 to 6 microns, were sectioned and examined using light microscope after fixation in formalin.
Results: In the short-term anesthesia group, dilation of the centrilobular veins and fluid accumulation were observed, with an intensity score of 2. Additionally, some hepatocytes exhibited degenerative-necrotic changes, characterized by acidophilic and dark cytoplasm, with an intensity score of 1. In the long-term anesthesia group, the liver tissue showed hyperemic changes in the portal space with a score of 1, as well as increased dilation of sinusoidal spaces and centrilobular veins of varying sizes and irregularities, also with an intensity score of 1. Fluid and blood accumulation were also noted in some of these structures. In the control group, cellular structures were maintained with complete regularity, and the intensity score of changes was determined to be zero.
Conclusion: Ketamine administration to pregnant rats can induce histopathological changes in the liver tissue of their offspring. These detrimental changes were more pronounced in the long-term group compared to both the short-term and control group.

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Background and Objective: Fear of childbirth is a common problem during pregnancy. Previous studies have shown that pregnancy outcomes and experiences can significantly vary across various ethnic groups. This study aimed to determine the prevalence of fear of childbirth among pregnant mothers of various ethnicities referring to comprehensive health service centers in Gorgan, Iran.
Methods: This descriptive-analytical study was conducted on 341 pregnant women of Fars, Turkmen, and Sistani/Baluch ethnicities using a random sampling method at comprehensive health service centers in Gorgan during 2023. Data collection instruments consisted of a demographic and pregnancy characteristics form and the Childbirth Fear Questionnaire (CFQ; Zar and Wijma).
Results: The mean fear of childbirth score in pregnant women was determined to be 69.88±20.19 (severe fear). Among all studied groups, mild fear (21 individuals), moderate fear (100 individuals), severe fear (147 individuals), and clinical fear (73 individuals) were identified in 6.2%, 29.3%, 43.1%, and 21.4% of the pregnant women, respectively. The combined prevalence of severe and clinical fear of childbirth among pregnant women of Sistani/Baluch, Turkmen, and Fars ethnicities was determined to be 73%, 73.3%, and 52.2%, respectively, and this difference was statistically significant (P<0.05). A statistically significant relationship was observed among the variables of age, gestational period, and the level of satisfaction with prenatal care received at comprehensive health service centers (P<0.05).
Conclusion: Severe and clinical fear of childbirth is more prevalent among pregnant women of Sistani/Baluch and Turkmen ethnicities compared to the Fars ethnicity.