Iranian Red Crescent Medical Journal <p>The Iranian Red Crescent Medical Journal (IR<span style="color: #ff0000;">C</span>MJ) is an international, open access, peer-reviewed, monthly, and ISI- Journal, affiliated to&nbsp;<strong>Iranian Hospital- Dubai</strong>, publishes original scientific studies in English that have direct clinical significance on&nbsp;<span style="color: #0033ff;">Basic Science, Clinical Medicine, Humanitarian Assistance, Trauma, and Disaster Management</span>.&nbsp;The journal strives to strengthen connections between research and practice, so enhancing professional development and improving practice within the field of medicine. Original papers submitted to this journal which do not adhere to the Instructions for Authors will be returned for appropriate revision to be in line with the Instructions for Authors. They may then be re-submitted.</p> ZamenPub en-US Iranian Red Crescent Medical Journal 2074-1804 Evaluation of trauma management in injured Iranian Hajj pilgrims in 2015 Mina stampede <p><strong>Introduction:</strong> The Muslim annual pilgrimage (Hajj) ceremony in 2015 was one of the most catastrophic and tragic events of the Hajj pilgrimage in history. Thousands of pilgrims have been tragically stampeded to death and injured in the land of Mina in Mecca, Saudi Arabia, on September 25 in 2015. The last official statistics declared that at least 2,431 pilgrims died and 427 pilgrims were missed in the blocked street. Furthermore, 464 corpses were Iranian</p> <p><strong>Objectives:</strong> The purpose of this study was to evaluate the treatment of the injured pilgrims by the Iranian Hajj Medical Team in Mina and assess its strengths and weaknesses in order to develop a comprehensive approach in dealing with similar events.</p> <p><strong>Methods:</strong> The records of the patients were obtained from the archives of the Islamic Republic of Iran Hajj Medical Center. Firstly, the demographic data, method of triage, cause of admission, treatment methods, and referral to Mecca hospitals were extracted, and then some interviews were performed with the members of the medical team who were present at the incident scene. Finally, a protocol was proposed for the management of patients in similar incidents.</p> <p><strong>Results:</strong> Out of a total of 1,633 referred patients, 567 injured pilgrims were admitted and treated during the incident. Due to the incomplete medical records, a total of 403 complete medical sheets were included in this study. Moreover, 362 cases (89.8%) improved after cooling and proper fluid replacement. They were discharged with therapeutic measures. A total of 41 injured pilgrims (10.2%) were referred to urban hospitals, and 13 cases of the referrals were due to acute respiratory distress syndrome. Furthermore, 12 subjects were referred for dialysis, and 4 cases of the referrals were due to anxiety disorders. Moreover, three cases of diabetic ketoacidosis, one case of epidural hemorrhage, one case of intracranial hemorrhage, one case of spleen hematoma, one case of sigmoid volvulus, and one case of gastrointestinal bleeding were successfully treated. The most common diagnosis was observed to be dehydration, followed by heat exhaustion and contusion. Approximately, all the victims had some degrees of the aforementioned injuries. Initial therapeutic attempts included rehydration, cooling in the cold tunnel, and correction of electrolyte imbalances. Performing a complete blood count with differential, blood urea nitrogen, sodium, and potassium tests, and urinary catheterization were determined as per case (if needed); nevertheless, fluid therapy and cooling were carried out (as primary resuscitation) for all the injured patients.</p> <p><strong>Conclusions:</strong> Therapeutic efficacy was evaluated as excellent due to zero mortality. As a result, it was decided to propose a treatment method for the Hajj Medical Team as a protocol for the management and treatment of injuries caused by mass gathering (e.g., contusion and heat exhaustion) in similar events. For the implementation of the best measures in similar situations, it is compulsory to organize medical teams with trained personnel.</p> <p>&nbsp;</p> Shaban Mehrvarz Shahram Manoochehry Mohammad javad Bagheri Behzad Einollahi Mohammad Ganjeh Taher Doroudi Seyyed ali Marashi Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.92 Serum Correlation of Nesfatin-1 with Angiographic, Echocardiographic, and Biochemical Findings in Patients with Coronary Artery Disease <p><strong>Background:</strong> Nesfatin, as an adipokine, has been shown to have a number of metabolic effects associated with a variety of inflammatory diseases. The current study aimed at investigating the relationship of nesfatin-1 levels with biochemical, echocardiographic, and angiographic findings, especially with the epicardial fat thickness (EFT) in patients with coronary artery disease.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted on 90 patients who were candidates for angiography. The patients were then divided into one control group (with normal angiography but a history of chest pain; n=30), as well as stable-AP (with a diagnosis of stable angina pectoris; n=30) and acute-MI groups (with a diagnosis of acute myocardial infarction; n=30). Demographic, biochemical, angiographic, and echocardiographic parameters of all subjects were evaluated in this study.</p> <p><strong>Results:</strong> Serum levels of nesfatin-1 in acute-MI and stable-AP groups were significantly reduced, compared to the healthy subjects (P&lt;0.001 and P&lt;0.01, respectively); however, there was no significant difference between acute-MI and stable-AP groups. In addition, the findings demonstrated a negative relationship of nesfatin-1 with low-density lipoprotein, Gensini score, white blood cell, troponin T, EFT, and <em>creatine kinase</em>-<em>MB</em> (CK-MB). However, there was a positive association between nesfatin-1 and left ventricle ejection fraction (%).</p> <p><strong>Conclusion:</strong> Decreased levels of nesfatin-1 in acute-MI and stable-AP groups as well as its association with several parameters, such as EFT, CK-MB, and Gensini score, may indicate the potential role of nesfatin-1 in the process of atherosclerosis, which requires further studies.</p> Afshin Nejati Hossein Doustkami Behzad Babapour Valeh Ebrahimoghlou Mohammad Reza Aslani Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.245 Cariogenic Dietary and Toothbrushing Practices of Children During the COVID-19 Outbreak <p><strong>Background:</strong> The implemented <em>COVID</em>-<em>19 prevention measures</em> exert negative effects on children’s nutrition and education, with approximately 1.5 billion children kept away from schools during this time.</p> <p><strong>Objectives:</strong> The present study aimed to assess the changes in toothbrushing and cariogenic dietary practices of children who spent most of their time at home during the COVID-19 pandemic.</p> <p><strong>Methods: </strong>The study was conducted on parents with children aged 1-15 years in Turkey from 1-26 May 2020 which was a period of confinement and self-isolation. A web-based questionnaire was prepared and distributed via email and social media upon the request of parents. The questionnaire consisted of 10 items divided into three parts. The first part of the questionnaire included items regarding the demographic data of the parents and children, the second part contained some items about the cariogenic dietary practices of children, and the last part encompassed items on children's toothbrushing frequency before and during the outbreak. Statistical analyses were performed using the Number Cruncher Statistical Systems&nbsp;(NCSS)&nbsp;software.</p> <p><strong>Results:</strong> A total of 1013 questionnaires were incorporated into the final analysis. Based on the results, children’s intake of jam, honey, and molasses increased; nonetheless, their intake of sugar-sweetened, fruit-flavored juices, flavored milk, candy, and chocolate reduced during the COVID-19 outbreak (P&lt;0.05). Moreover, no difference was found in the consumption frequencies of other foods and the frequency of toothbrushing of the children before and after the COVID-19 outbreak (P&gt; 0.05).</p> <p><strong>Conclusion:</strong> As evidenced by the obtained results, the cariogenic food consumption of children was not high and even decreased during the pandemic. Although not perfect, it is evident that parents did not experience much trouble managing their children’s consumption of cariogenic foods and beverages during the time spent at home.</p> Damla Aksit Bicak Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.331 Effective Reduction of Inflammatory and Coagulation Factors using Sitagliptin in Type 2 Diabetes <p><strong>Introduction:</strong> There are different drug-based treatments (i.e., oral or injective) for patients with type 2 diabetes. Pioglitazone and sitagliptin, among oral agents, can affect blood glucose control and lipid profile.</p> <p><strong>Objectives:</strong> The purpose of the current investigation was the assessment of the effects of adding sitagliptin or pioglitazone (as the third drug) to the combined metformin-sulfonylurea treatment on glycemic control, inflammatory factors, and lipid profile.</p> <p><strong>Methods:</strong> This clinical trial was carried out on 125 patients with type 2 diabetes undergoing metformin-glibenclamide treatment. The patients were randomly divided into three groups, namely the sitagliptin group receiving 100 mg of sitagliptin for 3 months (n=45), pioglitazone group receiving 30 mg of pioglitazone for 3 months (n=40), and control group (n=40). After the interventions, the anthropometric indices, glycated hemoglobin A1c level, lipid profile, fibrinogen, and high-sensitivity C-reactive protein (hs-CRP) were compared among the study groups.</p> <p><strong>Results:</strong> The sitagliptin group demonstrated significantly lower levels of hs-CRP (0.53±0.26 mg/L) and fibrinogen (314.08±48.09 mg/dL), compared to those reported for the pioglitazone and control groups. In contrast, significantly lower triglyceride levels (115.02±32.92 mg/dL) and significantly higher high-density lipoprotein cholesterol (51.57±11.14 mg/dL) were observed in the pioglitazone group in comparison to those reported for the sitagliptin and control groups.</p> <p><strong>Conclusion:</strong> The results of the present study suggest that sitagliptin reduces the levels of fibrinogen and hs-CRP. Nevertheless, pioglitazone has a more significant effect on the improvement of the lipid profile, compared to sitagliptin and combined metformin-sulfonylurea treatments.</p> <p>&nbsp;</p> Maryam Ghavami Jalil Houshyar Amir Mehdizadeh Mostafa Najafipour Farzad Najafipour Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.324 Combined-Modality Therapy for Locally Advanced Esophageal Cancer in Endemic Region of Turkey: A Single-Center Multimodal Experience <p><strong>Background:</strong> Esophageal cancer (EC) is known as the most common cancer around the world. The evidence supports that preoperative chemoradiotherapy (CRT) improves resectability and survival in locally advanced EC patients.</p> <p><strong>Objectives:</strong> The current study aimed to evaluate the results of treatment in patients suffering from EC in an endemic region.</p> <p><strong>Methods:</strong> In this study, a total of 180 EC patients treated with curative radiotherapy (RT) were retrospectively evaluated. Primary tumor location, histopathological characteristics, tumor, nodes, and metastases (TNM) status, gender, age, treatment modalities, and survival period were also assessed. The effects of prognostic factors on the survival rate were evaluated using single variable analysis.</p> <p><strong>Results:</strong> The median time of follow-up was reported as 22.9 months (range: 6-115 months). After 1-, 3-, and 5-year follow-up, the rates of survival were calculated at 86.6%, 46.6%, and 32.5%, respectively. The present study was conducted on 77 (42.8%) male and 103 (57.2%) female patients (mean age: 60±12 years). In histopathological assessment, squamous cell carcinoma was the most frequent diagnosis (n=156; -86.6%). The clinical stages were reported as II in 36.6% (n=66), IIIa in 23.4% (n=42), IIIb in 15.5% (n=28), and IIIc in 24.5% (n=44) of the patients. In this study, 54 (25%) patients were treated with definitive RT, 33 patients (18.3%) with postoperative adjuvant CRT or RT, 59 patients (32.8%) with preoperative CRT or RT, and 43 patients (23.9%) with definitive CRT. The Eastern Cooperative Oncology Group (ECOG) performance status was observed to be ECOG 0 in 51 subjects (28.4%), ECOG 1 in 95 subjects (52.8%), and ECOG 2 in 34 subjects (18.8%). Moreover, 96 (53.4%) and 84 (46.6%) patients received conventional and conformal RT, respectively. The median time of overall survival (OS) was reported as 29 months. In univariate analysis, the T stage (P=0.041), N stage (P=0.033), TNM staging (P=0.00), and concomitant CRT (0.001) were prognostic factors affecting median OS time. Concomitant CRT (hazard ratio [HR]: 0.513; 95% CI: 0.337-0.779; P=0.002) and TNM stage (HR: 2.265; 95% CI: 1.409-3.641) were observed statistically significant as independent prognostic factors of mortality in multivariate analysis.</p> <p><strong>Conclusions:</strong> Long-term survival using combined-modality therapy was demonstrated in patients with locally advanced EC. Furthermore, based on the results of multivariate analysis, TNM stage and concomitant CRT were considered independent prognostic factors of mortality.</p> hamit başaran Deniz Arslan Okan özdemir Menekşe Turna Yılmaz Özdemir Asuman Önol Mirik Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.325 Imaging Findings and Changes in Discharged Moderate Novel Coronavirus Pneumonia Patients with Positive Nucleic Acid Retest <p>The clinical and imaging data belonging to 52 discharged novel coronavirus pneumonia (NCP) patients with positive nucleic acid retesting results during the follow-up period were collected from the First People’s Hospital, Xiaogan, Hubei Province, China, for analysis. These moderate NCP patients underwent a plain CT scan before the admission, at the time of discharge, and at re-admission due to the positive result of their COVID-19 nucleic acid retesting. The CT signs of these patients were analyzed in this study and a total of 32 (61.54%) patients presented with 123 lesions with patchy fuzzy shadows. In addition, 24 (75%) and 8 (25%) patients out of the 32 patients, had lesions distributed in both lungs and single lung, respectively. It is worth mentioning that the CT manifestations varied in discharged moderate NCP patients whose COVID-19 nucleic acid retest was positive in the follow-up period. Most patients presented with patchy fuzzy shadows and ground-glass opacity (GGO) lesions distributed in the lower lobe of both lungs. The results of the study indicated that some discharged moderate NCP patients with positive COVID-19 nucleic acid retest developed new patchy fuzzy shadows and GGO lesions. Moreover, the recurrence of NCP needs to be verified once patchy fuzzy shadows and GGO lesions appear and are not absorbed during the follow-up period. This study provided a reference for the follow-up NCP evaluation.</p> Junda Wang Xin Deng Xia Zhang Xinping Zhu Yongchun Ke Jie Wang Pan Zhou Zhi Li Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.224 Prediction Model for Disease Progression and Relevant Prognostic Factors in Hodgkin Patients: An Application of Frailty Multistate Model <p><strong>Background: </strong>In clinical cancer studies, there has been a high tendency of searching for more specific and new prognostic factors in cancers in the last few years. This multistate study aimed to model the progression of Hodgkin's disease by accounting for individual effect (heterogeneity) using the joint and independent frailty models.</p> <p><strong>Method: </strong>After the utilization of the illness-death model, joint-modeling accounted for the dependency between relapse and death by considering the individual characteristics as a frailty term. Therefore, the effect of influential prognostic factors was evaluated on disease progression by frailty and joint-frailty multistate models.</p> <p><strong>Results: </strong>The individual predictions were determined using the frameworks of the both models. The model was applied to 389 Hodgkin lymphoma patients. Gender (male), age (over 55 years), and low level of hemoglobin (less than 10.5) were associated with an increased risk of death and relapse in patients. The likelihood cross-validation criterion was proposed to choose the joint frailty model as a better fitting model.</p> <p><strong>Conclusion: </strong>Multistate models were appropriate tools to study the whole event history of the subjects, which provided a deep insight into the dynamics of the disease. The problem of events-subjects dependency in the survival data was clarified using the multistate model. Therefore, the heterogeneity and dependency between the states led to more accurate estimations of the effects of the prognostic factors, thereby improving the predictions.</p> Fatemeh Javanmardi Fakher Rahim Amal Saki Malehi Ahmad Ahmadzadeh Mohamad Seghatoleslami Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.77 Evaluation of the Expression of Circulating miR-16 and miR-26a in the plasma of Gastric Cancer Patients in Guilan province, North of Iran <p><strong>&nbsp;Background and Aims: </strong>Gastric cancer (GC) is a global health problem and the second deadly type of cancer worldwide with 1000 deaths per year. Poor prognosis in the early stages is one of the burdens in the treatment of GC. MicroRNAs are 18-22 nucleotide non-coding RNAs which play critical roles in the regulation of gene expression. Nowadays, miRNAs are widely known as non-invasive biomarkers for various kinds of cancers. This study aimed to evaluate the expression level of circulating miR-16 and miR-26a in GC patients and investigate the potential prognostic role of these miRNAs.</p> <p><strong>Material and Methods:</strong> Initially, 20 plasma samples were obtained from pre-and post-operative GC patients, and the expression of miR-16 and -26a were compared with that of 20 healthy controls. The miRNAs expression was investigated using Real-Time quantitative PCR. The association between the expression levels of these miRNAs and clinicopathological features was also investigated in this study.</p> <p><strong>Results</strong>: MiR-16 was down-regulated in GC patients; however, miR-26a expression revealed no significant difference between patients and controls in this regard. Furthermore, the expression of two miRNAs showed no association with the grade, TNM stage, and smoking status of the patients. Eventually, decreased expression of miR-16 was not correlated with the expression level of miR-26a.</p> <p><strong>Conclusion</strong>: The downregulation of circulating miR-16 introduces this microRNA as a candidate biomarker for the non-invasive early prognosis of GC.</p> Tolou Babaei Hemmaty najmeh ranji Fatemeh Safari Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.214 Assessment of reliability and validity of the mental chronometry task based on the box and block test in multiple sclerosis patients <p><strong>Objectives:</strong>&nbsp; Motor imagery (MI) is the visualization of action without its overt performance.&nbsp; One of the measures of explicit MI is mental chronometry which &nbsp;has&nbsp; been&nbsp; applied&nbsp; to&nbsp; multiple sclerosis (MS)&nbsp; patients; nonetheless, &nbsp;&nbsp;the&nbsp; reliability&nbsp; and&nbsp; validity of this tool &nbsp;has&nbsp; &nbsp;&nbsp;been&nbsp; never confirmed.&nbsp; Therefore,&nbsp; the present study aimed to assess the reliability and validity of mental chronometry in&nbsp; MS&nbsp; patients.</p> <p><strong>Methods:</strong> A number of 60 MS patients who met the inclusion criteria were included in the present study via the census method. Thereafter, 20&nbsp; MS&nbsp; patients&nbsp; were tested&nbsp; via&nbsp; mental&nbsp; chronometry&nbsp; based&nbsp; on&nbsp; the&nbsp; box&nbsp; and&nbsp; block&nbsp; test, as well as kinesthetic&nbsp; and&nbsp; visual&nbsp; imagery&nbsp; questionnaire-20 (KVIQ-20) in&nbsp; two&nbsp; sessions&nbsp; with&nbsp; a&nbsp; 10-day&nbsp; interval.&nbsp; Intra-class&nbsp; correlation&nbsp; coefficients&nbsp; (ICCs)&nbsp; were&nbsp; calculated to determine&nbsp; the&nbsp; test-retest&nbsp; reliability &nbsp;of&nbsp; mental&nbsp; chronometry.&nbsp; Pearson’s correlation analysis&nbsp; was&nbsp; used&nbsp; to&nbsp; evaluate&nbsp; criterion&nbsp; validity&nbsp; with&nbsp; the&nbsp; KVIQ-20.</p> <p><strong>Results:</strong>&nbsp;&nbsp; The&nbsp; test-retest&nbsp; reliability&nbsp; for&nbsp; the&nbsp; mental&nbsp; chronometry&nbsp; was&nbsp; good&nbsp; (ICCs: visual&nbsp; analogue&nbsp; scale=0.88, mean&nbsp; execution&nbsp; and&nbsp; motor&nbsp; imagery&nbsp; absolute&nbsp; difference= 0.75, imagery&nbsp; duration=0.91, and execution&nbsp; duration=0.97).&nbsp; Moreover, the concurrent validity&nbsp; between&nbsp; the&nbsp; visual&nbsp; analogue&nbsp; scale&nbsp; of&nbsp; mental&nbsp; chronometry&nbsp; and&nbsp; KVIQ-20 was&nbsp; good.</p> <p><strong>Conclusion:</strong>&nbsp; As evidenced by the results&nbsp; of&nbsp; the&nbsp; present&nbsp; study,&nbsp; the&nbsp; mental&nbsp; chronometry based on box and block is&nbsp; a&nbsp; reliable&nbsp; and&nbsp; valid&nbsp; tool&nbsp; for the &nbsp;assessment&nbsp; of&nbsp; motor imagery&nbsp; in&nbsp; MS patients.</p> Maryam Rezaeian Zahra Assadollahi Hossien Azin Ayat Kaeidi Mahdieh Azin Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.274 Investigation of the Utility of Web-Based Videos About Varicose Veins <p><strong>Background and Objectives: </strong>Very few investigations and studies have been conducted on the provided information about varicose veins in web-based media worldwide. The present study aimed to investigate the categorization, characteristics, scientificity, and accuracy of such videos uploaded to YouTube.</p> <p><strong>Materials and Methods: </strong>YouTube was searched during November 2019, and the search keywords were "varicose vein", "varicose veins", and "varicose veins of lower extremities". The videos collected by retrieval were classified as useful, partially useful, and completely useless based on their scientific content, contemporariness, and accuracy. The analysis was mainly performed on the data collected from videos that were categorized as useful.</p> <p><strong>Results: </strong>In total, 635 (75.6%) out of 840 collected videos were excluded. Most videos on the website were uploaded by medical staff (31%, n=64). Based on the results, among the videos included in the data analysis, videos uploaded by official agencies were viewed more times than those uploaded by others. In addition, most of the useful videos were uploaded by official institutions.</p> <p><strong>Conclusions:</strong> Official institutions should provide more web-based videos with up-to-date, complete, and accurate information about varicose veins. Furthermore, effective search tools are needed for the identification of the videos uploaded by academic sources and institutions.</p> Zhoupeng Wu Yukui Ma Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.288 Clinical Characteristics of Patients Infected with Coronavirus Disease 2019 (COVID-19) in Iran: A Retrospective Cohort Study <p><strong>Background:</strong> Coronavirus disease 2019 (COVID-19) was introduced by the World Health Organization as a pandemic and emergency for human health. This study aimed to investigate the clinical characteristics of patients infected with COVID-19 in Guilan Province, Iran.</p> <p><strong>Methods:</strong> This retrospective study was conducted on 1,000 patients with a definitive diagnosis of COVID-19 pneumonia admitted to six hospitals in Guilan Province, Iran, from April 13 to June 14, 2020. This study evaluated the patients' clinical information, demographic characteristics, laboratory results, and chest computed tomography scans. &nbsp;</p> <p><strong>Findings: </strong>The mean age of the patients was obtained at 55±1.3 years, and the majority (n=800; 80%) of the cases were male. Furthermore, most patients had underlying diseases, including respiratory system disease (n=173; 17.3%), cardiovascular disease (n=711; 71.1%), and malignancy (n=146; 14.6%). The most common causes of the infection with COVID-19 included the presence in crowded places (n=733; 73.3%), close contact with the infected person (n=370; 82.2%), possession of pets (n=107; 23.2%), and family gathering (n=822; 82.2%). In addition, the most common clinical symptoms in patients included fever (n=911; 91.1%), cough (n=900; 90%), and dyspnea or shortness of breath (n=889; 88.9%). Other less common symptoms were diarrhea (n=160; 16%), vomiting (n=168; 16.8%), and headache (n=217; 21.7%). Dyspnea developed in 889 (88.9%) patients, and 660 (66%) cases had increased leucocytes.</p> <p><strong>Conclusion:</strong> COVID-19 causes mild to fatal pneumonia in patients. Therefore, early detection and treatment of these patients are of utmost importance. Timely treatment of the disease can reduce the severity of symptoms and prevent the further spread of the disease.</p> Latif Panahi Tofigh Yaghubi Marzieh Amiri Heydar ali Balou Abolfazl Etebarian Khorasgani somaye pouy Copyright (c) 2021 Iranian Red Crescent Medical Journal 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.87 Drug-drug Interactions in Kidney Transplant Patients with Coronavirus Disease 2019: A Report of Two Cases and Literature Review <p>On February 19, 2020, the first confirmed case of Coronavirus disease 2019, known as COVID-19, was identified in Iran. Afterward, the disease spread rapidly throughout the country. Some of the cases were asymptomatic, some had mild to severe symptoms, and some of them died. Transplant patients are highly at risk due to long-term immunosuppressive therapy, and precise treatment approaches are needed to not only cure the disease but also protect graft function.</p> <p>This study reports two kidney transplant patients with COVID-19 pneumonia, both of whom showed respiratory and gastrointestinal symptoms. High cyclosporine and tacrolimus trough levels were observed despite initial dose reduction. After a treatment program containing reduced immunosuppressant dose and the addition of pulsatile hydrocortisone, these patients recovered effectively. We also discuss the importance of drug-drug interactions related to COVID-19 treatment protocol medications, especially with immunosuppressants, in these patients.</p> <p>In conclusion, frequent monitoring of the trough levels of calcineurin and mammalian target of rapamycin inhibitors during hospitalization is recommended since it helps to determine the ideal treatment and prevent serious clinical toxicity.</p> Shahriyar Shahbazi Khamas Atefeh Jafari Elham Ramezanzadeh Copyright (c) 2021-03-27 2021-03-27 23 3 10.32592/ircmj.2021.23.3.313