Background: Chronic anal fissure is a common disease that is accompanied with pain and bleeding during defecation. Various surgical and non-surgical methods have been offered for the treatment of this condition. Objective: The aim of this randomised clinical study was to compare the effectiveness and safety of nifedipine and isosorbide dinitrate (ISDN) in the treatment of chronic anal fissure. Methods: This double-blind clinical trial study was performed on patients aged 20 to 60 years old in 2012 to 2013. The samples with a primary diagnosis of chronic anal fissure were enrolled from the patients admitted to public treatment at the educational Imam Ali Clinic, Shahrekord, Iran by researchers and general surgery specialists. The patients were randomised into two groups: nifedipine 0.3% (n = 35) or ISDN 0.2% (n = 35) applied three times a day for three weeks. The patients were examined on the 7th, 14th, and 21st days of treatment, and the symptoms including bleeding, pain, and healing status, as well as the side effects of the drugs, were assessed. Pain was evaluated using a visual analogue scale (VAS). Results: After 21 days of follow-up, complete healing was achieved in 77.1% (n = 27) of patients in the nifedipine group and 51.4% (n = 18) in the ISDN group (P = 0.05). The mean VAS of the pain on day 21 was 0.91 (SD 0.01) in the ISDN group and 0.45±0.78 in the nifedipine group, with a statistically significant difference (P = 0.038). The bleeding was similar in the two groups (P = 0.498). Conclusion: In view of the findings on healing status and pain in the patients, nifedipine may be significantly more effective in the treatment of chronic anal fissure than ISDN.

A plethora of paraneoplastic syndromes have been reported as remote effects of colorectal carcinoma (CRC). However, there is a dearth of data pertaining to the association of this cancer with demyelinating neuropathies. Herein, we describe the case of a young woman diagnosed with chronic inflammatory demyelinating polyneuropathy (CIDP). Treatment with intravenous immunoglobulins and prednisone did not improve her condition, and her neurological symptoms worsened. Subsequently, she was readmitted with exertional dyspnea, lightheadedness, malaise, and black stools. Colonoscopy revealed a necrotic mass in the ascending colon, which directly invaded the second part of the duodenum. Pathologic results confirmed the diagnosis of locally advanced CRC. Upon surgical resection of the cancer, her CIDP showed dramatic resolution without any additional therapy. Patients with CRC may develop CIDP as a type of paraneoplastic syndrome. Clinicians should remain cognizant of this potential association, as it is of paramount importance for the necessary holistic clinical management.

Objective: To establish a spatial geo-database for scorpions in Iran, and to identify the suitable ecological niches for the most dangerous scorpion species under different climate change scenarios. Methods: The spatial distribution of six poisonous scorpion species of Iran were modeled: Hemiscorpius lepturus, Androctonus crassicauda, Mesobuthus eupeus, Hottentotta saulcyi, Hottentotta zagrosensis, and Odontobuthus (O.) doriae, under RCP2.6 and RCP8.5 climate change scenarios. The MaxEnt ecological niche model was used to predict climate suitability for these scorpion species in the 2030s and 2050s, and the data were compared with environmental suitability under the current bioclimatic data. Results: A total of 73 species and subspecies of scorpions belonging to 19 genera in Iran were recorded. Khuzestan Province has the highest species diversity with 34 species and subspecies. The most poisonous scorpion species of Iran are scattered in the semi-arid climates, at an altitudinal range between 11 m and 2 954 m above sea level. It is projected that O. doriae, Androctonus crassicauda and Mesobuthus eupeus species would be widely distributed in most parts of the country, whereas the most suitable ecological niches for the other species would be limited to the west and/or southwestern part of Iran. Conclusions: Although the environmental suitability for all the species would change under the two climate change scenarios, the change would be more significant for O. doriae under RCP8.5 in the 2050s. These findings can be used as basis for future studies in the areas with the highest environmental suitability for the most dangerous scorpion species to fill the gaps in the ecology of scorpion species in these areas.