IntroductionInternational continence society defined mixed urinary incontinence (MUI) as “complaint of involuntary loss of urine associated with urgency and also with effort or physical exertion or on sneezing or coughing”., which include both urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) complaints. Urinary incontinence affects social behaviors, financial burden such as using class of drugs, rehabilitation floor muscles, and psychological suffering such as dissatisfaction in sexual activity. Diagnosis of urinary incontinence is based on history, physical examinations and supplemental evaluations like dye test, cystoscopy, urodynamic study, urine analysis, urine culture, and imaging technics. (1)At the first, conservative treatments are performed for patient such as biofeedback, pelvic floor muscle exercise, electrical stimulation and drug treatment. In the second step of treatment, surgery is considered. The surgery is usually used to address the failure of normal anatomic support of the bladder neck and proximal urethra, and intrinsic sphincter deficiency, meanwhile its implementation should be approached with caution for carefully. In some cases, surgery intervention also failed and other novel interventions should be considered. (2)Platelet rich fibrin glue, stem cells, butolonium toxins and TVT separately applied for treatment of patients, but this is the first time that these mixed modalities were used for the treatment of mixed urinary incontinence which did not respond to pharmaceutical and surgical treatment.

Introduction: COVID-19 is a global catastrophic event that causes severe acute respiratory syndrome. The mechanism of the disease remains unclear, and hypoxia is one of the main complications. There is no currently approved protocol for treatment. The microbial threat as induced by COVID-19 causes the activation of macrophages to produce a huge amount of inflammatory molecules and nitric oxide (NO). Activation of macrophages population into a pro-inflammatory phenotype induces a self-reinforcing cycle. Oxidative stress and NO contribute to this cycle, establishing a cascade inflammatory state that can kill the patient. Interrupting this vicious cycle by a simple remedy may save critical patients’ lives. Methods: Nitrite, nitrate (the metabolites of NO), methemoglobin, and prooxidant-antioxidant-balance levels were measured in 25 ICU COVID-19 patients and 25 healthy individuals. As the last therapeutic option, five patients were administered methylene blue-vitamin C-N-acetyl Cysteine (MCN). Results: Nitrite, nitrate, methemoglobin, and oxidative stress were significantly increased in patients in comparison to healthy individuals. Four of the five patients responded well to treatment. Discussion: NO, methemoglobin and oxidative stress may play a central role in the pathogenesis of critical COVID-19 disease. MCN treatment seems to increase the survival rate of these patients. Considering the vicious cycle of macrophage activation leading to deadly NO, oxidative stress, and cytokine cascade syndrome; the therapeutic effect of MCN seems to be reasonable. Accordingly, a wider clinical trial has been designed. It should be noted that the protocol is using the low-cost drugs which the FDA approved for other diseases.