Applications and outcomes of implementing telemedicine for hypertension management in COVID-19 pandemic: A systematic review.

INTRODUCTION: COVID-19 presented a significant challenge for patients with hypertension in terms of access to care. However, telemedicine offered the healthcare system opportunities that had previously been underutilized. Therefore, this study aims to systematically review the applications and outcomes of telemedicine for hypertension management during the COVID-19 pandemic. METHOD: A structured search was conducted in accordance with PRISMA guidelines across multiple databases, including PubMed, Cochrane, Web of Science, and Scopus. The search was limited to studies published from December 2019 until May 2023, resulting in a total of 3727 studies. After quality appraisal using the CASP checklists version 2018, 29 articles were included in the final review. Data analysis was performed using thematic analysis. RESULTS: Most of the studies reviewed had used the proprietary platforms (N = 14) and 11 studies had used public platforms such as social messengers or email. Also 9 studies relied on phone calls (N = 9) to record and transmit the clinical data. Some studies had applied two different approaches (proprietary/public platforms and phone). six articles (20.7%) focused only on hypertension control, while 23 articles (79.3%) examined hypertension as a comorbidity with other diseases. Also, the study identified 88 unique concepts, 15 initial themes, and six final themes for outcomes of using telemedicine for hypertension management during the COVID-19 pandemic. These themes include BP control, BP measurement and recording, medication management, mental health, care continuity and use and acceptance. CONCLUSION: Telemedicine provides patients with hypertension with the opportunity to engage in medical consultations in a more convenient and comfortable manner, with the same validity as in-person visits. Telemedicine facilitates the creation of a connected network to support patients with high BP at any time and in any location. Limitations and issues may arise due to patients and healthcare staff's unfamiliarity with telemedicine. These issues can be resolved through the ongoing use and continuous feedback.

Phytochemical profile, antioxidant, and wound healing activities of Echium amoenum (Boraginaceae).

Natural products' inflammatory and antioxidant properties have crucial roles in tissue repair and regeneration. This study aimed to investigate HPLC analysis, antioxidant activity, and wound-healing effect of Echium amoenum (EA) on rats. The EA was analysed for the determination of shikonin a derivative of naphthoquinone. In the wound healing assessment, forty Wistar rats were divided into five groups that were receiving the cream base, normal saline (NS), 1% silver sulfadiazine (SSD), and 5 and 10% EA cream (EAC). Shikonin was found in the EA extract. The average wound area on the 10th day was 0.71 ± 0.01, 0.86 ± 0.13, 0.58 ± 0.08, 0.53 ± 0.03 and 0.43 ± 0.04 cm2 for the cream base, NS, SSD, and 5 and 10% EAC, respectively. The collagen fibres were well formed and horizontally oriented in 5 and 10% EAC groups compared to other groups. EA cream was an effective treatment for wound healing in comparison with SSD.

Design of double Z-scheme Ag-Ag3O4/CuO-CuFe2O4 magnetic nanophotocatalyst via starch-templated microwave-combustion hybrid precipitation method and modified with corona-plasma: Remediation of dye contaminants.

Herein, the novel double Z-scheme Ag-Ag3O4/CuO-CuFe2O4 magnetic nanophotocatalyst with nanosphere-on-nanosheet-like morphology was synthesized via the corona-plasma-assisted starch-templated microwave-combustion-precipitation method to remove the dye pollutants. The CuO-CuFe2O4 meso/macroporous nanophotocatalyst was synthesized using a one-pot-stage combustion-microwave process with/without starch as a hard-template. Subsequently, surface modification was carried out by DC corona-plasma discharge technology at various voltages, namely 500, 1000 and 1500 V. Then, the Ag3O4 photocatalyst was deposited on the CuO-CuFe2O4 fabricated with starch-hard-template and treated with 1000 V corona-plasma (denoted as: Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P). The properties of the synthesized nanophotocatalysts were analyzed using various techniques, including X-ray diffraction (XRD), Diffuse reflectance spectroscopy (DRS), Transmission electron microscopy (TEM), Field emission scanning electron microscopy (FESEM), Brunauer-Emmett-Teller and Barrett-Joyner-Halenda (BET-BJH), Vibrating Sample Manetometer (VSM), and Photoluminescence (PL). The XRD analysis corroborated the presence of CuO, CuFe2O4 and Ag3O4 in the structure of all samples. The BET-BJH analysis indicates that the specific surface area of the Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst as the best sample is 2 m2/g, higher than other samples. Additionally, the DRS analysis revealed that the band gap of the Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst is about 1.68 eV with the surface plasmon resonance. The performance of the ternary heterostructured Ag-Ag3O4/CuO-CuFe2O4 (Starch) 1000 P nanophotocatalyst was 96.2% and 89.1% in the degradation of the crystal violet (10 mg/L) and acid orange 7 (10 mg/L), respectively, proving its outstanding degradation capacity.

Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium.

BACKGROUND: This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS: We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS: Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS: This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Magnitude and determinants of excess total, age-specific and sex-specific all-cause mortality in 24 countries worldwide during 2020 and 2021: results on the impact of the COVID-19 pandemic from the C-MOR project.

INTRODUCTION: To examine the impact of the COVID-19 pandemic on mortality, we estimated excess all-cause mortality in 24 countries for 2020 and 2021, overall and stratified by sex and age. METHODS: Total, age-specific and sex-specific weekly all-cause mortality was collected for 2015-2021 and excess mortality for 2020 and 2021 was calculated by comparing weekly 2020 and 2021 age-standardised mortality rates against expected mortality, estimated based on historical data (2015-2019), accounting for seasonality, and long-term and short-term trends. Age-specific weekly excess mortality was similarly calculated using crude mortality rates. The association of country and pandemic-related variables with excess mortality was investigated using simple and multilevel regression models. RESULTS: Excess cumulative mortality for both 2020 and 2021 was found in Austria, Brazil, Belgium, Cyprus, England and Wales, Estonia, France, Georgia, Greece, Israel, Italy, Kazakhstan, Mauritius, Northern Ireland, Norway, Peru, Poland, Slovenia, Spain, Sweden, Ukraine, and the USA. Australia and Denmark experienced excess mortality only in 2021. Mauritius demonstrated a statistically significant decrease in all-cause mortality during both years. Weekly incidence of COVID-19 was significantly positively associated with excess mortality for both years, but the positive association was attenuated in 2021 as percentage of the population fully vaccinated increased. Stringency index of control measures was positively and negatively associated with excess mortality in 2020 and 2021, respectively. CONCLUSION: This study provides evidence of substantial excess mortality in most countries investigated during the first 2 years of the pandemic and suggests that COVID-19 incidence, stringency of control measures and vaccination rates interacted in determining the magnitude of excess mortality.

The Global Road Traffic Death Rate and Human Development Index from 2000 to 2019: A Trend Analysis.

BACKGROUND: Numerous studies on the association between the human development index (HDI) and road traffic death rate (RTDR) merely focus on developed countries, not reflecting the relationship between the HDI components and RTDR in a time-trend analysis. Accordingly, this study analyzes the trends of RTDR and their association with the HDI and its components from 2000 to 2019. METHODS: The RTDR data of 154 countries were imported into the unconditional latent growth model (LGM) to assess the RTDR trends. The impact of the HDI and its components (viz., education, income, and life expectancy [LE viz]) on the trajectory of RTDR was also evaluated using the conditional LGM. RESULTS: The results of the unconditional LGM indicated an overall decreasing trend in RTDR. The conditional LGM results revealed the negative effect of the HDI and its components on the model parameters. The findings of random forests indicated that education and LE were the most crucial variables. CONCLUSION: Overall, this study emphasizes the significance of HDI and its components, particularly education and LE, in lowering the number of traffic fatalities. In this sense, improving formal education and LE could be one of the main policies that policymakers could consider to reduce RTDR.

Demanded interdisciplinary subjects for integration in medical education program from the point of view of graduated medical physicians and senior medical students: a nationwide mixed qualitative-quantitative study from Iran.

INTRODUCTION: This study aimed to detect interdisciplinary subjects for integration into the medical education program of Iran. METHODS: A qualitative-quantitative method was used. Firstly, interdisciplinary subjects demanded by medical graduates and senior medical students were defined by qualitative study. In the second stage, questionnaire was developed which based on the findings of qualitative stage, experts' opinion and reviewing of the national general guide of professional ethics for medical practitioners. Questionnaire consisted of demographic, occupational and thirteen interdisciplinary items. These items consisted of social determinants of health, social and economic consequences of disease, social prescribing, physicians' social responsibility, role of gender, racial, ethnic, social and economic issues in approach to patients, role of logic and mathematics in clinical decision-making, philosophy of medicine, maintaining work-life balance, self-anger management, national laws of medicine, religious law in medical practice, health system structure, and teamwork principles. Level and importance of knowledge and self-assessed educational needs were asked about each item. In the third stage, a national online survey was conducted. SPSS 25 was used for statistics. RESULTS: By content analysis of data in qualitative stage, 36 sub-themes and 7 themes were extracted. In the quantitative part, 3580 subjects from 41 medical universities across Iran participated in this study. 2896 (80.9%) were medical graduates and 684 (19.1%) were senior medical students. Overall, knowledge about interdisciplinary items was low to intermediate, while high to very high knowledge ranged from maximally 38.7% about socioeconomic consequences of disease to minimally 17.2% about social prescribing. Participants gave the most importance to the having knowledge about self-anger management (88.3%), maintaining work-life balance (87.2%) and social determinants of health (85.8%), respectively. However, national laws of medicine (77.6%), maintaining work-life balance (75.4%) and self-anger management (74%) were the first top three educational demands by participants. CONCLUSION: This study revealed a low to moderate level of knowledge about interdisciplinary topics among both graduated medical physicians and senior medical students. These groups showed a strong demand and tendency to know and to be educated about these topics. These findings underscore the urgency for educational reforms to meet the interdisciplinary needs of medical professionals in Iran.

Design of novel solar-light-induced KBi6O9I/Ag-AgVO3 nanophotocatalyst with Ag-bridged Z-scheme charge carriers separation and boosted photo-elimination of hospital effluents.

In this research, a novel solar-light-induced KBi6O9I/Ag-AgVO3 nanophotocatalyst with an Ag-bridged Z-scheme structure has been designed and synthesized through a sonochemical method to photo-degrade antibiotic hospital contaminants under simulated solar-light irradiation. Synthesized nanophotocatalysts with varying KBi6O9I to Ag-AgVO3 weight ratios underwent N2 Adsorption-Desorption, XRD, TEM, UV-Vis DRS, FESEM and PL analyses. The Ag-bridged Z-scheme-structured KBi6O9I/Ag-AgVO3 (1:1) nanophotocatalyst, demonstrated broad light absorption within the solar-light spectrum and showcased effective photocatalytic efficacy in degrading tetracycline antibiotic (88.3% and 83.5% removal for 25 and 50 mg/L, respectively, after 120 min). This performance outperformed other composited photocatalysts, as well as pure Ag-AgVO3 and KBi6O9I photocatalysts. The enhanced degradation efficiency of the KBi6O9I/Ag-AgVO3 (1:1) composite can be ascribed to the synergistic interaction of various elements. These include the surface plasmon resonance impact of silver nanoparticles, their pronounced sensitivity to solar irradiation, and the Z-scheme heterojunction configuration. Collectively, these factors work together to minimize the recombination rate of photoinduced electron-hole pairs, thereby amplifying the efficacy of photodegradation. Furthermore, the KBi6O9I/Ag-AgVO3 (1:1) composite photocatalyst displayed sustained pollutants elimination performance even after undergoing four consecutive cycles.

Potato-on-rod like of Z-scheme plasmon Ag2CrO4-Ag2Mo2O7 heterojunction nanophotocatalyst with high stability and accelerated photo-degradation evolution of organic contaminants.

The shocking increase of resistant dye pollutants in the environment and their harmful effects has become a potential threat to the ecosystem. In the current work, the novel and highly efficient potato-on-rod-like Z-scheme plasmon Ag2CrO4-Ag2Mo2O7 heterojunction nano-photocatalyst was synthesized by precipitation method to photodegrade different organic dyes under artificial sunlight. The required analysises were carried out to characterize nanophotocatalysts. FESEM and TEM results showed the placement way of potato-like Ag2CrO4 between/on rod-like Ag2Mo2O7 which was leading to suitable structure and surface morphology. Besides, the morphology observations released the meso-/macroporous potato-on-rod like architecture self-assembled by nanoparticles. DRS analysis also confirmed two band gap energies of 2.55 and 1.72 eV in Ag2CrO4-Ag2Mo2O7 (3:1) resulting from forming a heterojunction structure and the plasmon Ag. Ag2CrO4-Ag2Mo2O7 (3:1) nanophotocatalyst exhibited the most remarkable activity in the photodegradation of 10 mg/L 2-naphthol orange (97.8%), 10 mg/L rhodamine B (99.7%), 10 mg/L crystal violet (98.9%), and 10 mg/L methyl orange (56.1%) with a catalyst dosage of 0.1 gr for about 90 min. The appropriate energy band gap, the formation of the heterostructure, the presence of meso (0.0038 cm3/g) and macro (0.0044 cm3/g) holes, and pore diameter at about 17.2 nm based on BET-BJH analysis that facilitated the penetration of pollutant molecules, increased pollutant adsorption and demonstrated stunning capability of efficient light harvesting, the reason was electron-hole pairs recombination rate reduction. Moreover, the fabricated samples showed tremendous catalyst constancy and reusability even after the fourth run. Results have shown the remarkable photocatalytic activity under visible light and provide an environment-friendly and green strategy to overcome the challenges of organic pollutants present in aqueous solutions.

Applications, opportunities, and challenges in using Telehealth for burn injury management: A systematic review.

INTRODUCTION: Burns are global public health devastating and life-threatening injuries. Telehealth can be an appropriate answer for the effective utilization of health care resources, prevention referrals and reduce socio-economic burden of burns injuries. Thus, this study aimed to systematically evaluate the applications, opportunities, and challenges of using telehealth in burn injuries management. METHODS: A structured search was conducted according to PRISMA statement guidelines in the Web of Science, PubMed, Scopus, and Science Direct as well as the Google Scholar for studies published until June 28, 2022. Of the total 2301 yielded studies, 36 articles were included in the final review. Quality appraisal was done according to the Mixed Methods Appraisal Tool (MMAT) version 2018. Thematic analysis was applied for data analysis. RESULTS: Patient triage, transfer, and referral (38.9%) follow-up (22%), care (22%), consultation (9%), education (3%), and rehabilitation (3%) were the most prevalent application of telehealth, respectively. Our findings identified 72 unique concepts, eight initial themes, and two clinical and administrative final themes for opportunities of using telehealth in burn injury management. Furthermore, we identified 27 unique concepts, three initial themes, and two clinical and administrative final themes for remaining challenges. CONCLUSIONS: Despite providing pivotal opportunities such as improving burn injury diagnosis and quality of care, increasing patient and provider satisfaction, and cost containment using telehealth in burn injuries management, the concept faces challenges such as the impossibility of the physical examination of patients and technological difficulties. Our findings provide valuable information for policymakers and decision-makers infield of burn injuries and effective planning for using telehealth technology.

Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID-19 disease.

Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID-19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID-19 patients. PT and SE may present after PTM in COVID-19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID-19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID-19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID-19 and mild pulmonary damage may have a favorable outcome.

The utero-tonic effects of low dose intravenous ketamine in cesarean section under spinal anesthesia; A randomized double-blind clinical trial.

Background: Recently, the prevalence of cesarean section (CS) has been on the rise and the proper uterine tone is an important issue. We investigated the effects of intravenous (IV) ketamine on intraoperative bleeding and the need for oxytocin in CS under spinal anesthesia (SA). Methods: This study, took place at Alzahra hospital during 2020. Pregnant women candidate for elective CS under SA were divided into two groups of ketamine and placebo. In group K, after umbilical cord clamping, 0.25 mg/kg ketamine and in group P 2ccs normal saline was injected. Mean arterial pressure and heart rate were recorded at baseline, before and 5 minutes after cord clamping and at the end of the surgery. The drop in hemoglobin values, the administrated units of oxytocin and side effects were also recorded. Results: No significant difference was found in terms of patients' demographic data (P ≥ 0.05). The mean units of administrated oxytocin in group K was 34.61±6.63 and in group P; 48.47±12.15, which was significantly different (P=0.0001). The drop in Hb was less in group K, however not statistically significant (P=0.094). The need for methergine was significantly higher in group P (P=0.0001). The mean HR was significantly higher in group P (P=0.027), however, no significant difference was observed regarding the MAP (P=0.064). The incidence of hallucination (4.8%) and nystagmus (21%) was significantly higher in group K (P= 0.0001), but nausea and vomiting were more significant in group P (P= 0.027). Conclusion: Prophylactic administration of low-dose ketamine in CS under S.A could significantly reduce the administrated oxytocin units and the need for additional utero-tonics and was associated with less drop in Hb values.

Effectiveness of Repetitive Transcranial Magnetic Stimulation (rTMS) Add-On Therapy to a Standard Treatment in Individuals with Multiple Sclerosis and Concomitant Symptoms of Depression-Results from a Randomized Clinical Trial and Pilot Study.

BACKGROUND: Compared to the general population, persons with multiple sclerosis (MS) are at increased risk of suffering from major depressive disorder (MDD). Repetitive Transcranial Magnetic Stimulation (rTMS) was used successfully to treat individuals with MDD. Here, we conducted a randomized clinical trial and pilot study, and tested the effectiveness of rTMS adjuvant to a standard pharmacological treatment among persons with MS, compared to a sham condition. MATERIALS AND METHODS: A total of 40 persons with MS (mean age: 32 years; 42.5% females; median EDSS score: 4) and with moderate to severe symptoms of depression were randomly assigned to the rTMS or to the rTMS sham condition, always as adjuvant intervention to the standard treatment with sertraline, a selective serotonin reuptake inhibitor (SSRI). rTMS consisted of 10 sessions each of 37.5 min; the sham condition was identical to the active condition except for the absence of rTMS stimuli. At the beginning and two weeks after the end of the study, participants reported on their fatigue, while experts rated the severity of participants' depressive symptoms (Montgomery-Asberg Depression Rating Scale; MADRS), cognitive performance (Montreal Cognitive Assessment; MoCA), and degree of disability (Expanded Disability Status Scale; EDSS). RESULTS: Data were analyzed per intent-to-treat. Scores for depression, fatigue, and EDSS declined significantly over time (large effect sizes), but more so in the rTMS condition than in the sham condition (large effect sizes for the time by group-interactions). Compared to the sham condition, scores for depression were significantly lower in the rTMS condition. Scores for cognition improved over time in both study conditions (large effect size). CONCLUSION: Compared to a sham condition, adjuvant rTMS to a standard pharmacological treatment ameliorated typical MS-related symptoms (depression; fatigue; EDSS scores). Results from this pilot study suggested that rTMS might be routinely applied in persons with MS displaying symptoms of depression and fatigue.

Boerhaave's syndrome in a patient with achalasia: A rare case report.

INTRODUCTION AND IMPORTANCE: Boerhaave's syndrome (BS) is a rare spontaneous perforation of the esophagus with a high rate of morbidity that results in death in the case of delayed diagnosis and treatment. Here, we describe a patient with achalasia who was diagnosed with BS. CASE PRESENTATION: This present case is a 63-year-old man with a previous history of achalasia and with a complaint of sudden onset of severe right chest pain, epigastric pain, etc. to Razi hospital, Rasht, Iran in March 2022. CLINICAL DISCUSSION: Due to the clinical findings of the patients, the diagnosis was BS and the patient's condition was reported to be good at the two-month follow-up. CONCLUSION: Early diagnosis of BS results in more effective treatment. Also, stenting is suggested to be effective to reduce the rate of morbidity and mortality in patients with BS.

Nutrients in prevention, treatment, and management of viral infections; special focus on Coronavirus.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is a pandemic caused by coronavirus with mild to severe respiratory symptoms. This paper aimed to investigate the effect of nutrients on the immune system and their possible roles in the prevention, treatment, and management of COVID-19 in adults. METHODS: This Systematic review was designed based on the guideline of the Preferred Reporting for Systematic Reviews (PRISMA). The articles that focussed on nutrition, immune system, viral infection, and coronaviruses were collected by searching databases for both published papers and accepted manuscripts from 1990 to 2020. Irrelevant papers and articles without English abstract were excluded from the review process. RESULTS: Some nutrients are actively involved in the proper functioning and strengthening of the human immune system against viral infections including dietary protein, omega-3 fatty acids, vitamin A, vitamin D, vitamin E, vitamin B1, vitamin B6, vitamin B12, vitamin C, iron, zinc, and selenium. Few studies were done on the effect of dietary components on prevention of COVID-19, but supplementation with these nutrients may be effective in improving the health status of patients with viral infections. CONCLUSION: Following a balanced diet and supplementation with proper nutrients may play a vital role in prevention, treatment, and management of COVID-19. However, further clinical trials are needed to confirm these findings and presenting the strong recommendations against this pandemic.

Joint Optimization of Energy Consumption and Data Transmission in Smart Body Area Networks.

In Wireless Body Area Networks (BAN), energy consumption, energy harvesting, and data communication are the three most important issues. In this paper, we develop an optimal allocation algorithm (OAA) for sensor devices, which are carried by or implanted in human body, harvest energy from their surroundings, and are powered by batteries. Based on the optimal allocation algorithm that uses a two-timescale Lyapunov optimization approach, we design a framework for joint optimization of network service cost and network utility to study energy, communication, and allocation management at the network edge. Then, we formulate the utility maximization problem of network service cost management based on the framework. Specifically, we use OAA, which does not require prior knowledge of energy harvesting to decompose the problem into three subproblems: battery management, data collection amount control and transmission energy consumption control. We solve these through OAA to achieve three main goals: (1) balancing the cost of energy consumption and the cost of data transmission on the premise of minimizing the service cost of the devices; (2) keeping the balance of energy consumption and energy collection under the condition of stable queue; and (3) maximizing network utility of the device. The simulation results show that the proposed algorithm can actually optimize the network performance.

Determining the existence of the foramen of Huschke in patients with temporomandibular joint disorders using cone beam computed tomography: retrospective cohort study.

BACKGROUND: Foramen of Huschke has been presented as an unusual developmental defect in anteroinferior aspect of external auditory canal. It can be associated with significant otologic complications. The purpose of this study was to determine the association between existence of foramen of Huschke and temporomandibular joint disorders in Cone Beam Computed Tomography (CBCT) images. METHODS: Of an initial sample of 465 patients, we retrospectively evaluated the CBCT images of 118 individuals with clinical signs and symptoms of temporomandibular joint disorders as case group and 256 individuals as control group. The presence, size and localization of foramen of Huschke were assessed in the axial and corrected sagittal images. The sex and age distribution were determined. Fisher's exact test, T-test and Pearson's Chi-square were applied to assess the relationship between foramen of Huschke and temporomandibular joint disorders in the case and control groups considering age and sex. RESULTS: The foramen of Huschke prevalence was slightly higher in patients with temporomandibular joint disorders (3.4%) than patients without temporomandibular joint disorders (0.8%). However, the difference was not statistically significant (P = 0.082). foramen of Huschke was found in five females and one male. There was no significant difference between case and control groups considering the age of patients with foramen of Huschke (P = 0.683). There was no significant difference between the case and control groups, considering the right and left ears in distribution of foramen of Huschke (P = 0.099) (P = 0.183). CONCLUSIONS: Higher prevalence of foramen of Huschke in patients with temporomandibular joint disorders may suggest possible mechanism for temporomandibular joint disorders development that can be affected by presence of foramen of Huschke.

Domestic violence and associated factors during COVID-19 epidemic: an online population-based study in Iran.

BACKGROUND: The novel coronavirus disease 2019 has severely affected communities around the world. Fear and stress of being infected, along with pressure caused by lockdown, prevention protocols, and the economic downturn, increased tension among people, which consequently led to the rise of domestic violence (DV). Therefore, this study was conducted to determine the rate of change in DV and its associated factors during the COVID-19 epidemic in Shiraz, Iran. METHODS: In this cross-sectional study, 653 individuals with the age of over 15 years from Shiraz were participated through snowball sampling and filled out an online questionnaire through the WhatsApp platform. A 51-item, self-administered and multidimensional (knowledge, attitude, and practice) questionnaire was designed and assessed 653 participants. The gathered data was analyzed using SPSS software (version 25), and variables with a p-value of less than 0.05 were considered statistically significant. RESULTS: In this study, 64.2% of the respondents were within the age range of 31-50 years, and 72.6% of the subjects were female. Furthermore, 73.8 and 73.0% of the individuals were married and educated for over 12 years, respectively. The DV increased by 37.5% during the quarantine period, compared to before the pandemic. The emotional type was the most common type of violence; the sexual type was the least frequent. Multivariate analysis indicated that infection with COVID-19, drug use, high level of co-living observation of anti-COVID prevention protocols, and lower level of physical activity during the quarantine period had a positive and significant association with the occurrence of DV. CONCLUSION: Based on the obtained results, it is required to implement effective harm-reduction policies and measures in the community due to the increasing rate of DV during the COVID-19 epidemic.

Evaluation of Bacterial Coinfection and Antibiotic Resistance in Patients with COVID-19 Under Mechanical Ventilation.

Patients with confirmed SARS-CoV-2 are principally at risk of emerging superinfections, particularly those caused by Gram-negative bacteria. Therefore, in this retrospective cohort study, we investigated the presence of bacteria in endotracheal aspirate samples in severe COVID-19 patients under mechanical ventilation between 20 February 2020 and 21 September 2020 in Mazandaran Heart Center Hospital, Iran. Outcomes were compared between ICU patients with confirmed SARS-CoV-2 (corona group) and those who suffer from other disease (non-corona group). Out of 38 subjects who met the diagnostic criteria for ventilator-associated pneumonia (VAP) in ICU, 22 and 16 patients in corona and non-corona groups, respectively, were enrolled in the study. Hospital length of stay in 27% of case in corona group was > 10 days. Also, SOFA score was > 10 in 64% and 25% of corona and non-corona groups, respectively (P < 0.05). Moreover, the number of death was significantly higher among corona patients (45%) than non-corona group (6%) in ICU (P < 0.05). Acinetobacter spp. were the most common bacteria in nine corona patients (41%) that were 100% resistant to amikacin, gentamycin, cefixime, and imipenem antibiotics. The prevalence of antibiotic resistance among pathogens isolated from patients with COVID-19 under mechanical ventilation in ICU highlighted the importance of preventing coinfections caused by this pathogen, suggesting an essential standardized approach to antibiotic stewardship in patients with COVID-19 for successful treatment.

Influence of modafinil on early ejaculation - Results from a double-blind randomized clinical trial.

BACKGROUND: For men, early ejaculation is a serious health concern. Here, we tested the influence of modafinil (Profinil®) on early ejaculation. To this end, we performed a double-blind randomized clinical trial among men with early ejaculation. METHODS: A total of 46 men with early ejaculation (mean age: 37.35 years) and in stable marital relationships with regular weekly penile-vaginal intercourse were randomly assigned either to the modafinil (100 mg) or to the placebo condition. Compounds were taken about 4-6h before intended penile-vaginal intercourse. At baseline and four weeks later at the end of the study, participants completed a series of self-rating questionnaires covering early ejaculation. Female partners also rated their male partners' early ejaculation profile. RESULTS: Dimensions of early ejaculation improved over time, but only so in the modafinil condition, while no improvements were observed in the placebo condition. CONCLUSIONS: Among male adults in stable marital relationships with regular weekly penile-vaginal intercourse modafinil improved dimensions of early ejaculation, always compared to placebo. Given the strong effect of modafinil on cognitive-executive processes, it is conceivable, that modafinil acted both via physiological and cognitive-executive pathways.