Preexisting depression and COVID-19: a cohort study on the risk of susceptibility and hospitalization.

BACKGROUND: Depression can have negative effects on a person's physical health. However, the available evidence on the risk of susceptibility to COVID-19 and its adverse outcomes in people with mental disorders, including depression, is limited and inconsistent. Therefore, we investigated the relationship between major depressive disorder (MDD) and the risk of susceptibility to COVID-19 infection and hospitalization. The data used in the study were obtained from the Employees' Health Cohort Study of Iran (EHCSIR). METHODS: We conducted a cohort study that included 3355 participants who had complete data on major depressive disorder at baseline assessment and two annual telephone follow-ups between January 2020 and March 2022. Trained psychologists used the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) to identify major depressive disorders during the baseline assessment. We applied log binomial regression models to adjust for sociodemographic factors and background health conditions. RESULTS: We found that 11.4% of participants had lifetime MDD and 7.3% had MDD in the past 12 months. During the pandemic, 26.1% of participants were infected with COVID-19, and 14.4% of those who were infected were hospitalized. The risk of susceptibility to COVID-19 infection was significantly higher among participants with lifetime MDD than among those without MDD (adjusted risk ratio (ARR) = 1.24, 95% CI: 1.06-1.47). However, lifetime MDD or 12-month MDD was not independently associated with hospitalization among COVID-19 cases. CONCLUSIONS: Preexisting major depressive disorder may increase the risk of susceptibility to COVID-19.

Quality of life and its determinants in patients with noncystic fibrosis bronchiectasis.

BACKGROUND: Promoting quality of life (QoL) in patients with bronchiectasis, as a chronic disease, is a part of therapeutic principles. This study aimed to investigate QoL and its determinants in patients with noncystic fibrosis (CF) bronchiectasis. MATERIALS AND METHODS: This cross-sectional study was conducted on 62 patients (38.7% male, mean age: 44) with non-CF bronchiectasis and involvement of ≥2 lobes in Qazvin, Iran. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). The relationships of QoL subscales with clinical (cough, dyspnea, and sputum volume) and paraclinical (spirometry, computerized tomography scan, sputum microbiology, and 6-min walk test [6-MWT]) were assessed using Pearson's correlation coefficient and multiple linear regression analyses. RESULTS: The mean SGRQ total score was 53.1 (standard deviation 19.8) out of 100. The level of dyspnea (r = 0.543, P < 0.001), cough (r = -0.594, P < 0.001), 6-MWT (r = -0.520, P < 0.001), sputum volume (r = 0.423, P = 0.002), and number of exacerbations (r = 0.446, P = 0.009) had significant correlation with SGRQ total score. In multiple regression analysis, forced expiratory volume in 1 s was an independent predictor of the symptom (ß = -0.22, P = 0.048) and activity (ß = -0.43, P = 0.03) subscales, whereas cough was an independent predictor of the symptom subscale (ß = -2.1, P = 0.002). CONCLUSION: In patients with non-CF bronchiectasis, the extent of lung impairment has a lower effect on the QoL than clinical symptoms. It seems that the QoL can be improved through the proper treatment of clinical symptoms and rehabilitation for promoting 6-MWT.

COVID-19 Population Survey of Iran (COPSIR) study protocol: Repeated survey on knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust during COVID-19 epidemic.

Background: The worldwide emergence and rapid expansion of COVID-19 emphasizes the need to assess the knowledge gap and to predict the disease-related behaviors and reactions during this epidemic. Methods and design: COVID19 Population Survey of Iran (COPSIR) is a repeated cross sectional survey that will be conducted in 8 waves. In each wave, 515 Iranian adults aged 18 years or older will be randomly selected and interviewed by phone. The study waves will be performed at approximately weekly intervals. The survey tool is adapted from COSMO (COVID-19 Snapshot MOnitoring) study. This study will provide information on trends of knowledge, risk perception, preventive behaviors, psychological problems, essential needs, and public trust among Iranian adults during COVID-19 epidemic. Discussion: The key findings of each wave will be immediately reported to the National Headquarters for Coronavirus Control to set better policies for disease control and prevention. Moreover, if a message is extracted from the results of this study that needs to be communicated to the public, it will be done through the mass media.

Malnutrition and birth related determinants among children in Qazvin, Iran.

Background: Little is known about the effect of birth weight, birth order and number of siblings on the nutritional status in children in Iran, especially in Qazvin province. The aim of this study was to provide the current data on malnutrition and birth related determinants among children in Qazvin, Iran. This study was conducted in six cities of Qazvin province (Iran), during December 2009-December 2010. Data on age, weight and height were taken and birth weight, number of children in family, birth order, parental career and educational state and family caretaker were collected by a questionnaire that a trained team filled in. Sample size was1351, almost 225 children under 6-years-old from each city participated in the study (692 boys and 659 girls). In each city, subjects were randomly selected among children who had profiles at health centers. The overall prevalence of wasting, stunting and underweight was 10.3%, 5.8% and 4.8% respectively. There was association between 'birth weight' and wasting ( P = 0.022), stunting ( P = 0.032) and underweight ( P < 0.001). A non-significant association was obtained between factors 'number of children at home' and 'birth order' with wasting, stunting and underweight. These data suggest that birth weight can influence malnutrition indicators; therefore, knowing risk factors of malnutrition in population subgroups is important for planners in country because it helps the future studies concentrate on the most determining ones.

Comparison of adjunctive therapy with metformin and acarbose in patients with Type-1 diabetes mellitus.

OBJECTIVE: All the aforementioned data have stimulated interest in studying other potential therapies for T1DM including noninsulin pharmacological therapies. The present study attempts to investigate the effect of adjunctive therapy with metformin and acarbose in patients with Type-1 diabetes mellitus. METHOD: In a single-center, placebo-controlled study (IRCT201102165844N1) we compared the results of two clinical trials conducted in two different time periods on 40 patients with Type-1 diabetes mellitus. In the first section, metformin was given to the subjects. After six months, metformin was replaced with acarbose in the therapeutic regimen. In both studies, subjects were checked for their BMI, FBS, HbA1C, TGs, Cholesterol, LDL, HDL, 2hpp, unit of NPH and regular insulin variations. RESULTS: Placebo-controlled evaluation of selected factors has showna significant decrease in FBS and TG levels in the metformin group during follow up but acarbose group has shown substantial influence on two hour post prandial (2hpp) and regular insulin intake decline. Moreover, Comparison differences after intervention between two test groups has shown that metformin has had superior impact on FBS and HbA1C decline in patients. Nonetheless, acarbose treatment had noteworthy influence on 2hpp, TGs, Cholesterol, LDL, and regular insulin intake control. CONCLUSION: The results of this experiment demonstrate that the addition of acarbose or metformin to patients with Type-1 diabetes mellitus who are controlled with insulin is commonly well tolerated and help to improve metabolic control in patients.

Sleep architecture and obstructive sleep apnea in obese children with and without metabolic syndrome: a case control study.

PURPOSE: Obesity and biochemical parameters of metabolic disorders are both closely related to obstructive sleep apnea (OSA). The aim of this study was to compare sleep architecture and OSA in obese children with and without metabolic syndrome. METHODS: Forty-two children with metabolic syndrome were selected as case group and 38 children without metabolic syndrome were matched for age, sex, and BMI as control group. The standardized Persian version of bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity and duration of sleep, snoring (BEARS) and Children's Sleep Habits Questionnaires were completed, and polysomnography (PSG) was performed for all study subjects. Scoring was performed using the manual of American Academy of Sleep Medicine for children. Data were analyzed using chi-square test, T test, Mann-Whitney U test, and logistic regression analysis. RESULTS: Non-rapid eye movement (NREM) sleep and N1 stage in the case group were significantly longer than the control group, while REM sleep was significantly shorter. Waking after sleep onset (WASO) was significantly different between two groups. Severe OSA was more frequent in the control group. Multivariate logistic regression analysis showed that severe OSA (OR 21.478, 95 % CI 2.160-213.600; P = 0.009) and REM sleep (OR 0.856, 95 % CI 0.737-0.994; P = 0.041) had independent association with metabolic syndrome. CONCLUSIONS: Obese children with metabolic syndrome had increased WASO, N1 sleep stage, and severe OSA. But the results regarding sleep architecture are most likely a direct result of OSA severity. More longitudinal studies are needed to confirm the association of metabolic syndrome and OSA.

Association of meat and dairy consumption with normal weight metabolic obesity in men: the Qazvin Metabolic Diseases Study.

BACKGROUND: Insulin resistance (IR) is not limited to obese individuals. Normal weight individuals may also be insulin resistant. The aim of this study was to determine the association of lifestyle and diet patterns with IR in normal weight Iranian men. METHODS: This cross-sectional study was conducted in 232 men with a body mass index lower than 25 kg/m(2) (aged 20-72 years old) between September 2010 and April 2011 in Qazvin, Iran. Metabolically obese normal weight (MONW) was defined as IR using the homeostatic model assessment (HOMA). The optimal cut point to diagnose IR was the 80th percentile of HOMA-IR values in normal subjects. The HOMA-IR cut point was 2.48. Dietary pattern was assessed by a semi-quantitative food frequency questionnaire. Data were analyzed using backward logistic regression and ANCOVA. RESULTS: Fat and meat consumption and energy intake in subjects with MONW were more than subjects without MONW. Each serving of meat consumption was associated with three times increased risk of MONW (OR: 3.06), while each serving of dairy consumption was associated with 56 % lower risk of MONW with borderline significance (OR: 0.64). Adjusted mean of HOMA-IR in the first tertile of dairy consumption was significantly higher than other tertiles. Adjusted HOMA-IR value in the third tertile of meat consumption was significantly higher than the second tertile. CONCLUSION: Higher meat consumption was associated with MONW in men. Higher meat consumption and lower dairy consumption were associated with higher means of HOMA-IR.

Tick-borne Relapsing Fever in Children in the North-west of Iran, Qazvin.

Relapsing fever is caused by the Borrelia species of spirochetes. Louse-borne epidemics of the disease may happen but the endemic disease is generally transmitted to humans by the bite of an infected tick (Ornithodorus). Clinical and laboratory findings of tick-borne relapsing fever in children in the north-west of Iran, Qazvin, were evaluated. This study was conducted from September 1992 to September 2012. Records from 53 cases of tick-borne relapsing fever (TBRF) were reviewed. In positive cases, febrile illness, and spirochetes were recognized in peripheral blood preparations. Of the 53 children younger than 12 years, fifty two percent were male and about one third (34%) of the patients were in the age range of 7-12 years. The disease is recorded through the whole year but its peak occurs during summer (52.8%) and autumn (32.1%). Sixty eight percent of patients were living in urban areas but had frequent travel to rural area. Thirty two percent of the cases were living in rural areas where their dwellings were close to animal shelters. All (100%) of the 53 subjects were febrile. Travellers to the rural areas with high prevalence of the disease should be attentive of the risk of tick-borne relapsing fever and use suitable control measures. Consequently relapsing fever should be considered when patients who live in or have vacationed in north-west of Iran show a recurring febrile illness.

Safety and efficacy of RCP recombinant spike protein covid-19 vaccine compared to Sinopharm BBIBP: A phase III, non-inferiority trial.

Background: We conducted a phase III, non-inferiority trial comparing safety and efficacy of RCP recombinant spike protein Covid-19 vaccine to BBIBP (Sinopharm). Methods: Adult Iranian population received RCP or BBIBP in a randomized, double blind and an additional non-randomized open labeled trial arms. Eligible participants signed a written informed consent and received two intramuscular injections three weeks apart. In the randomized arm, an intranasal dose of vaccine or adjuvant-only preparation were given to the RCP and BBIBP recipients at day 51 respectively. Participants were actively followed for up to 4 months for safety and efficacy outcomes. Primary outcome was PCR + symptomatic Covid-19 disease two weeks after the second dose. The non-inferiority margin was 10% of reported BBIBP vaccine efficacy (HR = 1.36). Results: We recruited 23,110 participants (7224 in the randomized and 15,886 in the non-randomized arm). We observed 604 primary outcome events during 4 months of active follow-up including 121 and 133 in the randomized and 157 and 193 cases in the non-randomized arms among recipients of RCP and BBIBP respectively. Adjusted hazard ratios for the primary outcome in those receiving RCP compared with BBIBP interval were 0.91 (0.71-1.16) and 0.62 (0.49-0.77) in the randomized and non-randomized arms respectively. The upper boundary of 99.1% confidence interval of HR = 0.91 (0.67-1.22) remained below the margin of non-inferiority in the randomized arm after observing the early stopping rules using O'Brien Fleming method. Conclusion: Our study showed that the RCP efficacy is non-inferior and its safety profile is comparable to the BBIBP.

Diagnostic Accuracy of the Quantitative C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Urinary Tract Infections among Infants and Children.

OBJECTIVES: The aim of this study was to evaluate the diagnostic accuracy of the quantitative C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count in urinary tract infections (UTI) among hospitalised infants and children in Qazvin, Iran. METHODS: This cross-sectional study was conducted on 127 hospitalised children ranging in age from 2 months to 12 years old 31.79 months (SD 30.73) who were suspected of having a UTI and who did not receive antibiotics prior to being seen at a Qazvin teaching children's hospital between 2005 and 2006. A urine analysis (U/A) and urine culture (U/C) were performed. The blood was taken for CRP, ESR and WBC analyses. U/C has been considered the gold standard test for a UTI and dimercaptosuccinic acid renal scintigraphy (DMSA) as the gold standard for an upper UTI (pyelonephritis). These tests were used to determine the diagnostic accuracy, which is represented as the percent of correct results. RESULTS: Within the study population, 72 patients (56.7%) were younger than two years old 9.86 months (SD 4.56) and 55 (43.3%) were older than two years old 63.58 months (SD 30.96). One hundred and two patients (80.3%) were female. There were 100 cases that had a positive U/C. Of the patients with a positive U/C, 81 had pyuria (WBC more than 5/hpf), 71 had a peripheral WBC count of more than 10 000 /mL, 95 had a CRP of more than 10 mg/L and 82 had an ESR > 10 mm/h. The sensitivity and specificity as well as the positive and negative predictive values and the accuracy of CRP when using U/C as the gold standard were, respectively, 96%, 11.1%, 80.2%, 50%, and 78%; when using ESR as the gold standard were, respectively, 55%, 40%, 77.6%, 17.2%, and 52%; and when using WBC counts as the gold standard were, respectively, 69%, 52%, 86.6%, 35.6%, and 65%. The accuracy of CRP, ESR and WBC counts when considering the DMSA as the gold standard were 58.3%, 62.8%, and 64.5%, respectively. CONCLUSION: Although acute phase reactants can help in the diagnosis of a UTI, they are not pathognomonic. CRP, ESR and WBC were neither completely sensitive nor specific for detecting a UTI and its localisation site in Iranian children. Therefore, in a country where advanced clinical diagnostic tests are available, the advanced test should be used in conjunction with CRP, ESR and WBC analyses. Finally, a combination of laboratory tests along with history and exact clinical examination are needed for the diagnosis of a UTI and its localisation site.