Epidemiological features of COVID-19 in Iran.

Background: The first confirmed case of COVID-19 in Iran was reported in February 2019. The current study aimed to investigate the epidemiological aspects of COVID-19 disease in Isfahan province and evaluate the chances of infection and death in the population. Materials and Methods: In this cross-sectional study, 21,203 confirmed cases of COVID-19, based on the polymerase chain reaction test, referred to outpatient facilities from February 2019 to July 2020 in Isfahan province are studied. Disease incidence, mortality, and case fatality rate, as well as odds ratio (OR) of infection and death, were calculated and analyzed using SPSS version 20. Results: The highest incidence of the disease was within the age group of 30-39 years 4911 (23.9%) and males 11,561 (54.5%). Mortality in people over 80 years (207 [32.9%]), men (370 cases [58.7%]), diabetics (182 cases [28.9%]), and people with cardiovascular disease (165 people [26.2%]) was more. In multivariate analysis, patients with a cancer diagnosis had the highest OR of death (OR = 4.03 confidence interval [CI]: 2.56-6.35) (P < 0.001), followed by those with immune deficiency disease (OR = 2.46 CI: 1.07-5.63) (P = 0.03). As the number of comorbidities increased, the risk of death increased in the total population, so that in patients with more than 4 underlying diseases, compared to the group without disease, the chance of death increased 6.33 times. Conclusion: This study showed that people with cancer and chronic respiratory disease had a higher chance of COVID-19 infection. People over the age of 60, people with cancer, and immunodeficiency also had a higher chance of COVID-19 mortalityW.

Epidemiological Status and Health System Screening of COVID 19 Hospitalized Patients in Isfahan, Iran.

Background: The first case of Covid-19 disease was identified in Iran on February 19, 2020, and spread rapidly throughout the country. The aim of this study was to investigate the characteristics of COVID-19 hospitalized patients in Isfahan province of Iran from February 29, 2020, to July 21, 2020, and evaluate the effect of health system screening on the final outcome patients. Methods: In this cross-sectional study, all patients with positive COVID-19 PCR test and patients with negative PCR test but suspected clinical symptoms of COVID 19, admitted to Isfahan hospitals from February 29 to July 21were included in the study and the epidemiological characteristics of patients such as demographic characteristics, underlying disease, early signs and symptoms and the final outcomes of patients were analyzed using SPSS software version 20. Results: Of 11817 inpatients with COVID-19, 6590 (55.9%) were male, 1222 (10.4%) died, 9759 (82.8%) were discharged, and 4324 (36.7%) of hospitalized patients were asymptomatic. Among the hospitalized patients, 4642 (35.8%) had received primary screening services, and the mean age of the screened patients was statistically significantly higher than the group without primary screening (58.9±20.61, 55.08±21.57, P=0.068). 6914 (64.6%) of hospitalized patients had a positive initial PCR test, which was statistically significantly higher in patients with diabetes and an early symptom of sore throat. The Odds Ratio (OR) of readmission was most significantly associated with underlying cancer (OR=3.05, CI 95% 1.31-7.1) (P=0.011). The rate of readmission was statistically significantly higher in elderly, rural residents, and patients with underlying disease, diabetic, and hypertensive patients (P<0.05). Conclusion: This study showed that about half of the people who tested positive for COVID- 19 needed to be hospitalized, and about 9 percent mostly diabetic and hypertensive patients, needed readmission. More than half of the hospitalized people were not screened by the health system. However, screening by the health system had no effect on the length of hospital stay and disease outcome.

Comparing the Effects of Melatonin and Zolpidem on Mental Health and Sexual Function in Men With Opioid Addiction: Evidence From a Randomized Clinical Trial.

Background: Mental health problems and impaired sexual function are widely reported among those suffering from drug abuse, particularly among those under methadone maintenance therapy (MMT). Aims: The current study aimed to, firstly, investigate the effect of melatonin and zolpidem on mental health and sexual function of those with drug abuse under MMT, and, secondly, to compare the effects of melatonin and zolpidem on the studied outcomes. Methods: The current randomized, single-blind, placebo-controlled clinical trial was conducted on 98 participants who were randomly assigned into three groups of melatonin (n = 34), zolpidem (n = 32), and placebo (n = 32). All participants received the intervention once a day for 30 days, without changes in nutrition. Mental health and sexual function were measured before and 30 days after the intervention. Results: The mean age of participants in the groups of melatonin, zolpidem, and placebo was 35.8 ± 9.6 years (22-58 years of old), 35.9 ± 9.3 years (21-58), and 37.2 ± 7.8 years (26-53), respectively. Sexual function mean score was significantly increased from 38 to 41 in the melatonin group, while it deceased in zolpidem (from 39.1 to 38) and placebo (39.25-38.59) groups. Also, mental health mean scores improved statistically significantly in the melatonin group (from 60.65 to 43.56; p = 0.002), and descriptively in the zolpidem group (57.88-51.18; p = 0.129). Concerning both outcomes, the observed improvement was considerably higher in the melatonin group. The highest improvement was observed in dimensions of overall satisfaction and depression in the melatonin group (1.18 and -8.4, respectively). Conclusion: Melatonin could significantly improve both mental health and some domains of sexual function of those with drug abuse under MMT, while zolpidem did not show a significant effect. Trial Registration Number: https://www.irct.ir/trial/53047, identifier: IRCT20201214049718N1.

Clinical Symptoms of COVID-19 and Their Association with Disease Outcome.

Background: COVID-19 pandemic placed immense pressure on health systems. The current study aimed to evaluate the symptoms of COVID-19 in Isfahan province and their association with disease outcome. Materials and Methods: In this cross-sectional study, which was conducted on patients with a definite diagnosis of COVID-19, as a part of the investigations performed by the Deputy for Public Health of the Isfahan University of Medical Sciences, the frequency of underlying diseases, and general, respiratory, gastrointestinal, neurological, renal, cardiac, dermal, hearing symptoms are assessed using a checklist. The participants were followed up 1 month after definitive diagnosis, and the outcome of the disease (recovery or death) was recorded. Results: Of 300 patients, 143 (47.4%) were male and 157 (52.6%) were female. The mean age of patients was 43 ± 17.84 years. Muscle pain and fatigue were the most common early symptoms (63% and 60.3%, respectively). Age, sex, level of education, and occupation of patients and general, respiratory, and gastrointestinal symptoms and underlying diseases of respiratory disease showed a statistically significant association with the disease outcome (P < 0.05). Conclusion: General, respiratory, and gastrointestinal symptoms were associated with an increased risk of death due to COVID-19. General, visual, and hearing symptoms, and diabetes, cardiovascular diseases, and respiratory disease had a statistically significant association with the hospitalization of patients.

Neuro-Immuno-Endocrine Interactions in Early Life Stress and Heroin Withdrawal Timeline.

Both heroin abuse and early life stress (ELS) affect the immune system and the hypothalamic-pituitary-adrenal (HPA) axis. Additionally, accelerated aging due to mild inflammation has been indicated in these conditions. The present study aims to compare plasma levels of apoptosis markers, inflammatory markers, and stress hormones during early heroin abstinence period. Thirty-one individuals with heroin/opioid use disorder who had heroin-ELS and 26 of their siblings who were not abusing substances (ELS), and 32 individuals with heroin/opioid use disorder without a history of ELS (heroin-no ELS) were included in the study. The levels of interleukin-6, C-reactive protein, erythrocyte sedimentation rate, albumin, alanine transaminase, aspartate transaminase, and white blood cell count were assessed as the inflammatory and biochemistry markers. Also, apoptosis markers including tumor necrosis factor (TNF)-related weak inducer of apoptosis, TNF-related apoptosis-inducing ligand, soluble tumor necrosis factor receptor type I as apoptosis markers were detected by enzyme-linked immunosorbent assay. ELS was simultaneously evaluated using the Childhood Trauma Questionnaire, Minnesota Multiphasic Personality Inventory, and beck depression inventory scales. Besides, heroin craving was assessed by Daily Drinking/Drug Questionnaire score in individuals with heroin use disorder. This is the first study to evaluate the inflammatory, stress, and apoptosis markers during heroin abstinence, supporting the association between ELS and peripheral pro-inflammatory markers' levels and HPA axis.

The Effects of Oxytocin on Withdrawal, Craving and Stress Response in Heroin-Dependent Patients: A Randomized, Double-Blind Clinical Trial.

Opioid dependence is an increasing clinical and public health problem. Current pharmacotherapies have limited efficacy and cause serious side effects. Increasing bodies of evidences suggest the neuropeptide, oxytocin (OT), as a potential treatment for drug abuse disorders. The current study was designed to evaluate the effect of OT on withdrawal, craving and anxiety scores, cortisol and dehydroepiandrosterone sulphate (DHEAS) blood level in heroin-dependent male patients. This randomized, double-blind placebo-controlled clinical trial was conducted on 58 males with opioid dependence by Abstinence Center of Addictive People in Iran. The participants were randomly allocated to receive intranasal OT (single dose; 40 IU, n = 29) or placebo (n = 29). Heroine withdrawal, craving and anxiety scores were measured using the Opioid Withdrawal Scale, Visual Analogue Scale and (Desire for Drug Questionnaire), and Hamilton checklist respectively. The cortisol and DHEAS levels at baseline and different post-intervention time were measured using a competitive immunoanalysis method. Acute OT administration reduced craving and withdrawal scores but did not change anxiety significantly. Single dose of OT decreased the level of cortisol and improved the cortisol/DHEAS ratio in the heroin users during abstinence (p < 0.01). These results suggest that OT may be useful in the attenuation of craving, withdrawal symptom in heroin-dependent patients and might be considered a new potential treatment for heroin dependence where positive effects of OT on stress-related hormones may be involved in this effect of OT.

Malnutrition is associated with depression in rural elderly population.

BACKGROUND: Aging induces physiological changes and affects all of organs. Nutritional status and mental health deteriorate with aging. As malnutrition and depression are main problem in elderly this study was performed to assess the association between malnutrition and depression among rural elderly. MATERIALS AND METHODS: Three hundred and seventy rural elderly aged over 60 years were examined in a cross-sectional study by systematic sampling method and using mini nutritional assessment (MNA), which is a standard questionnaire for evaluating nutrition status. Depression was evaluated by a validated questionnaire in the elderly. Correlation between Socio-demographic characteristic, diseases, and nutrition status was obtained by t-test, Chi-square test and logistic regression in elderly population. RESULTS: Mean ± SD age was 70.6 ± 7.3 years. Frequency of malnutrition was similar in both genders. According to MNA, 3.8% of subjects suffered from malnutrition, 32.7% were at risk of malnutrition and 63.5% were well-nourished. Nutrition status correlated with body mass index (P = 0.028) and depression (P = 0.001). The risk of severe depression in patients with malnutrition was 15.5 times higher than non-depressed persons (odd ratio: 15.5; 95% CI: 2.9-82.5). CONCLUSION: Depression could act as a powerful risk for malnutrition in elderly population that it should be controlled by physicians.

Metabolic syndrome in ischemic stroke: A case control study.

INTRODUCTION: The metabolic syndrome has known as an independent risk factor of stroke. The occurrence of this syndrome is due to genetic factors and lifestyle. This study was performed on the frequency of metabolic syndrome prevalence in ischemic stroke patients compare to control. MATERIALS AND METHODS: one hundred ischemic stroke patients and 100 controls (with the same age and sex) were evaluated for this study. RESULT: 62% of patient and 34% of controls had metabolic syndrome criteria according to National Cholesterol Education Program (NCEP) {OR: 3.2; 95% CI (1.9-9.7), P=0.001} Prevalence of metabolic syndrome in women was more than men (52% vs. 44%) {OR: 0.72; 95% CI (0.4, 1.3)}. Beside of metabolic syndrome, prevalence of metabolic syndrome components was significantly higher in stroke patients compare to controls. CONCLUSION: metabolic syndrome prevalence are more common in stroke patients compare to controls, but it should be noticed that the controls are in a risk of future stroke so they need special treatment to prevent it.

The prevalence of hypertension among the elderly in patients in Al-Zahra Hospital, Isfahan, Iran.

BACKGROUND: In this study, we discussed aging and common diseases associated with it which can lead to hospitalization. Hypertension was also evaluated as one of the factors affecting morbidity and mortality in elderly people. METHODS: In this cross-sectional study, data was collected using checklists and extracting information from medical records in Al-Zahra Hospital (Isfahan, Iran). Data was then analyzed using descriptive statistics according to the research questions in SPSS. RESULTS: A total number of 11,018 people aged 60-99 years were studied. Cardiovascular diseases were the most common cause of hospitalization [2063 patients (18.7%)]. In patients with cardiovascular diseases, 84 were suffering from hypertension, 76 had primary hypertension, 7 had hypertensive heart disease with or without congestive heart failure, and 1 had secondary hypertension. Among all hypertensive patients, there were 37 males (44.05%) and 47 females (55.95%). Moreover, 34 people aged 60-69, 30 aged 70-79, 18 aged 80-89 and 2 aged 90-99 years. Duration of hospitalization was less than 1 day for 12 people, 1-2 days for 27, 3-5 days for 25, 6-10 days for 14, 15-11 days for 6, and more than 15 days for 1 person. CONCLUSION: Prevention and treatment of hypertension is important in order to control this disease. Untreated or poorly/untimely controlled hypertension would thus leave permanent side effects. It may thus leave sustained side effects if remain untreated or poorly/untimely controlled. However, people with hypertension were in minority in our study. Therefore, more research in this field with larger sample size is necessary for further identification of factors affecting quality of life in elderly people.

Association of serum alanine aminotransferase levels with cardiometabolic risk factors in normal-weight and overweight children.

OBJECTIVE: This study aimed to determine the prevalence of increased alanine aminotransferase (ALT), defined by a gender-specific cutoff value, among normal weight and overweight children; and to assess the relationship of increasing ALT levels with cardiometabolic risk factors. METHODS: This cross-sectional study was conducted among school students, aged 6-18 years in Isfahan, Iran. Based on the body mass index (BMI) percentiles, a group of normal-weight was compared with a group of overweight and obese students. Gender differences were considered for increased levels of ALT, i.e. 19U/L and 30U/L for girls and boys respectively. FINDINGS: The study participants consisted of 1172 students (56.2% girls), with a mean (SD) age of 12.57 (3.3) years. Among overweight/obese students the mean triglycerides (TG) and diastolic blood pressure was significantly higher in those with increased ALT than in those with normal ALT levels. The logistic regression analysis showed that among overweight/obese boys, for each 1 unit increase in ALT, the odds ratio (OR) of TG, total cholesterol and systolic blood pressure increased significantly. After adjusting for age, these associations remained significant, and the OR of high density lipoprotein cholesterol (HDL-c) decreased significantly. In the model adjusting for age and BMI, the ORs of TG and HDL-c remained significant. After adjusting for age and waist circumference, HDL-c was the only parameter with significant OR. Among overweight/obese girls, in all models applied, the OR was significant for TG and total cholesterol. A significant independent association was documented for waist circumference and increase in ALT after adjustment for BMI. CONCLUSION: This study documented significant relationship of increased ALT levels, defined by a gender-specific cutoff point, with cardiometabolic risk factors and hypertriglyceridemic-waist phenotype in Iranian children and adolescents.