The prevalence of thyroid disorders in COVID-19 patients: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to evaluate the prevalence of thyroid disorders in COVID-19 patients. DATA SOURCES: Scopus, PubMed, ISI Web of Science, and Google Scholar databases were used in this review. We also consider the results of grey literature. STUDY SELECTIONS: Cohort, cross-sectional, and case-control studies were included. DATA EXTRACTION AND SYNTHESIS: The required data were extracted by the first author of the article and reviewed by the second author. The Pooled prevalence of outcomes of interest was applied using the meta-prop method with a pooled estimate after Freeman-Tukey Double Arcsine Transformation to stabilize the variances. OUTCOMES AND MEASURED: The different thyroid disorders were the main outcomes of this study. The diseases include non-thyroidal illness syndrome, thyrotoxicosis, hypothyroidism, isolated elevated free T4, and isolated low free T4. RESULTS: Eight articles were included in our meta-analysis(Total participants: 1654). The pooled prevalence of events hypothyroidism, isolated elevated FT4, isolated low FT4, NTIS, and thyrotoxicosis were estimated (Pooled P = 3%, 95% CI:2-5%, I2: 78%), (Pooled P = 2%, 95% CI: 0-4%, I2: 66%), (Pooled P = 1%, 95% CI: 0-1%, I2: 0%), (Pooled P = 26%, 95% CI: 10-42%, I2: 98%), and (Pooled P = 10%, 95% CI: 4-16%, I2: 89%), respectively. CONCLUSION: Thyroid dysfunction is common in COVID-19 patients, with a high prevalence of non-thyroidal illness syndrome (NTIS) and thyrotoxicosis. Our meta-analysis found a 26% prevalence of NTIS and a 10% prevalence of thyrotoxicosis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022312601.

Endogenous testosterone does not improve prediction of incident cardiovascular disease in a community-based cohort of adult men: results from the Tehran Lipid and Glucose Study.

Introduction: To explore the predictive value of testosterone added to the Framingham Risk Score (FRS) for cardiovascular disease (CVD).Methods: Among 816 men, 30-70 years/old, without prevalent CVD, from a community-based cohort (Tehran Lipid and Glucose Study), we assessed the predictive value of testosterone with incident CVD, using three multivariate Cox proportional-hazards models. Model I: FRS variables; model II: Model I plus total testosterone; model III: Model II plus Systolic blood pressure (SBP) * total testosterone (the best fit interaction-term between testosterone and FRS variables). Discriminations and goodness-of-fit were assessed by the C-statistic and the approach of Grønnesby, respectively. p Value <.05 was significant.Results: During 12 years of follow-up, 121 CVD events occurred. In all models, age, treated SBP, smoking, and diabetes were associated with increased CVD (p values <.05). Neither testosterone (models II and III), nor SBP * testosterone (model III) were associated with CVD (p values >.05). The C-statistics for models I, II, and III were 0.819, 0.820, and 0.821, respectively, indicating no significant improvement in the discrimination power. The models' goodness-of-fit did not improve compared with the FRS.Conclusion: Testosterone could not add to the predictive value of FRS for CVD in men, either directly, or through interactions with FRS variables.

Development of a new method for sampling and monitoring oncology staff exposed to cyclophosphamide drug.

Treatment using cytotoxic drugs is considered to be the most common treatment for cancers. However, the widespread use of these drugs on the health status of the staff at the oncology department has become a great concern. Due to challenges of sampling and analysis of cytotoxic drugs, the aim of this study was to development a novel practical method called Needle trap devices (NTD) for sampling and analysis of personal exposure to cyclophosphamide drug. The sampler consisted of a stainless steel hyper needle gauge 21 of length 9 cm packed with Carboxen 1000 for adsorbing cyclophosphamide. A total of 41 samples of staff's air breathing zone in different wards of the oncology department were taken with the sampler. Samples were analyzed by gas chromatography coupled with electron capture detector (ECD). Linear range concentration was 212-1062 µg/m(3), and LOD and LOQ were 100 and 191 µg/m(3), respectively. The mean inter-day and intra-day coefficient variations for standards within linear range concentration were 8.9 and 4.8 %, respectively. Detectable levels of cyclophosphamide were measured in 31.7 % of air samples. The developed method is user-friendly, quick, and precise for sampling of airborne cyclophosphamide. The results showed that some staff of the oncology department were exposed to the carcinogenic drug and their health were at risk. Since carcinogens do not have a threshold and oncology staffs with their continuous exposure might be at risk, therefore, proper work practice and adequate control measures are essential to ensure their wellbeing.

Monotheistic and spiritual style literature in traditional medicine's resources.

The basis for success of Iranian Gnostics, poets and scientists were moral teaching, attention to origin and searching for specific goals in creation of human and creatures as well as finding some of his essence in studying all phenomena regarding the creation of universe by divine attitude. There is no surprise that such relationship was bilateral and according to his promise to those who truly follow him such that he will show the right path of learning to human in order to obtain the secrets of life. This relationship has resulted in growth of famous Iranian scientists such as Rhazes, Ahvazi, Avicenna, Ferdousi and… at the beginning of the second millennium. Thus, goal of this research is to study the style of writing in original resources of traditional medicine. In order to increase the accuracy of this study, an electronic database version of traditional medicine resources has been prepared. Writing style of Alhavi book (by Rhazes), Kamel-al-Sanaah (by Ahvazi), Canon of Medicine (by Avicenna) and Zakhireye Khwarazmshahi (by Jorjani) was considered. This task was accomplished by searching using related key words such as God, creator, magnificent, omnipotent, transcendent, omniscient and many other similar words and then encoding them. Finally, content analysis of these words was performed. Hundreds of monotheistic words and many small and great texts related to monotheistic literature have been encountered in the literature, and some are mentioned in the following. Rhazes has started some parts of Alhavi by remembering the name of merciful God and saluting his prophets and has mentioned "God" for more than 570 times and the word "God willing" for more than 215 times. Ahvazi has written his book called Kamel-al-Sanaah by using monotheistic literature, so that both volumes of book are started by remembering the name of God and saluting his prophets. In the introduction of first volume of his book, he has acknowledged God due to conferring logic and wisdom to human and has used the word "God" more than 230 times in his book. He has also referred to a famous testimony of Hippocrates and added some more issues in relation to medical ethics. Avicenna has started the Canon of Medicine in five volumes by remembering God and saluting his prophets. When referring to points related to having specific goal in structure of body organs, he immediately has praised God. Jorjani also has followed up the same attitude of three mentioned writers. We have found out that any of the Iranian poets, Gnostics and scientists who have studied nature have reached to the same conclusion from their own point of view, meaning, they all have observed permanent emergence of God in all phenomena of universe. Poets considered the beauties of nature, Gnostics studied mental issues and scientists of natural sciences explored the physiology and anatomy of human body; however, all of them referred to beauty, magnificent, discipline and having goal in creation of universe and all of its phenomena in their books. They have written their valuable books by benefiting monotheistic literature and have published their research results by inference of seeking God and paved the way for next generations. They experienced the usefulness of cumulative effects of spirituality, religion and health on performance and thereby emphasizing the need to incorporate spirituality and religion in teachings curriculums.

Prevalence of depressive symptoms and suicidal behaviors among Iranian high school students: A systematic review and meta-analysis.

AIM: The objective of this meta-analysis was to determine the prevalence of depressive symptoms and suicidal behaviors among high-school students in Iran. MATERIALS AND METHODS: A comprehensive search strategy was conducted in the following original databases: PubMed, Web of Science (ISI), Scopus, Psycinfo, and national databases, including the Scientific Information Database (SID) and MagIran, from January 1988 through January 2023. Studies that reported the prevalence of depressive symptoms and suicidal behaviors among high school students in Iran were included. Two investigators extracted all relevant data independently. For deriving mean prevalence rates, random-effects meta-analyses were used. We assessed the quality of studies by the Joanna Briggs Institute (JBI). RESULTS: Total of 67 studies (45,798 participants) were included in the syntheses on depressive symptoms and suicidal ideation. For depressive symptoms, the mean prevalence rate was 48 % (40 %, 55 %). 2804 participants were enrolled for assessing of the prevalence of suicide ideation, and the mean prevalence rate was 21 % (6 %, 36 %). The meta-analysis pooling of the prevalence estimates of suicide attempts was 18 % (15 %, 20 %). CONCLUSIONS: Approximately half of the high school students experience depressive symptoms and, astonishingly, one in five high school students experiences suicidal ideation, so to identify strategies for preventing and treating depressive symptoms and suicidal behaviors in this special population, further research and policymaking are urgently needed.

The religious and social principles of patients' rights in holy books (Avesta, Torah, Bible, and Quran) and in traditional medicine.

Health protection and promotion in healthy people and restoring patients' health have been the most important themes in medicine and health throughout our history. Therefore, discussion of different aspects of patients' rights includes implementation of these objectives by the medical community, including physicians, nurses, pharmacists, etc., and the people in charge of health affairs. The principal objective of our research is the study of medical ideology and the approaches of our ancestors in relation to different aspects of patients' rights. To study the different ideologies of traditional medicine in relation to patients' rights, appropriate data were extracted from the original resources of traditional medicine and from religious books. By means of library research we studied these resources in addition to electronic versions of the Alhavi book (by Rhazes), the Kamel-al-Sanaah (by Ahvazi), the Canon of Medicine (by Avicenna), the Zakhireye Khawrazmshahi (by Jorjani), the Avesta, the Torah, the Bible, the Quran, and many other resources, and, finally, after searching, gathering, and encoding the findings, analyzed them qualitatively for thematic content. The holy Avesta book clearly insists on the competence of physicians and setting the appointment fee in accordance with peoples' income. The Old Testament (holy Torah) warned government officials who did not observe patients' rights. In the four gospels (holy Bible) the importance of treatment and taking care of the patient is stressed. After the emergence of Islam, medical students, before beginning the principal courses, had to study Islamic jurisprudence, ethics, logic sciences, natural sciences, geometry, astrology, calculus, and similar courses so that after purifying their soul they could enter the saintly profession of physicians. The holy Quran refers to saving the life of a human irrespective of social class, race, and religion, and insists on exemption of patients from physical activity, including the physical aspects of prayer. In these resources, some warnings are offered in relation to fake drugs, the lack of awareness of some physicians, the need for complete preparedness of medical society, and the need to manufacture appropriate drugs and offer a suitable medical service. This information is to familiarize medical and health authorities and persons receiving health services. According to the evidence available about traditional medicine, there was no specific difference between public and professional ethics, public and professional rights, or rights and ethics-ethics were no different from rights nor rights from ethics. So ethics are similar to the soul in the body of rights, and rights are similar to the litter of ethics, and they have developed in parallel with each other. Traditional medicine is community-based and preservation of the health of healthy people is given priority over the treatment of patients; there is insistence that "health rights" has wider scope than "patients' rights". It can be stated that health rights in Iran both before and after the emergence of Islam have been based on guidance from divine religions, observation of humanist ethics, passing suitable courses in the basic sciences, and an introduction to the practical piety of our ancestors, in addition to the syllabus of medical and health education.

The socio-political situation of Avicenna's time and his spiritual messages: on the occasion of 1031 st birth anniversary of Avicenna (23 August 980).

In the fourth century A.H. (tenth century AD) many thinkers, philosophers, jurisprudents, poets, and authors were present in different scientific, literary and health fields in ancient Iran and Islamic world that by their hard attempts the sciences and literature were safe from incidents and resulted in growth, development and innovation of Islamic sciences. Meanwhile, Avicenna was superior to all others and the most famous scientist. He was a great human that by attempting hard, perseverance, stability, patience, and believing in God could complete supreme scientific ranks and compiled encyclopedia of Canon of Medicine and besides gathering many written important issues that most of them were confiscated at libraries of kings. He added medical experiences of ancient Iran and especially Jondishapour University and also his personal experiences and finally Canon of Medicine by benefiting from monotheistic style and science based on faith was written. He has written a book that is regarded as root and basics of modern medicine and by completing it some infrastructure health viewpoints and common medicine were created. It is a kind of book that in spite of scientific advances and production of modern research tools many of its contents are replaced with modern methods of medicine and health, but still many of its health basic messages, research orientation and monotheism with great dynamic mode is considerable at world's medical references. The aim of this study is evaluate the political situation of Avicenna's time and a review of his Godly writings. This is a library study by using electronic version of Canon of Medicine and other related resources. Findings, include writing style of monotheistic literature, and freeing from nihilism and affiliating diseases to Satan, jinn and such issues. It is necessary that our students within course of Iranian and Islamic culture and civilization to be more familiar with monotheistic thoughts and activities of scientists like Avicenna.

Long-term Complications of COVID-19 in Nursing Staff; a Retrospective Longitudinal Study.

Introduction: Although the lungs are the main target of coronavirus disease (COVID-19), infection is also associated with a high rate of extra-pulmonary complications. This study aimed to evaluate the one-year incidence of long-term COVID-19 complications among the nursing staff. Methods: This study is a retrospective longitudinal study. All nursing staff working in public hospitals affiliated with Shahid Beheshti University of Medical Sciences who had been affected with COVID-19 were included in the study via convenience sampling method. The patients were recruited from 20th February 2020 to 20th March 2021. Result: 1762 nursing staff with a mean age of 35.08 ± 8.02 (Range: 22-66) years were studied (73.5% female). The results showed that among those who reported at least one type of complication, the duration of complications was significantly longer than 1 week and the median was 8 weeks. The findings demonstrated that complications occurred in 65% of infected females. For men, this rate was 62.3%. Generalized pain, anxiety disorders, and skin complications were among the complications that were significantly more common in women than in men. Additionally, the incidence of anosmia, ageusia, anxiety disorders, and skin complications was significantly higher in younger people than in older people. The comparison of complications revealed that nurses were significantly more likely than other occupations to experience respiratory complications, anosmia and ageusia, generalized pain, and skin complications and that outpatients experienced significantly more complications than hospitalized patients. Conclusion: The one-year cumulative incidence of long-term complications in nursing staff with COVID-19 was 64.3%. The most common complications were respiratory complications, generalized pain, anosmia, and ageusia, respectively.

Efficacy and safety of add-on Viola odorata L. in the treatment of COVID-19: A randomized double-blind controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Severe Acute Respiratory Syndrome (SARS) due to the novel coronavirus has become the highest priority that threatens human health. This situation demands widespread vaccination and the innovation of new therapeutic methods. Despite drug discoveries, the need for approving new medicaments is felt because of adverse effects and lack of efficacy. Several medicinal plants including Viola odorata L. are recommended in traditional Persian medicine for alleviating respiratory infection symptoms. Recent studies showed anti-inflammatory, antioxidant, anti-asthmatic, antitussive, analgesic, and antibacterial activities of sweet violet. These enhance respiratory functions, reduce pulmonary inflammation, and decline mucous membrane edema. This study aimed to evaluate the efficacy of sweet violet syrup in alleviating the manifestations of COVID-19 infection. MATERIAL AND METHODS: A randomized parallel-group double-blind controlled trial was conducted at Al-Zahra general hospital, Isfahan, Iran. A total of 108 outpatients were enrolled in the study. The patients were randomly allocated to intervention and placebo groups, with 54 patients in each group. The allocation was concealed using sealed opaque envelopes. The intervention group received violet syrup and the control group received placebo syrup, an add-on to the conventional treatment. The outcomes were COVID-19 manifestations, such as dyspnea, cough, myalgia, headache, and diarrhea, considered as outcomes of the study and were evaluated twice using a visual analog scale before the intervention and after 7 days, at the end of the study. Patients were followed daily by phone calls to monitor proper drug consumption and possible side effects. RESULTS: No significant difference was between groups regarding demographic characteristics and vital signs before and after the treatment. Although all symptoms have improved significantly in both groups, patients who received violet syrup recovered faster and the mean severity scores of cough (P = 0.025), myalgia (P = 0.036), headache (P = 0.037), and diarrhea (P = 0.044) decreased greater in comparison to control group. CONCLUSION: This study, the first clinical trial on the effectiveness of Viola odorata on SARS-CoV-2 patients, showed that Viola odorata L. effectively controls prevalent manifestations of COVID-19 including cough, myalgia, headache, and diarrhea. Regarding this survey, the violet syrup can be mentioned as a complementary treatment for viral influenza-like infections in which cough, myalgia, headache, and diarrhea are prominent.

Demographic, Epidemiologic, and Clinical Characteristics of Human Monkeypox Disease Pre- and Post-2022 Outbreaks: A Systematic Review and Meta-Analysis.

(1) Background: In early May 2022, an increasing number of human monkeypox (mpox) cases were reported in non-endemic disparate regions of the world, which raised concerns. Here, we provide a systematic review and meta-analysis of mpox-confirmed patients presented in peer-reviewed publications over the 10 years before and during the 2022 outbreak from demographic, epidemiological, and clinical perspectives. (2) Methods: A systematic search was performed for relevant studies published in Pubmed/Medline, Embase, Scopus, and Google Scholar from 1 January 2012 up to 15 February 2023. Pooled frequencies with 95% confidence intervals (CIs) were assessed using the random or fixed effect model due to the estimated heterogeneity of the true effect sizes. (3) Results: Out of 10,163 articles, 67 met the inclusion criteria, and 31 cross-sectional studies were included for meta-analysis. Animal-to-human transmission was dominant in pre-2022 cases (61.64%), but almost all post-2022 reported cases had a history of human contact, especially sexual contact. The pooled frequency of MSM individuals was 93.5% (95% CI 91.0-95.4, I2: 86.60%) and was reported only in post-2022 included studies. The male gender was predominant in both pre- and post-2022 outbreaks, and the mean age of confirmed cases was 29.92 years (5.77-41, SD: 9.38). The most common clinical manifestations were rash, fever, lymphadenopathy, and malaise/fatigue. Proctalgia/proctitis (16.6%, 95% CI 10.3-25.6, I2: 97.76) and anal/perianal lesions (39.8%, 95% CI 30.4-49.9, I2: 98.10) were the unprecedented clinical manifestations during the 2022 outbreak, which were not described before. Genitalia involvement was more common in post-2022 mpox patients (55.6%, 95% CI 51.7-59.4, I2: 88.11). (4) Conclusions: There are speculations about the possibility of changes in the pathogenic properties of the virus. It seems that post-2022 mpox cases experience a milder disease with fewer rashes and lower mortality rates. Moreover, the vast majority of post-2022 cases are managed on an outpatient basis. Our study could serve as a basis for ongoing investigations to identify the different aspects of previous mpox outbreaks and compare them with the current ones.

Evaluation of a novel SARS-CoV-2 rapid antigenic test diagnostic value in respiratory samples; is the reported test accuracy similar to values in the real-world? A cross-sectional study.

Background and Aims: Although reverse transcription-polymerase chain reaction (RT-PCR) assay was introduced as the gold standard to detect SARS-CoV-2, the method was known to be time-consuming besides the requirement for an equipped laboratory. This survey aims to investigate a novel SARS-CoV-2 antigen test as a diagnostic tool in COVID-19 patients to overcome these limitations in addition to evaluating COVID-19 population characteristics. Methods: A retrospective cross-sectional study was carried out during the first semester of 2021, and about 1070 nasopharyngeal samples were collected to compare the E-Health Barakat Company SARS-CoV-2 antigen rapid test results with RT-PCR reports as the reference method. Results: Totally 537 participants were included in this study for employing RT-PCR and the antigen test sequentially. The novel antigen rapid test sensitivity is considered 21.09% in the real world, though 81% in the manufacturer's instruction has been mentioned. Moreover, the most revealed manifestations were found respiratory symptoms and fatigue sensations. Conclusion: This study is the first one on evaluating the SARS-CoV-2 antigen test in our country. Although the novel antigen assay was found quick and easy to perform, the test performance was very disappointing. The extensive false-negative results made it an inappropriate candidate for mass screening.

Vaginal bleeding as a sign of Crimean-Congo hemorrhagic fever infection: a case report.

BACKGROUND: Crimean-Congo hemorrhagic fever is a severe vector-borne viral hemorrhagic fever with considerable mortality in humans. This disease is endemic in Afghanistan, and its incidence rate has rapidly increased in recent years. This infection can cause a broad range of hemorrhage manifestations including epistaxis, petechial or purpuric rashes, hematemesis, and melena; however, vaginal bleeding is also reported as a rare manifestation. CASE PRESENTATION: We report the case of a previously healthy 30-year-old Afghan female of shepherding occupation, with a sudden onset of fever, generalized body pain, epistaxis, and vaginal bleeding. She was admitted to the hospital after 7 days of symptom manifestation, with predominant signs being high fever, vaginal bleeding, and elevated liver enzymes. The serological test result for Crimean-Congo hemorrhagic fever was positive. She was treated with oral ribavirin and discharged with normal parameters. CONCLUSIONS: People in high-risk professions in endemic areas should be informed that vaginal bleeding is a serious symptom and requires immediate action and, therefore, might be attributed to nongynecologic disorders.

Knowledge, Attitudes, and Practices About COVID-19 Among Healthcare Workers in Iran During the First Wave of the Pandemic.

Background and Objective: Investigating the knowledge, attitudes, and practices about the coronavirus disease 2019 (COVID-19) among healthcare workers (HCWs) could be an early step toward identifying their potential educational needs and possible factors involved in misinformation. The objective of this study was to investigate the knowledge, attitudes, and practices about COVID-19 among healthcare workers in Iran during the first wave of the pandemic. Materials and Methods: The current descriptive-correlational study was conducted during the 1st days of the COVID-19 epidemic in Iran from March 24th to April 3rd, 2020. Participants included all healthcare workers at hospitals, including physicians, dentists, pharmacists, nurses, midwives, laboratory and radiology assistants, and other hospital professionals during the study period. Data were collected through an online self-administrative questionnaire. Results: The responses of 1,310 participants were analyzed, of which 900 (68.7%) were female. The mean (SD) knowledge score was 25.4 (3.3), 84.7% out of 30. More than 90% of participants correctly recognized the main symptoms, transmission route, and preventive measures for COVID-19. The mean (SD) attitude score was 16.9 (1.1), 93.9% out of 18. Most participants agreed with keeping safe physical distancing, self-isolation upon symptom onset, and city lockdowns. The mean (SD) score for general practices about COVID-19 was 20.8 (2.0), 86.7% of 24. Conclusion: The knowledge and practice of HCWs were appropriate, and their attitudes were mainly positive. However, there is still room for improvement regarding concerning misinformation and quackeries about COVID-19.

Bedaquiline-containing regimens and multidrug-resistant tuberculosis: a systematic review and meta-analysis.

OBJECTIVE: Multidrug-resistant tuberculosis (MDR-TB) is a life-threatening infectious disease. Treatment requires multiple antimicrobial agents used for extended periods of time. The present study sought to evaluate the treatment success rate of bedaquiline-based regimens in MDR-TB patients. METHODS: This was a systematic review and meta-analysis of studies published up to March 15, 2021. The pooled treatment success rates and 95% CIs were assessed with the fixed-effect model or the random-effects model. Values of p < 0.05 were considered significant for publication bias. RESULTS: A total of 2,679 articles were retrieved by database searching. Of those, 29 met the inclusion criteria. Of those, 25 were observational studies (including a total of 3,536 patients) and 4 were experimental studies (including a total of 440 patients). The pooled treatment success rate was 74.7% (95% CI, 69.8-79.0) in the observational studies and 86.1% (95% CI, 76.8-92.1; p = 0.00; I2 = 75%) in the experimental studies. There was no evidence of publication bias (p > 0.05). CONCLUSIONS: In patients with MDR-TB receiving bedaquiline, culture conversion and treatment success rates are high even in cases of extensive resistance.

Tele-medicine and improvement of mental health problems in COVID-19 pandemic: A systematic review.

INTRODUCTION: Tele-medicine services have been developed in response to the COVID-19 pandemic, which disrupts mental health services. The present study investigates the effectiveness of telephone-delivered services for psychological disorders in the COVID-19 pandemic. METHODS: We searched PubMed/Medline, Embase and Cochrane Controlled Register of Trials for relevant clinical studies up to February 1, 2022. Following terms were used: "severe acute respiratory syndrome", "Coronavirus", "Coronavirus infection", "SARS-CoV-2", "COVID-19", "mental disorder", "mental health", "mental health program", "mental health service", "psychiatric service", "telemedicine", "Telehealth", "Tele-health", "Telecare", "Mobile health". RESULTS: Twelve relevant clinical articles were included in our study. Eight articles were parallel randomized controlled trials (RCTs), two were Quasi-experimental, and one was a multicenter retrospective cohort study. A total of 1900 adults (18 years old or above that) were included. Online telecommunication methods like online apps and videoconference were the most common interventions. The most prevalent measured outcome was levels of anxiety and depression among participants. Eleven out of 12 articles showed a significant association between telemedicine and mental health improvement. CONCLUSIONS: The included studies in the current systematic review reported the probable efficacy of telemedicine in improving mental health disorders during the COVID-19 pandemic. But it is not possible to determine the best telecommunication method for each mental disorder in different populations and the preference of patients is still face to face therapy. So RCTs in different populations with previous mental disorders or chronic diseases are required to investigate the further telemedicine's efficacy on managing mental problems.

COVID-19: National Pandemic Management Strategies and their Efficacies and Impacts on the Number of Secondary Cases and Prognosis: A Systematic Review.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for an acute respiratory disease designated COIVD-19, which has spread throughout the world. Despite all the struggles with this virus, still, the majority of societies are affected by COVID-19, which raises many questions such as are these ways of management enough, which is crucial in order to contain the virus spread, and which is not effective. In this systemic review, we tried to summarize the data on different ways of managing COVID-19 outbreaks. Through understanding the efficacy and downsides of different approaches to manage COVID-19, public health officials, governing bodies, and health care administrators may be better equipped with the tools necessary to best manage COVID-19 and pandemics. Methods: This systematic review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles were selected using several databases PubMed, ScienceDirect, and Google Scholar, all peer-reviewed and published articles from December 1, 2019 to April 23, 2020 that met the inclusion criteria were selected. Results: The majority of the included articles were mathematical modeling, cohort studies (n = 9), cross-sectional (n = 6), and one case series. Most articles originated from China and then Singapore. The measures that have been practiced in these articles consisted of close contact tracing and case isolation, quarantine, strict surveillance, lockdown, and travel surveillance. Conclusions: The most effective approach is at least the combination of case detection and isolation, and contact tracing or containment measures. In the literature, travel controls seem to be ineffective, personal hygiene should be tough and emphasized.

FTO genotype was associated with breast cancer in HER2 negative patients.

BACKGROUND: The fat mass and obesity-associated (FTO) gene may influence the risk of breast cancer (BC). The single nucleotide polymorphisms (SNPs) of FTO gene may exert different impacts on different types of BC. In this study, we investigated the association between FTO SNP rs9939609 and the status of estrogen receptor (ER), progesterone receptor (PR), P53, and human epidermal growth factor receptor-2 (HER-2) in BC patients. METHODS: Our case-control study was included 540 Iranian participants aged 35 to 70 (180 women with BC as the case group and 360 healthy controls). After genotyping for risk allele rs9939609 of the FTO gene, a logistic regression was applied to elucidate the association between FTO SNP rs9939609 and BC risk based on the receptor status. RESULTS: The number of HER-2 negative patients was significantly higher in FTO rs9939609 risk allele carrier group (61.5% vs. 41.4%, P < 0.05). A significant association was found between BC and rs9939609 FTO gene polymorphism only in HER2 negative BC patients (OR = 1.79, CI95%: 1.2-3.56, P = 0.03). No association was identified between FTO rs9939609 polymorphism and the status of ER, PR, and P53. CONCLUSION: We indicated that FTO SNP rs9939609 can be a potential therapeutic target particularly in HER-2 negative BC cases. The importance of this risk allele in BC pathogenesis needs to be further highlighted.

Knowledge, Attitudes, and Safety Practices About COVID-19 Among High School Students in Iran During the First Wave of the Pandemic.

Background: School closures have inevitably deprived students of their traditional source of information. The objective of this study was to determine knowledge, attitudes, and safety practices about COVID-19 among high school students in Iran. Methods: This study was conducted from March 24th-April 3rd, 2020. Data were collected via an online-parent-administrative questionnaire. Results: Responses of 704 students were analyzed. Students' mean (SD) knowledge score was 21.5 (4.6) of 30. More than 90% of students knew about the cause of the disease, the routes of transmission, and the most renowned symptoms: dyspnea and cough. Social-and- audiovisual-media were the leading information source. Most students believed that people need to keep safe physical distancing, everyone should isolate themselves upon symptoms onset, people should avoid unnecessary in-person contact with family and friends, and that cities need to go under lockdowns if needed. Students' mean (SD) practice score was 20.2 (2.5) of 24. Most students did not go on a trip, and more than 80% said they would wear facemasks when going outside. Conclusions: High school students' knowledge and safety practices about COVID-19 were somewhat satisfactory, and their attitudes toward the disease were mainly positive. Nevertheless, some witnessed knowledge gaps, negative attitudes, and unsafe practices in the study highlighted the need for targeted education on the pandemic. Social and mass media's significant role and potential could be utilized to battle misinformation and deliver proper knowledge to young adolescents.

Predictors of Intensive Care Unit Admission among Hospitalized COVID-19 Patients in a Large University Hospital in Tehran, Iran.

BACKGROUND: The rapid increase in the spread of COVID-19 and the numbers of infected patients worldwide has highlighted the need for intensive care unit (ICU) beds and more advanced therapy. This need is more urgent in resource-constrained settings. The present study aimed to identify the predictors of ICU admission among hospitalized COVID-19 patients. STUDY DESIGN: The current study was conducted based on a retrospective cohort design. . METHODS: The participants included 665 definite cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  hospitalized in Imam Hossein Hospital from February 20 to May 14, 2020. The baseline characteristics of patients were assessed, and multivariate logistic regression analysis was utilized to determine the significant odds ratio (OR) for ICU admission. RESULTS: Participants were aged 59.52±16.72 years, and the majority (55.6%) of them were male. Compared to non-ICU patients (n=547), the ICU patients (n=118) were older, had more baseline comorbidities, and presented more often with dyspnea, convulsion, loss of consciousness, tachycardia, tachypnea, and hypoxia, and less often with myalgia. Significant OR (95% CI) of ICU admission was observed for the 60-80 age group (2.42, 95%CI: 1.01; 5.79), ≥80 age group (3.73, 95%CI: 1.44; 9.42), ≥3 comorbidities (2.07, 95%CI: 1.31; 3.80), loss of consciousness (6.70, 95%CI: 2.94, 15.24), tachypnea (1.79, 95%CI: 1.03, 3.11), and SpO2<90 (5.83, 95%CI: 2.74; 12.4). Abnormal laboratory results were more common among ICU-admitted patients; in this regard, leukocytosis (4.45, 95%CI: 1.49, 13.31), lymphopenia (2.39, 95%CI: 1.30; 4.39), elevated creatine phosphokinase (CPK) (1.99, 95%CI: 1.04; 3.83), and increased aspartate aminotransferase (AST) (2.25, 95%CI: 1.18-4.30) had a significant OR of ICU admission. Chest computer tomography (CT) revealed that consolidation (1.82, 95%CI: 1.02, 3.24), pleural effusion (3.19, 95%CI: 1.71, 5.95), and crazy paving pattern (8.36, 95%CI: 1.92, 36.48) had a significant OR of ICU admission. CONCLUSION: As evidenced by the obtained results, the predictors of ICU admission were identified among epidemiological characteristics, presenting symptoms and signs, laboratory tests, and chest CT findings.

Contact Lens Associated Bacterial Keratitis: Common Organisms, Antibiotic Therapy, and Global Resistance Trends: A Systematic Review.

Introduction: Contact lens wearing has been increased globally during recent decades, which is one of the main risk factors for developing microbial keratitis. Microbial keratitis is a severe and dangerous condition that causes cornea inflammation. It can lead to corneal scarring and perforation or even endophthalmitis and visual loss if it remains untreated. Among bacterial, fungal, protozoal, and viral agents which can cause microbial keratitis, bacteria are the most common cause. Therefore, in this study, we aim to find common causative bacteria, sensitivity, and resistance to antibiotics and the outcome of antibiotic therapy in contact lens-related bacterial keratitis. Methods: A systematic search was carried out in PubMed/Medline, EMBASE, and Web of Science for published studies and medRxiv for preprints up to February 30, 2021, and May 14, 2021, respectively. A combination of the following keywords was used: "Infection", "Corneal infection", "Keratitis", "Microbial keratitis", and "Contact lens", Also, we used the "Contact lenses" MeSH term. Lists of references for each selected article and relevant review articles were hand-searched to identify further studies. Results: Twenty-six articles were included. From 1991 to 2018, 2,916 episodes of contact lens-related microbial keratitis) CLMK(with 1,642 episodes of proven bacterial keratitis have been reviewed in these studies. Studies were conducted in 17 countries with different geographical regions, and four studies were conducted in Iran, which is the highest number of studies among these countries. According to 20 studies, the mean age of patients was 30.77 years. Females with 61.87% were more than males in 19 studies. A percentage of 92.3% of patients used soft contact lenses, and 7.7% of patients used hard contact lenses (including RGP), according to 16 studies. Pseudomonas aeruginosa, Staphylococcus spp., and Serratia marcescens were the three most common bacteria isolated from samples of patients with contact lens-related bacterial keratitis. Overall, isolated bacteria were most sensitive to fluoroquinolones and aminoglycosides, especially ciprofloxacin and gentamicin respectively, and most resistant against penicillin and cephalosporins especially cefazolin and chloramphenicol. Almost all patients responded well to antibiotic therapy, with some exceptions that needed further surgical interventions. Conclusion: Antibiotics are efficient for treating almost all patients with contact lens-related bacterial keratitis if they are appropriately chosen based on common germs in every geographical region and the sensitivity and resistance of these germs against them. In this regard, Pseudomonas aeruginosa is the most common causative germ of contact lens-associated bacterial keratitis all over the world and is almost fully sensitive to ciprofloxacin. Because of some different results about the sensitivity and resistance of germs against some antibiotics like gentamicin, vancomycin, and chloramphenicol in the Middle East region, especially Iran, more in vitro and clinical studies are suggested.