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Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.
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Loneliness has been associated with different health outcomes in the following domains: general health, well-being, physical health, mental health, sleep, and cognitive function. However, the most significant associations fall into mental health- and well-being-related outcomes. Moreover, loneliness is an identified risk factor for all-cause mortality. This article overviews the systematic and meta-analytic studies, which have investigated epidemiology and etiology, associated medical and neuropsychiatric conditions, and interventions for loneliness. Meta-analyses have associated higher levels/prevalence of loneliness with pathological conditions, including physical (cardiovascular diseases, obesity, and cancer) and mental health conditions (dementia, cognitive impairment, depression, anxiety, suicide, substance abuse, frailty, and addiction). Furthermore, loneliness commonly occurs to people during particular physiological conditions, for example, childhood, adulthood, elderly, pregnancy, and taking care of others. Moreover, young adults commonly experience transient loneliness. For all these pathological/physiological conditions, COVID-19 has been confirmed as a loneliness-worsening condition. Genetic background, in addition to environmental factors, plays a role in the etiology of loneliness. Biomarkers mainly include neural correlates, including aberrations in the structure/function of cognitive or emotional control-related brain regions, inflammatory correlates, and anthropometric measures. The current interventions for loneliness alleviation are mostly focused on older people, for whom the evidence derived from systematic or meta-analytic studies shows none-to-moderate benefits and substantial heterogeneity across studies. The evidence is not adequate to conclude about the effectiveness of interventions in youth. In addition to the need for pathology- and population-specific interventions for loneliness reduction/prevention, there is a need to survey loneliness longitudinally to examine the causality of loneliness-health associations. © 2022 Heart and Mind ;Published by Wolters Kluwer - Medknow.
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Background: Regarding the growing burden of non-communicable diseases (NCDs) and exposure to their risk factors, and the continuous need for nationwide data, we aimed to develop the latest round of the STEPwise Approach to NCD Risk Factor Surveillance (STEPS) survey in 2021 in Iran, while the COVID-19 pandemic was still present.Methods: In addition to the three main steps of this survey, including questionnaires, physical measurements, and laboratory assessments, we adapted the survey with the situation caused by the COVID-19 pandemic, by adding to various aspects of study phases and changing some scientific and executive procedures in this round of STEPS survey in Iran. These changes were beyond the initial novelties embedded within the survey before the pandemic, by refining the study protocol benefiting from the previous experiences of the STEPS survey.Results: By amending the required changes, we could include a total of 27 874 individuals in the first step of the survey. This number was 27 745 and 18119 for the second and third steps. Comparing the preliminary results with the previous nationwide surveys, this study was highly representative on both national and provincial levels. Also, implementing the COVID-19 prevention and control strategies in all stages of survey led to the least infection transmission between the study investigators and participants.Conclusion: The novel initiatives and developed strategies in this round of Iran STEPS survey provide a state-of-the-art protocol for national surveys in the presence of an overwhelming catastrophe like the COVID-19 pandemic and the triggered limitations and shortages of resources.
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Objective: Hyposmia and anosmia are the most frequent complaints of patients with COVID-19. It can disappear after a short time or can last for an unknown period. Finding a suitable treatment for restoring the patients' smell. The objective of this study is to review the effects of numerous types of corticoids on COVID-19-induced hyposmia and anosmia. Method(s): A narrative literature review was performed to analyze the effects of different forms of corticosteroids in various dosages for the treatment of COVID-19-induced hyposmia and anosmia. Result(s): There is not a lot of data on the effects of corticosteroids on COVID-19-induced hyposmia and anosmia;however, despite little evidence for the efficacy of these drugs in hyposmia and anosmia caused by COVID-19, their effect in improving these symptoms whether in oral or nasal spray forms has been reported in recent literature. Most of the studies show that corticosteroids, whether nasal or systemic, are not as effective as they are thought to be. Conclusion(s): Using topical corticosteroids as nasal sprays or systemic corticosteroids cannot help to improve the patient's ability to smell. These methods were sometimes mixed with other methods such as olfactory training to improve the patient's olfactory sense. However, the results of the studies showed diversity in the efficacies of each treatment plan. In most of the studies which used olfactory training along with corticosteroid therapy as a therapy for hyposmia/anosmia induced by COVID-19, olfactory training showed a better result. Copyright@Author(s).
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Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned an year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.
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Context: Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 can involve multiple organs, especially the heart, in some children with prior COVID-19 infection. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) guidelines provide valuable case definitions for MIS-C, as utilized in this study. We aimed to identify and summarize the echocardiographic findings of MIS-C based on these case definitions. Evidence Acquisition: We performed a systematic search in PubMed, Embase, Scopus, and Cochrane databases. An additional source was also utilized to extend the identified records. The articles underwent a two-step screening process. Then, eligible articles were included in the qualitative synthesis. Results: We identified 33 eligible studies, recruiting 1,392 patients with MIS-C. Male patients were the majority, with 791 (56.8%) cases. The mean age of the patients was 8.3 ± 5.9 years, while 28.5% of the children were identified with underlying conditions. The most common echocardiographic findings were left ventricular systolic dysfunction (34.91%), valvular regurgitation (29.08%), pericardial involvement (22.58%), and coronary abnormalities (18.0%). Conclusions: MIS-C is a rare complication of COVID-19 in children. Early cardiologic investigations, especially echocardiography, can reveal manifestations, including myocardial dysfunction, coronary abnormalities, valvular pathologies, and pericardial involvement. © 2022, Author(s).
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Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned an year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.
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The new emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a huge burden of morbidity and mortality worldwide. One of the predisposing factors which might increase the infection susceptibility and its complications can be the Inborn Errors of Immunity (IEI). One hundred and seventeen primary immunodeficient (PID) pediatric patients were monitored from March to December 2020 for any signs and symptoms of SARS-CoV-2 infection. Among them twenty-eight children were symptomatic and nineteen out of the twenty-eight patients took the coronavirus PCR test. Out of them, the PCR test results of 9 patients were positive. Herein, we report the nine cases of pediatric patients with IEI who were also infected with SARS-CoV-2 with a positive PCR test. We observed a variation in clinical manifestations, clinical courses, and outcomes among IEI pediatric patients affected with COVID-19. In our survey, prompt diagnosis and appropriate monitoring for possible complications were shown to be effective in reducing the mortality rate of the SARS-CoV-2 affected patients with IEI. Although there is no approved treatment for SARS-CoV-2 infection, supportive treatment might reduce the complications and lead to better outcomes. This study received approval from the Research Ethics Committee of Mashhad University of Medical Science with the ethics code of IR.MUMS.REC.1399.155. (https://ethics.research.ac.ir/EthicsProposalViewEn.php?id=129963).
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Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the "severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned a year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.
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Introduction: The COVID-19 pandemic has resulted in societal-level changes to sleep and other behavioral patterns. Objective, longitudinal data would allow for a greater understanding of sleep-related changes at the population level. Methods: N= 163,524 deidentified active Fitbit users from 6 major US cities contributed data, representing areas particularly hard-hit by the pandemic (Chicago, Houston, Los Angeles, New York, San Francisco, and Miami). Sleep variables extracted include nightly and weekly mean sleep duration and bedtime, variability (standard deviation) of sleep duration and bedtime, and estimated arousals and sleep stages. Deviation from similar timeframes in 2019 were examined. All analyses were performed in Python. Results: These data detail how sleep duration and timing changed longitudinally, stratified by age group and gender, relative to previous years' data. Overall, 2020 represented a significant departure for all age groups and both men and women (P<0.00001). Mean sleep duration increased in nearly all groups (P<0.00001) by 5-11 minutes, compared to a mean decrease of 5-8 minutes seen over the same period in 2019. Categorically, sleep duration increased for some and decreased for others, but more extended than restricted. Sleep phase shifted later for nearly all groups (p<0.00001). Categorically, bedtime was delayed for some and advanced for others, though more delayed than advanced. Duration and bedtime variability decreased, owing largely to decreased weekday-weekend differences. WASO increased, REM% increased, and Deep% decreased. Additional analyses show stratified, longitudinal changes to sleep duration and timing mean and variability distributions by month, as well as effect sizes and correlations to other outcomes. Conclusion: The pandemic was associated with increased sleep duration on average, in contrast to 2019 when sleep decreased. The increase was most profound among younger adults, especially women. The youngest adults also experienced the greatest bedtime delay, in line with extensive school-start-times and chronotype data. When given the opportunity, the difference between weekdays and weekends became smaller, with occupational implications. Sleep staging data showed that slightly extending sleep minimally impacted deep sleep but resulted in a proportional increase in REM. Wakefulness during the night also increased, suggesting increased arousal despite greater sleep duration.
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The new coronavirus (SARS-CoV-2) is rapidly spreading across communities around the world. Respiratory droplet transmission is a common transmission route for many airborne diseases, including novel coronavirus disease (COVID-19). Wearing the face mask prevents respiratory droplet transmission. Both face mask leakage and non-use of the face mask under high-speed wind conditions can increase the risk of SARS-CoV-2 transmission. The respiratory droplets’ behavior during sneezing or coughing (i.e., the size and the distance between droplets) depends on face mask wearing. The respiratory droplets during coughing and sneezing break apart into extremely small respiratory droplets (i.e., cloud of aerosol) upon interaction with the high-speed wind condition. The volume-of-fluid (VOF) method has been used to study the deformation and breakup of a single respiratory droplet placed in high-speed wind flow in the presence of smaller neighboring respiratory droplets. The effect of the diameter of respiratory droplets and the distance between them on the breakup mechanism has been investigated using open-source field operation and manipulation (OpenFOAM) libraries. The results are presented for the dimensionless distance and the normalized diameter of the secondary respiratory droplet in the ranges of 2 to 6 and 0.4 to 0.8, respectively. According to the results of simulations, the spreading of SARS-CoV-2 increases with a decrease in respiratory droplet breakup time. In addition, the effects of ambient relative humidity and temperature on the cloud of respiratory particles were analyzed. © 2021, AAGR Aerosol and Air Quality Research. All rights reserved.
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Introduction: Population-level objective estimates of changes in health metrics over the course of the COVID-19 pandemic are sparse. This study evaluated change in resting heart rate (RHR) determined by optical plethysmography and relationships to changes in other lifestyle health behaviors (sleep and activity). Methods: Data were obtained from N=197,988 Fitbit users who wore their heart-rate enabled Fitbit device to sleep and had detected sleep stages at least 10 days in the month of January, the baseline period;and synced their devices at least once in the last 10 days of April. In addition, potential participants needed to reside in one of 6 target cities: Chicago, Illinois;Houston, Texas;Los Angeles, California;San Francisco, California;New York City, New York;and Miami, Florida. Users who met these criteria were randomly selected. Daily RHR, sleep duration (minutes), sleep duration variability (standard deviation), bedtime, step count, and active minutes were estimated by the device. Differences between January (before the pandemic) and April (peak of stay-at-home orders) was computed. Correlations between change in RHR and change in other variables were evaluated, stratified by age and sex. Results: For all age groups, in both men and women, mean RHR declined from January to April by about 1bpm, with the highest reductions in the youngest adults (all p<1x10-100 ). In general, acrossboth genders and all age groups, reductions in RHR were correlated with greater sleep duration, delaying bedtime, reduced sleep variability, and more active minutes. Steps were also associated in younger (but not older) adults. Results for ages 18-29 and >=65 are displayed in the Table. Discussion: During the COVID-19 pandemic, RHR decreased robustly but very slightly. Reductionsin RHR were correlated with improvements in other health behaviors (sleep and activity). Causal relationships could not be evaluated, but future studies may explore whether even small changes in health behaviors can measurably impact population RHR.
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Novel coronavirus disease (COVID-19) pandemic has become a global health emergency. It has been reported that a few conditions, including cancer, predispose individuals to SARS-CoV-2 infection and severe form of COVID-19. These findings led us to evaluate the susceptibility of colon adenocarcinoma (COAD) patients to SARS-CoV-2 infection by investigating ACE2 expression in their tumor tissues. The expression analysis revealed that both mRNA and protein levels of ACE2 had increased in colon cancer samples than normal group. Next, the prognosis analysis has indicated that the upregulation of ACE2 was not correlated with patient survival outcomes. Further assessment displayed the hypomethylation of the ACE2 gene promoter in COAD patients. This methylation status has a strong negative correlation with ACE2 gene expression. The functional enrichment analysis of the genes that had similar expression patterns with ACE2 in colon cancer tissues demonstrated that they mainly enriched in Vitamin digestion and absorption pathway. Finally, we found that ACE2 gene expression had a significant association with the immune cell infiltration levels in COAD patients. In conclusion, it has plausible that COAD patients are more likely to be infected with SARS-CoV-2 and experience severe injuries. Moreover, COVID-19 would bring unfavorable survival outcomes for patients with colon cancer by way of immune cell infiltration linked process. The present study highlights the importance of preventiveactionsfor COAD patients during the COVID-19 pandemic.
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Objectives After the outbreak of a new viral disease in Wuhan, China, in late December 2019, COVID-19 in a very short time and rapidly became a global pandemic. Through a systematic review, the present paper investigated the requirements of Mental Health Services during the COVID-19 outbreak. Methods A comprehensive search was conducted through PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and Scopus. PsychINFO and CINAHL data banks were also searched. The primary roots for the development of the search strategy developed based on the keywords of “Covid”, “mental health”, “care”, “services”. All relevant studies were included without any limitation of publication time or the papers’ language as it was not possible to conduct a formal systematic review given the nature of the publications. Instead, it was decided to conduct a mixed systematic and complementary narrative review covering different interested domains. Results Out of 80 papers, after excluding duplications, 58 articles were selected for the refinement pro-cess. Three refining steps based on the titles, abstracts, and full texts led to data extraction from 4 eligible papers. Considering the importance of the problem, related findings, key points, and research findings were summarized and presented in terms of critical components of infrastructure and resources, includ-ing policy for at-risk groups, different approaches to mental health service delivery, indirect contexts for mental health service delivery, follow-up attitudes, and complementary research. The results of the study indicate that many studies considered the consequences of physical aspects and diagnostic symp-toms. Thus, aspects of mental health have been either less focused or even neglected. In mental health consequences, immediate attention and intensive programs to assess mental health, preparation for support and treatment, and prevention services are emphasized. Conclusion During the implementation of mental health interventions, to improve services and to con-sider the limitations and challenges of implementing programs, it is necessary to pay attention to the attitudes of target groups and their preferences. © 2020, Iran University of Medical Sciences. All rights reserved.
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On 30 July 2020, a total number of 301,530 diagnosed COVID-19 cases were reported in Iran, with 261,200 recovered and 16,569 dead. The COVID-19 pandemic started with 2 patients in Qom city in Iran on 20 February 2020. Accurate prediction of the end of the COVID-19 pandemic and the total number of populations affected is challenging. In this study, several widely used models, including Richards, Gompertz, Logistic, Ratkowsky, and SIRD models, are used to project dynamics of the COVID-19 pandemic in the future of Iran by fitting the present and the past clinical data. Iran is the only country facing a second wave of COVID-19 infections, which makes its data difficult to analyze. The present study's main contribution is to forecast the near-future of COVID-19 trends to allow non-pharmacological interventions (NPI) by public health authorities and/or government policymakers. We have divided the COVID-19 pandemic in Iran into two waves, Wave I, from February 20, 2020 to May 4, 2020, and Wave II from May 5, 2020, to the present. Two statistical methods, i.e., Pearson correlation coefficient (R) and the coefficient of determination (R2), are used to assess the accuracy of studied models. Results for Wave I Logistic, Ratkowsky, and SIRD models have correctly fitted COVID-19 data in Iran. SIRD model has fitted the first peak of infection very closely on April 6, 2020, with 34,447 cases (The actual peak day was April 7, 2020, with 30,387 active infected patients) with the re-production number R0=3.95. Results of Wave II indicate that the SIRD model has precisely fitted with the second peak of infection, which was on June 20, 2020, with 19,088 active infected cases compared with the actual peak day on June 21,2020, with 17,644 cases. In Wave II, the re-production number R0=1.45 is reduced, indicating a lower transmission rate. We aimed to provide even a rough project future trends of COVID-19 in Iran for NPI decisions. Between 180,000 to 250,000 infected cases and a death toll of between 6,000 to 65,000 cases are expected in Wave II of COVID-19 in Iran. There is currently no analytical method to project more waves of COVID-19 beyond Wave II. © 2020 IEEE.