Investigating the impact of air pollution and temperature changes on emergency admissions (cardiovascular + respiratory) disease in the city of Bojnord, northeastern Iran.

Cardiovascular (CVD) + Respiratory diseases are recognized as the main cause of death worldwide. Fluctuations in temperature and air pollution have been reported as one of the most important causes of cardiovascular & respiratory diseases. Therefore, in the current study, we assessed the relationship between ambient air temperature and pollution on the number of total emergency hospital admission due to cardiovascular and respiratory conditions in the City of Bojnord, northeastern Iran. The meteorological data, including daily temperature, relative humidity and concentrations of five air pollutants CO, NO2, NOX SO2, and PM10 were obtained from online electronic sensors at the Bojnurd meteorological station from 21th March 2018 to 20th March 2020. Statistical analysis, penalized distributed lag non-linear method was applied using R Software. Also, sensitivity analysis test was calculated by using appropriate application. The results of the study revealed that the effect of higher and lower temperatures was observed immediately from the first day and the second week, respectively. Also result showed with increase and decrease temperature, significantly increased the risk of hospitalization by 36% (RR, 1.36; 95% CI (1), 0.95 to 1.95) and 17% (RR, 1.17; 95% CI (1), 0.88 to 1.55) until the lag 25th day, respectively. Based on the results, increasing temperature significantly increased the hospitalization rate of cardiopulmonary patients, but the effect of cold was not significant on the population as well as age and gender subgroups. Study have also proved that there is no significance correlation between air pollutant and Cardiovascular & respiratory diseases.

Ultrasparse Ultrasonic Synthetic Aperture Focus Imaging by Passive Sensing.

Ultrasonic synthetic aperture focus techniques (SAFTs) using less than the total number of available array elements to transmit ("sparse" transmissions) have been recently used in both medical imaging and industrial nondestructive testing (NDT) imaging to increase test speed and simplify multiplexer hardware. The challenge of sparse arrays is to obtain a reasonable image quality given the reduced transmitter-receiver combinations available to the beamforming process. This article proposes a "ultrasparse" SAFT method that employs a minimum number of transmitter elements (from one to four elements only) to obtain an entire full-matrix capture (FMC) set of waveforms. Specifically, a "virtual" FMC is obtained from normalized cross-power spectra between each array element pair in an implementation of "passive" ultrasonic sensing. In order to maintain high image quality without sacrificing imaging speed (e.g., applying a minimal initial time delay and keeping a short time recording window), several key steps have to be taken in this "passive" imaging mode, specifically: 1) the use of carefully designed segment-averaged normalized cross-power spectrum (NCPS) for robust passive reconstruction of the ultrasonic impulse response function (IRF) between two receivers; 2) the use of both the causal and acausal portions of the passively reconstructed IRFs; and 3) the compounding of multiple wave modes in the beamforming process. These steps also ensure the elimination of the near-field blind zone hence potentially enabling near-field imaging. The article first reviews the theory of passive IRF reconstruction between two receivers, comparing time-averaged cross correlation versus segment-averaged NCPS, and then demonstrates the application to ultrasparse SAFT FMC imaging of drilled holes in an aluminum block using a linear transducer array where only one to four elements are used in transmission.

COVID-19 and cancer risk arising from ionizing radiation exposure through CT scans: a cross-sectional study.

BACKGROUND: The surge in the utilization of CT scans for COVID-19 diagnosis and monitoring during the pandemic is undeniable. This increase has brought to the forefront concerns about the potential long-term health consequences, especially radiation-induced cancer risk. This study aimed to quantify the potential cancer risk associated with CT scans performed for COVID-19 detection. METHODS: In this cross-sectional study data from a total of 561 patients, who were referred to the radiology center at Imam Hossein Hospital in Shahroud, was collected. CT scan reports were categorized into three groups based on the radiologist's interpretation. The BEIR VII model was employed to estimate the risk of radiation-induced cancer. RESULTS: Among the 561 patients, 299 (53.3%) were males and the average age of the patients was 49.61 ± 18.73 years. Of the CT scans, 408 (72.7%) were reported as normal. The average age of patients with normal, abnormal, and potentially abnormal CT scans was 47.57 ± 19.06, 54.80 ± 16.70, and 58.14 ± 16.60 years, respectively (p-value < 0.001). The average effective dose was 1.89 ± 0.21 mSv, with 1.76 ± 0.11 mSv for males and 2.05 ± 0.29 mSv for females (p-value < 0.001). The average risk of lung cancer was 3.84 ± 1.19 and 9.73 ± 3.27 cases per 100,000 patients for males and females, respectively. The average LAR for all cancer types was 10.30 ± 6.03 cases per 100,000 patients. CONCLUSIONS: This study highlights the critical issue of increased CT scan usage for COVID-19 diagnosis and the potential long-term consequences, especially the risk of cancer incidence. Healthcare policies should be prepared to address this potential rise in cancer incidence and the utilization of CT scans should be restricted to cases where laboratory tests are not readily available or when clinical symptoms are severe.

Web-Based Information on Spinal Cord Stimulation: Qualitative Assessment of Publicly Accessible Online Resources.

BACKGROUND: Despite the growing accessibility of web-based information related to spinal cord stimulation (SCS), the content and quality of commonly encountered websites remain unknown. OBJECTIVE: This study aimed to assess the content and quality of web-based information on SCS. METHODS: This qualitative study was prospectively registered in Open Science Framework. Google Trends was used to identify the top trending, SCS-related search queries from 2012 to 2022. Top queried terms were then entered into separate search engines. Information found on websites within the first 2 pages of results was extracted and assessed for quality using the DISCERN instrument, the Journal of the American Medical Association benchmark criteria, and the Health on the Net Foundation code of conduct certification. Website readability and SCS-related information were also assessed. RESULTS: After exclusions, 42 unique sites were identified (scientific resources: n=6, nonprofit: n=12, for-profit: n=20, news or media: n=2, and personal or blog: n=2). Overall, information quality was moderate (DISCERN). Few sites met all the Journal of the American Medical Association benchmark criteria (n=3, 7%) or had Health on the Net Foundation certification (n=7, 16%). On average, information was difficult to read, requiring a 9th- to 10th-grade level of reading comprehension. Sites described SCS subcategories (n=14, 33%), indications (n=38, 90%), contraindications (n=14, 33%), side effects or risks (n=28, 66%), device considerations (n=25, 59%), follow-up (n=22, 52%), expected outcomes (n=31, 73%), provided authorship details (n=20, 47%), and publication dates (n=19, 45%). The proportion of for-profit sites reporting authorship information was comparatively less than other site types (n=3, 15%). Almost all sites focused on surgically implanted SCS (n=37, 88%). On average, nonprofit sites contained the greatest number of peer-reviewed reference citations (n=6, 50%). For-profit sites showed the highest proportion of physician or clinical referrals among site types (n=17, 85%) indicating implicit bias (ie, auto-referral). CONCLUSIONS: Overall, our findings suggest the public may be exposed to incomplete or dated information from unidentifiable sources that could put consumers and patient groups at risk.

The biogas upgrading from landfill leachate pretreated with low-frequency ultrasonic: anaerobic digestion performances and energy balance.

The efficient biogas production from landfill leachate (LL) is one of hot topics in anaerobic digestion systems. Higher bioavailability of LL can be achieved by application a feasible and promising pretreatment technologies in order to utilize as a substrate for anaerobic reactors. Here, the enhanced bioavailabity of LL using the low-frequency ultrasonic process and energy balance in anaerobic digestion process was estimated within incubation period of 24 days. The optimal performance of low-frequency ultrasonic for LL biodegradability index: sCOD and TVFA were estimated under influencing parameters: ultrasonic density (UD) (0.02-0.14 W/mL) and Ultrasonic time (UT) (0-12 min). Moreover, the effects of low-frequency ultrasonic pretreatment process on biogas production in batch mode anaerobic reactors operated at 37 ± 1 °C were surveyed for daily and cumulative methane production, operational performance and energy balance. An increased sCOD (820 mg/L) and TVFA (659 mg/L) were observed under optimum codition: UD (0.1 W/mL) and UT (10 min). The highest methane production (430 mL) was found in reactor 4, where %15 volume ratio of LL pretreated with low frequency ultrasonic were feed in. Energy balance assessment indicated that output energy for anaerobic reactors assissted with ultrasonic in range of + 6.99 and + 7.98 kJ/g VS removed. Therefore, incorporation the low-frequency ultrasonic and digestion process revealed a promising and economic technique to improve biomethane potential and energy balance from LL.

Relationship between academic success, distance education learning environments, and its related factors among medical sciences students: a cross-sectional study.

BACKGROUND: Academic success is among the most important criteria for determining students' competence. Hence, one of the concerns of education system researchers has always been investigating its associated factors. Therefore, this study aimed to determine the relationship between academic success, distance education learning environments, and its related factors among Shahroud University of Medical Sciences students. METHODS: This cross-sectional study was conducted on 208 medical sciences students who completed at least two online and two in-person academic semesters. Participants were selected through the convenience sampling method and filled out three questionnaires, including the demographic information form, the Academic Success Inventory for College Students, and the Distance Education Learning Environments Survey. Finally, the data were analyzed using descriptive statistics and inferential tests (t-test, ANOVA, Pearson's correlation coefficient, and multiple linear regression). RESULTS: In this study, students reported moderate levels of academic success (107.81 ± 10.72). Moreover, they assessed their distance education learning environment as the positive points were more than the negative points (74.10 ± 14.89). Distance education learning environment (ß = 0.233 and P < 0.001) and field satisfaction (ß = 9.797 and P = 0.001) were also mentioned as factors related to students' academic success. CONCLUSION: According to the present results, it is suggested to improve the learning environment of distance education and increase students' satisfaction to enhance their academic outcomes such as academic success.

Challenges, recent development, and opportunities of smart waste collection: A review.

Population growth and changing consumption patterns make waste management a significant global challenge. Studies evaluated that by 2050 almost 67 % of the Earth's population will live in megacities, which guides the requirement of smart assistance to answer the citizens' demands. Waste collection is an efficient IoT service that takes advantage of cost and energy efficiency. The fundamental end of this study is a review of utilizing IoT for waste collection to introduce technologies for waste collection in an eco-friendly method. This study investigated information and communication technologies (ICTs), including spatial, identification, acquisition, and data communication technologies. It also reviews several energy harvesting technologies for more cost reduction. The results showed that applying these technologies reduces costs and energy usage and can change the future of waste management.

Antibiotic use and multiple sclerosis: A systematic review and meta-analysis.

BACKGROUND: Epidemiological studies have shown conflicting results between antibiotic use and multiple sclerosis (MS) risks. The present systematic review and meta-analysis were conducted to assess the association between antibiotic use and the risk of MS. METHODS: PubMed, Scopus, Embase, Web of Science, and Google Scholar as well as reference lists of retrieved studies were searched systematically to identify studies were assessed the relationship between antibiotic use and MS up to September 24, 2022. Random-effects model was used for the calculation of pooled Odds ratio (OR) and 95% confidence intervals (CI). RESULTS: Five independent studies containing 47,491 participants were included in the meta-analysis. The overall results of included studies showed a non-significant positive association between antibiotic use (OR overall=1.01, 95%CI: 0.75-1.37) and a non-significant negative association between penicillin use (OR overall= 0.83; 95%CI: 0.62-1.13) and MS risk. Heterogeneity was (I2=90.1, P heterogeneity < 0.001) and (I2=90.7, P heterogeneity < 0.001) in antibiotics and penicillin use groups respectively. CONCLUSION: Our meta-analysis did not show a significant association between antibiotic or penicillin use with the risk of MS. However, due to the limitations of this study, further well-designed studies are required to confirm our findings.

Railroad Sleeper Condition Monitoring Using Non-Contact in Motion Ultrasonic Ranging and Machine Learning-Based Image Processing.

An ultrasonic sonar-based ranging technique is introduced for measuring full-field railroad crosstie (sleeper) deflections. Tie deflection measurements have numerous applications, such as detecting degrading ballast support conditions and evaluating sleeper or track stiffness. The proposed technique utilizes an array of air-coupled ultrasonic transducers oriented parallel to the tie, capable of "in-motion" contactless inspections. The transducers are used in pulse-echo mode, and the distance between the transducer and the tie surface is computed by tracking the time-of-flight of the reflected waveforms from the tie surface. An adaptive, reference-based cross-correlation operation is used to compute the relative tie deflections. Multiple measurements along the width of the tie allow the measurement of twisting deformations and longitudinal deflections (3D deflections). Computer vision-based image classification techniques are also utilized for demarcating tie boundaries and tracking the spatial location of measurements along the direction of train movement. Results from field tests, conducted at walking speed at a BNSF train yard in San Diego, CA, with a loaded train car are presented. The tie deflection accuracy and repeatability analyses indicate the potential of the technique to extract full-field tie deflections in a non-contact manner. Further developments are needed to enable measurements at higher speeds.

Concentration of heavy metals in leachate, soil, and plants in Tehran's landfill: Investigation of the effect of landfill age on the intensity of pollution.

Heavy metals are one of the important pollutants in landfill leachate. Plants and soil near the landfill may be contaminated by leachate. In this study, by evaluating the heavy metals in the leachate of two landfills and the soil and plants near them, the amount of pollution caused by the leachate in the environment around the landfills in Tehran was investigated. This study was conducted in three stations, soil and plant samples were prepared according to a specific protocol. Also, three indexes including PI, PINemerow, and BF were used to interpret the results. The results showed that the concentration of total metals in the old landfill leachate and new landfill leachate was only 12% different and was 24.13 mg/L on average. In the new landfill leachate, iron had the highest concentration among metals, which was 22.94 and 17.01 mg/L in two samples. In the old landfill leachate, the concentration of manganese was 15.71 mg/L, which was the highest among the studied metals. The concentration of heavy metals in the soil of the old landfill was 24.6% lower than the concentration of metals in the soil of the new landfill. In all samples, the highest metal concentration in the soil was related to manganese, which was 33.65-34.14 mg/L. Cadmium had the lowest concentration in soil compared to other metals. The concentration of total metals in the studied plants was 29-60 ppm. The PInemerow for studied stations was 0.1711, 0.1708, and 0.1463. The highest PI in the case of lead was observed at the second station equal to 0.54. The highest BF in case of Atriplex Undulata was more than 6 and related to cadmium, while the highest BF in case of Atriplex Cinearea was more than 3.5 related to cadmium. This study showed that the soil and plants of the landfill were contaminated with heavy metals under the influence of leachate, and the ability of plants to uptake and accumulate metals can be used to manage soil pollution near the landfill.

No pain, no strain: Targin® mitigates pain and constipation following spinal cord injury.

BACKGROUND: Opioids effectively reduce chronic pain, but present significant side effects including opioid-induced constipation. Oxycodone/naloxone decreases pain and constipation in cancer patients, however its effect on spinal cord injury population remains understudied. METHODS: We assessed whether oxycodone/naloxone reduces pain, constipation, and severity of autonomic dysreflexia in an individual with spinal cord injury. A 55-year-old male with C5 lesion presented with chief complaint of chronic pain received 5/2.5 mg and 20/10 mg oxycodone/naloxone for 6 and 2 weeks, respectively. RESULTS: Oxycodone/naloxone improved pain, bowel function, and autonomic dysreflexia severity. INTERPRETATION: Oxycodone/naloxone was effective in managing chronic pain and constipation in the studied case.

Multiple sclerosis incidence temporal trend in the Northeast of Iran: Using the Empirical Bayesian method.

BACKGROUND: In recent years dramatic changes in multiple sclerosis (MS) incidence have been reported in different provinces in Iran. This study was conducted to assess MS incidence temporal trends from March 21, 2005, to March 20, 2020, and provide a forecast until the end of 2025 in Shahroud county. METHODS: This longitudinal study was carried out based on the data obtained from the MS registration system in Shahroud county. First, the annual incidence rates were calculated based on the year of diagnosis and smoothed using the Empirical Bayesian Method. Then temporal trends and annual percent change (APC) of MS incidence were analyzed using Joinpoint (JP) regression. Finally, the univariate time series model analysis was used to estimate the MS incidence trend until the end of 2025. RESULTS: A total of 234 newly diagnosed cases (60 [25.64%] males and 174 [74.36.4%] females) were examined in this study. The mean age of patients at the time of diagnosis was 31.40 ± 3.78. It was 32.01 ± 6.35 and 30.66 ± 4.27 years for males and females, respectively (P<0.22). The mean annual MS incidence was 5.99 ± 1.46, 3.03 ± 0.21, and 8.98 ± 2.79 per 100,000 in overall, males and females respectively. The MS incidence increased significantly from 5.67 (95% CI: 3.63-7.99) in 2005 to 7.58 (95% CI: 5.17-10.28) in 2020 with an APC of 4.5 (2.8 - 6.1). The MS incidence had a non-linear time trend in the study period and the best time trend fitted to the annual MS incidence trend was the non-linear quadratic curve. Based on this model, the annual MS incidence is expected to increase until the end of 2025. CONCLUSION: Shahroud county is one of the high-risk areas for MS and the increasing trend of MS incidence in it is similar to regional and global changes. This study, also, showed that MS incidence in Shahroud county will be increasing in the coming years.

The prognostic effect of ST-elevation in lead aVR on coronary artery disease, and outcome in acute coronary syndrome patients: a systematic review and meta-analysis.

BACKGROUND: Rapid diagnosis of coronary artery disease has an important role in saving patients. The aim of this study is to evaluate if aVR lead ST-elevation (STE) can predict LM/3VD, left main (LM) disease, and three-vessel disease (3VD), outcome in acute coronary syndrome (ACS) patients. METHODS: In this systematic review and meta-analysis, 45 qualified studies were entered. Scopus, Pub med, Google scholar, Web of science, Cochrane library were searched on 12 November 2021. RESULTS: This systematic review includes 52,175 participants. In patients with STE, the total odds ratios for LM, 3VD, and LM/3VD were 5.48 (95% CI 3.88, 7.76), 2.21 (95% CI 1.78, 3.27), and 6.21 (95% CI 3.49, 11,6), respectively. STE in lead aVR was linked with in-hospital death (OR = 2.99, CI 1.90, 4.72) and 90-day mortality (OR = 3.09, CI 2.17, 4.39), despite the fact that it could not predict 30-day mortality (OR = 1.11, CI 0.95, 1.31). The STE > 1 mm subgroup had the highest sensitivity for LM (0.9, 95% CI 0.82, 0.98), whereas the STE > 0.5 mm (0.76, 95% CI 0.61, 0.90) subgroup had the highest sensitivity for LM/3VD. The appropriate cut-off point with highest specificity for LM/3VD and LM was STE > 1.5 mm (0.80, 95% CI 0.75, 0.85) and STE > 0.5 mm, respectively (0.75, 95% CI 0.67, 0.84, I2 = 97%). CONCLUSION: The odds of LM and LM/3VD were higher than 3VD in ACS patients with STE in lead aVR. Also, STE > 0.5 mm was the best cut-off point to screen LM/3VD, whereas for LM diagnosis, STE > 1 mm had the highest sensitivity. Furthermore, LM/3VD had a higher overall specificity than LM.

May I Have This Dance: A Case-Series on the Acute Cardiometabolic Demand of Wheelchair Dancing in Recreational Dancers with Spinal Cord Injury.

OBJECTIVES: This case-series investigated energy expenditure, cardiovascular responses, and psychosocial outcomes during two wheelchair dancing routines with different tempos. METHODS: Three individuals with chronic, non-traumatic spinal cord injuries [males, mean age 42 (13) years, C3-T12, AIS D, schwannoma=1, poliomyelitis=1, ependymoma=1] performed slow (rumba, 80 bpm) and fast (salsa, 170 bpm) wheelchair dance routines. Physiological [heart rate, blood pressure, relative oxygen consumption (VO2), metabolic task equivalent] and psychosocial parameters [ratings of perceived exertion, enjoyment and Brunel Mood Score] were measured pre, during, and post-dancing. RESULTS: All participants showed an elevation in heart rate and relative VO2 from rest to dancing with a subsequent decrease in these parameters post-dance for both routines. Relative to the slow dance routine, two out of three participants demonstrated greater heart rate, relative VO2, ratings of perceived exertion, and enjoyment during the fast dance routine. For all three participants, metabolic task equivalents ranged from 1.7-2.4 (slow) and 2.1-3.8 (fast), suggesting the intervention was of light to moderate intensity for slow and fast dance routines, respectively. Enjoyment ratings ranged from "quite a bit" to "extremely." No differences in Brunel mood subscales were observed. CONCLUSION: This case-series offers a preliminary understanding of the acute cardiometabolic and psychosocial responses to wheelchair dance routines of differing intensities per¬formed by individuals with spinal cord injury. Responsiveness observed among these participants suggests the potential use of wheelchair dance for promoting physical activity and improving psychological well-being.

Isolated systolic hypertension and its associated risk factors in Iranian middle age and older population: a population-based study.

BACKGROUND: Isolated systolic hypertension (ISH), is the most common form of hypertension in older adults. However, the ISH prevalence is not well known in many developing countries such as Iran. This study was conducted to determine the ISH prevalence and its related risk factors in an Iranian population. METHODS: Data were obtained from the second phase of the Shahroud eye cohort study (ShECS) in 2014. ShECS is a longitudinal population-based study which the first phase had been conducted in 2009 using the stratified multistage cluster sampling design on 5190 people aged 40 to 70 years. The ISH prevalence was determined based on the eighth Joint National Commission guidelines for different demographic variables. The associated risk factors were estimated by multiple logistic regression and a two-tailed p-value less than 0.05 was considered significant. RESULTS: The ISH prevalence was 15.89% (95% CI: 14.88-16.96). It was 15.68% (14.12-17.39) and 15.87% (14.54-17.29) for men and women, respectively. The prevalence of ISH increased significantly with increasing age. The 65-70 compared to 45-69 year age group (OR = 4.21), body mass index (OR = 1.03), diabetes (OR = 1.64), retirement, compared to practitioner job (OR = 1.53), and waist to hip ratio (WHR) (OR = 9.81) were significantly associated with ISH prevalence. CONCLUSIONS: ISH is highly prevalent among the older adult population in Iran. Given the risk of cardiovascular disease associated with ISH, it is recommended to conduct education and public health interventions to improve the detection, prevention, and treatment of ISH.

COVID-19 cases, hospitalizations and deaths after vaccination: a cohort event monitoring study, Islamic Republic of Iran.

Objective: To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V. Methods: We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death. Findings: Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination. Conclusion: The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.

Risk Factors Associated with Mortality in COVID-19 Patient's: Survival Analysis.

Background: The effect of related factors on recovery or death rates may vary from country to country. Therefore, we aimed to investigate the relationship between demographic, clinical, laboratory factors on the survival rates of confirmed cases of COVID-19 in Shahroud, Iran. Methods: This is an analytical study of the estimation of the survival of patients with COVID-19. Patients who had positive PCR test were considered as COVID-19 cases, and the 2-month survival of these patients was estimated. Among the diseases, heart disease and diabetes were considered as separate variables, and the patients' histories of other diseases were included in the model as comorbidities. Results: Of 396 confirmed patients hospitalized, 109 patients (27.5%) had a history of heart disease, 100 (25.3%) were diabetic, and 80 (20.2%) had a history of other comorbidities. The number of deaths due to the disease was 59 (14.9%). The median age of those who died was 76 years. The multivariate Cox regression analysis shows that heart disease increases hazard ratio more than two times (HR=2.37, 95% CI: 1.33-4.23). The neutrophil-to-lymphocyte ratio (NLR) factor, (HR=1.15, 95% 1.08-1.22), and older age (HR=1.06, 95% CI: 1.03-1.08) increases the risk of death significantly. Conclusion: The heart disease history, NLR factor and older age are associated with death of COVID-19 and may be helpful for the early warning and prediction of disease progression.

Cigarette butt littering consequences: a study of pollution rate on beaches and urban environments.

Cigarette butts are hazardous wastes that are not properly discarded by most smokers. They are one of the most abundant litters in the environment and a threat to various organisms because they leak numerous pollutants. This study aimed to assess the distribution of cigarette butts in a coastal city south of the Caspian Sea in Mazandaran Province, Iran. Observations were performed using the visual survey technique based on standardized protocol. The results showed 11,261 littered cigarette butts in 15 studied urban areas ( an average of 0.306 units per square meter). Also, the average density of littered cigarette butts on the studied beaches was 0.106 per square meter. The littered cigarette butts had significant spatial variation, and the number of counts was 135 to 2090. The land-use has a significant effect on the density of littered cigarette butts due to its population density. The inquiry's index demonstrated that 33.3% of the studied urban areas are high pollution and severe pollution, while all beaches are high and severe. Therefore, a significant focus must be considered to reduce cigarette butts littering due to the collection problems and challenges of cigarette butt management. Because the pollution on the beaches is higher than in urban areas, improving waste management services and establishing a regular cleaning program are essential.