Therapeutic effects of olfactory training and systemic vitamin A in patients with COVID-19-related olfactory dysfunction: a double-blinded randomized controlled clinical trial.

OBJECTIVES: The new corona virus infection, has a wide range of clinical manifestations. Fever and cough are the most common symptoms. The olfactory function may be also affected with COVID-19. In this randomized clinical trial, we wanted to evaluate the therapeutic effect of olfactory training with and without oral vitamin A for COVID-19-related olfactory dysfunction. METHODS: Patients answered to the standard Persian version of anosmia reporting tool and performed the quick smell test before and after 12 weeks and at the end of the 12 months follow up. The patients were randomly allocated to three groups; Group A treatment with olfactory training, Group B treatment with oral vitamin A and olfactory training, and Group C as control group which only underwent nasal irrigation twice a day. Patients were treated for 3 months and followed up for 12 months. RESULTS: Totally 90 patients were included in three groups. After interventions, 76.9% of patients in Group A, 86.7% of patients in Group B, and 26.7% of patients in Group C completely improved. The average intervention time was statistically significant in relationship with the final olfactory status of the patients in the 12 months follow-up. The olfactory training has significantly improved the smell alteration at the end of 3- and 12- months follow-up in A and B groups. CONCLUSION: A three-months olfactory training is effective for improvement of COVID-19-related olfactory dysfunction. Adding daily oral vitamin A to olfactory training did not lead to better results in improving olfactory dysfunction. LEVEL OF EVIDENCE: Step 2 (Level 2*): Randomized trial.

Components of Health Surveillance System in Natural Disasters that Affect Military Health Services: A Systematic Review.

Background: Military health surveillance system, as the first responder in natural disasters, plays an important role in public health. This study aimed to identify those components of the health surveillance system, which influence military health services in natural disasters. Methods: Five databases of Medline, SCOPUS, Web of Science, ProQuest, Cochrane Library, and search engines of Scholar Google, scienceopen.com, openGery.eu, and WHO.int were reviewed from Jan 1990 to Jan 2022. Due to the heterogeneity of the included studies, various JBI quality assessment tools were applied and the extracted data were analyzed by meta-synthesis method. Results: Out of 6538 retrieved studies, after the duplicates and irrelevant studies identified in screening stage were removed, 174 studies extracted from the electronic search of databases and 16 studies retrieved from the manual search of other sources were reviewed based on the study inclusion criteria. Finally, 24 studies with inclusion criteria were selected for data extraction. Ten criteria of monitoring, detecting, data collection and reporting, tracking, type of surveillance system, operational readiness, coordination and interaction, feasibility, flexibility, and acceptability were identified as effective components in the surveillance system of military health services. The identified components were classified into two main categories of structural and operational components. Conclusion: The structural components of the military health surveillance system describe the important infrastructural features of the health surveillance system to preparing for natural disasters; and the operational components explains the effective functional features of military health surveillance system in response of natural disasters. The results of this study help policymakers in military health services implement a more effective health surveillance system in natural disasters.

Respond quickly and effectively! Components of the military health surveillance system in natural disasters: A qualitative study.

BACKGROUND: The systematic collection, analysis, and interpretation of health data by health surveillance systems provide timely and comprehensive surveillance of public health, identification health priorities, and, consequently, a quick and timely response to reduce damage during natural disasters. Since military forces appear as first responders at the scene of accidents, the present study aimed to identify the components of the military health care system during natural disasters. MATERIALS AND METHOD: Qualitative data collected through semi-structured interviews were analyzed via the conventional content analysis approach to identify the components of the military health care system in natural disasters. The participants consisted of 13 experts who were experienced in providing health services in the military and the civilian health care system during natural disasters in January 2022 to June 2022. RESULT: The identified components were classified into four main categories, namely, pre-requisite components (comprehensive health care, defined position, and providing information), driving components (system efficiency, effective communication), operational components (contingent performance, effective response), and promotional components (purposeful support, pre-disaster preparation). CONCLUSION: In conclusion, the military health surveillance system is a cooperative service for the national health system in which data is essential for making decisions on health and treatment measures during disasters. This study-by identifying four categories of the important components in the design, implementation, and development of the military health surveillance system-provides a comprehensive view of an appropriate and evidence-based military surveillance system in disasters.

Efficacy and Safety of Sinopharm Vaccine for SARS-CoV-2 and breakthrough infections in Iranian Patients with Hemoglobinopathies: A Preliminary Report.

Background: The ongoing COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to high morbidity and mortality worldwide. Vaccination against SARS-CoV-2 is a leading strategy to change the course of the COVID-19 pandemic. Aims of the study: Our aim was to investigate the efficacy and side effects of the Sinopharm vaccine in patients with hemoglobinopathies in Iran and the frequency of breakthrough infection after a full course of vaccination. Methods: A multicenter cross-sectional study of 434 patients with hemoglobinopathies (303 ß-thalassemia major, 118 ß-thalassemia intermedia, and 13 sickle-thalassemia) were conducted from March to July 2021 in IRAN. All patients have received the first dose of the China Sinopharm vaccine and received the second dose of the vaccine 28 days apar. Antibody testing: Detection of immunity after vaccination was evaluated by commercial enzyme-linked immunosorbent assay (Pishtazteb ELISA commercial kit), including a surrogate virus neutralization test (sVNT), for detection of SARS-CoV-2 immunoglobulins (IgA, IgM, IgG), total neutralizing antibody (NAb). Results: The mean age of patients was 35.0 ± 8.5 (from 18 to 70) years, and 55.6% were positive for the antibody. Overall, 48.2% of the studied population had at least one side effect after vaccination. The most frequent side effects were fever and chills, dizziness, and body pain. A total of 90 (20.7%) vaccinated patients developed breakthrough infections after two doses of Sinopharm vaccination. Disease severity was recorded, and it was classified as mild in 77.8%, moderate in 13.6%, and severe in 7.4% of patients. One 28-year-old woman with ß-thalassemia major died eight days after diagnosing a breakthrough SARS-CoV-2 infection. Conclusion: No safety concerns were identified in patients who received two doses of the Sinopharm vaccine. Its efficacy was not optimal due to the lack of effect on new variations of the virus. However, our data show that it seems to be protective against the severity of COVID-19 infection in patients with hemoglobinopathies. The frequency of breakthrough infections after two doses of Sinopharm vaccination supports the evolving dynamic of SARS-CoV-2 variants requiring special challenge since such infection may represent a risk for vulnerable patients.

Vocal tract discomfort and voice handicap index in patients undergoing thyroidectomy.

PURPOSE: This study aims to investigate the frequency and severity of vocal tract discomfort (VTD) symptoms and to determine the relationship between VTD and type of thyroidectomy, voice problem history, vocal abuse, and misuse behaviors, and the voice handicap index (VHI) in the thyroidectomy patients undergoing thyroidectomy, pre- and post-operatively pre- and post-thyroidectomy. MATERIALS: The sample comprised 21 thyroidectomy patients undergoing thyroidectomy, including 10 patients with total thyroidectomy and 11 patients with partial thyroidectomy. The participants underwent videolaryngoscopy examination and completed the voice history questionnaire, the VTD scale, and the VHI, before and after the surgery. RESULTS: Dryness was the most frequently occurring symptom, pre- and post-thyroidectomy. Participants with total thyroidectomy reported significantly higher frequency and severity of tickling than those in the preoperative status (p<.05). The frequency and severity of many VTD symptoms in the participants with voice problems and a vocal abuse and misuse history were higher than those without such a history at both assessment times (p<.05). There was significant correlation between the frequency and severity of VTD and VHI scores, pre-thyroidectomy pre-operatively (r = 0.488-0.575, p<.05). CONCLUSIONS: An increment in the frequency and severity of tickling was reported by total thyroidectomy patients, post-thyroidectomy post-operatively. The type of thyroidectomy, voice problem history, and vocal abuse and misuse behaviors seem to influence the frequency and severity of VTD. Considering the correlation between VTD and VHI, the VTD scale provides important clinical information and can be used for evaluation and consultation purposes.

Effectiveness of vitamin D therapy in improving metabolomic biomarkers in obesity phenotypes: Two randomized clinical trials.

BACKGROUND: Uncertainty remains about the effect of vitamin D therapy on biomarkers of health status in obesity. The molecular basis underlying this controversy is largely unknown. OBJECTIVE: To address the existing gap, our study sought to compare changes in metabolomic profiles of obesity phenotypes (metabolically healthy obese (MHO) and metabolically unhealthy obese (MUHO)) patients with sub-optimal levels of vitamin D following vitamin D supplementation. METHODS: We conducted two randomized double-blind clinical trials on participants with either of the two obesity phenotypes from Tehran province. These phenotypes were determined by the Adult Treatment Panel-III criteria. Patients in each of the MHO (n = 110) and MUHO (n = 105) groups were separately assigned to receive either vitamin D (4000 IU/d) or placebo for 4 months. Pre- and post-supplementation plasma metabolomic profiling were performed using Liquid chromatography coupled to a triple quadrupole mass spectrometry. Multivariable linear regression was used to explore the association of change in each metabolite with the trial assignment (vitamin D/placebo) across obesity phenotypes. RESULTS: Metabolites (n = 104) were profiled in 82 MHO and 78 MUHO patients. After correction for multiple comparisons, acyl-lysophosphatidylcholines C16:0, C18:0, and C18:1, diacyl-phosphatidylcholines C32:0, C34:1, C38:3, and C38:4, and sphingomyelin C40:4 changed significantly in response to vitamin D supplementation only in MUHO phenotype. The interaction analysis revealed that vitamin D therapy was different between the two obesity phenotypes based on acyl-lysophosphatidylcholines C16:0 and C16:1 and citrulline which were altered significantly after supplementation. Changes in metabolites were associated with changes in cardiometabolic biomarkers after the intervention. CONCLUSIONS: Vitamin D treatment influenced the obesity-related plasma metabolites only in adults with obesity and metabolically unhealthy phenotype. Therefore, not all patients with obesity may benefit from an identical strategy for vitamin D therapy. These findings provide mechanistic basis highlighting the potential of precision medicine to mitigate diseases in health-care settings.

Multidimensional Fatigue Inventory in People With Hepatitis B Infection: Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version.

There is no valid and well-established tool to measure fatigue in people with chronic hepatitis B. The aim of this study was to translate the Multidimensional Fatigue Inventory (MFI) into Persian and examine its reliability and validity in Iranian people with chronic hepatitis B. The demographic questionnaire and MFI, as well as Chronic Liver Disease Questionnaire and EuroQol-5D (to assess criterion validity), were administered in face-to-face interviews with 297 participants. A forward-backward translation method was used to develop a culturally adapted Persian version of the questionnaire. Cronbach's α was used to assess the internal reliability of the scale. Pearson correlation was used to assess criterion validity, and known-group method was used along with factor analysis to establish construct validity. Cronbach's α for the total scale was 0.89. Convergent and discriminant validities were also established. Correlations between the MFI and the health-related quality of life scales were significant (p < .01). The scale differentiated between subgroups of persons with the hepatitis B infection in terms of age, gender, employment, education, disease duration, and stage of disease. Factor analysis indicated a four-factor solution for the scale that explained 60% of the variance. The MFI is a valid and reliable instrument to identify fatigue in Iranians with hepatitis B.

Annual and seasonal spatial models for nitrogen oxides in Tehran, Iran.

Very few land use regression (LUR) models have been developed for megacities in low- and middle-income countries, but such models are needed to facilitate epidemiologic research on air pollution. We developed annual and seasonal LUR models for ambient oxides of nitrogen (NO, NO2, and NOX) in the Middle Eastern city of Tehran, Iran, using 2010 data from 23 fixed monitoring stations. A novel systematic algorithm was developed for spatial modeling. The R(2) values for the LUR models ranged from 0.69 to 0.78 for NO, 0.64 to 0.75 for NO2, and 0.61 to 0.79 for NOx. The most predictive variables were: distance to the traffic access control zone; distance to primary schools; green space; official areas; bridges; and slope. The annual average concentrations of all pollutants were high, approaching those reported for megacities in Asia. At 1000 randomly-selected locations the correlations between cooler and warmer season estimates were 0.64 for NO, 0.58 for NOX, and 0.30 for NO2. Seasonal differences in spatial patterns of pollution are likely driven by differences in source contributions and meteorology. These models provide a basis for understanding long-term exposures and chronic health effects of air pollution in Tehran, where such research has been limited.

Cross-Cultural Adaptation and Psychometric Assessment of the Liver Disease Symptom Index 2.0 to Measure Health-Related Quality of Life Among Iranian Patients With Chronic Hepatitis B.

PURPOSE: There are only a few measures to assess quality of life among patients with liver disorders. The aim of this study was to determine the psychometric properties of the Liver Disease Symptom Index Version 2.0 (LDSI 2.0), a disease specific measure of health-related quality of life (HRQOL), in Persian-speaking patients with chronic hepatitis B. METHOD: Using a cross-sectional design, 312 patients were recruited. Data were collected from the patients using the LDSI 2.0, Chronic Liver Disease Questionnaire, and EuroQol. Convergent and discriminant validity were investigated. Known-groups validity and factor structure of the scale were also determined. Receiver operating characteristics was used to discriminate patients based on their general health status. RESULTS: Significant correlations were found between HRQOL measures. Disease duration, disease stage, and serum aspartate aminotransferase differentiated patients. Factor analysis determined a seven-factor solution that explained 70% of the total variance. Area under the curve in receiver operating characteristics analysis was 0.706; 95% confidence interval = [0.648, 0.764]. CONCLUSIONS: The LDSI2.0 is an appropriate HRQOL scale for use among Iranian patients with chronic hepatitis B based on its solid psychometric properties in this population.

Correlation between serum zinc levels and successful immunotherapy in recurrent spontaneous abortion patients.

BACKGROUND: Immunotherapy with paternal lymphocytes plays an important role in preventing recurrent spontaneous abortion (RSA) and is an effective treatment for it. This kind of treatment is performed as an immunotherapy method in several centers in the world. It attributes to the production of anti-paternal cytotoxic antibodies (APCAs) in women with RSA. Production of APCA after lymphocyte immunotherapy (LIT) in RSA patients gives them a better chance for successful pregnancy. Regarding the important effect of trace elements on the function of the immune system, we tried to investigate the correlation between serum zinc level and the success of LIT in RSA. MATERIALS AND METHODS: Serum zinc concentration was determined in two groups of RSA patients using atomic absorption spectrophotometer systems. Group (a) that responded to the paternal lymphocytes and their cross-match test was positive, and group (b) that had no response to the paternal lymphocytes immunizations and their cross-match test was negative. RESULTS: Serum zinc levels in group (a) patients were 74.98 ± 11.88 µg/dl, which was significantly higher than those in group (b) with the zinc concentration of 64.22 ± 9.22 µg/dl. CONCLUSIONS: Zinc deficiency may be one of the substantial causes of negative results for LIT in RSA patients. Therefore, compensation of zinc defect before LIT can be a promising approach to improve the immune response in patients.

Spiritual coping, religiosity and quality of life: a study on Muslim patients undergoing haemodialysis.

AIM: The number of haemodialysis patients globally is increasing and spiritual resources may help overcome adjustment problems among such patients. This study examined the relationships between spiritual/religious, demographic and clinical variables and quality of life among Iranian Muslims undergoing haemodialysis. METHODS: Using a cross-sectional design, 362 haemodialysis patients were surveyed from three general hospitals located in Tehran, Iran. Spiritual coping strategies, Duke University Religion Index, EQ-5D 3L and a demographic questionnaire were administered. Hierarchical regression was used to identify predictors of quality of life and health status. RESULTS: The distribution of reported problems across dimensions of quality of life was: mobility (59.4%), usual activities (30.4%), self-care (21.3%), pain/discomfort (47.8%) and anxiety/depression (29.3%). Univariate analysis showed that factors such as age, sex, marital status, location, number of children, body mass index, serum albumin, having diabetes mellitus or other comorbidity, as well as spiritual/religious factors that were related to quality of life, health status or both. Regression models revealed that demographics, clinical variables and especially spiritual/religious factors explained about 40% of variance of quality of life and nearly 25% of the variance in health status. CONCLUSION: Spiritual resources may contribute to better quality of life and health status among haemodialysis patients. Further longitudinal studies are needed to determine whether these associations are causal and the direction of effect.