Case report: Varicella zoster virus encephalitis following COVID-19 vaccination in an immunocompetent individual.

The varicella zoster virus (VZV) is a latent viral infection and its reactivation has been reported following different conditions such as immunosuppression. This study presents a confirmed case of VZV encephalitis following the first dose administration of the Sinopharm COVID-19 vaccine. A 63-year-old immunocompetent woman who developed VZV encephalitis after first dose administration of Sinopharm COVID-19 vaccine. A final diagnosis of VZV encephalitis was made based on positive CSF PCR results for VZV infection. Treatment was administered with acyclovir and she returned to normal life without any neurological sequelae. In this report, VZV reactivation and VZV encephalitis have been observed after COVID-19 vaccination; however, the results of this report should be considered with some caution, and continued post-vaccine surveillance of adverse events is recommended to explore whether any causal association with VZV reactivation is biologically plausible in this context, or if it is just a coincidence.

Sexual function and sexual quality of life in men with genital warts: a cross-sectional study.

BACKGROUND: Human papillomavirus is the most common sexually transmitted infection, usually passing from one person to another after the first sexual activity. Infection with this virus and the occurrence of genital warts (GWs) could have several effects on patients' health. This study was performed to evaluate the sexual function and sexual quality of life (SQOL) in men with GWs. METHODS: This cross-sectional study was conducted from September 2019 to March 2020 with a sample size of 105 men with GWs in the dermatology clinic of Shahid Faghihi Hospital in Shiraz University of Medical Sciences, Iran. Data were collected using a demographic questionnaire, the International Index of Erectile Function (IIEF), and the Sexual Quality of Life-Men (SQOL-M) questionnaires and analyzed by descriptive and inferential tests with SPSS software version 22. RESULTS: The mean score for overall sexual function in men was 48.50 ± 8.89. About 35.2% of men had overall sexual dysfunction (SD). The highest disorder rate was related to the erection domain (85.7%), and the lowest was related to the desire domain (5.7%). In the erection domain, most men (54.3%) experienced mild to moderate erectile dysfunction. The mean score for SQOL-M was 38.36 ± 14.47, and 56.2% of them had a good SQOL. CONCLUSIONS: GWs affected men's erection more than the other sexual function domains. SD in men with GWs has a significant impact on their SQOL and ED was associated with impaired SQOL. Therefore, it is recommended to pay more attention to SD screening alongside SQOL assessment of men with GW.

Human papillomavirus is the most common sexually transmitted infection. Infection with this virus and the occurrence of genital warts (GWs) could have several effects on men and women's health. In this cross-sectional study, we examined the sexual function and sexual quality of life (SQOL) in men with GWs. Of the 105 men, 35.2% had sexual dysfunction (SD). The highest disorder rate was related to the erection domain (85.7%), and the lowest was related to the desire domain (5.7%). In the erection domain, most men (54.3%) experienced mild to moderate erectile dysfunction. 56.2% of them had a good SQOL. SD in men with GWs has a significant impact on their SQOL. Therefore, it is recommended that assessment of sexual function and SQOL should be done when men with GWs refer to health services.

Priorities for a gender-sensitive sexually transmitted infections and human immunodeficiency virus (STIs/HIV) services: An exploratory mixed methods study.

Background and Aim: Providing gender-sensitive health services is emphasized by the World Health Organization. This study aimed to assess and prioritize the needs for the gender-sensitive sexually transmitted infections/human immunodeficiency viruses (STIs/HIV) prevention services by a valid and reliable questionnaire. Methods: This was an exploratory mixed methods sequential study in Shiraz Iran 2019. The first phase was a qualitative study on 37 providers and managers of the services who were recruited using the purposive and then snowball sampling method. In the second phase, following the content analysis of the qualitative data and a review of related literature, a questionnaire was developed and its psychometric properties were evaluated. Then, in the third phase, the questionnaire was used to assess and prioritize the needs through a quantitative descriptive cross-sectional study on all 290 providers of STI/HIV prevention services affiliated with Shiraz University of Medical Sciences. Results: The finding of the qualitative phase showed gender-sensitive STI/HIV prevention services should provide gender-sensitive care and education by the trained personnel and manages with appropriate facilities and equipment. Providing these services also requires supportive policies, intersectoral cooperation, and community capacitation. In the second phase, a questionnaire was developed with 63 items. Assessment of psychometric properties of the questionnaire demonstrated the scale content validity index and ratio (S-CVI = 0.98 and S-CVR = 0.87, respectively), as well as the reliability of the questionnaire (internal consistency = 0.972 and intracluster correlation coefficient = 0.910). Results of the third descriptive phase of the study demonstrated the highest priorities for gender-sensitive education (92.01 ± 11.76%) and care services (92.11 ± 12.04%), respectively. Conclusions: To improve the quality of the services, a gender-based education and care process, as well as a gender-sensitive structure, including gender-sensitive personnel, facilities, and management are necessary. Recognizing and meeting the needs for gender-sensitive services will improve the quality of the services.

Self-Referred Walk-in (SRW) versus Emergency Medical Services Brought Covid-19 Patients.

OBJECTIVE: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. METHODS: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days' passing, respiratory distress, PO2 at arrival, admission length and in-hospital death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients. RESULTS: There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant and lower than SRW group (p<0.05). Despite the SRW patients, respiratory distress was associated with lower survival in EMS group (p<0.05). Days passing the symptom's beginning was significantly different between EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in patients higher than 75 years old in both groups (p<0.05). Higher PO2 at arrival was associated with lower mortality rate of Hazard Ratio of 0.959 (p<0.001) and 0.903 (p<0.001) in EMS and SRW groups, respectively. The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group. CONCLUSION: It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.

Aluminum Phosphide Poisoning Mortality Rate in Iran; a Systematic Review and Meta-Analysis.

INTRODUCTION: According to statistics provided by the forensic medicine facility of Iran, there are a high number of Aluminum phosphide (ALP) poisoning-related deaths in the country; while the mortality rate varies in different studies. This study aimed to determine a pooled estimate of ALP poisoning mortality rate in Iran. METHODS: The present study was a systematic review and meta-analysis of the mortality rate of ALP poisoning in Iran. Through the quarry of Persian and English databases, using "aluminum phosphide", "phosphine", "rice pills", "poisoning", and "Iran" as keywords, and no time restrictions, studies reporting mortality rate in ALP poisoning cases were collected. The random-effects model was used to pool the proportions of mortality and age of survivors versus non-survivors. RESULTS: 21 studies with 3432 cases of ALP poisoning were included in this meta-analysis. The pooled mortality rate of ALP poisoning in Iran was 39.6%, (95% CI: 31.5%-47.9%; I2 = 95%). Since there was significant publication bias, the trim-and-fill correction was conducted and the corrected pooled mortality rate was estimated to be 27.3% (95% CI: 18.9%- 36.5%), which is the rate that should be considered for clinical guidance. Morality rate in male and female patients was 62.3% (95% CI: 53.5%-70.8%) and 37.7% (95% CI: 29.2%-46.5%), respectively (p < 0.01). Survivors had significantly lower mean age than non-survivors (SMD: -0.26 (95% CI: -0.37 to -0.15); p < 0.01; I2=0%). CONCLUSION: According to this report, the Mortality rate of ALP poisoning in Iranian population is about 27%, with men having a higher fatality rate than women. Poisoning at a younger age is associated with better results.

Gender Differences in COVID-19 Deceased Cases in Jahrom City, South of Iran.

OBJECTIVE: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising mortality rate in Jahrom city. METHODS: This is a descriptive-analytical retrospective study that was conducted from the beginning of March 2020 to the end of November 2020. The study population were included all patients with COVID-19 who admitted to Peymaniyeh Hospital in Jahrom and died of COVID-19. Clinical and demographic data were collected from medical records and analyzed by SPSS software. RESULTS: In this study, 61 patients (57.54%) were men and 45 patients (42.36%) were women. The mean age was 68.7±18.33 in men and 68.82±14.24 in women. The mean hospitalization length was 9.69±7.75 days in men and 9.69±7.75 days in women patients. There was no statistically significant difference between men and women patients (p>0.05). The results showed that 17 (27.87%) men and 28 (45.9%) of women patients had hypertension and the prevalence of this disease was significantly higher in women than men (p=0.01). In this study, 7 (11.48%) men and 13 (21.31%) women had hyperlipidemia. The frequency of hyperlipidemia in women cases was significantly higher than in men patients (p=0.024). Men cases' diastolic blood pressure (mean=77.53) was significantly higher than women's diastolic blood pressure at the same time with a mean of 71.42 (p<0.05). CONCLUSION: The findings of the study represented the mortality rate in men which is higher than women patients. The prevalence of underlying diseases such as hypertension and hyperlipidemia were higher in women than men. Despite higher mortality among women, symptoms such as fever and dyspnea were less common in women than men.

Needs for a gender-based perimarital couples' counselling services in Iran.

AIM: To assess needs for a gender-sensitive perimarital counselling services in Iran. DESIGN: A descriptive cross-sectional study. METHODS: This was a study on all 236 premarital counselling providers in 37 health centres in Shiraz-Iran. The tools for data collection included the following: (a) a demographic information questionnaire and; (b) a valid and reliable Needs Assessment questionnaire for Gender-Sensitive Perimarital Counseling Services (GSPCS) in 3 sections of needs for process, structure and policy making of the perimarital counselling services. Data were analysed using SPSS 21. RESULTS: All health providers with average working experience of 8.63 (SD 5.35) years participated in the study. Results demonstrated highest scores for needs related to facilities as the structure of the services (90.09 SD 13.70 per cent) and community empowerment (89.50 SD 16.67 per cent) as the necessary policy for the gender-sensitive services. We concluded that providing gender-sensitive perimarital counselling healthcare services needs to reform the process, structure and policies of the services.

Correlation between Clinical Symptoms and Lab Tests with Endoscopic Severity Indexes in Patients with Inflammatory Bowel Diseases.

BACKGROUND The Crohn's Disease Endoscopic Index of Severity (CDEIS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are two validated endoscopic scoring system to evaluate patients with inflammatory bowel diseases (IBD). We conducted this study to evaluate the correlation between clinical symptoms and lab tests with these indexes in patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS In this analytical study, 373 consecutive patients referred to Shahid Mohammadi Hospital with IBD were enrolled. All patients underwent complete ileocolonoscopy, and the endoscopic severity indexes (CDEIS and UCEIS) were calculated, and their relation with clinical symptoms and lab tests was evaluated. RESULTS Fever observed only in six patients (1.6%). It was associated with significantly higher CDEIS and UCEIS (p = 0.02 and p < 0.001, respectively). Also, diarrhea was correlated with significantly higher UCEIS (p < 0.001). The mean fecal calprotectin was 647.64 ± 409.37 µg/g in CD and 567.30 ± 342.49 µg/g in UC patients. Higher calprotectin level was observed in patients with higher CRP level (p = 0.001), erythrocyte sedimentation rate (ESR) level, CDEIS, and UCEIS (r = 0.438; 0.473; and 0.517; respectively, all with p < 0.001). CONCLUSION Our study showed that although fever and diarrhea are associated with higher endoscopic severity scores in patients with IBD, no clinical symptom could reliably predict the endoscopic results, alone. Furthermore, higher fecal calprotectin level is associated with higher ESR and C reactive protein levels, CDEIS, and UCEIS.

Design and psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services: a sequential exploratory study.

BACKGROUND: Providing gender sensitive reproductive health service is recently emphasized by health organizations. This study aims to develop and assess psychometric properties of a questionnaire to assess gender sensitivity of perinatal care services (GS-PNCS) to be used by managers of perinatal services. METHODS: This study is a mixed sequential (Qualitative-Quantitative) exploratory study. In the qualitative phase, 34 participants were interviewed and the items were generated. To evaluate the validity; face, content and construct validity were assessed. The reliability was assessed by internal consistency and stability calculation. RESULTS: The content validity and reliability were demonstrated by S-CVR = 0.92 and S-CVI = 0.98, Cronbach's α = 0.880 and the ICC = 0.980 to 0.947. Exploratory factor analysis showed 8 factors which explained more than 52.53% of the variance. CONCLUSION: GS-PNCS is a valid and reliable questionnaire, with 49 items to assess gender sensitivity of perinatal care services and helps health care managers and planners to improve the quality of the services.

The effect of self-care education regarding high-risk behaviors of acquired immune deficiency syndrome and smoking on knowledge and attitude of adolescent girls: An experimental study to health promotion.

BACKGROUND: The vulnerability of the youth to acquired immune deficiency syndrome (AIDS) and smoking is one of the most important public health issues around the world. Adequate knowledge about AIDS and smoking is a powerful tool for promoting positive attitudes and safe behaviors. OBJECTIVE: This study aimed to determine the effect of self-care education on AIDS and smoking on the level of adolescents' knowledge and health attitude. MATERIALS AND METHODS: This experimental study was conducted in the academic year of 2017-2018, and the participants were selected using randomized cluster sampling. These participants included 220 female students of the third grade of middle school in Isfahan (105 in the intervention group and 115 in the control group). Data were collected using a demographic questionnaire; a researcher-made questionnaire on knowledge about AIDS, knowledge about smoking, and attitudes toward smoking; and a standard questionnaire on students' attitude toward AIDS. After completing the pretest, the intervention group performed two training sessions and completed the posttest 1 month later. One month after completing the pretest, the control group completed the posttest and did not receive an intervention. Finally, the data were analyzed using descriptive statistics, statistical tests, and statistical software SPSS version 22. RESULTS: The results showed that despite the similarity between the two groups at the beginning of the study, after self-care education, the knowledge level of AIDS (P < 0.001) and attitude toward AIDS (P < 0.001) and the knowledge level of smoking (P < 0.001) and attitude toward smoking (P < 0.001) in the intervention group were significantly higher than the control group. In intragroup analysis, it was also observed that the difference between the scores before and after was only significant in the intervention group. CONCLUSION: It seems that education can promote the level of knowledge and attitude of adolescents toward AIDS.

Needs assessment for gender sensitive reproductive health services for adolescents.

Background A dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents. Objective This study aims to assess needs for gender sensitive reproductive health care services for adolescents. Methods This was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21. Results Three hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services. Conclusions Providing gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.

Fourteen Years of Experience of Liver Transplantation for Wilson's Disease; a Report on 107 Cases from Shiraz, Iran.

BACKGROUND AND AIM: Liver transplantation is a potential cure for liver damage from Wilson's disease but the course of neuropsychiatric manifestations after transplantation remains undetermined. MATERIAL AND METHODS: In this study, data on all patients who'd received a liver transplant for Wilson's disease at the Shiraz Organ Transplantation Center between December 2000 and March 2014 were reviewed and compared to data on a control group who'd received a liver transplant over the same period but due to other causes. RESULTS: Out of 2198 patients who'd received a liver transplant in the period; 107 patients were diagnosed with Wilson's disease (21 with fulminant hepatic failure); age of patient ranged from 5 to 59 years; 56.07% of patients in this series had some type of neuropsychiatric manifestation before transplantation, of which 66.67% showed improvement after the procedure. 18 patients had aggravation of neuropsychiatric symptoms after transplantation. These neuropsychiatric symptoms were mostly for anxiety, tremor and depression but there were four cases of new onset dysarthria, rigidity and ataxia in various combinations. Survival rates of 1-month, 1-year, and 5-years for patients with Wilson's disease were 88%, 86%, 82%, respectively, evaluations were not statistically different from that of the control group. CONCLUSIONS: Liver transplantation showed good long-term results in patients with Wilson's disease, even in those presenting fulminant hepatic failure. Neuropsychiatric manifestations normally show improvement after transplantation but in some cases new onset of manifestations occurred after successful liver transplantation.

Is red cell from an otherwise healthy G6PD-deficient donor efficient for transfusion to fauvism patients?

AIM: Glucose-6-Phosphate dehydrogenase (G(6)PD) deficiency is the most common X-linked defect of enzyme pathways in human. The aim of this study was to inspect the efficacy of G(6)PD deficient red cell transfusion to G(6)PD patients, who were admitted for hemolysis after Broad bean ingestion, and to find out whether prolong management program and retransfusion are needed as severe hemolysis would take place. METHODS: This was a cross-sectional study, which was performed on patients admitted to hospital due to hemolytic anemia after broad bean ingestion in Jahrom and Shiraz medical school hospitals on February and March 2007. 2(ml) samples of transfusion blood bags, were sent to the laboratory in order to investigate the G(6)PD enzyme sufficiency. Hemoglobin level was checked six hours after blood transfusion. We compared the amount of hemoglobin level elevation after transfusion in patients received G(6)PD sufficient and G(6)PD deficient red cell using independent sample t-test. RESULT: In 114 transfused bags, 14 bags (12.3%) were G(6)PD deficient. We divided patients into two groups. Group A received G(6)PD sufficient red cell and group B were transfused with G(6)PD deficient red cell. Hemoglobin level was significantly raised after transfusion of red cell in each group. The amount of hemoglobin elevation was more in group A in comparison to group B. CONCLUSION: Based on our study results, proper hemoglobin level would be achieved using non G(6)PD deficient red cell for transfusion to G(6)PD deficient patients.