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Background: We aimed to estimate the prevalence of physical inactivity in all districts of Iran and the disparities between subgroups defined by various measures. Methods: Small area estimation method was employed to estimate the prevalence of physical inactivity in districts based on the remaining districts in which data on the level of physical inactivity were available. Various comparisons on the estimations were done based on socioeconomic, sex, and geographical stratifications to determine the disparities of physical inactivity among districts of Iran. Results: All districts of Iran had a higher prevalence of physical inactivity compared with the world average. The estimated prevalence of physical inactivity among all men in all districts was 46.8% (95% uncertainty interval, 45.9%–47.7%). The highest and lowest estimated disparity ratio of physical inactivity were 1.95 and 1.14 in males, and 2.25 and 1.09 in females, respectively. Females significantly had a higher prevalence of 63.5% (62.7%–64.3%). Among both sexes, the poor population and urban residents significantly had higher prevalence of physical inactivity than rich population and rural residents, respectively. Conclusions: The high prevalence of physical inactivity among Iranian adult population suggests the urgent need to adopt population-wide action plans and policies to handle this major public health problem and avert the probable burden. [ABSTRACT FROM AUTHOR]

Introduction: The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children has been reported in the literature, which is now referred to as a multisystem inflammatory syndrome in children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome. Case Presentation: This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles. Conclusions: Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable. [ABSTRACT FROM AUTHOR]

Background: Sustainable Development Goal 3.2 (SDG 3.2) is to reduce Under-5 and neonatal mortality rates (U5MR and NMR), two major health systems' performance indicators, globally by 2030. We aimed to report Iran's U5MR and NMR status during 2010–2017 and its achievement of SDG 3.2 by 2030, using scenario-based projection. Study design: To estimate the national and subnational levels of U5MR and NMR, we applied an Ensemble Bayesian Model Averaging (EBMA) with Gaussian Process Regression (GPR) and Spatio_temporal models. We used all available data sources including: 12-year data from the Death Registration System (DRS), two censuses, and a demographic and health surveys (DHS). This study employed two approaches, Maternal Age Cohort (MAC) and Maternal Age Period (MAP), to analyze summary birth history data obtained from censuses and DHS. In addition, we calculated the child mortality rate directly from DHS using the complete birth history method. National and subnational NMR was projected up to 2030 with a scenario-based method using average Annual Rate of Reduction (ARR) introduced by UN-IGME. Results: In 2017, national U5MR and NMR were 15·2 (12·4–18·0) and 11·8 (10·4–13·2), with an average ARR of 5·1% (2·1–8·9) and 3·1% (0·9–5·8) during 2010–2017, respectively. According to our projection scenarios, 17 provinces have not fulfilled SDG 3.2 for NMR yet, and the current trend (the current trend of NMR improvement in Iran) will not result in reaching SDG for some provinces by 2030; However, if each province has the same neonatal mortality annual reduction rate as the best-performing province in the same region, besides achieving SDG, the national NMR will be reduced to 5·2, and almost 92,000 newborn lives will be saved. Conclusions: Iran has achieved SDG3.2 regarding U5MR and NMR; however, there are provincial inequalities. For all provinces to reach SDG3.2, health policies should focus on reducing provincial inequalities by precise planning for neonatal health care. [ABSTRACT FROM AUTHOR]

Background: Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study. Methods: We retrieved epidemiologic data of BC from the Global Burden of Disease (GBD) 1990–2019 database. Epidemiology and burden of BC and its risk factors were explored besides the Quality of Care Index (QCI) introduced before, to assess the provided care for patients with BC in various scales. Provided care for BC risk factors was investigated by their impact on years of life lost and years lived with disability by a novel risk factor quality index (rQCI). We used the socio‐demographic index (SDI) to compare results in different socio‐economic levels. Results: In 2019, 1,977,212 (95% UI: 1,807,615–2,145,215) new cases of BC in females and 25,143 (22,231–27,786) in males was diagnosed and this major cancer caused 688,562 (635,323–739,571) deaths in females and 12,098 (10,693–13,322) deaths in males, globally. The all‐age number of deaths and disability‐adjusted life years attributed to BC risk factors in females had an increasing pattern, with a more prominent pattern in metabolic risks. The global estimated age‐standardized QCI for BC in females in 2019 was 78.7. The estimated QCI was highest in high SDI regions (95.7). The top countries with the highest calculated QCI in 2019 were Iceland (100), Japan (99.8), and Finland (98.8), and the bottom countries were Mozambique (16.0), Somalia (8.2), and Central African Republic (5.3). The global estimated age‐standardized rQCI for females was 82.2 in 2019. Conclusion: In spite of the partially restrained burden of BC in recent years, the attributable burden to risk factors has increased remarkably. Countries with higher SDI provided better care regarding both the condition and its responsible risk factors. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is one of the leading cancers, with a high burden worldwide. As a developing country, Iran is facing with population growth, widespread tobacco use, demographic and epidemiologic changes, and environmental exposures, which lead to cancers becoming a severe concern of public health in Iran. We aimed to examine the burden of lung cancer and its risk factors in Iran. Methods: We utilized the Global Burden of Disease 2019 data and analyzed the total burden of the lung cancer and seven related risk factors by sex, age at national and sub‐national levels from 1990 to 2019. Results: The lung cancer age‐standardized death rate increased from 11.8 (95% Uncertainty Interval: 9.7–14.4) to 12.9 (11.9–13.9) per 100,000 between 1990 and 2019. This increase was among women from 5 (4.2–7.1) to 8 (7.2–8.8) per 100,000; in contrast, there was a decline among men from 18.5 (14.8–22.6) to 17.8 (16.2–19.4) per 100,000. The burden of lung cancer is concentrated in the advanced age groups. Smoking with 53.5% of total attributable deaths (51.0%–55.9%) was the leading risk factor. At the provincial level, there was a wide range between the lowest and highest, from 8.3 (7.0–10.0) to 19.1 (16.4–22.0) per 100,000 population in the incidence rate and from 8.7 (7.3–10.3) to 20.6 (17.7–24.0) per 100,000 population in mortality rate, respectively in Tehran and West Azerbaijan provinces in 2019. Conclusion: The increasing trend of lung cancer burden among the entire Iranian population, the inter‐provincial disparities, and the significant rise in burden of this cancer in women necessitate the urgent implementation and development of policies to prevent and manage lung cancer burden and strategies to reduce exposure to risk factors. [ABSTRACT FROM AUTHOR]

Background: The increasing burden of hypertension in low- to middle-income countries necessitates the assessment of care coverage to monitor progress and guide future policies. This study uses an ensemble learning approach to evaluate hypertension care coverage in a nationally representative Iranian survey. Methods: The data source was the cross-sectional 2016 Iranian STEPwise approach to risk factor surveillance (STEPs). Hypertension was based on blood pressure ≥140/90 mmHg, reported use of anti-hypertensive medications, or a previous hypertension diagnosis. The four steps of care were screening (irrespective of blood pressure value), diagnosis, treatment, and control. The proportion of patients reaching each step was calculated, and a random forest model was used to identify features associated with progression to each step. After model optimization, the six most important variables at each step were considered to demonstrate population-based marginal effects. Results: The total number of participants was 30541 (52.3% female, median age: 42 years). Overall, 9420 (30.8%) had hypertension, among which 89.7% had screening, 62.3% received diagnosis, 49.3% were treated, and 7.9% achieved control. The random forest model indicated that younger age, male sex, lower wealth, and being unmarried/divorced were consistently associated with a lower probability of receiving care in different levels. Dyslipidemia was associated with reaching diagnosis and treatment steps; however, patients with other cardiovascular comorbidities were not likely to receive more intensive blood pressure management. Conclusion: Hypertension care was mostly missing the treatment and control stages. The random forest model identified features associated with receiving care, indicating opportunities to improve effective coverage. [ABSTRACT FROM AUTHOR]

Purpose: To express a global view of care quality in major causes of mortality and morbidity in children and adolescences Methods: We used primary epidemiologic indicators from the Global Burden of Disease 1990–2017 database. We have created four secondary indices from six primary indices in order to assess the care quality parameters. We conducted a principal component analysis on incidence, prevalence, mortality, Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability Adjusted Life Years (DALYs) to create an index presented by quality-of-care index (QCI) to compare different countries. Results: The global QCI scores of respiratory infection, enteric infection, leukemia, foreign body aspiration, asthma, epilepsy, diabetes mellitus, dermatitis, road injury, and neonatal disorders have improved remarkably. These causes showed equal distribution of qualified care for both sexes. The global trend of QCI score for mental health showed a steady pattern during the same time and disparities favoring females was evident. The quality of care for these causes was notably higher in developed areas. Conclusions: The global QCI revealed a universal growth in major causes of death and morbidity in <20y during 28 years. Quality of care is an associate of the level of country's development. Despite effective interventions, inequities still remain. Implementation of policies to invest in quality improvement and inequality elimination is needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION Amidst the COVID-19 pandemic, an international effort has been concerted to identify the factors associated with more adverse outcomes to better allocate resources and perform more effective targeted preventive measures. This study aims to describe the risk of COVID-19 adverse outcomes among individuals with a history of being ever cigarette smokers and being ever hookah users. METHODS We combined two databases, including the Iran national registry of COVID-19 patients, including 2020 with 656258 hospitalized patients and STEPs survey 2016 with 30541 participants. After merging the two databases using the national ID, the association was investigated between being ever smoker or hookah user and the adverse outcomes of COVID-19 including death, need for a ventilation therapy, and admission in the intensive care unit (ICU), among 474 severe acute respiratory infections (SARI) cases and 211 PCR-positive patients. RESULTS Among 211 PCR-positive patients, 40 (19%) patients were ever hookah users and 28 (13.3%) were ever cigarette smokers. Death occurred in 27 (12.8%) patients and severe COVID-19 in 17 (11.6%). Among 211 PCRpositive patients, ever cigarette smokers had 4.2 times (95% CI: 1.1-15.4, p=0.03) higher odds of ICU admission and 4.2 times (95% CI: 1.1-15.4, p=0.03) increased odds for need of ventilation, compared with non-smokers. Besides, ever hookah users had 3.9 times (95% CI: 1.1-13.6, p=0.03) higher odds for need of ventilation therapy, compared with non-hookah users. CONCLUSIONS Tobacco use and hookah smoking were associated with adverse outcomes among COVID-19 patients in Iran. [ABSTRACT FROM AUTHOR]

This study aims to investigate the prevalence of depression and impaired sexual function following the hysterectomy in Iran. This study was performed as a retrospective cohort study, from August 2017 to August 2018. Fifty-two patients with a cesarean hysterectomy and 52 with cesarean section were considered as the cases and controls, respectively. Depression and sexual function were assessed 3–6 months following the surgery in both cases and controls. Depression was evaluated by using Beck Depression Inventory (BDI) questionnaire-II-Persian. Sexual function was assessed using the Female Sexual Function Index (FSFI). The average BDI in cases was 15.37 ± 7.6 and in controls was 13.06 ± 6.7. Mild to moderate depression was detected 57.3 percent of whom with hysterectomy and 36.5 percent of whom with C/S, the BDI sum score did not differ significantly between cases and controls (p =.096). The FSFI in cases was 20.06 ± 6.96, and controls was 21.7 ± 9.83 without any significant difference (p =.364). The depression had not been significantly different between women who underwent hysterectomy and were not following 3–6 months after surgery. Furthermore, both groups had impaired sexual function after the surgery. [ABSTRACT FROM AUTHOR]

Aim: This study was performed to evaluate the effects of vaginal versus intramuscular progesterone supplementations on the mood, quality of life, and metabolic changes in pregnant women with the history of previous preterm birth.Methods: This study was conducted as a prospective, randomized, open label, clinical trial evaluated 100 pregnant women who referred for prenatal visit, with 16-17 weeks of gestation from September 2014 through October 2015. The mothers were then randomly allocated into two groups: the vaginal progesterone group to receive 400 mg cyclogest vaginal suppositories (Actavis, UK limited, England) once daily, and the intramuscular progesterone group to receive weekly intramuscular injections of 250 mg of 17-hydroxyprogesterone caproate (17-HPC) (Bayer Schering Pharma, Germany), starting from the 16th to the 35th weeks of pregnancy. Demographics, medical and obstetrical history, sleeping disturbances, alteration in sexual desire, nausea/vomiting, serum levels of fasting blood sugar (FBS), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were evaluated, first and 8 weeks later.Results: About 11 (11.2%) screened positive for psychosocial disorders; 25 (25.5%) had sleep disturbance, 11 (11.2%) had alteration in sexual desire, and 29 (29.6%) had nausea/vomiting upon enrollment. After 2 months of receiving daily vaginal progesterone, there was a significant increase in the GHQ-28 score (p < .001), and rates of positive screening for psychosocial disorders (p = .001) in this group. No statistically significant differences were observed in the HDL levels (p = .06), LDL levels (p = .15), rates of impaired FBS (p = .08), nausea/vomiting (p = .2), sexual desire alteration (p = .56), and sleep disturbance (p = 1) in the participants who were randomized to this group.Conclusion: Our results indicated that psychosocial disorders increased significantly at 24th week gestational age after 2 months of progesterone consumption in both groups which could show psychological impact of progesterone regardless of the route of consumption. This calls for higher psychological attention in these women. [ABSTRACT FROM AUTHOR]

Background: The arterial switch operation [ASO] is the surgical procedure of choice for correction of the TGA. This is one of the most complex cardiac surgeries, with coronary artery transfer being the most important factor determining the success of the surgery. Objectives: This study aims to investigate the outcomes of ASO operated by a single surgeon and assess the accuracy of echocardiography in identifying the coronary artery pattern before the ASO, this may lead to a better familiarization with the ASO. Methods: A retrospective study was conducted by operative and postoperative case note review of 125 patients from March 2015 to 2018. We assessed the outcomes of the arterial switch operation. Concomitant defects as atrial septal defects, patent ductus arteriosus and small ventricular septal defects were defined as the simple TGA and other defects were defined as the complex TGA. Coronary artery pattern determination by echocardiography prior to the surgery and during the operation was investigated, as well. 30-day mortality, post-operative neurologic complications, cardiac anatomic complications, arrhythmia, plasma lactate level and cardiopulmonary bypass time [CPB time] during the surgery were recorded. Results: The mean age and weight of the patients were 29.09 (1 - 180) days and 3506.48 (2400 - 9700) grams. Most of the patients (64%) were male. 105 (84%) of the patients had simple and 20 (16%) had complex TGA. Unusual coronary pattern during echocardiography was observed in 17 (13.6%) subjects and unusual coronary pattern during the operation was observed in 7 (5.6%) patients. The incidence of the major anatomical lesions was not significant. 20 (16%) had neurologic complications, including seizure in 14 (11.2%) patients, brain hemorrhage was found in 5 (4%) patients, as well as chorea and wrist drop in the remaining patients. Post-operative arrhythmia was observed in 16 (12.8%) patients. The mortality rate was 4% (5 patients). The CPB time was 202.73-36.99 minutes. Conclusions: Our post-operative results of the ASO indicate excellent results. This signifies high experience and knowledge regarding this surgery. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate fetal cardiac changes in gestational diabetic mothers, compared to healthy ones by means of different indices and to determine which index can first represent the alterations. Methods: The study was conducted as an observational cross-sectional study, including 25 pregnant women with gestational diabetes as the cases and 50 healthy pregnant women as the controls. The preload index, left and right side myocardial performance index (MPI), Interventricular septal hypertrophy, the left and right side cardiac output were assessed in all the patients. Results: The gestational ages were 31.65 ± 8.02 and 31.64 ± 5.37 weeks in case and control group respectively, without any signifi- cant difference. Both of the left and right ventricular MPI did not differ statistically between the case and controls. The cases had a greater Interventricular septal hypertrophy but the cardiac output was similar. The preload index was higher in the fetuses of the gestational diabetic mothers. Conclusions: In our study, the MPI did not show any difference between the fetuses of the gestational diabetic mothers and non-diabetic ones; but, fetuses of gestational diabetic mothers had a greater value of PLI, representing early diastolic function changes in right heart even before the overt heart failure occurred. This could be a sign of vasculopathy in gestational diabetic mothers. [ABSTRACT FROM AUTHOR]

The article focuses on absent aortic valve (AAV) is a rare congenital heart anomaly has associated with a high mortality rate. Topics include AAV is detectable in the perinatal period and is frequently associated with other cardiac anomalies, including double outlet right ventricle, hypoplastic left heart syndrome, and mitral atresia, and AAV is associated with severe aortic regurgitation that can lead to rapid and accompanied by growth retardation in the fetus, and ultimately fetal demise.

Objectives: Ventricular septal defect (VSD) includes 40% of congenital heart diseases. Surgical closure of VSD is the most common procedure in pediatric cardiac surgery. Weight is the most restrictive factor for performing the surgery as it complicates the operation and post-operative care. The aim of this study was to determine the results of the surgery for the patients undergoing this procedure with the weight under 5 kilograms and to catch a good insight into performing surgery at lower age and weight. Methods: A retrospective study was conducted by operative and postoperative case note review of 54 patients from March 2014 to 2017. We assessed the outcomes of the early surgical closure of the ventricular septal defects. Results: In our study, the weight was 4.4 + 0.61 kilograms and the age was 5.72 + 2.22 months. Post-surgical result by echocardiography showed reduced immediate pulmonary artery pressure in all patients, other post-surgical evaluations showed 1 (1.9%) mild, 1 (1.9%) moderate to severe pericardial effusion, 1 (1.9%) first degree AV Block, 2 (3.7%) right bundle branch block and 4 (7.4%) complete heart block leading to permanent pace maker implantation. Significant myocardial stunning (ejection fraction < 40%) was noted in 6 (11.11%). The patient mortality in the first 30 days was zero and there was no post-operative immediate endocarditis, seizure, bleeding or cardiac arrest. Conclusions: Observations can prove increased ability, knowledge and techniques of the surgeons operating VSDs. Based on the outcomes, earlier surgical VSD closure is recommended. [ABSTRACT FROM AUTHOR]

A 30-month-old girl was referred to our clinic because of a large ASD secundum and severe pulmonary valve stenosis. Due to her clinical and paraclinical situation we decided to perform the surgery. The patient had no other symptoms except for those related to ASD. During the surgery we found a mass with its satellite nodule on the tricuspid valve. Histopathological examination of the mass revealed larval elements and infiltration of eosinophils. [ABSTRACT FROM AUTHOR]

Background: Mechanical PR Interval (MPRI) is an important parameter in the fetus as a surrogate for PR interval. Normal values of MPRI have been reported with controversial effects of Fetal Heart Rate (FHR) and Gestational Age (GA). However, the effect of HR-correction on PR interval is unknown. Objectives: This study aimed to obtain the reference values of fetal MPRI in a large series of normal fetuses by pulsed-Doppler fetal echocardiography. This was done to determine the influence of fetal sex, Heart Rate (HR), GA, and maternal age on MPRI and to calculate the novel HR-Corrected Mechanical PR Interval (CMPRI) to investigate whether HR-correction of PR interval can decrease the influence of HR. Materials and Methods: This cross-sectional study was performed on 516 consecutive normal singleton fetuses. By extrapolation from Bazett's formula, we corrected the MPRI for HR. Impact of fetal sex, HR, and GA on MPRI and CMPRI was studied. Mean ± standard deviation, 5th, 50th, 95th, and 99th percentiles of MPRI and CMPRI were also calculated. Then, the data were entered into Stata, version 12 and analyzed using t-test, ANOVA, and linear regression. Results: Reference values of MPPR and CMPRI were provided in four GA groups; i.e., 14 - 18, 19 - 22, 23 - 26, and 27 - 38 weeks. Fetal sex and maternal age had no influence on either MPRI or CMPRI. After adjustment for fetal sex, GA, and maternal age, there was a 0.14-millisecond (ms) decrease in MPRI and a 8.06-ms increase in CMPRI for every single increase in FHR. Additionally, adjusted linear regression model indicated a 0.43-ms increase in MPRI and a 2.53-ms increase in CMPRI per gestational week. The results of paired t-test showed no significant difference between fetal MPRI and neonatal PR interval. Conclusions: This study provided reference values for MPRI and CMPRI in fetus from 14 to 38 weeks of gestation from the 5th to the 99th percentile. The results also revealed significant correlations between both FHR and GA and MPRI and CMPRI. Furthermore, HR correction of MPRI did not add any advantage in terms of HR-independency of mechanical PR interval. [ABSTRACT FROM AUTHOR]

A 13-year-old girl, as a known case of type III Gaucher disease, was referred to us for a cardiac assessment. Our investigations revealed wall thickening and calcification in the ascending thoracic aorta, transverse arch, and isthmus. Calcification was also present in the proximal portion of the brachiocephalic trunk while the osteal narrowing of right common carotid was also notable. The other finding included isolated thrombocytopenia. We decided to perform surgery after two months of enzyme replacement therapy. [ABSTRACT FROM AUTHOR]

• Hydroxychloroquine and antibiotics were the most common drugs associated with AGEP. • Hydroxychloroquine was associated with a prolonged treatment duration of AGEP. • Seventeen (23%) patients had systemic organ involvement. • Recurrence was detected in six (8.1%) patients after resuming the same drug. Acute generalized exanthematous pustulosis (AGEP) is a severe skin pustular drug reaction that can lead to life-threatening consequences. In this study, we have investigated the characteristics and outcomes of patients with AGEP in a tertiary skin hospital. From March 2007 to December 2019, medical records of all patients diagnosed with AGEP, were assessed. Demographic data, culprit drug, past medical history, laboratory tests, recurrence, and systemic organ involvement were all documented as well. Seventy-four patients, including 54 women (73%) and 20 men (27%), with a mean age of 44.3 ± 16.5 years were evaluated. The most common comorbidities among the patients were rheumatoid arthritis and diabetes. In addition, hydroxychloroquine, cephalosporin, and amoxicillin were found as the three most common medications associated with AGEP induction. Among the study group, seventeen (23%) patients had systemic organ involvement (nine (12.2%), six (8.1%), and five (6.8%) had hepatic, renal and pulmonary involvement, respectively). All patients responded to oral prednisolone within a median of five days (IQR = 4; ranged 2–14). The median duration of treatment was significantly longer in hydroxychloroquine group compared to other drugs (8 versus 5 days; HR 0.57,95%CI 0·35–0.91). Likewise, the median duration of treatment was significantly longer in febrile patients compared to the afebrile ones (7 versus 4 days; HR 0.46, 95%CI 0.25–0.85). Recurrence occurred in six patients after resuming treatment with the same medication. The mean Naranjo score was 7.6 ± 0.9 denoting a probable causal relationship. In this study, we found that using hydroxychloroquine and presence of fever are the risk factors potentially leading to a prolonged treatment duration of AGEP. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have demonstrated that both children and adult patients with a history of congenital heart disease (CHD) are at high risk for coronavirus disease 2019 (COVID-19) infection. This study investigates the status of COVID-19 infection among children undergoing surgical repair within the past 2 years. Methods: All alive patients operated on in a tertiary referral center between March 2018 and March 2020 were recruited in the present study. Detailed demographics, past medical and surgical history, and physical examination were reviewed for each patient. During the COVID-19 pandemic, data regarding the patient's status were collected by telephone survey from April 15 to April 30, 2020. Results: A total number of 210 patients are analyzed in this study. Participants' median age was 21.59 months [interquartile range (IQR) = 12-54.67], and 125 (59.5%) were female. The median interval between surgery and COVID-19 assessment was 305 days (IQR = 215-400). In addition, 67 (32%) patients used angiotensin receptor blocker (ARB)/angiotensin-converting enzyme (ACE) inhibitor (spironolactone and/or captopril). Sixteen patients (7.6%) were symptomatic and had positive chest CT results and/or RT-PCR compared to the previously reported prevalence of COVID-19 among the pediatric population (2.4% of children with <18 years of age); the prevalence of COVID-19 among the patients operated on due to CHD in the present study was significantly higher ( p = 0.00012). Two patients were admitted to the intensive care unit (ICU); one patient was discharged 2 weeks later with acceptable status, and one patient died 2 days after ICU admission due to cardiac and respiratory arrest and myocarditis. The complexity of the underlying cardiac disorders was not different between patients with low risk ( p = 0.522), suspicious patients ( p = 0.920), and patients positive for COVID-19 ( p = 0.234). The ARB/ACE inhibitor consumption was not associated with the COVID-19 infection [ p = 0.527, crude odds ratio (OR) = 1.407, 95% CI = 0.489-4.052]. Conclusion: Children with a history of previous CHD surgery are more susceptible to infections, especially those infections with pulmonary involvements, as the lung involvement could cause worsening of the patient's condition by aggravating pulmonary hypertension. The results of the current study indicate that these patients are more prone to COVID-19 infection compared to the healthy children population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Aghaei Moghadam, Mohammadzadeh, Sattarzadeh Badkoubeh, Ghamari, Rabbani, Mohebbi, Zeinaloo, Ashrafi, Kamran, Masoominasab, Mahmoudi, Zamani Mehryan and Mirzaaghayan.)

Background: Identifying the cardiac changes could help design measures to recover the cardiovascular system and lessen the mortality and morbidity rate. Accordingly, this cross-sectional study was performed to evaluate the echocardiography indices which are indicators of the cardiac alterations of the children with COVID19 infection. Methods: This study was performed as a cross-sectional study evaluating echocardiography indices in children infected with COVID19. Fifteen children, known cases of the COVID19, and 14 healthy children were enrolled. Evaluated parameters include left ventricle ejection fraction (LVEF), left ventricle end-diastolic diameter (LVED), mitral valve Sa (MV Sa), Tricuspid annular plane systolic excursion (TAPSE), and laboratory parameters. Results: The participants' mean age and weight were 62.8 (±48.0) months and 19.95 (±15.67) kg, respectively. None of the laboratory and echocardiography parameters differed between males and females, between patients with and without positive past medical history, between the patients with and without respiratory tract symptoms, and between patients with and without GI tract symptoms (P.0.05). Patients had significantly higher TAPSE ( p = 0.027), although MV Sa ( p = 0.01) was significantly higher among healthy children. LV EF ( p = 0.425) and LVED diameter ( p = 0.603) were not different significantly. None of the patients had pericardial effusion, pleural effusion, and cardiac tamponade. Conclusion: The heart can be involved during the disease course in children, even at the level of echocardiography indices. This could contribute to a worse prognosis, higher morbidity, and mortality rate, especially in patients with overt myocardial involvement. Non-classic indicators, including LVEF, may not be conclusive for cardiac involvement in non-symptomatic patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Mamishi, Zeinaloo, Haji Esmaeil Memar, Khodabandeh, Mirzaaghayan, Abdolsalehi, Eshaghi, Gorji, Ghamari and Aghaei Moghadam.)

Background: Known as a rare disease, Kimura disease is a chronic, allergic and inflammatory process. It may overlap other allergic conditions, as well., Case Presentation: This study is going to present a 36-year-old woman, with cough, dyspnea and bone pain. Other differential diagnoses were excluded during the investigations. The definite diagnosis was made by excisional biopsy and pathological investigations., Conclusion: This was a rare medical condition with remarkable diagnostic challenge., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)