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Background: Finding effective outpatient treatments to prevent COVID-19 progression and hospitalization is necessary and is helpful in managing limited hospital resources. Repurposing previously existing treatments is highly desirable. In this study, we evaluate the efficacy of Favipiravir in the prevention of hospitalization in symptomatic COVID-19 patients who were not eligible for hospitalization. Methods: This study was a triple-blind randomized controlled trial conducted between 5 December 2020 and 31 March 2021 in three outpatient centers in Isfahan, Iran. Patients in the intervention group received Favipiravir 1600 mg daily for five days, and the control group received a placebo. Our primary outcome was the proportion of hospitalized participants from day 0 to day 28. The outcome was assessed on days 3, 7, 14, 21, and 28 through phone calls. Results: Seventy-seven patients were randomly allocated to Favipiravir and placebo groups. There was no significant difference between groups considering baseline characteristics. During the study period, 10.5% of patients in the Favipiravir group and 5.1% of patients in the placebo group were hospitalized, but there was no significant difference between them (p-value = 0.3). No adverse event was reported in the treatment group. Conclusions: Our study shows that Favipiravir did not reduce the hospitalization rate of mild to moderate COVID-19 patients in outpatient settings.

Purpose: Human papillomavirus is suggested as a well-known risk factor for cervical cancers and nowadays, primary HPV typing is recommended as an alternative test to cervical cytology. Methods: This cross-sectional study evaluated the liquid-based cervical smears of 700 women with no history of HPV vaccination and cervical dysplastic disease from 2017 to 2020 in Isfahan, Iran. Here, we try to compare the prevalence of HPV genotypes using COBAS (@roch) with the results of pap smear cytology in evaluating the most appropriate test for cervical cancer screening, especially in low-resource societies. Results: The prevalence of HPV infection was 23.3%, including 8.7% with HPV 16/18 and 14.6% with other HR (high-risk) HPVs. Considering positive HPV genotypes, the frequency of HR HPV decreases in older age groups; 42.1% compared to 6.8%. In cytology reports, 8 out of 16 individuals with high-risk lesions were negative for any type of HPV; on the other hand, there were 129 HR HPV-positive patients out of 570 negative or low-risk pap smear results.Conclusion: It assumed that there is no superiority for HPV genotyping over cytology or vice versa in detecting high-risk patients for cervical cancer; As only 26.8% of women with HPV show abnormal cytology; and from those with normal cytology, 17.9% were positive for HR HPV. Screening with one method had a rare but high risk of delay in the timely detection of cervical cancer. Above that, the high prevalence of HPV infection in unvaccinated women also reveals the need for studies on the cost-effectiveness of universal vaccination.

Background: The Comprehensive Child Development Center was established in 2012 in the center of Isfahan province to rapidly identify and intervene in the developmental problems of children. The aim of this study was to evaluate the implementation of this program. Methods: This was a descriptive-analytical study conducted based on the framework for evaluating public health programs established by the Center for Disease Control and Prevention of United States of America with regard to evaluation of infrastructure, process and outcome. The infrastructure’s checklist included an area of land, equipment, workforce and equipment completed with presence of researcher at the center. Process and outcome evaluation was performed for 127 registered children during 2019. A satisfaction questionnaire was completed in person or remotely by parents of 144 children referred to the center in 2019 and 2020. Data were analyzed using descriptive statistics and independent t-test, and one-way ANOVA was carried out through SPSS 16 software. Results: The overall compliance of infrastructure with standards was 75.42%, with the highest compliance related to the equipment and the lowest related to the specialized workforce. The degree of compliance of the process compared with the standard one varied in different dimensions. 6.30 % of the children were cured and 76.38 % quit treatment. The most common reasons for treatment discontinuation were lack of appointment (29.53 %) and long distance (18.12 %). The overall satisfaction score was 83.90 ± 14.08. The satisfaction of the parents who completed the questionnaire in person was higher than those who completed the questionnaire remotely. Conclusion: The results of this study revealed that the rate of complete cure is low and the rate of treatment discontinuation is high, whose main reasons were the lack of appointment to admit children with developmental disorders and long distance. It is suggested that, in order to solve the problem, the Ministry of Health establish more centers and provide the required workforce.

Introduction: Red blood cell distribution width (RDW) has been introduced as a predictive factor for mortality in several critical illnesses and infectious diseases. This study aimed to assess the possible relationship between RDW on admission and COVID-19 in-hospital mortality. Method: This cross-sectional study was performed using the Isfahan COVID-19 registry. Adult confirmed cases of COVID-19 admitted to four hospitals affiliated with Isfahan University of Medical Sciences in Iran were included. Age, sex, O2 saturation, RDW on admission, Intensive Care Unit admission, laboratory data, history of comorbidities, and hospital outcome were extracted from the registry. Cox proportional hazard regression was used to study the independent association of RDW with mortality. Results: 4152 patients with the mean age of 61.1 ± 16.97 years were included (56.2% male). 597 (14.4%) cases were admitted to intensive care unit (ICU) and 477 (11.5%) cases died. The mortality rate of patients with normal and elevated RDW was 7.8% and 21.2%, respectively (OR= 3.1, 95%CI: 2.6-3.8), which remained statistically significant after adjusting for age, O2 saturation, comorbidities, and ICU admission (2.03, 95% CI: 1.68-2.44). Moreover, elevated RDW mortality Hazard Ratio in patients who were not admitted to ICU was higher than ICU-admitted patients (3.10, 95% CI: 2.35-4.09 vs. 1.47, 95% CI: 1.15-1.88, respectively). Conclusion: The results support the presence of an association between elevated RDW and mortality in patients with COVID-19, especially those who were not admitted to ICU. It seems that elevated RDW can be used as a predictor of mortality in COVID-19 cases.

Background: Nurses experience moral distress due to barriers in the workplace in the process of moral decision-making. It seems that the psychological ability of nurses in clinical environments can reduce their moral distress. Objectives: The present study aimed to investigate the relationship of moral distress and psychological ability of nurses working in hospitals affiliated to Shahroud University of Medical Sciences in 2018. Methods: In this descriptive-correlational study, all eligible nurses were included in the study through the convenience sampling method. Two questionnaires were used to collect the data, including Corleychr('39')s Moral Distress Scale and Spritzer’s Psychological Empowerment. Finally, data analysis was performed using descriptive and analytical statistics. SPSS software was used to analyze the data by descriptive and inferential statistics tests such as independent t-test, Pearson’s correlation, and unilateral analysis. (P-vlue

COVID-19 infection affects different organs of the human body, and blood cells are not an exception. Peripheral blood smear (PBS) is a simple and available method to investigate blood cells’ morphologic changes. In this study, we aimed to determine the morphologic changes and abnormalities of COVID-19 patients and their relation to the patients’ clinical course. In this prospective cross-sectional study, we included 89 PCR-positive COVID-19 patients. A pathologist examined the PBS findings of these patients. The patients’ clinical course, including severity, outcome, intubation, and ICU admission, was extracted from their profiles. The statistical analyses were done to find out the relation between PBS findings and patients’ clinical course. Results showed that smudge cells are the most frequent abnormality in our participants. Other findings were schistocyte; atypical lymphocytes; and increased large granular lymphocytes, shift to left of granulocytes, giant platelets, and leukoerythroblastic reaction. Our results did not show any statistically significant relationship between PBS findings and their clinical course. Although other studies suggested PBS as a possible predictive tool for COVID-19 disease, our study showed that these findings could not predict nor relate to the patients’ clinical course. Supplementary Information The online version contains supplementary material available at 10.1007/s12308-021-00459-3.

Purpose: The COVID-19 pandemic and governmental counter measurements, confinement in particular, have changed the routines of everyday life of people all over the world. To assess the psychological consequences of daily life changes during COVID-19 pandemic in the Iranian population.Method: We performed an anonymous online survey in the first 3 weeks of March 2020. Participants had to rate their stress levels and depressive symptoms during the last two weeks and before the pandemic retrospectively. The changes in psychological measurements and its association with socio-demographic factors and burdens due to confinement were assessed.Results: Overall, among the 3210 subjects who participated in our study, we observed an increase in both stress levels and average depression score. However, about 23% of subjects reported a decrease in their stress levels during the pandemic. The burden of childcare at home, restrictions in private life, and the burden of thoughts about the future were positively correlated with changes in stress levels and depression scores. On the other hand, feeling relieved in the pandemic condition, and enjoying more family time associated with less change in stress levels and depression scores. Being religious and older age were identified as resilience factors, whereas being a student, seeking a job, and having a psychiatric disorder history were identified as risk factors for depression.Conclusion: Stress levels and depressive symptoms have increased during COVID-19 pandemic and this increase is in relation to different social and personal burdens due to confinement strategy.

Background: Health-care workers (HCWs) as frontline soldiers are involved in the war against COVID-19. Not only their protection from COVID-19 is important but also their mental health is a concern. This study aimed to measure the psychological distress among HCWs in the time of COVID-19 in Isfahan, Iran. Materials and Methods: A cross-sectional study was conducted in the 2nd month of the spread of COVID-19 in Isfahan, Iran (March 16 to April 3). A total of 321 HCWs participated in an online survey and answered the General Health Questionnaire, the Insomnia Severity Index, and the Medical Outcomes Study Social Support Survey. t-test and ANOVA were used for comparing variables between groups. Multiple linear regression was used to evaluate the predictive factors of psychological distress. Results: About 34% of our HCWs suffer from some levels of psychological distress. The result of multiple linear regression (R2: 0.41) shows that the predictive variables with the highest value were insomnia, working as a medical resident, and lack of social support (standardized coefficient of beta: 0.51, 0.25, and 0.16, respectively; P < 0.05). Conclusion: The result of our study shows that about one-third of HCWs in COVID-19 special hospitals have some psychological problems. Being a medical resident, suffering from insomnia, and lack of social support are predictive variables.

Objectives To estimate the cost effectiveness of introducing the quadrivalent human papillomavirus (HPV) vaccine into the national immunization program of Iran. Methods The CERVIVAC cost-effectiveness model was used to calculate incremental cost per averted disability-adjusted life-year by vaccination compared with no vaccination from both governmental and societal perspectives. Calculations were based on epidemiologic parameters from the Iran National Cancer Registry and other national data sources as well as from literature review. We estimated all direct and indirect costs of cervical cancer treatment and vaccination program. All future costs and benefits were discounted at 3% per year and deterministic sensitivity analysis was used. Results During a 10-year period, HPV vaccination was estimated to avert 182 cervical cancer cases and 20 deaths at a total vaccination cost of US $23,459,897; total health service cost prevented because of HPV vaccination was estimated to be US $378,646 and US $691,741 from the governmental and societal perspective, respectively. Incremental cost per disability-adjusted life-year averted within 10 years was estimated to be US $15,205 and US $14,999 from the governmental and societal perspective, respectively, and both are higher than 3 times the gross domestic product per capita of Iran (US $14,289). Sensitivity analysis showed variation in vaccine price, and the number of doses has the greatest volatility on the incremental cost-effectiveness ratio. Using a two-dose vaccination program could be cost-effective from the societal perspective (incremental cost-effectiveness ratio = US $11,849). Conclusions Introducing a three-dose HPV vaccination program is currently not cost-effective in Iran. Because vaccine supplies cost is the most important parameter in this evaluation, considering a two-dose schedule or reducing vaccine prices has an impact on final conclusions.

Background: Cardiac patients’ beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients’ beliefs about illness and treatment. Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α

Background: The incidence of overweight and obesity in children has increased in recent decades. Physical activity (PA), which is a multidimensional behavior, has an important role in preventing and decreasing obesity. The aim of the study is to evaluate the knowledge, attitude, and exercise habits of middle school students and also explore the differences regarding demographic variables in Isfahan, Iran. Materials and Methods: One thousand seven hundred and forty-one middle school students were studied in this cross-sectional study, in 2015, Isfahan. Knowledge, attitude, and pattern of PA were evaluated by a questionnaire. Data were described using central tendency and dispersion values, as well as t-test, Chi-square, ANOVA, and linear regression tests for further analysis. Results: Students living in Khour and Biabanak and Tiran got the highest and lowest scores in knowledge (mean ± standard deviation: 9 ± 1.32 and 6.7 ± 2.19, respectively). Education of the father is the only variable which was associated with the knowledge about PA after adjusting for other factors. About 62.5% of the students mentioned a good attitude toward PA. About 50% of the students said that they always and often do exercise. The most favorable exercise for all the students was walking. Conclusion: We provide the pattern of PA among middle school students of Isfahan province, which can be used to design evidence-informed policies and interventions that aim to increase PA in students.

The affiliation of the 6th author Dr. Abolfazl Mehdizadehkashi was incorrect. It has been corrected to Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.

The coronavirus COVID-19 is affecting 213 countries and territories around the world. Iran was one of the first affected countries by this virus. Isfahan, as the third most populated province of Iran, experienced a noticeable epidemic. The prediction of epidemic size, peak value, and peak time can help policymakers in correct decisions. In this study, deep learning is selected as a powerful tool for forecasting this epidemic in Isfahan. A combination of effective Social Determinant of Health (SDH) and the occurrences of COVID-19 data are used as spatiotemporal input by using time-series information from different locations. Different models are utilized, and the best performance is found to be for a tailored type of long short-term memory (LSTM). This new method incorporates the mutual effect of all classes (confirmed/ death / recovered) in the prediction process. The future trajectory of the outbreak in Isfahan is forecasted with the proposed model. The paper demonstrates the positive effect of adding SDHs in pandemic prediction. Furthermore, the effectiveness of different SDHs is discussed, and the most effective terms are introduced. The method expresses high ability in both short- and long- term forecasting of the outbreak. The model proves that in predicting one class (like the number of confirmed cases), the effect of other accompanying numbers (like death and recovered cases) cannot be ignored. In conclusion, the superiorities of this model (particularity the long term predication ability) turn it into a reliable tool for helping the health decision-makers.

Background: High systolic blood pressure is the leading risk factor for global mortality. Applying effective strategies to control hypertension is a rising concern. Guidelines are approved to be effective in the management of patients with cost-effective interventions. The aim of this study is to evaluate the adherence of family physicians working in Isfahan health centers to the national hypertension guideline, in 2019. Methods: Using a cross-sectional study, the practice of 43 physicians selected by a multistage sampling method from the perspective of hypertension management was observed in 377 visits. The data gathering form was designed according to the national hypertension guideline. Adherence to the guideline was evaluated by dividing the earned score by the most score one can earn. Data were analyzed using Independent T-test, Pearson correlation and linear regression model. Results: The mean score of adherence to the national hypertension guideline was 33.6 ± 16.42%. There was a significant association between physician's sex, years passed from graduation, type of occupation contract, type of university of education, and attending empowerment class and adherence to the national hypertension guideline. Conclusions: The results of our study show that family physicians just follow one-third of the recommendations in the national hypertension guideline.

The development of resistance toward current cancer therapy modalities is an ongoing challenge in gynecological cancers, especially ovarian and cervical malignancies that require further investigations in the context of drug- and irradiation-induced resistance. In this regard, curcumin has demonstrated beneficial and highly pleiotropic actions and increased the therapeutic efficiency of radiochemotherapy. The antiproliferative, anti-metastatic, anti-angiogenic, and anti-inflammatory effects of curcumin have been extensively reported in the literature, and it could also act as a chemopreventive agent which mitigates the out-of-target harmful impact of chemotherapeutics on surrounding normal tissues. The current review discussed the modulating influences of curcumin on some cell and molecular features, including the cell signaling and molecular pathways altered upon curcumin treatment, the expression of target genes involved in the progression of gynecological cancers, as well as the expression of genes accountable for the development of resistance toward common chemotherapeutics and radiotherapy. The cell molecular targets implicated in curcumin's resensitizing effect, when used together with cisplatin, paclitaxel, and irradiation in gynecological cancers, are also addressed. Finally, rational approaches for improving the therapeutic benefits of curcumin, including curcumin derivatives with enhanced therapeutic efficacy, using nanoformulations to advance curcumin stability in physiological media and improve bioavailability have been elucidated.

The development of resistance toward current cancer therapy modalities is an ongoing challenge in gynecological cancers, especially ovarian and cervical malignancies that require further investigations in the context of drug- and irradiation-induced resistance. In this regard, curcumin has demonstrated beneficial and highly pleiotropic actions and increased the therapeutic efficiency of radiochemotherapy. The antiproliferative, anti-metastatic, anti-angiogenic, and anti-inflammatory effects of curcumin have been extensively reported in the literature, and it could also act as a chemopreventive agent which mitigates the out-of-target harmful impact of chemotherapeutics on surrounding normal tissues. The current review discussed the modulating influences of curcumin on some cell and molecular features, including the cell signaling and molecular pathways altered upon curcumin treatment, the expression of target genes involved in the progression of gynecological cancers, as well as the expression of genes accountable for the development of resistance toward common chemotherapeutics and radiotherapy. The cell molecular targets implicated in curcumin’s resensitizing effect, when used together with cisplatin, paclitaxel, and irradiation in gynecological cancers, are also addressed. Finally, rational approaches for improving the therapeutic benefits of curcumin, including curcumin derivatives with enhanced therapeutic efficacy, using nanoformulations to advance curcumin stability in physiological media and improve bioavailability have been elucidated.

The affiliation of the 6th author Dr. Abolfazl Mehdizadehkashi was incorrect. It has been corrected to Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.

Prevalence of postpartum depression is estimated to be about 10-15% worldwide. Many risk factors are supposed to play a role leading a new mother to maternal postpartum depression which can considerably affect the baby, mother, family and also the society.To investigate the prevalence of maternal postpartum depression and its association with social support.Using a cross-sectional study, 200 new mothers who attended three teaching hospitals in Tehran, Iran were selected with a convenience sampling. Postpartum depression was assessed using the Iranian version of Edinburgh Postpartum Depression Scale and women's levels of social support were measured using the Iranian version of Social Support Questionnaire.Prevalence of postpartum depression was 43.5% in new mothers. The mean (±Standard Deviation) score of social support network was 2.09±0.99; which is lower in depressed mothers in comparison to non-depressed mothers (1.78±0.87 vs. 2.33±1.00 respectively, P0.001). A reverse significant association was found between social support and postpartum depression after adjusting for confounding variables such as past history of depression, illness of baby and medication consumption during pregnancy (Odds Ratio=0.47, 95% Confidence Interval=0.33-0.67).The bigger the social network of a mother, the less postpartum depression occurs. It is suggested to educate the family about the very important role of social support and improve it in every aspect of health care in order to prevent postpartum depression.

The aim of this study was to compare the relative efficacy of baclofen and self-applied transcutaneous electrical nerve stimulation (TENS) for the treatment of spasticity in the lower extremities in multiple sclerosis (MS).A randomized controlled clinical trial was conducted from September 2010 to June 2011. Fifty-two patients with MS presenting muscle spasm in the leg at 20-50 years of age were randomly allocated to receive a four-week treatment course of either baclofen (10 mg twice daily, increasing over three weeks to 25 mg) or self-applied TENS. Response to treatment was assessed at four weeks after commencement of the intervention by modified Ashworth scale (MAS).Spasticity decreased in both groups. Of the 26 people treated with TENS, the mean (standard deviation (SD)) MAS decreased from 1.77 (0.29) at baseline to 0.73 (0.70) at the four-week follow-up (P0.001). Correspondingly, in the 26 people treated with baclofen, the mean (SD) MAS decreased from 1.73 (0.38) to 1.15 (0.63) (P0.001). The mean difference in MAS score at the four-week follow-up was significantly lower in the TENS group than the baclofen group (mean difference -0.42; 95% CI, -0.79, -0.05; P0.05).This study demonstrates that both baclofen and TENS can be effective in reducing MS-related spasticity. The mean MAS score was significantly lower in the TENS group. However given the side-effect profile of baclofen, TENS may have some benefits over baclofen.

Background: Between 10 and 20% of children with Kawasaki disease (KD) will not respond to intravenous immunoglobulin (IVIG) treatment, and are prone to coronary abnormalities. A variety of predicting scoring systems, including the Kobayashi system, have been proposed, but have not yet been evaluated using Iranian patients. Objectives: To evaluate the Kobayashi scoring system with regard to predicting response to IVIG treatment in Iranian children. Patients and Methods: All patients who received a final diagnosis of KD at Aliasghar children’s hospital between 1982 and 2013, and who met the inclusion criteria, were enrolled in this retrospective cohort study. We excluded patients with missing data, abnormal echocardiographic finding on admission, late admission, atypical or afebrile cases, and those who had received an insufficient amount of IVIG. We compared demographic and echocardiographic data before IVIG, and within 7 days of treatment, as well as C reactive protein (CRP), sodium, aspartate aminotransferase, platelet levels, neutrophil percentage, age of patients, and duration of fever before IVIG administration, in treatment responders and non-responders. Results: Of the 141 cases, 97 patients met the criteria and were enrolled. Of these, 19 (19.6%) did not respond to IVIG. A total of 61.8% of patients were male, and the mean patient age was 36.9 months (SD = 32.1 months). Echocardiographic evaluation revealed early coronary involvement in 15.3% of patients, and coronary abnormalities were diagnosed in 10% of patients within the first 10 days of presentation and concurrent with their IVIG treatment. A between-groups comparison of quantitative CRP, absolute neutrophil count, and platelet count showed that platelet count alone was significantly higher in nonresponders (P = 0.04). With regard to items of Kobayashi scoring system, data were present for just 41 cases, but a significant difference between the two groups was shown, with the treatment-refractory group having a significantly higher score (P = 0.002). Receiver-operating characteristic curve analysis revealed that the optimum cut-off point for our population would be 2, which makes the sensitivity of the test equal to 75%, with a specificity of 60%. Conclusions: This preliminary study showed that patients with KD and a high Kobayashi score are at greater risk of being unresponsive to IVIG treatment. Further studies, preferably multicenter evaluations, are required in order to understand the exact application of various scoring systems in the management of people with KD in Iran.

The aim of current study was to determine women´s maternal asthma in pregnancy, delivery and birth outcomes. Using a retrospective cohort design, data of 580 pregnant women were gathered form a large teaching hospital in Tehran, Iran. The medical records of pregnant women who had attended this hospital between 2009 and 2011 were assessed. Data of delivery and birth outcomes were gathered by observation and medical records of women. Multiple logistic regression and adjusted odds ratio (OR) were used to assess the independent association of asthma and outcomes. 274 patients (47.2%) were in “asthmatic group” and 306 patients (52.8%) were in the “non-asthmatic group”. Basic and demographic variables showed the same distribution across two groups. Maternal asthma showed an adjusted relationship with gestational diabetes (OR=2.64), gestational hypertension (OR=3.79), cesarean delivery (OR=2.68), small for gestational age (OR=2.86), premature rupture of membrane (OR=2.18), preterm delivery (OR=1.74), abnormal vaginal bleeding (OR=3.75), and low birth weight (OR=1.78) significantly (p