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BACKGROUND: Little is known about the association between Human Immunodeficiency Virus (HIV) infection and risk of death among hospitalized COVID-19 patients. We aimed to investigate this association using a multicenter study. MATERIAL AND METHODS: This multicenter study was conducted using the registry database of Coronavirus Control Operations Headquarter from March 21, 2021 to January 18, 2020 in the province of Tehran, Iran. The interest outcome was COVID-19 death among hospitalized patients living with and without HIV. The Cox regression models with robust standard error were used to estimate the association between HIV infection and risk of COVID-19 death. The subgroup and interaction analysis were also performed in this study. RESULTS: 326052 patients with COVID-19 were included in the study, of whom 127 (0.04%) were living with HIV. COVID-19 patients with HIV were more likely to be female, older, and to have symptoms such as fever, muscular pain, dyspnea and cough. The death proportion due to COVID-19 was 18 (14.17%) and 21595 (6.63%) among HIV and non-HIV patients, respectively. Patients living with HIV had lower mean survival time compared to those without HIV (26.49 vs. 15.31 days, P-value = 0.047). Crude risk of COVID-19 death was higher among HIV patients than in non-HIV group (hazard ratio[HR]: 1.60, 1.08–2.37). Compared to those without HIV, higher risk of COVID-19 death was observed among patients with HIV after adjusting for sex (1.60, 1.08–2.36), comorbidities (1.49, 1.01–2.19), cancer (1.59, 1.08–2.33), and PO2 (1.68, 1.12–2.50). However, the risk of COVID-19 death was similar in patients with and without HIV after adjusting for age (1.46, 0.98–2.16) and ward (1.30, 0.89–1.89). CONCLUSION: We found no strong evidence of association between HIV infection and higher risk of COVID-19 death among hospitalized patients. To determine the true impact of HIV on the risk of COVID-19 death, factors such as age, comorbidities, hospital ward, viral load, CD4 count, and antiretroviral treatment should be considered.

Background: Job burnout is a prolonged response to chronic emotional and interpersonal stressors. Objectives: This study aimed to evaluate job burnout and identify its effective predictors among health sector employees during the COVID-19 pandemic. Methods: This cross-sectional study encompassed 1898 employees of the Shahid Beheshti University of Medical Sciences in the summer of 2020. Logistic regression was used to determine factors associated with job burnout. The required data were collected electronically using the Maslach Burnout Inventory (MBI) and analyzed with SPSS software version 26 and R4.0.2 software. Results: Of 1898 participants, 74.3% were female. Composite job burnout (CJB), emotional exhaustion (EE), and depersonalization (DP) were the most common at low levels, whereas reduced personal accomplishment (RPA) was the most frequent at moderate levels. In this regard, factors such as female gender, age groups of 40 - 49 and ≥ 50 years, and exposure to COVID-19 were the main independent risk factors for job burnout. Conclusions: Reduced personal accomplishment was moderate despite relatively low levels of job burnout, EE, and DP. Accordingly, effective interventions are suggested to improve different aspects of the work-life with an emphasis on critical situations. Moreover, regarding the significant relationship between job burnout with gender, age, and exposure to COVID-19, it is recommended to increase the employees’ knowledge about job burnout.

Background: Wilson’s disease is a rare autosomal recessive genetic disorder of copper metabolism, which is characterized by hepatic and neurological disease. ATP7B encodes a transmembrane protein ATPase (ATP7B), which functions as a copper-dependent P-type ATPase. The mutations in the gene ATP7B (on chromosome 13) lead to Wilson’s disease and is highly expressed in the liver, kidney, and placenta. Consequently, this enzyme was considered a special topic in clinical and biotechnological research. For in silico analysis, the 3D molecular modeling of this enzyme was conducted in the I-TASSER web server. Methods: For a better evaluation, the important characteristics of this enzyme such as the rare codons of the ATP7B gene were evaluated by online software, including a rare codon calculator (RCC), ATGme, LaTcOm, and Sherlocc program. Additionally, the multiple sequence alignment of this enzyme was studied. Finally, for evaluation of the effects of rare codons, the 3D structure of ATP7B was modeled in the Swiss Model and I-TASSER web server. Results: The results showed that the ATP7B gene has 35 single rare codons for Arg. Additionally, RCC detected two rare codons for Leu, 13 single rare codons for Ile and 28 rare codons for the Pro. ATP7B gene analysis in minmax and sliding_window algorithm resulted in the identification of 16 and 17 rare codon clusters, respectively, indicating the different features of these algorithms in the detection of RCCs. Analyzing the 3D model of ATP7B protein showed that Arg816 residue constitutes hydrogen bonds with Glu810 and Glu816. Mutation of this residue to Ser816 cause these hydrogen bonds not to be formed and may interfere in the proper folding of ATP7B protein. Furthermore, the side chain of Arg1228 does not form any bond with other residues. By mutation of Arg1228 to Thr1228, a new hydrogen bond is formed with the side chain of Arg1228. The addition and deletion of hydrogen bonds alter the proper folding of ATP7B protein and interfere with the proper function of the ATP7B position. On the other hand, His1069 forms the hydrogen bonds with the His880 and this hydrogen bond adhere two regions of the protein together, which is critical in the final structural folding of ATP7B protein. Conclusion: Previous studies show that synonymous and silent mutations have been linked to numerous diseases. Given the importance of synonymous and silent mutations in diseases, the aim of this study was to investigate the rare codons (synonymous codons) in the structure of ATP7B enzyme. By these analyses, a new understanding was developed and our findings can further be used in some fields of the clinical and industrial biotechnology.

Objective: The aim of study was to conduct a time-based analysis to utilize the obtained knowledge for forecasting the trend of accidents in the future. Methods: The present study, which was conducted as a cross-sectional research, investigated deaths from traffic accidents in Fars Province during a five-year period from 2013 to 2018. The pseudo-regression model of Spline was used to predict the increase in mortality rate by 2021. Results: The forecasted values indicated a decline in deaths from traffic accidents by 2021. A total of 8020 records of accidents leading to death were included in the study. The mean mortality rate from traffic accidents in the province was approximately estimated to be 33.7 per 100,000 populations. More than half of the people who died (52.36%) were in a car, 25.57% were motorcycle riders, and 19.93% were pedestrians. The highest rate of deaths was observed in the age group of 16 to 25 years old (21.5%). The data indicated a reduction in the rate of death among car riders and pedestrians and an increase in the number of deaths among motorcycle riders. The trend of deaths occurred outside the city had been increasing while the trend of deaths occurred inside the city had been decreasing. Conclusion: The present regulations are only able to reduce a small number of deaths each year. In order to achieve a downward trend in mortality with a steeper pace, it is necessary to design and implement more intelligent standards, not merely the stricter ones. This project has been approved by the research ethic committee, as well as, supported with grant number of 97-01-38-17825 by Shiraz University of Medical Sciences in Shiraz, Iran.

Background: It is essential to pay special attention to sexual health of transgender women. The aim of this study was to assess sexual behaviors and vulnerability of transgender women to sexually transmitted infections (STIs) including AIDS.Method: A cross-sectional study was conducted using convenient sampling from August 2019 to march 2020 in Iran. 127 transgender women participated in this study .A researcher-made questionnaire was applied for evaluating sexual behaviors, STIs and HIV. Results: The mean age of participants and their age of sexual debut were 27.6 and 16.9, respectively. 92.1% of participants were single with experience of sex and 59.3% had one sex partner in the last 2 years. 96.9% of the participants were heterosexual with 67.2% reporting experiencing orgasm in at least 50% of their sexual intercourse. However, 42.5% reported dyspareunia and the same percentage reported low or very low sexual satisfaction. The majority of participants had little knowledge of the symptoms (33.9%) and complications (44.1%) of STIs. Although 87.4% and 72.4% of participants had never been tested for a STI and HIV, 1.6% were infected with HIV and 18.1% with STIs. Conclusion: Sexual interests of Iranian transgender women were aligned with those of cisgender women. In terms of sexual function, despite the higher rate of orgasm in transgender women, sexual satisfaction was lower in them compared to that of cisgender women due to dyspareunia and body dissatisfaction, which highlights the need to investigate for more effective surgeries and specific sexual counseling interventions in this group.

During extensile lateral approach to the calcaneus, in order to see all fractured fragments and subtalar joint, all soft tissues including insertion site of superior peroneal retinaculum (SPR) on the calcaneus should be released. The aim of this study was to evaluate the probability of peroneal tendon dislocation by releasing all soft tissues attached to the calcaneus. In 10 fresh cadavers, after standard extensile lateral approach to the calcaneus in right side, all soft tissues attached to the lateral wall of the calcaneus were excised. In the left side of each cadaver, all soft tissues inserted to the superior border of calcaneal tuberosity in addition to the lateral wall of the calcaneus were cut out. Probable anterior dislocation of peroneal tendons in the retromalleolar groove was assessed by placing a clamp into the peroneal tendon sheath from distal to proximal and advancing it to the retromalleolar groove. Also by careful dissection, any instability of peroneal tendons was visualized. Not any anterior dislocation of peroneal tendons to the lateral malleolus tip was seen in any stage of the procedure. Insertions of the SPR to the fascia of the deep posterior compartment of the leg and the Achilles tendon sheath are the main soft tissue stabilizer of the peroneal tendons in the retromalleolar groove. So resection of the insertion site of the SPR to the calcaneus might not result in the peroneal tendon instabilities.

Objective Globally, suicide is the second leading cause of death among young people. Although completed suicide is rare before puberty, the incidence of adolescent suicide has increased significantly at the late ages of 10–19. Hence, this study investigates the adolescent suicide, aged 10–19, in southern Iran. Methods In this cross-sectional study, all data regarding the demographics, causes, methods, outcomes, past medical history of suicide attempts and suicide death were collected from the Mental Health and Suicide Surveillance Systems of Fars province between 2011 and 2016. Results Overall 6-year incidence rate of suicide attempts and death were 193.49/100,000 and 7.91/100,000, respectively. Case-fatality rate was 4.09%. During the period of 6 years, an increasing trend has been observed for both the rates of suicide attempt and death. Family conflicts were the major cause and medication overdose was the main method of suicides. After controlling the effects of confounders by logistic regression, male gender, living in the rural area and age are among the risk factors of fatality in suicide attempts. Conclusions Suicide attempts and deaths have been increased in adolescents. Therefore, due to the vulnerability of this age group, we need to understand all components of suicide to educate families and to help policy makers.

*Corresponding Author Email: saeedghmail@yahoo.com ABSTRACT Suicide is considered as the tenth cause of the death worldwide. Among different pesticides, organophosphorus pesticides (OPs) are the most widely used, but they are highly toxic, so there are increasing suicide reports about use of them. Considering the low rate of organophosphorus pesticides in the suicide reports, these two cases helped us to improve our customary methods of extraction. In this study, two cases of suicide related to a 25-yearold girl and 36-year-old man who have taken high doses of Diazinon. Both cases were dead on arrival to the hospital so no medical cases were done for them and they were brought to the Fars Legal Medicine Organization. They were suspected of using some toxins or drugs. Diazinon and Dithion were extracted using modified solid phase extraction method in the gastric content of both cases by GC-MS analysis. Modified solid phase extraction method is so helpful for toxicological analysis and detection of cause of the death in suicide, homicide or accidental died cases of organophosphorus poisoning referred to legal medicine organization.

Background: Childhood and adolescent injuries are among the most significant health system hazards, especially in developing countries including Iran. In this report, we evaluated the main characteristics of all cases of pediatric injury-related mortality in Shiraz in a 5 - year - period. Methods: This cross - sectional study comprised all injury- related deaths in children and adolescents up to 18 years of age, from September 2011 to September 2016 in Shiraz, Iran. The required information about demographic factors including age, sex, cause of death, the manner and location of death and time period between injury and death was collected for all the cases. Results: There were 485 cases (66% male) with mean age of 8.7 ± 5.9 years. The crude mortality rate was 21.6 per 100000 population in each year. Infants had the lowest rate during the first year (6.4%) and children between 1 to 4 years had the highest rate of death (28.7%). Accident was the most common manner of death occurring in 393 (81.0%) followed by suicide in 58 (12.0%) decedents. Mortality due to electrical injury, traffic accidents, falling down, burns, drowning and blunt trauma were more common in the 1 - 4 years age group. Suffocation, poisoning, work accident and firearm were the most common cause of death in 15 - 18 year - old children. Except for aspiration, firearm and penetrating trauma, all other causes were more common in boys. The most common location of death was at the scene of injury (48 %). The majority of deaths occurred in the first 6 hours after injury (311 cases, 64.1%). Conclusions: Most cases of pediatric injury - related mortality were secondary to preventable injuries and occurred during the first 6 hours and before arriving at the hospital. Thus, injuries should be considered as one of the priorities of the health system and preventive measures such as educating the caregivers regarding these events should be emphasized.

Purpose: An analysis and identification of the hidden relationships between effective factors in the mortality rate caused by road accidents in Fars Province of Iran to prevent and reduce traffic accidents in the future. Methods: This cross-sectional study was conducted to integrate all the pervious researches performed on mortality rate of road traffic accidents in Fars Province from March 21, 2013 to March 20, 2017. In order to reveal the relationships between the factors affecting mortality rates of road traffic accidents, the data regarding road traffic accidents extracted from resources such as Legal Medicine Organization, Traffic Police, Accident & Emergency Department, as well as Department of Roads and Urban Development of Fars Province, then cleaned and the applicable attributes embedded in the data all aggregated for further analysis. It should be noted that the data not related to Fars Province were deleted, the data analyzed, converted and the aggregation between various attributes identified. The aggregation between these different attributes as well as the FP-growth algorithm and two indexes of support and confidence calculated and interesting and effective rules extracted. In the end, several accident-provoking factors, the degree of consecutive and interdependence of each one in road accidents identified and introduced. The statistical analysis was conducted by using Rapid Miner software. Results: Of the 6216 people dead due to road traffic accidents, 4865 (79.02%) were male and 1292 (20.98%) were female, 59 of them have no clear gender. The largest portion of people died of road traffic accidents belonged to married and self-employed men who collided with motorcycles in autumn. Moreover, young individuals (aged 19–40 years) with secondary educational level who died of accidents in summer at 12:00 a.m. and then 5:00 p.m. in outer city main roads of Kazerun-Shiraz, then Darab-Shiraz, Fasa-Darab and in within-city main streets had the highest mortality rates. Among women, the middle-aged group (aged 41–65 years) followed by young-aged group (aged 19–40 years) with elementary educational level and then illiterate accounted for the highest mortality rate of road traffic accidents. The automobiles involved in accidents included Pride, Peugeot 405, Peykan pickup, Samand, Peugeot Pars, other vehicles and motorcycles. Conclusion: The high mortality rate of illiterate and low-literate in various age groups indicates that educational level plays a crucial role as a factor in road accidents, requiring related organizations such as Traffic Police and Ministry of Education to take necessary measures and policies. Keywords: Road traffic accidents, Mortality, Vehicle, Fars province Iran

Background Suicide is a critical psychological issue worldwide with an increasing trend. This study investigated suicide comprehensively. Methods In this cross-sectional study, we reviewed data of 28 552 suicide attempts during 2011-16, in Southern Iran. To calculate age-standardized incidence rates, population statistics were derived from the Statistical Center of Iran and the National Organization for Civil Registration. We used the standard population of World Health Organization 2012 to adjust the suicide attempts and deaths rates by age. Results The mean age of participants was 26.8 ± 10.6 years with the highest suicide attempts rates in the age groups of 15-24 and 25-34 years (48% and 32.5%, respectively); 58.7% were women and 52.9% were single. Case-fatality rate (CFR) was 6.27%. Annual age-standardized incidence rates of suicide attempts during the 6-year period has increased (P 0.05). Logistic regression model showed male sex, rural area, older age, psychological and somatic disorders, and family history of suicide as significant factors. Conclusions In this comprehensive study, although the age-standardized mortality rate of suicide in southern Iran was lower than in other countries, the increasing trend of suicide attempts during the study period served as an alarming sign in this province.

Background Hepatitis B virus (HBV) as an infectious disease that has nine genotypes (A - I) and a 'putative' genotype J. Objectives The aim of this study was to identify the rare codon clusters (RCC) in the HBV genome and to evaluate these RCCs in the HBV proteins structure. Methods For detection of protein family accession numbers (Pfam) in HBV proteins, the UniProt database and Pfam search tool were used. Protein family accession numbers is a comprehensive and accurate collection of protein domains and families. It contains annotation of each family in the form of textual descriptions, links to other resources and literature references. Genome projects have used Pfam extensively for large-scale functional annotation of genomic data; Pfam database is a large collection of protein families, each represented by multiple sequence alignments and hidden Markov models (HMMs). The Pfam search tools are databases that identify Pfam of proteins. These Pfam IDs were analyzed in Sherlocc program and the location of RCCs in HBV genome and proteins were detected and reported as translated EMBL nucleotide sequence data library (TrEMBL) entries. The TrEMBL is a computer-annotated supplement of SWISS-PROT that contains all the translations of European molecular biology laboratory (EMBL) nucleotide sequence entries not yet integrated in SWISS-PROT. Furthermore, the structures of TrEMBL entries proteins were studied in the PDB database and 3D structures of the HBV proteins and locations of RCCs were visualized and studied using Swiss PDB Viewer software®. Results The Pfam search tool found nine protein families in three frames. Results of Pfams studies in the Sherlocc program showed that this program has not identified RCCs in the external core antigen (PF08290) and truncated HBeAg gene (PF08290) of HBV. By contrast, the RCCs were identified in gene of hepatitis core antigen (PF00906 and the residues 224 - 234 and 251 - 255), large envelope protein S (PF00695 and the residues 53-56 and 70 - 84), X protein (PF00739 and the residues 10 - 24, 29 - 83, 95 - 99. 122 - 129, 139 - 143), DNA polymerase (viral) N-terminal domain (PF00242 and the residues 59 - 62, 214 - 217, 407 - 413) and protein P (Pf00336 and the residues 225 - 228). In HBV genome, seven RCCs were identified in the gene area of hepatitis core antigen, large envelope protein S and DNA polymerase, while protein structures of TrEMBL entries sequences found in Sherlocc program outputs were not complete. Conclusions Based on the location of detected RCCs in the structure of HBV proteins, it was found that these RCCs may have a critical role in correct folding of HBV proteins and can be considered as drug targets. The results of this study provide new and deep perspectives about structure of HBV proteins for further researches and designing new drugs for treatment of HBV.

Non-suicidal self-harm includes cutting, scratching, burning and minor overdosing. There have been few studies that have examined the rate and pattern of self-harm among different individuals of the society. We performed a population-based study to determine different aspects of non-suicidal self-harm in cases referred to legal medicine organization of Fars Province and south Iran. In a population-based longitudinal survey, we applied data from cases referred to legal medicine organization of Fars province. The survey included questions about the history, method, frequency, age of onset and help-seeking for non-suicidal self-harm. The data about non-suicidal self-harm were collected since 2007 to 2011 and analyzed using students' T-test for continuous data and χ2 for binary or categorical data using SPSS ver. 21.0. Totally 2166 individuals were diagnosed who had ever harmed themselves. Self-injuries such as cutting, scratching and self-hitting were the most common forms of non-suicidal self-harm (83.2%). The mean age of onset was 25.7 ± 2.6 years. Self-injury was more frequent in males and individuals with lower education levels mostly unemployed. The most frequent injury site was posterior side of the body for example shoulders (157; 9.8%) and the most type of the injury was bruise in 398(55.26%) cases. Hard objects (1197; 55.26%) were the most used devices for self-injury followed by cutting and sharp devices. Among those who reported non-suicidal self-harm, 56% had sought help while self-injury. We found a high prevalence of non-suicidal self-harm in different individuals of the society in Fars province since 2007 to 2011. Many mental-health symptoms as well as legal and financial gains should be evaluated for any association with this behavior.

Legal Medicine Research Center, Legal Medicine Organization, Tehran, IR Iran Department of Theology, Faculty of Literature and Humanities Science College, Yasouj University, Yasouj, IR Iran Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Midwifery, Maternal Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran Corresponding author: Marzieh Akbarzadeh, Department of Midwifery, Maternal Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116474250, Fax: +98-711647425, E-mail: akbarzadm@sums.ac.ir

Organ weight is one important indicator to discern normal from abnormal condition in forensic pathology as well as in clinical medicine. The present study aimed to investigate morphometric parameters and organ weights of southern Iranian adults, which can be fundamental sources to be compared to abnormal cases. Morphometric parameters and weights of 6 organs (heart, liver, kidney, spleen, appendix, and brain), which were harvested from 501 southern Iranian adults (385 males and 116 females) during ordinary postmortem examination, were measured. All the organs were heavier in males than in females. Heart, brain, spleen, and right kidney were significantly heavier in males compared to females, but no significant difference was observed between the 2 sexes regarding the weights of the rest of the organs. Moreover, brain and heart became heavier as one got older and most organs were heavier in middle-aged individuals compared to other age groups. Furthermore, various types of correlations were observed between different organs’ weights and body parameters. These results can be useful anatomical data for autopsy investigations, clinical practices, and research in southern Iran.