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Introduction Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began, necessary measures to prevent virus transmission and reduce mortality have been implemented, including mandatory public use of masks, regular hand-sanitizing and hand-washing, social distancing, avoidance of crowds, remote work, and cancellation of public events. During and after the introduction of COVID-19 lockout, we performed a systematic review of available published literature to investigate the incidence of seasonal influenza and other respiratory viral infections. Methods PubMed, Embase, Web of Science, Scopus, Science Direct, Google Scholar, Research Gate, and the World Health Organization databases and websites were systematically searched for original studies concerning the impact of COVID-19 prevention means and measures on other common respiratory infectious diseases during the pandemic published by March 2021. Results The findings showed that the adherence to health protocols to prevent COVID-19 could help to reduce the incidence of other infectious diseases such as influenza, pneumonia, and Mycobacterium tuberculosis. Conclusion The implemented prevention measures and protocols might have reduced the incidence of influenza and some other common respiratory infections. However, controversies exist on this matter and future large population-based studies might provide further information to address these controversies.

Introduction Since the epidemic of COVID-19 attracted the attention, reports were surrounding electrocardiographic changes in the infected individuals. We aimed at pinpointing different observed ECG findings and discussing their clinical significance. Methods We conducted a systematic search in PubMed, Embase, and Scopus databases. We included eligible original papers, reports, letters to the editors, and case reports published from December 2019 to May 10, 2020. Results The team identified 20 articles related to this topic. We divided them into articles discussing drug-induced and non-drug-induced changes. Studies reported an increased risk of QTc interval prolongations influenced by different therapies based on chloroquine, hydroxychloroquine, and azithromycin. Although these medications increased risks of severe QTc prolongations, they induced no arrhythmia-related deaths. In the non-drug-induced group, ST-T abnormalities, notably ST elevation, accounted for the most observed ECG finding in the patients with COVID-19, but their relation with myocardial injuries was under dispute. Conclusion This systematic review suggests that identifying ECG patterns that might be related to COVID-19 is vital. Provided that physicians do not recognize these patterns, they might erroneously risk the lives of their patients. Furthermore, important drug-induced ECG changes provide awareness to the health-care workers on the risks of possible therapies.

After the initial outbreak of the new Coronavirus in Wuhan at the end of December 2019, many new cases were reported in other provinces of China and also many other countries over the world, including South Korea, Italy, Iran, Japan, and 68 other countries. We present a case report of a 61-year-old woman with a history of diabetes mellitus who was referred to the emergency department of a referral hospital in Tehran, Iran. The patient presented with fever, chills, and myalgia within three days. Laboratory analysis showed increased levels of erythrocyte sedimentation rate (ESR), and mild leukopenia. SARS-CoV-2 PCR test –under the Iran Ministry of Health and Medical Education (MoH&ME) guidelines– was conducted and the result was positive. The chest X-ray showed bilateral ground-glass opacity. O2 saturation was 87% (without O2 therapy). The patient was hospitalized and treated with Oseltamivir 75 mg every 12 hours, Lopinavir/Ritonavir (Kaletra) 400/100 mg every 12 hours and hydroxychloroquine 400 mg stat. The patient's last O2 saturation measured was 93% and she had no fever on the 10th day of hospitalization. Therefore, she was discharged from hospital and quarantined at home according to the Iran Ministry of Health protocol.

Background: The recent outbreak of the coronavirus disease (COVID-19) in China has rapidly spread throughout the world and there are many reports of symptoms ranging from malaise to acute respiratory distress syndrome (ARDS) caused by this infection. However, few reports have been discussed surgical outcomes in COVID-19 patients. Case Presentation: In this report, we described a case of an elderly female developed with postoperative pulmonary complications after uneventful elective minor surgery. The patient was asymptomatic before the operation with no history of cough or fever. After surgery, the patient developed respiratory distress and chest radiological imaging revealed bilateral ground-glass opacities. It seems any type of surgeries requiring local anesthesia or general anesthesia may contribute to worsening outcomes in patients with covid19.

Background: Azithromycin has been considered as a possible therapeutic agent for COVID-19 patients. However, there is limited data on its efficacy. Case Presentation: We describe three patients diagnosed with COVID-19 who did not respond to the initial treatment but improved dramatically upon adding azithromycin with a successful outcome. Conclusion: We have presented evidence of the potential beneficial effect of the azithromycin in the treatment of patients with COVID-19 in three different clinical settings. More evidence is needed regarding the microbiological data, safety, and efficacy of this medication in the management of COVID-19.

Background: To assess the effectiveness of vitamin C treatment against coronavirus disease 2019 (COVID-19)Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received high-dose of vitamin C (six gr daily) added to the same regimen. Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. On the 3rd day of hospitalization, the mean core body temperatures was significantly lower and SpO2 was higher In the case group (p value = 0.001, and 0.014, respectively). The median length of hospitalization in case group which was significantly longer than the control group (8.5 days vs. 6.5 days) (p value = 0.0280). There was no significant difference in SpO2 levels at discharge time, the length of ICU stay, and mortality between the two groups.Conclusions: We did not find significantly better outcomes in the group who were treated with high-dose vitamin C in addition to the main treatment regimen at discharge.Trial registration: The project was registered by Iranian Registry of Clinical Trials.IRCT20200411047025N1

Introduction In the current COVID-19 pandemic, disease diagnosis is essential for optimal management and timely isolation of infected cases in order to prevent further spread. The aim of this study was to systematically review the assessment of risk and model the predictors of mortality in COVID-19 patients. Methods A systematic search was conducted of PubMed, Scopus, Embase, Google Scholar, and Web of Science databases. Variables associated with hospital mortality using bivariate analysis were included as potential independent predictors associated with mortality at the p

Background: Echocardiography is a reliable means for the diagnosis of functional and valvular diseases of the heart in HIV positive and HIV negative patients. The current study was to evaluate echocardiographic abnormalities in HIV positive patients under an antiretroviral therapy (ART) program in Tehran, Imam Khomeini Hospital, Iran. Methods: This is a descriptive cross-sectional study, conducted among 231 HIV-1 positive patients under ART. All HIV positive patients including 150 men (65%) and 81 women (35%) (mean age of 41 years) were assessed by trans-thoracic echocardiography (TTE) in Imam Khomeini Hospital, over the period from 2013 to 2014. Results: The mean CD4 count was 408 cell/μl, and the average left ventricular ejection fraction (LVEF) was 59.5%. There was an inverse correlation between age and LVEF level. Nevirapine users showed a significantly higher LVEF than non-users. Left ventricular systolic dysfunction (LVSD) was diagnosed in 5.6% along with the increase in age, while left ventricular diastolic dysfunction (LVDD) was reported in 19.5% of patients associated with age and smoking. Here, the mean systolic pulmonary arterial pressure (SPAP) was only 20 mmHg and just four percent of the patients suffered pulmonary hypertension. Almost 44% had a heart valve disorder among which mitral valve prolapse is the most common problem. Pericardial effusion was not found in any patients. Conclusion: It seems that heart disorders with no suggestive symptoms in HIV positive patients, and mainly older adults who have traditional risk factors for heart diseases, should be seriously considered by health providers.

We reviewed the medical charts of 1,700 patients diagnosed with HIV who referred to a central HIV clinic in Tehran between 2004 and 2017. Participants who had a viral load of > 200 copies/mL after six months or more on antiretroviral therapy (ART) were grouped as virologic failure (VF). We assessed the demographic characteristics, diagnosis date, first ART regimen, and resistance to various ART drugs. Out of 1,700 patients, 72 (4.2%) had a treatment failure. Among those with treatment failure, 51.3% were on zidovudine + lamivudine + efavirenz, 13.9% were on tenofovir + lamivudine + lopinavir/ritonavir, and 12.5% were on tenofovir + emtricitabine + efavirenz. In patients with treatment failure, the highest resistance was to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) combination (44.4%). In these patients, resistance to tenofovir (one of the NRTIs) was 29.1%. The highest treatment failure was observed among patients treated with nevirapine (NVP) and efavirenz (EFV)-based regimen. Our findings suggest that protease inhibitors should be considered as first-line drugs in ART regimens in VF patients in Iran.

Objective: To examine potential correlations between perceived social support and disease coping styles among people living with HIV infection at a referral center in Tehran. Methods: In an observational study, 112 patients were recruited between April and July 2012. Along with demographic characteristics, availability of tangible, informational, and emotional support was measured using subscales extracted from the medical outcomes study: social support survey; disease coping styles were investigated in four groups (problem-focused, emotion-focused, engagement-based, and meaning-based). Data were analyzed to examine whether social support subscales predict coping styles. Results: Almost 70% of the patients were male, and 52% reported sexual contact as their perceived route of infection. Use of coping styles was positively correlated with social support scores (rs = 0.53, P < 0.001), and informational support had significant influence on implementation of three out of the four coping styles (emotion-focused, problem-focused, engagement-based). Being married and not reporting the route of infection were associated with higher social support scores; monthly income and level of education had significant associations with the use of various coping styles. Conclusions: Patients who implement strategies to cope with HIV/AIDS have received more informational and emotional support. This study recommends that the delivery of informational support in a comprehensive package can practically target the current demands of our patients; while thorough investigation of potential effects on disease coping, response to treatment, and compliance can aid us in the design of interventions to target stigma at societal level.

Objective: The present study assessed the prevalence of adverse drug reactions (ADRs) among HIV positive patients referred to Imam Khomeini hospital in Tehran, Iran. Methods: This is a cross sectional study regarding side effects of Highly Active Antiretroviral Therapy (HAART) in HIV positive patients referred to Voluntary Counseling and Testing (VCT) center in Imam Khomeini Hospital of Tehran, Iran during a period of the year 2009 to 2010. Two hundred patients under antiretroviral treatment evaluated for the side effects of drug based on available records, face to face interviews and written lab data. Results: Data was collected from a sample of 200 HIV positive patients (72% male). Injection drug use was the most common route of HIV transmission. Co-infections were found in the majority of patients (60.5%). Eleven percent had positive test for Hepatitis C (HCV). Tuberculosis was the most prevalent opportunistic infection. 188 (94%) patients experienced at least one adverse drug reaction. The most frequent clinical and para clinical findings were skin rash (28%) and abnormal liver function tests (36%). Conclusions: Given the high prevalence of adverse drug reactions among HIV positive patients taking antiretroviral therapy (ART) in this study, clinicians should be aware of ADRs at the initiation of ART as complications can affect patients’ adherence to the therapy.

After its identification in 1980s, HIV has infected more than 30 million people worldwide. In the era of highly active anti-retroviral therapy, anti-retroviral drug resistance results from insufficient anti-retroviral pressure, which may lead to treatment failure. Preliminary studies support the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developed world; however, a highly heterogeneous horde of viral quasi-species are currently circulating in developing nations. Thus, the prioritizing of strategies adopted in such two worlds should be quite different considering the varying anti-retroviral drug resistance prevalence. In this article, we explore differences in anti-retroviral drug resistance patterns between developed and developing countries, as they represent two distinct ecological niches of HIV from an evolutionary standpoint.

Background: Due to the increase of HIV patients’ survival, rheumatologic symptoms associated with HIV such as septic arthritis, psoriatic arthritis and other manifestations have increased. Also, diseases such as systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) can be intensified during AIDS. Objectives: The aim of this cross-sectional study was to evaluate the prevalence and nature of rheumatologic manifestations in HIV positive patients, Tehran, Iran. Materials and Methods: This cross-sectional investigation was done on 200 HIV infected patients from 2009 to 2010. Demographic characteristics (age and sex), the route of HIV transmission and the duration of infection, existence of any concurrent infection such as hepatitis B (HBV) and hepatitis C (HCV) infections, last CD4 count, regimen and duration of the anti-retroviral therapy, presence of any musculoskeletal manifestation and joint disease and their quantity and quality were obtained. Patients were also examined by a clinician and information was recorded via checklists. Data were analyzed using SPSS software and reported as means and percentages. Results: Two hundred HIV patients including 153 male and 47 female participated in the study. Sixty three patients (31.5%) had musculoskeletal manifestations. The most prevalent complaints were arthralgia in 25 patients (39.7%), myalgia in seven patients (11.1%) and unspecified spondyloarthritis in four patients (6.3%). Also, a borderline association was observed between HBV-HIV co-infection and presence of musculoskeletal findings (P = 0.047). Conclusions: Considering the high prevalence of rheumatologic manifestations in patients with HIV/AIDS and its probable relation to the quality of life of patients, there is a pressing need for evaluating patients in this regard, especially among patients who are receiving highly active anti-retroviral therapy (HAART) and experience better clinical responses.

Background: The human immune system can be impaired due to lack of adherence to treatment among HIV positive patients. This is reflected in lower levels of CD4 count and incomplete viral suppression leading to the disease's progression and increased risks of opportunistic infections. Little is known about adherence to antiretroviral therapy (ART) and Tuberculosis (TB) treatment and barriers to ART adherence faced by prisoners. Therefore, we conducted a study to evaluate adherence to ART, treatment of latent TB infection (LTBI), and TB treatment and barriers of ART adherence in the Great Tehran Prison in 2014. Materials and Methods: We conducted a study to evaluate adherence to ART, latent TB infection treatment, and TB treatment via Directly Observed Therapy (DOT) among HIV positive patients in the Great Tehran Prison in 2014. Furthermore, we examined the barriers of adherence to ART through focus group discussions (FGDs) with 22 people living with HIV in the prison. Results: The mean of adherence to ART, latent TB infection treatment, and TB treatment were 93.3%, 92.7% and 93.3%, respectively. Addiction, negative drug reactions, bad experiences with staffs, and psychosocial and nutritional problems were cited as the most common barriers to adherence. Conclusion: It is recommended to implement DOT for ART in Iranian prisons. In addition, through removing the barriers and implementation of DOT for ART, HIV positive prisoners can achieve a complete adherence.

Background The rate of human immunodeficiency virus type 1 (HIV-1) infection in Iran has increased dramatically in the past few years. While the earliest cases were among hemophiliacs, injection drug users (IDUs) fuel the current epidemic. Previous molecular epidemiological analysis found that subtype A was most common among IDUs but more recent studies suggest CRF_35AD may be more prevalent now. To gain a better understanding of the molecular epidemiology of HIV-1 infection in Iran, we analyzed all Iranian HIV sequence data from the Los Alamos National Laboratory. Methods All Iranian HIV sequences from subtyping studies with pol, gag, env and full-length HIV-1 genome sequences registered in the HIV databases (www.hiv.lanl.gov) between 2006 and 2013 were downloaded. Phylogenetic trees of each region were constructed using Neighbor-Joining (NJ) and Maximum Parsimony methods. Results A total of 475 HIV sequences were analyzed. Overall, 78% of sequences were CRF_35AD. By gene region, CRF_35AD comprised 83% of HIV-1 pol, 62% of env, 78% of gag, and 90% of full-length genome sequences analyzed. There were 240 sequences re-categorized as CRF_AD. The proportion of CRF_35AD sequences categorized by the present study is nearly double the proportion of what had been reported. Conclusions Phylogenetic analysis indicates HIV-1 subtype CRF_35AD is the predominant circulating strain in Iran. This result differed from previous studies that reported subtype A as most prevalent in HIV- infected patients but confirmed other studies which reported CRF_35AD as predominant among IDUs. The observed epidemiological connection between HIV strains circulating in Iran and Afghanistan may be due to drug trafficking and/or immigration between the two countries. This finding suggests the possible origins and transmission dynamics of HIV/AIDS within Iran and provides useful information for designing control and intervention strategies.

Background: HIV/AIDS is one of the diseases which not only makes threats to physical health, but also, due to the negative attitudes of people and the social stigma, affects the emotional and social health of patients. The aim of this study was to identify the psychological, social, and family problems of people living with HIV/AIDS (PLWHA) in Iran. Methods: In this qualitative study, we used purposive sampling to enroll PLWHA, their families, and physicians and consultants in two cities of Kermanshah and Tehran. Each group of PLWHA, their families, physicians, and consultants participated in two focus group discussions (FGDs), and a total of eight FGDs were conducted. Six interviews were held with all key people, individually. Results: Based on the views and opinions of various groups involved in the study, the main problems of PLWHA were: Ostracism, depression, anxiety, a tendency to get revenge and lack of fear to infect others, frustration, social isolation, relationship problems, and fear due to the social stigma. Their psychological problems included: Marriage problems, family conflict, lack of family support, economic hardships inhibiting marriage, and social rejection of patient′s families. Their family problems were: Unemployment, the need for housing, basic needs, homelessness, and lack of social support associations. Conclusions: It seems that the identification and focusing on psychological, social, and family problems of affected people not only is an important factor for disease prevention and control, but also enables patients to have a better response to complications caused by HIV/AIDS.

We designed a study to follow newly-released prisoners with HIV in the great prison of Tehran from October 2013 to May 2014. Among 34 patients, only 12 persons (35.3%) had a successful follow-up. Using encouragers, offering appropriate incentives and enabling patients to connect with healthcare services after release can be effective means to continue the treatment.

Pulmonary hypertension is rare but is one of the complications that occur due to HIV infection. Symptoms of HIV-associated pulmonary arterial hypertension are often non-specific but the main symptom of the disease is dyspnea. In this cross-sectional study, we measured systolic pulmonary arterial pressure (SPAP) by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort) in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5%) and 62 females (46.5%). The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4%) of them had SPAP ≤ 30 mmHg (normal), six (3.6%) had SPAP: 31-35 mmHg (borderline) and five (3%) had SPAP > 35 mmHg (pulmonary hypertension). Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study.

A total of 2,305 consecutive newborns at Shariati Hospital, Tehran, Iran, and 1,706 at Lolagar Hospital, Tehran, Iran, were examined for 2 years (2004-2006). Mongolian spots were found in 11.4% and 37.3% of newborns at Shariati and Lolagar hospitals, respectively. The most frequent site of involvement is the sacral, followed by the gluteal area.

This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.مشاكل تقديم الخدمات للأشخاص المصابين بفيروس العَوَز المناعي البشري/الإيدز: من وجهة نظر مقدمي الخدمات والمستفدين.قباد مرادي، مينو محرز، محمد مهدي كَوبا، معصومة دجمان، سيد أحمد سيد علنيقى، خالد رحماني، حسين ملك أفضلي أردكاني.هدفت هذه الدراسة إلى التعرُّف على مشاكل الرعاية الصحية المقدَّمة للأشخاص المصابين بفيروس العَوَز المناعي البشري في مدينتين كبيرتين: طهران وكرمنشاه. فباستخدام طرق كيفية، شاركت مجموعتان رئيسيتان من مجموعات الأطراف المعنية - هما مقدِّمو الخدمات (واضعو سياسات ومديرون وأطباء ومستشارون) ومتلقو الخدمات (الأشخاص المصابون بفيروس العَوَز المناعي البشري وأقاربهم) - شاركوا في مناقشات جماعية مركّزة ومقابلات متعمِّقة. وقد حدّد الباحثون 24 موضوعاً تغطي المشاكل الصحية الرئيسية للأشخاص المصابين بفيروس العَوَز المناعي البشري؛ بما في ذلك: نقص تغطية خدمات الرعاية الصحية وعدم ملاءمتها، وتعاطي المرضى للمخدرات، وخوف المرضى من الوصمة، والإرهاق المهني لمقدِّمي الخدمات، وعدم رضا المرضى عن بعض الخدمات المقدَّمة من قِبَل مراكز/عيادات الإرشاد، وعدم مراعاة الطاقم الطبي للسرّية، وعدم حصول المرضَى على الخدمات التخصصية المطلوبة. وخلص الباحثون إلى أن المشاكل والاحتياجات التي تم التعرُّف عليها يمكن أن تثري تصميم وتنفيذ البرامج الصحية في هذا البلد وفي أماكن أخرى من إقليم شرق المتوسط.Difficultés dans l'offre de services aux personnes touchées par le VIH/sida : point de vue des prestataires et des bénéficiaires de services.La présente étude qualitative visait à identifier les problèmes de soins de santé pour les personnes vivant avec le VIH dans deux grandes villes : Téhéran et Kermanshah. Deux grands groupes de parties intéressées — des prestataires de services (responsables politiques, administrateurs, médecins et conseillers) et des bénéficiaires de services (les personnes vivant avec le VIH et leur famille) — ont participé à des groupes de discussions thématiques et à des entretiens approfondis. Nous avons identifié 24 thèmes couvrant les principaux problèmes de santé des personnes vivant avec le VIH et notamment la couverture incomplète et insuffisante des services de soins de santé, l'abus de substances psychoactives des patients, la crainte de la stigmatisation ressentie par les patients, l'épuisement professionnel chez certains prestataires de services, l'insatisfaction des patients au sujet de certains services proposés par des centres de conseil/des dispensaires, l'échec du personnel médical à respecter la confidentialité, et le manque d'accès des patients aux services spécialisés nécessaires. Les difficultés et les besoins identifiés peuvent servir de base à l'élaboration et la mise en œuvre de programmes de santé dans notre pays et ailleurs dans la Région de la Méditerranée orientale.

Background: Quickness of diagnosis and getting results in prisons is lower than other settings. The present study aimed to assess the quickness of HIV and Tuberculosis diagnostic process in the Great Tehran Prison. Materials and Methods: The present study evaluated the quickness of HIV diagnostic testing (ELISA, Western Blot and CD4 count) in the Great Tehran Prison over the period of October 2013 to May 2014. Also, all suspected tuberculosis (TB) patients in the prison were examined for the occurrence of active TB through collecting 35 chest X-rays and 215 sputum specimens for acid-fast bacillus (AFB) testing at the health center laboratory. Results: The average interval between when test requests were made by a physician and when HIV ELIZA/ Western Blot was obtained was relatively long time. On average, the interval between a physician's requests for CD4 count to assess the results was eight days. The average time interval between test requests by a physician to deliver sputum samples to the laboratory was four days. However, the average time interval between a physician's requests for sputum samples to assess the results was 16 days. Conclusion: Due to the significance of positive and negative results for making decision on diagnosis, initiation and follow up of treatment procedure, the time intervals should become shorter.