Showing papers by "Tehran University of Medical Sciences published in 2020"
TL;DR: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates, and there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries.
5,802 citations
Christopher J L Murray1, Christopher J L Murray2, Christopher J L Murray3, Aleksandr Y. Aravkin2 +2269 more•Institutions (286)
TL;DR: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure.
3,059 citations
University of Oxford1, World Health Organization2, Centre for the AIDS Programme of Research in South Africa3, University of the Philippines4, Complutense University of Madrid5, Tehran University of Medical Sciences6, University of British Columbia7, Public Health Foundation of India8, National Academy of Sciences9, Claude Bernard University Lyon 110, University of Bristol11, University of Bern12, University of Oslo13, University College Cork14, Cayetano Heredia University15, Indian Council of Medical Research16, Vilnius University17, Memorial Hospital of South Bend18, University of Lausanne19, University of the Witwatersrand20, Oswaldo Cruz Foundation21, Public Health Agency of Canada22, University of Verona23
TL;DR: These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay.
Abstract: Background World Health Organization expert groups recommended mortality trials of four repurposed antiviral drugs - remdesivir, hydroxychloroquine, lopinavir, and interferon beta-1a - in patients hospitalized with coronavirus disease 2019 (Covid-19). Methods We randomly assigned inpatients with Covid-19 equally between one of the trial drug regimens that was locally available and open control (up to five options, four active and the local standard of care). The intention-to-treat primary analyses examined in-hospital mortality in the four pairwise comparisons of each trial drug and its control (drug available but patient assigned to the same care without that drug). Rate ratios for death were calculated with stratification according to age and status regarding mechanical ventilation at trial entry. Results At 405 hospitals in 30 countries, 11,330 adults underwent randomization; 2750 were assigned to receive remdesivir, 954 to hydroxychloroquine, 1411 to lopinavir (without interferon), 2063 to interferon (including 651 to interferon plus lopinavir), and 4088 to no trial drug. Adherence was 94 to 96% midway through treatment, with 2 to 6% crossover. In total, 1253 deaths were reported (median day of death, day 8; interquartile range, 4 to 14). The Kaplan-Meier 28-day mortality was 11.8% (39.0% if the patient was already receiving ventilation at randomization and 9.5% otherwise). Death occurred in 301 of 2743 patients receiving remdesivir and in 303 of 2708 receiving its control (rate ratio, 0.95; 95% confidence interval [CI], 0.81 to 1.11; P = 0.50), in 104 of 947 patients receiving hydroxychloroquine and in 84 of 906 receiving its control (rate ratio, 1.19; 95% CI, 0.89 to 1.59; P = 0.23), in 148 of 1399 patients receiving lopinavir and in 146 of 1372 receiving its control (rate ratio, 1.00; 95% CI, 0.79 to 1.25; P = 0.97), and in 243 of 2050 patients receiving interferon and in 216 of 2050 receiving its control (rate ratio, 1.16; 95% CI, 0.96 to 1.39; P = 0.11). No drug definitely reduced mortality, overall or in any subgroup, or reduced initiation of ventilation or hospitalization duration. Conclusions These remdesivir, hydroxychloroquine, lopinavir, and interferon regimens had little or no effect on hospitalized patients with Covid-19, as indicated by overall mortality, initiation of ventilation, and duration of hospital stay. (Funded by the World Health Organization; ISRCTN Registry number, ISRCTN83971151; ClinicalTrials.gov number, NCT04315948.).
2,001 citations
TL;DR: The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years.
1,016 citations
Joan B. Soriano1, Parkes J Kendrick2, Katherine R. Paulson2, Vinay Gupta2 +311 more•Institutions (178)
TL;DR: It is shown that chronic respiratory diseases remain a leading cause of death and disability worldwide, with growth in absolute numbers but sharp declines in several age-standardised estimators since 1990.
829 citations
Sadaf G. Sepanlou1, Saeid Safiri2, Catherine Bisignano3, Kevin S Ikuta4 +198 more•Institutions (106)
TL;DR: Mortality, prevalence, and DALY estimates are compared with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries, and a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017.
670 citations
TL;DR: Current therapeutic options, preventive methods and transmission routes of COVID-19 are discussed and infection prevention, early viral detection and identification of successful treatment protocols provide the best approach in controlling disease spread.
603 citations
TL;DR: There are differences in lymphocyte subsets among patients with COVID-19, asymptomatic infection and healthy people, suggesting that lymphocytes subsets may have certain clin value in the diagnosis and disease assessment of CO VID-19.
537 citations
Eötvös Loránd University1, Yale University2, University of Cape Town3, Flinders University4, University of Calgary5, University of Queensland6, Nottingham Trent University7, Macedonian Academy of Sciences and Arts8, University of Lausanne9, University of Duisburg-Essen10, Auckland University of Technology11, University of Cambridge12, Sapienza University of Rome13, Lithuanian University of Health Sciences14, University of Porto15, University of Ulm16, Stellenbosch University17, University of Zurich18, University of Chieti-Pescara19, Catholic University of Korea20, University of Lübeck21, University of Valencia22, Tehran University of Medical Sciences23, Bellvitge University Hospital24, Tel Aviv University25, Hertfordshire Partnership University NHS Foundation Trust26
TL;DR: Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns and the present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.
501 citations
TL;DR: In this paper, the authors compared the impregnation method with the physical mixing method used in activating with alkali hydroxides and found that the activated carbon obtained through physical mixing had a higher porosity than the activated activated carbon produced by the impravnation method.
Abstract: Activated carbon refers to a wide range of carbonised materials of high degree of porosity and high surface area. Activated carbon has many applications in the environment and industry for the removal, retrieval, separation and modification of various compounds in liquid and gas phases. Selection of the chemical activator agent is a major step controlling the performance and applicability of activated carbon. Here, we review chemical activators used to produce activated carbon. We compare the impregnation method with the physical mixing method used in activating with alkali hydroxides. We selected 81 articles from Google Scholar, PubMed, Scopus, Science Direct, Embase and Medlin databases. Eighteen articles report the activation with potassium hydroxide, 17 with phosphoric acid, 15 with zinc chloride, 11 with potassium carbonate, nine with sodium hydroxide, and 11 with new activating agents. Activation with phosphoric acid is commonly used for lignocellulosic material and at lower temperatures. Zinc chloride generates more surface area than phosphoric acid but is used less due to environmental concerns. Potassium carbonate, in comparison with potassium hydroxide, produces higher yields and a higher surface area for the adsorption of large pollutant molecules such as dyes. Activating with potassium hydroxide in terms of surface area and efficiency shows better results than sodium hydroxide for various applications. Also, the comparison of the physical mixing method and the impregnation method in activation with alkali metals indicates that the activated carbon obtained through physical mixing had a higher porosity than the activated carbon produced by the impregnation method.
422 citations
TL;DR: There were large disparities between high-, middle- and low-income countries with total health expenditures in high- Income countries being over 400 times those in low- income countries, with the ratio for annual direct health expenditure per person between these groups of countries is more than 39-fold.
TL;DR: A multi-institution adjudicated case series from Iran which includes 9 pregnant women diagnosed with severe COVID-19 disease during their latter 2nd or 3rd trimester is described, and in each and every instance the maternal outcomes were more severe when compared to other high and low-risk familial/household members.
TL;DR: All research carried out on the mental health status of health care workers (HCWs) to bring policymakers and managers’ attention is reviewed to recommend the supportive, encouragement & motivational, protective, and training & educational interventions.
Abstract: The novel coronavirus 2019 (COVID-19) is widely spreading all over the world, causing mental health problems for most people. The medical staff is also under considerable psychological pressure. This study aimed to review all research carried out on the mental health status of health care workers (HCWs) to bring policymakers and managers’ attention. A literature search conducted through e-databases, including PubMed, EMBASE, Scopus, and Web of Science (WoS) from December 2019 up to April 12th 2020. All cross- sectional studies published in English which assessed the health workers’ psychological well-being during the SARS-CoV-2 pandemic included. Study quality was analyzed using NHLBI Study Quality assessment tools. One hundred relevant articles were identified through systematic search; of which eleven studies were eligible for this review. Their quality score was acceptable. The lowest reported prevalence of anxiety, depression, and stress among HCWs was 24.1%, 12.1%, and 29.8%, respectively. In addition, the highest reported values for the aforementioned parameters were 67.55%, 55.89%, and 62.99%, respectively. Nurses, female workers, front-line health care workers, younger medical staff, and workers in areas with higher infection rates reported more severe degrees of all psychological symptoms than other health care workers. Moreover, vicarious traumatization in non-front-line nurses and the general public was higher than that of the front-line nurses. During SARS-CoV-2 outbreak, the health care workers face aggravated psychological pressure and even mental illness. It would be recommended to the policymakers and managers to adopt the supportive, encouragement & motivational, protective, and training & educational interventions, especially through information and communication platform.
University of West Bohemia1, Macquarie University2, Tehran University of Medical Sciences3, Razi University4, Islamic Azad University5, Edinburgh Napier University6, University of Wisconsin-Madison7, Louisiana State University8, Texas A&M University–Kingsville9, University of Toronto10, Babol University of Medical Sciences11
TL;DR: A response to combat the virus through Artificial Intelligence (AI) is rendered in which different aspects of information from a continuum of structured and unstructured data sources are put together to form the user-friendly platforms for physicians and researchers.
Abstract: COVID-19 outbreak has put the whole world in an unprecedented difficult situation bringing life around the world to a frightening halt and claiming thousands of lives. Due to COVID-19's spread in 212 countries and territories and increasing numbers of infected cases and death tolls mounting to 5,212,172 and 334,915 (as of May 22 2020), it remains a real threat to the public health system. This paper renders a response to combat the virus through Artificial Intelligence (AI). Some Deep Learning (DL) methods have been illustrated to reach this goal, including Generative Adversarial Networks (GANs), Extreme Learning Machine (ELM), and Long/Short Term Memory (LSTM). It delineates an integrated bioinformatics approach in which different aspects of information from a continuum of structured and unstructured data sources are put together to form the user-friendly platforms for physicians and researchers. The main advantage of these AI-based platforms is to accelerate the process of diagnosis and treatment of the COVID-19 disease. The most recent related publications and medical reports were investigated with the purpose of choosing inputs and targets of the network that could facilitate reaching a reliable Artificial Neural Network-based tool for challenges associated with COVID-19. Furthermore, there are some specific inputs for each platform, including various forms of the data, such as clinical data and medical imaging which can improve the performance of the introduced approaches toward the best responses in practical applications.
TL;DR: To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—the authors estimated additional population equivalents with UHC effective coverage from 2018 to 2023, and quantified frontiers of U HC effective coverage performance on the basis of pooled health spending per capita.
TL;DR: This review aimed to investigate the involvement of different organs in COVID-19 patients, particularly in severe cases, and to define the potential underlying mechanisms of SARS-CoV2 induced multiorgan failure.
Abstract: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) in December 2019 form Wuhan, China leads to coronavirus disease 2019 (COVID-19) pandemic. While the common cold symptoms are observed in mild cases, COVID-19 is accompanied by multiorgan failure in severe patients. The involvement of different organs in severe patients results in lengthening the hospitalization duration and increasing the mortality rate. In this review, we aimed to investigate the involvement of different organs in COVID-19 patients, particularly in severe cases. Also, we tried to define the potential underlying mechanisms of SARS-CoV2 induced multiorgan failure. The multi-organ dysfunction is characterized by acute lung failure, acute liver failure, acute kidney injury, cardiovascular disease, and as well as a wide spectrum of hematological abnormalities and neurological disorders. The most important mechanisms are related to the direct and indirect pathogenic features of SARS-CoV2. Although the presence of angiotensin-converting enzyme 2, a receptor of SARS-CoV2 in the lung, heart, kidney, testis, liver, lymphocytes, and nervous system was confirmed, there are controversial findings to about the observation of SARS-CoV2 RNA in these organs. Moreover, the organ failure may be induced by the cytokine storm, a result of increased levels of inflammatory mediators, endothelial dysfunction, coagulation abnormalities, and infiltration of inflammatory cells into the organs. Therefore, further investigations are needed to detect the exact mechanisms of pathogenesis. Since the involvement of several organs in COVID-19 patients is important for clinicians, increasing their knowledge may help to improve the outcomes and decrease the rate of mortality and morbidity.
TL;DR: This virtual platform could be used by smartphones or webcam-enabled computers and allows physicians to effectively screen patients with early signs of COVID-19 before they reach to hospital.
TL;DR: Older age, male gender, hypertension, CVDs, diabetes, COPD and malignancies were associated with greater risk of death from COVID-19 infection, and these findings could help clinicians to identify patients with poor prognosis at an early stage.
Abstract: Purpose: Coronavirus disease 2019 (COVID-19) is an emerging disease that was first reported in Wuhan city, the capital of Hubei province in China, and has subsequently spread worldwide. Risk factor...
TL;DR: This prediction might support policymakers and health care managers to plan and allocate health care resources accordingly and support data mining algorithms can be employed to predict trends of outbreaks.
Abstract: Background: The recent global outbreak of coronavirus disease (COVID-19) is affecting many countries worldwide. Iran is one of the top 10 most affected countries. Search engines provide useful data from populations, and these data might be useful to analyze epidemics. Utilizing data mining methods on electronic resources’ data might provide a better insight into the COVID-19 outbreak to manage the health crisis in each country and worldwide. Objective: This study aimed to predict the incidence of COVID-19 in Iran. Methods: Data were obtained from the Google Trends website. Linear regression and long short-term memory (LSTM) models were used to estimate the number of positive COVID-19 cases. All models were evaluated using 10-fold cross-validation, and root mean square error (RMSE) was used as the performance metric. Results: The linear regression model predicted the incidence with an RMSE of 7.562 (SD 6.492). The most effective factors besides previous day incidence included the search frequency of handwashing, hand sanitizer, and antiseptic topics. The RMSE of the LSTM model was 27.187 (SD 20.705). Conclusions: Data mining algorithms can be employed to predict trends of outbreaks. This prediction might support policymakers and health care managers to plan and allocate health care resources accordingly.
TL;DR: Methylprednisolone pulse administration at the beginning of the early pulmonary phase of illness decreased the mortality rate and improved pulmonary involvement, oxygen saturation and inflammatory markers in COVID-19 patients.
Abstract: Background There are no determined treatment agents for the severe coronavirus disease 2019 (COVID-19); therefore, it is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system. Methods We conducted a single-blind, randomised, controlled, clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day−1 for 3 days) or standard care alone. The study endpoint was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population. Results Sixty-eight eligible patients underwent randomisation (34 patients in each group) from April 20, till Jun 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician during treatment and excluded from the ITT population. Patients with clinical improvement were higher in the methylprednisolone group than in the standard care group (94·1% versus 57·1%), and the mortality rate was numerically lower in the methylprednisolone group (5·9% versus 42.9%; p Conclusions Our results suggested that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase.
TL;DR: Mechanisms and the potential therapeutic targeting of cytokine storm syndrome are discussed in this paper.
TL;DR: Although IFN did not change the time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality.
Abstract: To the best of our knowledge, there is no published study on the use of interferon s-1a (IFN s-1a) in the treatment of severe COVID-19. In this randomized clinical trial, the efficacy and safety of IFN s-1a were evaluated in patients with severe COVID-19. Forty-two patients in the interferon group received IFN s-1a in addition to the national protocol medications (hydroxychloroquine plus lopinavir-ritonavir or atazanavir-ritonavir). Each 44-µg/ml (12 million IU/ml) dose of interferon s-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group consisted of 39 patients who received only the national protocol medications. The primary outcome of the study was time to reach clinical response. Secondary outcomes were duration of hospital stay, length of intensive care unit stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects, and complications during the hospitalization. Between 29 February and 3 April 2020, 92 patients were recruited, and a total of 42 patients in the IFN group and 39 patients in the control group completed the study. As the primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 ± 5.8 versus 8.3 ± 4.9 days, respectively, P = 0.95). On day 14, 66.7% versus 43.6% of patients in the IFN group and the control group, respectively, were discharged (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.05 to 6.37). The 28-day overall mortality was significantly lower in the IFN than the control group (19% versus 43.6%, respectively, P = 0.015). Early administration significantly reduced mortality (OR, 13.5; 95% CI, 1.5 to 118). Although IFN did not change the time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality. (This study is in the Iranian Registry of Clinical Trials under identifier IRCT20100228003449N28.).
Tehran University of Medical Sciences1, Tabriz University of Medical Sciences2, Shahid Beheshti University of Medical Sciences and Health Services3, University of Sydney4, Monash University5, University of Michigan6, Arak University of Medical Sciences7, Babol University of Medical Sciences8, Iran University of Medical Sciences9, Royal Cornwall Hospital10, University of Oxford11
TL;DR: Positive associations, but with fluctuations, were found between age standardised years lived with disability for neck pain and sociodemographic index at the global level and for all Global Burden of Disease regions, suggesting the burden is higher at higher sociodEMographic indices.
Abstract: Objective To use data from the Global Burden of Disease Study between 1990 and 2017 to report the rates and trends of point prevalence, annual incidence, and years lived with disability for neck pain in the general population of 195 countries. Design Systematic analysis. Data source Global Burden of Diseases, Injuries, and Risk Factors Study 2017. Main outcome measures Numbers and age standardised rates per 100 000 population of neck pain point prevalence, annual incidence, and years lived with disability were compared across regions and countries by age, sex, and sociodemographic index. Estimates were reported with uncertainty intervals. Results Globally in 2017 the age standardised rates for point prevalence of neck pain per 100 000 population was 3551.1 (95% uncertainty interval 3139.5 to 3977.9), for incidence of neck pain per 100 000 population was 806.6 (713.7 to 912.5), and for years lived with disability from neck pain per 100 000 population was 352.0 (245.6 to 493.3). These estimates did not change significantly between 1990 and 2017. The global point prevalence of neck pain in 2017 was higher in females compared with males, although this was not significant at the 0.05 level. Prevalence increased with age up to 70-74 years and then decreased. Norway (6151.2 (95% uncertainty interval 5382.3 to 6959.8)), Finland (5750.3 (5058.4 to 6518.3)), and Denmark (5316 (4674 to 6030.1)) had the three highest age standardised point prevalence estimates in 2017. The largest increases in age standardised point prevalence estimates from 1990 to 2017 were in the United Kingdom (14.6% (10.6% to 18.8%)), Sweden (10.4% (6.0% to 15.4%)), and Kuwait (2.6% (2.0% to 3.2%)). In general, positive associations, but with fluctuations, were found between age standardised years lived with disability for neck pain and sociodemographic index at the global level and for all Global Burden of Disease regions, suggesting the burden is higher at higher sociodemographic indices. Conclusions Neck pain is a serious public health problem in the general population, with the highest burden in Norway, Finland, and Denmark. Increasing population awareness about risk factors and preventive strategies for neck pain is warranted to reduce the future burden of this condition.
TL;DR: The air of patient rooms with confirmed COVID-19 in the largest hospital in Iran, on March 17, 2020, was investigated and all air samples were negative, however, it is suggested further in vivo experiments should be conducted using actual patient cough, sneeze and breath aerosols to show the possibility of generation of the airborne size carrier aerosol and the viability fraction of the embedded virus in those carrier aerosols.
TL;DR: The results of this study showed that keratoconus had a low prevalence in the world and eye rubbing, family history of keratconus, allergy, asthma, and eczema were the most important risk factors according to the available evidence.
Abstract: Purpose:This study was conducted to determine the prevalence and risk factors for keratoconus worldwide.Methods:In this meta-analysis, using a structured search strategy from 2 sources, 4 electronic databases (PubMed, Web of Science, Google Scholar, and Scopus) and the reference lists of the selecte
TL;DR: It is recommended that improving vitamin D status in the general population and in particular hospitalized patients has a potential benefit in reducing the severity of morbidities and mortality associated with acquiring COVID-19.
Abstract: Background To investigate the association between serum 25-hydroxyvitamin D levels and its effect on adverse clinical outcomes, and parameters of immune function and mortality due to a SARS-CoV-2 infection. Study design The hospital data of 235 patients infected with COVID-19 were analyzed. Results Based on CDC criteria, among our study patients, 74% had severe COVID-19 infection and 32.8% were vitamin D sufficient. After adjusting for confounding factors, there was a significant association between vitamin D sufficiency and reduction in clinical severity, inpatient mortality serum levels of C-reactive protein (CRP) and an increase in lymphocyte percentage. Only 9.7% of patients older than 40 years who were vitamin D sufficient succumbed to the infection compared to 20% who had a circulating level of 25(OH)D< 30 ng/ml. The significant reduction in serum CRP, an inflammatory marker, along with increased lymphocytes percentage suggest that vitamin D sufficiency also may help modulate the immune response possibly by reducing risk for cytokine storm in response to this viral infection. Conclusion Therefore, it is recommended that improving vitamin D status in the general population and in particular hospitalized patients has a potential benefit in reducing the severity of morbidities and mortality associated with acquiring COVID-19.
TL;DR: The current treatments, novel approaches such as antibody-drug conjugation systems (ADCs), nanoparticles, nanoparticles (albumin-, metal-, lipid-, polymer-, micelle-based nanoparticles), and BCSCs-based therapies are presented.
TL;DR: A literature review was performed to identify relevant articles on COVID-19 published up to April 30, 2020 and found evidence of a hyper-inflammatory immune response in critically ill patients, which leads to acute respiratory distress syndrome (ARDS) and multi-organ failure.
TL;DR: There is an urgent need to rapidly scale up the diagnostic capacity to detect COVID-19 and its complications and further studies are needed to elaborate and confirm the causative relationship between SARS-CoV-2 and the reported extrapulmonary manifestations of CO VID-19.
TL;DR: The role of bile acids and the gut microbiome in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) was investigated in a cohort of Caucasian patients with biopsy-proven NAFLD, lean healthy controls, and experimental murine models as mentioned in this paper.