Iranian Journal of Public Health
Year:2020 | Volume:49 | Issue:8|Papers Count:31

Background: Assessing the quality of life in HIV/AIDS patients is of great importance not only for evaluating the effect of the disease, but also to measure the impact of the interventions in order to improve their quality of life in clinical researches. Therefore, this study aimed to systematically review the quality of life of HIV/AIDS patients in Iran. Methods: In this systematic review and meta-analysis, the literature search using the related chain of keywords was conducted from 1 Jan 1987 to 30 Apr 2019 in PubMed, Scopus, Web of Science, Embase, Iranian Scientific Information Database (SID), and Magiran. Moreover, hand search of the key journals and the gray literature was performed. The meta-analysis was performed by CMA2 software. Results: Out of the 1576 retrieved records, eight studies met the inclusion criteria. The average age of the patients was 37. 15 ± 9. 46 years. The average score of quality of life before and after sensitivity analysis was (39. 13 [28. 36-49. 901 95% CI P>0. 000] vs. 49. 05 [46. 31-51. 79 95% CI P>0. 000]). Moreover, the average score of quality of life was respectively 38. 86± 3. 83 vs. 40± 6. 37 among married compared with single patients, 56. 33± 4. 67 vs. 43. 64± 1. 94 for employment vs. unemployment status. While quality of life was measured in terms of education level, the score was 29. 59± 9. 34 vs. 41. 65± 4. 45 in the individuals with primary school versus academic education. Conclusion: The QOL score of the HIV/AIDS patients in Iran was significantly low. Therefore, the study highlights the importance of strengthening efforts to undertake necessary investigations in order to provide adequate health insurance, extensive and affordable welfare services, and more appropriate social and mental supports in order to improve the quality of life of the individuals with HIV/AIDS in Iran.

Background: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). Method: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI). Results: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1. 08; 95% CI: 0. 34 to 3. 50) and SARSCoV (OR=0. 77; 95% CI: 0. 34 to 1. 3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2. 52; 95% CI: 1. 41 to 4. 50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections. Conclusion: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID19 patients should be avoided.

Background: It is of paramount importance to reduce the probability of clinical risks to improve the quality of health care services, make the relationship between service providers and patients more effective, enhance patient satisfaction, and decrease the rate of complaints regarding medical errors in hospitals. This study aimed at detecting potential and unacceptable risks occurring in the hospital ICUs. Methods: In this systematic review, all studies examining the risk assessment of ICUs in hospitals using Failure Mode and Effect Analysis method were reviewed. Google scholar, PubMed, Scopus, SID, Magiran and Web of Science databases were searched to find relevant articles published from 1980 to 2019. Results: The most frequent failures detected in the reviewed articles consisted of high risk of infection inwards for medical and nursing operations, high infection rates inwards for medical devices’ operation within the unit, and early discharge. Moreover, the processes through which potential high-risk Failures were examined in these studies were injection or prescription process, suction process, the process of inserting or removing endotracheal tubes, the process of transferring patients from the operation room to the unit or vice versa, pressure ulcers, and processes related to the medical devices’ operation. Conclusion: There are many possible reasons for failure occurring throughout these processes, and the failure modes occurring in these processes are more probable to cause serious damages to patients, have high repeatability with low probability of failure detection as the failures cannot be discovered by the personnel.

Background: This systematic review and meta-analysis of the observational studies aimed at evaluating the infertile women’ s attitude toward gestational surrogacy. Methods: Published studies until Jan 2019 were searched using PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, ISI Web of Science, Proquest and Google scholar, MagIran, SID and IranMedex. Studies in English or Persian language surveyed attitudes toward surrogacy for infertile women published until Jan 2019. Animal studies and studies with poor methodological quality were excluded from the review. Results: Six eligible studies including 1359 infertile women were identified. Of these, 559 and 742 women agreed and disagreed with surrogacy respectively. The overall event rate of positive attitude for surrogacy in infertile women was %39. 7 (%95 CI=24. 5 to 57. 1, P=0. 245). Conclusion: The infertile women’ s attitude toward surrogacy is not strongly positive. We believe, more studies should be conducted among different socioeconomic, religious and cultural groups.

Background: To investigate the expressions of fibrinogen (Fib) and Interleukin-12 (IL-12) in serum of neonatal necrotizing enterocolitis (NEC), and to analyze the correlation between the two and their relationship with clinicopathological features. Methods: Forty two children with NEC treated in Xuzhou Children’ s Hospital, Xuzhou Medical University Xuzhou, China from 2016-2019 were selected as an observation group and 40 children who underwent physical examination at the same period as a control group. The expression levels of Fib and IL-12 in the serum of two groups were detected by ELISA. The correlation between Fib and IL-12 in the observation group and the correlation among the expressions of Fib, IL-12, the clinicopathological features and common examination indexes of the children with NEC were investigated by Pearson correlation analysis. Results: The levels of Fib and IL-12 in the serum of the children in observation group were significantly higher than those in the control group were (P<0. 05). There was a significant positive correlation between the levels of Fib and IL-12 in the serum of the children in observation group (P<0. 05). The expression levels of Fib, IL12 were not significantly correlated with sex and age of NEC children, but correlated with vomiting, diarrhea, bloody stool and bradycardia in NEC children (P<0. 05). Fib and IL-12 were positively correlated with erythrocyte level (P<0. 05) and negatively correlated with platelet level. Conclusion: The expressions of Fib and IL-12 in the serum of NEC children can objectively predict the severity of NEC.

Background: We aimed to identify factors related to childbirth intention in multicultural marriage migrant women in Korea. The study was based on the raw data of a National Survey on Multicultural Families 2015 in Korea, covering 7 countries and 31, 047 participants. Methods: Data were analyzed with multiple regression analysis using SPSS and WIN 21. 0 programs. Results: First, the consistent outcome in the seven countries was Residence period in Korea. The shorter the period of residence in Korea and the lower the age, the higher childbirth intentions. Second, the major factors according to country were Economic Activity, Satisfaction of Marital Relationship, Life Satisfaction, and Education. The most influential factors in each country were economic activity in Taiwan and Hong Kong, satisfaction with marital relationships in Korean-China, life satisfaction in Cambodia, and education in Mongolia and the Philippines. The higher the participation in economic activities, satisfaction with marital relationship, life satisfaction, and education level, the greater the number of childbirth intentions. Third, a contradictory result was found in State of health. In Vietnam, better health predicted greater numbers of childbirth intentions, while in China, Korean-Chinese, Mongolia, Cambodia, worse health predicated greater numbers of childbirth intentions. Conclusion: The findings suggest a need for a comprehensive multicultural policy and support services for multicultural marriage migrant women that considers characteristics such as country, cultural differences, and nationality in order to contribute to family formation and settlement of Korean society.

Background: We explored the spatio-temporal characteristics of urban heat island (UHI) effect on cardiovascular diseases (CVDs). Methods: The land surface temperatures (LST) were retrieved from four Landsat remote-sensing images’ data, the temperature data from 95 meteorological stations, and analysis data on CVDs mortality. Based on these data, landscape pattern indexes were used to analyze the pattern-process-function and the mechanism. Results: During 1984– 2017, the effects of UHI on CVDs increased, thereby increased the mortality by 28. 8%. The affected areas gradually expand from the central area of the city and undergo three evolution stages; the highly affected areas are mainly distributed in central and southern regions, and patches increase in number. The areas and ratio of high-level patches also show an upward tendency, increasing dominance in the overall landscape. Patches of the overall landscape become more complicated in shape, whereas those of high-level ones become less complicated. Concentration degree of the overall landscape decreases gradually with the types of landscapes patches increasing, reaching a rather even space distribution. Conclusion: Increased temperatures exacerbated by UHI lead to increased CVD mortality. As cities expand, the effects of UHI on CVDs increase in terms of both intensity and areas, with the overall landscape in uneven distribution, high-level affected areas in point distribution, and low-level ones in large-area concentration.

Background: The shoulder joint has a wide range of motion, but is vulnerable to sport-related injuries. We aimed to evaluate the differences in the proprioception of the shoulder should instability, and shoulder pain in high school baseball players with shoulder instability following a 12-week rehabilitation exercise program. Methods: We enrolled 13 baseball players with shoulder instability who visited the Orthopedics Department at Konkook University Hospital in Seoul, South Korea and 12 controls without shoulder instability. We examined the dominant shoulder and the non-dominant shoulder for both groups. We restricted participation to individuals who had no other orthomechanical disease in the past six months, except for instability of the shoulder, and no physical limitation to participate in the exercise. We measured the proprioception of the shoulder and shoulder instability, and we also evaluated pain with the Visual Analog Scale before and after the rehabilitation program. To verify the differences between groups, we used a two-way analysis of variance, and a two-way analysis of covariance was used when a significant difference was found at the pretest (baseline between groups). Results: Proprioception was associated with shoulder instability. The Visual Analog Scale rating improved in the dominant shoulder with instability; and a positive change was found in the dominant shoulder without instability after the rehabilitation program (P < 0. 05). Conclusion: The 12-week rehabilitation exercise program might improve the proprioception and pain of patients with shoulder instability. However, further studies with more participants and a rehabilitation exercise program should be undertaken.

Background: The aim of this study was to investigate the overall impact of PM2. 5, PM10, NO2, SO2, CO, and O3 on the admission of cardiovascular and cerebrovascular disease. Methods: We collected data on cardiovascular and cerebrovascular disease admissions from two hospitals in Shenyang Liaoning, China from Jan 2014 to Dec 2017, as well as daily measurements of six pollutants at 11 sites in Shenyang. The generalized additive model was used to assess the association between daily contaminants and admission to cardiovascular and cerebrovascular disease. Results: The single-contamination model showed a significant correlation between NO2, O3, PM10 and cardiovascular and cerebrovascular diseases at lag0 day. Air pollutants had lag effects on different gender groups. Excess relative risks (ERs) associated with a 10 μ g/m 3 increase were 1. 522(1. 057, 1. 988) on lag02 for NO2, 0. 547% (0. 367%, 0. 728%), 0. 133% (0. 061%, 0. 205%) on lag3 for O3 and PM10. The dual pollutant model showed that the effects of NO2, O3, and PM10 after adjusting the influence of other pollutants were still statistically significant. Conclusion: Short-term exposure to ambient air pollution (NO2, O3, and PM10) may be associated with an increased risk of daily cardiovascular and cerebrovascular admission, which may provide reliable evidence for further understanding of the potential adverse effects of air pollution on cardiovascular and cerebrovascular diseases.

Background: There is growing evidence that DM may play an important role in the occurrence of unsuccessful TB treatment outcomes. This study was undertaken to examine the prevalence of DM among TB population, compare the profile of TB patients with and without DM and determine the effect of DM on unsuccessful treatment outcomes among TB patients in Kelantan state, Malaysia from 2012 to 2016. Methods: A cross sectional study was conducted in Sep 2017 using data from registered TB cases in Kelantan state, Malaysia from 2012 to 2016. The profile of TB patients with and without DM were compared in univariable analysis. Multiple logistic regression was used to determine association between DM and unsuccessful treatment outcomes. Results: A total of 1854 TB patients were diagnosed with DM. The annual proportion was ranging from 26 to 29%. TB patients with DM had an older age, live single, low educational status, poor chest x ray finding and diagnosed with smear positive sputum compared to TB patients without DM. TB patients with DM had three times higher risk to develop unsuccessful TB treatment outcomes compared to TB patients without DM (95% CI 2. 47-3. 58; P = 0. 012) in multivariable analysis. Conclusion: Those with DM had the worst prognosis of TB outcomes among the significant risk factors. TB control program in Malaysia will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.

Background: To investigate the expression and diagnostic value of LncRNA H19 in the blood of patients with osteoarthritis. Methods: A total of 130 cases of patients with osteoarthritis admitted to Jinling Hospital, Nanjing, China from Jun 2016 to Jul 2017 were elected as the study group, and 100 patients who underwent physical examination in Jinling Hospital during the same period were selected as the control group. The differences in expression levels of LncRNA H19 between the two groups were compared, the diagnostic value of LncRNA H19 in osteoarthritis and its relationship with clinical characteristics of patients with osteoarthritis were analyzed. Results: The expression level of LncRNA H19 increased in peripheral blood of patients with osteoarthritis (P<0. 05). The AUC, critical value, sensitivity and specificity of the diagnosis of osteoarthritis were 0. 891, 1. 879, 96. 00% and 85. 73%, respectively. The expression level of LncRNA H19 was related to K-L grading, and the expression level of LncRNA H19 increased with K-L grading. Pearson correlation analysis showed that LncRNA H19 was negatively correlated with bone metabolism indexes PINP, N-MID, BGP, BALP and Lysholm score (P<0. 05), and positively correlated with bone metabolism indexes β-CTX, VAS score and WOMAC score (P<0. 05). Conclusion: LncRNA H19 is highly expressed in peripheral blood of patients with osteoarthritis, which is closely related to the occurrence and development of osteoarthritis and has a good diagnostic value for osteoarthritis.

Background: Mercury is a common environmental contaminant and it is also harmful to human health. Among reported toxicities, its harmful effect on hypertension is poorly documented. In Kazakhstan, Temirtau city has been reported to have a high level of mercury contamination from an acetaldehyde production factory. Therefore, we aimed to investigate the association between serum profile of cytokines and the development of hypertension among the exposed citizens. Methods: We selected 81 individuals for study, out of them, 41 exposed ones suffered hypertension and 40 – unexposed healthy controls in villages Chkalovo, Samarkand, Gagarinskoye, Tegiszhol, Rostovka in 2016. Mercury content in urine was studied by inversion voltammetry. Cytokine levels of IL-2, IL-6, IL-10 and TNF-α were determined by ELISA. Results: Mercury-exposed citizens, especially those with hypertension, had significantly higher concentrations of inflammatory cytokines TNF-α , IL-2, IL-6 and anti-inflammatory cytokine IL-10 as compared to the unexposed population. The dependence of the mercury level in urine on IL-2 content was also detected. Therefore, chronic low doses of exposure to mercury were associated with an increase in serum levels of immune markers and with the increased risk of hypertension. Conclusion: The presence of mercury in the body probably affected the expression of interleukin-2, one of the main cytokines that coordinate immune response.

Background: Exposure to toxic metals remains a public health problem with lifelong impacts on childhood growth and development. We aimed to investigate metals effects on preschool children’ s anthropometric variables. Methods: The study was conducted in Tehran, Iran, from Jul 2013 to Mar 2016. We measured scalp hair metal concentrations (lead, cadmium, arsenic, zinc, manganese, and cobalt), using inductively coupled plasma mass spectrometry, in 207 preschool children’ s (36 to 72 months old). Results: A significant negative correlation between children's hair lead levels and children's weight was found (r= − 0. 178, P<0. 05). Linear regression analysis confirmed the relationship when adjusted for the confounders, including children's age, sex, height, family income, and maternal education (β = − 0. 191; t= − 3. 426, P< 0. 01). The ANOVA analysis showed a significant (P<0. 01) difference between hair lead level and children's weightfor-age percentiles. Totally and separately, in almost all weight percentiles, hair lead levels were higher in girls than boys. Conclusion: The present study on Iranian children showed the current levels of lead exposure might negatively influence on children growth, with higher risk for girls than boys.

Background: Although much medical knowledge comes from observational research, such studies are more prone to confounding and bias than others. This study was conducted to evaluate the adherence of the observational studies published in Iranian medical journals to the STROBE (strengthening the reporting of observational studies in epidemiology) statement. Methods: In this cross-sectional study, we selected 150 articles of Iranian medical journals, using multistage sampling from Aug 2016 to Jun 2017. The reported items of the STROBE statement in the articles was determined and considered as the adherence of the articles to the statement. The adherence of the articles with different characteristics was compared. Results: The adherence of the articles to the statement varied from 24% to 68% with a mean score of 48%± 9%. The lowest mean scores were found in the Result (36%) and Method (49%) sections. The adherence was significantly better in the articles published in the journals indexed in PubMed or Web of Knowledge (ISI) databases (P<0. 001) and those written by cooperation of the authors from other countries (P=0. 044). Conclusion: The evaluated articles in our study had not adequately reported the items recommended by the STROBE statement. This indicates deficiency in key elements for readers to assess the validity and applicability of a study.

Background: Unwanted pregnancy is a type of unplanned pregnancy that can endanger health of mother and child. This study aimed to determine the prevalence of unwanted pregnancy and its associated factors and consequences in Iran. Methods: This cross-sectional study was conducted in regions with low, moderate and high risk of maternal death. Two provinces were randomly selected in each region and 24 public health centers in each province during 2007-2012. Thereafter, 15-20 mothers, received at least one session of pregnancy care, were selected from each healthcare center. Data were gathered from both health records and interview with the mothers. Results: Of 2714 participants, 86. 4% and 13. 6% had respectively wanted and unwanted pregnancies. The underlying factors of unwanted pregnancy were determined as low distance with previous and next pregnancy, economic problems and have enough children. Moreover, there were significant relationships between unwanted pregnancy and place of residence, mother’ s age and education, father’ s education, pre-pregnancy care and number of previous pregnancies and children. There were also significant association between unwanted pregnancy and pregnancy care, anemia, exposure to risk factors and disease, intake of folic acid and iron, domestic violence, bitter memories and men’ s participation. Conclusion: Although the prevalence of unwanted pregnancy has had a significant decrease in Iran, these mothers still require a higher level of educational, counseling and supportive services due to their low access to pregnancy care services and high exposure to associated risk factors.

Background: Efflux pumps are involved in resistance of Acinetobacter baumannii isolates to antimicrobial agents. AdeABC efflux pump is one of the RND superfamily efflux pump and consists of adeA (membrane fusion), adeB (multidrug transporter) and adeC (outer membrane) genes. In this study, the frequency of adeA, adeB and adeC genes among A. baumannii isolates with resistance to erythromycin, trimethoprim, meropenem and imipenem was investigated. Methods: Overall, 79 strains of A. baumannii were isolated from patients admitted to two major hospitals in Tehran during 2016. Antibiotic susceptibility testing was determined by disc diffusion and microdilution methods according to Clinical and Laboratory Standards Institute (CLSI) guideline. The presence of adeA, adeB and adeC genes was also determined using Multiplex PCR assay. Results: The highest and the lowest resistance among A. baumannii isolates were to trimethoprim (93%) and erythromycin (53%), respectively. The frequency of adeA, adeB and adeC genes was 96. 2%, 96. 2% and 91. 1 % respectively. There was a significant relationship between imipenem resistance and presence of efflux pump genes (P<0. 05). Conclusion: According to the high prevalence of the AdeABC efflux system genes, it may involve in resistance of clinical isolates of A. baumannii to imipenem, especially.

Background: We aimed to examine resveratrol effects on gene expression of Bcl-2, Bax and Bcl-2/Bax ratio in endometrial stromal cells derived from women with and without endometriosis. Methods: Endometrial tissues were obtained from 40 endometriotic patients and 15 non-endometriotic controls undergoing laparoscopic surgery or hysterectomy in the gynecology ward of Rassoul Akram Hospital, Tehran, Iran from 2015 to 2017. After the enzymatic digestion, eutopic (EuESCs) and ectopic (EESCs) endometrial stromal cells from patients with endometriosis as well as endometrial stromal cells from non-endometriotic controls (CESCs) were treated with or without resveratrol (100 µ M) and the levels of Bcl-2, Bax and Bcl-2/Bax gene expression ratio in the cells from all origins were examined at 6, 24 and 48 h post-treatment by real-time PCR. Results: Resveratrol treatment increased Bcl-2 expression in CESCs at 24 and 48 h and in EuESCs at 48 h (P<0. 05), but had no significant effects on the expression of this gene in EESCs. On the other hand, resveratrol treatment increased Bax expression in EuESCs at 6 h and decreased its expression in EESCs at 48 h (P<0. 05). Regarding the Bcl-2/Bax gene expression ratio, resveratrol treatment increased Bcl-2/Bax gene expression ratio in CESCs and EuESCs at 48 h (P<0. 01). However, this treatment had no significant differential effect on Bcl-2 and Bcl-2/Bax gene expression ratio between CESCs and EuESCs at 48 h. Conclusion: Resveratrol treatment significantly increased Bcl-2/Bax gene expression ratio in EuESCs and CESCs but had no significant effect in EESCs.

Background: Breast cancer is the most common invasive malignancy among women in the world. The current breast cancer therapies pose significant clinical challenges. Low-dose chemotherapy represents a new strategy to treat solid tumors in combination with natural products such as green tea catechins. Epigallocatechin-3-gallate (EGCG) is the major polyphenolic extract from green tea with potent anticancer and antioxidant effects. The purpose of this study was to investigate the effects of EGCG, Arsenic trioxide (ATO) and gamma radiation on MCF-7 cell line. Methods: The anti-proliferative effects of EGCG and ATO individually, moreover in combination with radiation on MCF-7 cells were evaluated with MTT assay. The expression of apoptotic gens (Bax, Bcl-2, Caspase-3 and Fas) was assessed by real-time PCR. Results: Based on the results of MTT assay, EGCG and ATO exhibited dose and time-dependent antiproliferative effects on MCF-7 cells. The combined therapy of EGCG and ATO in presence and absence radiation could rise cell death up to 80%. Moreover, integrated therapy made Bax up-regulated and Bcl-2 downregulated. Conclusion: In assessment synergistic effects of integrated therapy with EGCG and ATO and irradiation had been significant impact on low dose chemotherapy for breast cancer treatment.

In Jan 2020, the outbreak of the 2019 novel coronavirus (SARS-CoV-2) in Wuhan, Hubei Province of China spread increasingly to other countries worldwide which WHO declared it as a public health emergency of international concern. Iran was included in the affected countries. Throat swab specimens were collected and tested by using real-time reverse transcription PCR (RT-PCR) kit targeting the E region for screening and RNA dependent RNA polymerase for confirmation. Conventional RT-PCR was conducted for the N region and the PCR products were sequenced by Sanger sequencing. The first seven cases of SARS-CoV-2 infections were identified in Qom, Iran. This report describes the clinical and epidemiological features of the first cases of SARS-CoV-2 confirmed in Iran. Future research should focus on finding the routes of transmission for this virus, including the possibility of transmission from foreign tourists to identify the possible origin of SARS-CoV-2 outbreak in Iran.

Dear Editor-in-Chief: Adolescent years have become a starting point for the formation of health behaviors that have lifetime consequences (1, 2). Adolescent age (adolescent, teenage) is a transition period from child to adulthood (3). ‘ Healthy lifestyle habits during adolescence can prevent many of the diseases and disabilities in adulthood and later’ (4). A healthy lifestyle is a system of activities consciously aimed at strengthening, preserving and maintaining the health of both the individual and society (5)...

Dear Editor-in-Chief: With advancing age, the incidence rate of Alzheimer’ s disease and dementia gradually increases, and mortality from either Alzheimer’ s disease or dementia has increased in recent decades (1). Recently, one third of adults older than 65 yr of age die from either Alzheimer’ s disease or dementia(1)...

Dear Editor-in-Chief: Currently, 14000 mushroom species are known to exist (1). This study aimed to determine Pb, Cd, Ni, Cr, Mn, Co, Cu and Zn contents in 9 species wild edible mushrooms growing in the Batak Mountain, Bulgaria and thus to assess the health risk index arisen from the long-term consumption of them...

Dear Editor-in-Chief: Coronary artery disease (CAD) is the leading cause of death worldwide (1). Age is a major contributor to the alteration of vascular function, that even in the absence of conditions like hypertension or diabetes, age-associated modifications occur (2). The increasing percent of aging population is the explanation why CAD remains the leading cause of mortality even in countries with high standard of living where adequate public health measures have been taken for risk reduction...

Dear Editor-in-Chief: Pakistan is a densely populated, low-income country with an estimated population of 21 million (1). Pakistan is endemic for several communicable and non-communicable mainly due to unawareness in general population, unhygienic lifestyle, poor sanitary conditions in populated areas (2)...

Dear Editor-in-Chief: Despite its perceived benefits, globalization has deepened health threats across borders (1). Such a situation has transformed heath into a multifaceted and transnational phenomenon, whose challenge is beyond the capacity of independent institutions and countries to address. Major political or economic unions like the G7 and G20 have strengthen both their interests and commitment to take up the issue of global health agenda more progressively and actively (2)...

Dear Editor-in-Chief: A group of pneumonia patients in Wuhan created an alarm worldwide by the end of December 2019. This emerging pneumonia soon became as a novel coronavirus (2019-nCoV or COVID-19) (1). More than 80% of individuals with COVID19 have a "mild illness and will heal" whereas it is lethal in 2% of reported cases (2). The age and sex of individuals are two risk factors of COVID19 susceptibility and its clinical outcome (3). It is therefore highly important to specify briskly the odds ratio for mortality adjusted to comorbidities that are highly prevalent globally, by age and sex, to prevent COVID-19 specific mortality (4)...

Dear Editor-in-Chief: Molar-Incisor Hypo-mineralization (MIH) is defined as dysplasia of enamel structure caused by defects in ameloblasts during early developmental stages. Clinically, defect in enamel translucency is interpreted as demarcated opacity of white, cream, yellow or brown colors (1, 2). Toothache, increased sensitivity, malformation, increased susceptibility to plaque accumulation are considered as complications of MIH (3, 4). The definitive cause of molar-incisor hypoplasia is unknown, but it can be related to various environmental factors associated with systemic conditions (1, 5)...

Dear Editor-in-Chief: Coronavirus Disease 2019 (COVID-19) pandemic as a new infectious disease has forced all healthcare systems to utilize technology-based services more than ever before (1). With previous successful experiences of using health-related technologies in the management of infectious respiratory epidemics such as SARS and MERS, it can be expected that most of them be useful in this new type of epidemic as well...

Dear Editor-in-Chief: Natural disasters such as floods, storms, and earthquakes as inevitable events sometimes threaten the physical and mental health of various communities around the world (1)...

Dear Editor-in-Chief: Iranian Death Registration System (DRS) has become an ongoing process in recent years, but despite this progress, the Iranian DRS had several shortcomings (1, 2). Several factors affecting morbidity and mortality data collected by the Iranian DRS. For example, in Tehran, the capital of Iran, the mortality data were registered by Behesht-e-Zahra cemetery from 1995 to 2010, as well as in Isfahan, a central province of Iran, the mortality data were registered by Bagh-e-Rezvan Cemetery from 2007 to 2010 (2). Moreover, Alborz Province was separated from Tehran Province in 2011 which many cases of death related to this province were registered in Tehran Province earlier than 2011 (2)...

Dear Editor-in-Chief: The outbreak of the COVID-19 caused a substantial public health crisis in Wuhan, China, and then expeditiously spread all over China. CoVID19 is a “ public-health emergency of international concern” due to the pandemic is escalating rapidly (1)...