Journal of Arak University Medical Sciences
Year:2021 | Volume:23 | Issue:5 (147)|Papers Count:16

Today, the main way for diagnosis and treatment is the use of research evidences which is called Evidence-Based Medicine (EBM). It is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. That is, the preferability of a method of practice should be determined based on the studies with the highest level of evidence. Currently, with the rapid spread of the Coronavirus Disease 2019 (COVID-19) in the world, the consideration of EBM principles has become more important and the medical community is needed to make the best effort to ensure that the response to COVID-19 should be based on the scientific evidences, not on personal opinions and emotions.

Background and Aim Coronavirus Disease 2019 (COVID-19), as a viral disease, has increasingly highlighted the need for lifelong exercise due to its immunological and physiological effects is necessary on health. In this review study, while examining the effects of moderate-intensity exercise on the physiological and immunological responses associated with COVID-19, appropriate exercise patterns during the COVID-19 pandemic are presented. Methods & Materials In this study, the search was conducted in Web of Science, Scopus, ISC, PubMed, Google Scholar, MagIran, and Noor databases on related articles using the following keywords: coronavirus, COVID-19, exercise and coronavirus, exercise and immune system, high-intensity exercise and immune system. Ethical Considerations All ethical principles in writing this article have been observed according to the instructions of the National Ethics Committee and the COPE regulations. Results: Moderate-intensity exercise can help boost the function of the immune system. On the other hand, high-intensity exercise can have negative effects on the immune system, which can be a bad strategy increasing the risk of infectious diseases. Results Moderate-intensity exercise can help boost the function of the immune system. On the other hand, high-intensity exercise can have negative effects on the immune system, which can be a bad strategy increasing the risk of infectious diseases. Conclusion Due to the onset of the second wave of COVID-19 in the world, it is recommended to continue to exercise at home observing the hygiene rules (maintaining humidity and disinfecting environmental surfaces) and using appropriate intensity and duration.

Background and Aim Coronaviruses are a large family of viruses that are known to cause respiratory tract infections in humans. SARS-CoV-2 is a new type of this family initiated in late 2019 and its related disease is known as Coronavirus Disease 2019 (COVID-19). Common symptoms of COVID-19 include fever, dry cough, fatigue, myalgia, arthralgia and shortness of breath. Methods & Materials In This narrative review a literature search was conducted in scientific databases including Google Scholar and PubMed to find studies published from December 2019 to May 10 2020 on the role the extrapulmonary manifestations of COVID-19. Ethical Considerations Ethical issues (including plagiarism, misconduct, data fabrication, falsification, double publication or submission, redundancy) have been completely observed by the authors. Results In addition to respiratory symptoms, involvement of various organs such as gastrointestinal tract, nervous system, skin, olfactory system, cardiovascular system, liver, kidney, and eyes was also reported. Extrapulmonary manifestations of COVID-19 included anosmia, ageusia, skin rash, chickenpox-like blisters, acute cardiac failure with increased troponin levels, kidney inflammation and edema, common gastrointestinal symptoms (e. g. diarrhea, nausea and vomiting), elevated liver enzyme levels, neurological disorders (e. g. stroke), nonspecific symptoms (e. g. headache and dizziness), and decreased consciousness level. Conclusion The hypothetical mechanisms of various organ involvements during COVID-19 include immune-mediated inflammation such as cytokine storm, respiratory dysfunction, hypoxemia, cellular damage, or combination of these mechanisms. Further studies should be conducted on the causes of various COVID-19-induced damages to determine the exact relationship between the pathogenesis, prognosis and severity of the disease.

Background and Aim Coronavirus Disease 2019 (COVID-19) is one of the most important viral diseases in the current decade which has caused widespread crisis worldwide. The disease was first reported on December 8, 2019 in Wuhan, Hubei Province, China, in the patients with acute respiratory distress syndrome. On January 8, 2020, the Centers for Disease Control and Prevention in China identified the virus, and it was named 2019-nCoV by the World Health Organization (WHO). The name of the disease was later changed to COVID-19. According to the International Committee on Taxonomy of Viruses, the virus is called SARSCoV-2 which belongs to the family of Coronaviridae. The viruses of this family have caused outbreaks in several countries (SARS in 2003 and MERS in 2013) which have led to death and economic loss. Methods & Materials In this review study, COVID-19 was studied from various aspects including evolutionary process and molecular biology of its virus. The selected articles were examined based on the information available in the WHO database. SARS-CoV-2 proteins were identified molecularly and functionally using data analysis and bioinformatics methods, and then related drugs and their effects on virus replication and inhibition were investigated. Ethical Considerations All ethical principles were observed in this study. Results Studies on the structure of SARS-CoV-2 and drug therapies to inhibit the disease progression showed that the use of different pharmaceutical strategies is effective in treating COVID-19 depending on the progression of the disease. Molecular studies showed that the use of nucleoside analogues and protease inhibitors is effective in the course of the disease and intravenous immunoglobulin, aminoquinoline compounds, TMPRSS2 inhibitors and viral S protein can be effective in the early stages of disease. Conclusion In order to control COVID-19, it is very important to study the structure of SARS-CoV-2 virus and its biology in the body. It is essential to identify the drugs that affect the virus based on its biological structure. Due to the structural changes of the virus and successive mutations in the virus genome as well as the emergence of resistant strains or highly contagious strains, further studies on the structure of SARS-CoV-2 and its changes in the body are recommended for designing pharmaceutical and therapeutic strategies. These strategies varies according to the stage of the disease, such that some drugs prevent the virus from entering the target cells in the early stages of the disease and other drugs, in combination with the virus’ surface glycoproteins, prevent the virus antigen from binding to receptors in the host cells. In the late stages of the disease, antiviral drugs including protease inhibitors and nucleoside analogues, interfere with the replication and structure of the virus. Due to intermittent changes in the virus and the development of drug-resistant viruses, it is important to continuously review virological and clinical studies and the performance of existing drugs against SARS-CoV-2.

Background and Aim Coronavirus Disease 2019 (COVID-19) pandemic has reduced the physical activity of people worldwide. The purpose of this study is to provide a practical guide for performing physical activities at home during the COVID-19 pandemic. Methods & Materials The study was conducted by using library method and reviewing the books and articles on home-based physical activity, to provide a scientific basis for performing physical activity at home. In this regard, various physical activities with and without equipment at homes were examined. Ethical Considerations This article is a review article with no human or animal sample. Results Home-based practical suggestions for staying active and cope with its physical and psychological consequences of the COVID-19 pandemic were reported walking or running on a treadmill, the use of stationary bikes, and body weight resistance exercise, in addition to aerobic exercise. Conclusion This proposed physical activity programs can be used during the pandemic at home by people with sedentary lifestyle.

Background and Aim In the current Coronavirus Disease 2019 (COVID-19) pandemic, there have been many concerns about the transmission of the virus from the mother to the infant. This is more important due to the need for the management of breastfeeding. This study aims to review the latest studies on breastfeeding during the COVID-19 pandemic. Methods & Materials This is a review study on articles about breastfeeding during the COVID-19 pandemic published from December 2019 to May 2020. The search was conducted in SID, PubMed, Scopus, Science Direct, Google Scholar, Ovid, and MagIran databases using the keywords: New coronavirus, COVID-19, breast milk, and breastfeeding Ethical Considerations All ethical principles in writing this article have been observed according to the instructions of the National Ethics Committee and the COPE regulations. Results So far, there is no evidence of COVID-19 virus in breast milk or its transmission through breastfeeding. All mothers with confirmed or suspected COVID-19 should continue to breastfeed their infants in accordance with the hygiene and respiratory precautions. Conclusion Breastfeeding protects the baby against infectious diseases. Given that the studies reported the absence of COVID-19 virus in breast milk are very limited, this study can help mothers manage breastfeeding during the COVID-19 pandemic. Since there are still many unknowns of this emerging disease, more studies are needed on managing breastfeeding in this pandemic.

Background and Aim In December 2019, the new coronavirus disease (COVID-19) was first identified in Wuhan, China, and then spread rapidly around the world, such that the World Health Organization reported it as a pandemic. This study aims to review the epidemiological findings, transmission methods, clinical manifestations, radiological symptoms, prognosis and treatment of COVID-19 in children, as well as the differences caused by the virus between children and adults. Methods & Materials The search was conducted in databases such as PubMod, Scopus, ScienceDirect and Google Scholar using the keywords “ COVID-19” , “ Coronavirus” , “ Children” , and “ Pandemic” . Ethical Considerations Ethical principles have been observed in accordance with the guidelines of the National Ethics Committee and the COPE regulations. Results Most of the data related to COVID-19 are related to the course of this disease in adults and related information for children is limited. Most findings suggested that the course of the disease is milder in children and the infection caused by the virus has a better prognosis in children. Due to the mild clinical symptoms in children, many of them are not diagnosed in the early stages of the infection. With the increase in the number of cases worldwide, the prevalence of this disease in children is certainly increasing. Conclusion COVID-19 has milder clinical symptoms and a better prognosis in children. Today, no vaccine or antiviral drug has been developed for this disease; hence, prevention is the best solution.

Background and Aim Coronaviruses are a large family of viruses that cause disease in humans and animals. Coronavirus Disease 2019 (COVID-19) is an acute respiratory infectious disease caused by a new coronavirus. The World Health Organization has declared this infectious disease as a global pandemic. Objective: This study aims to review the latest research advances in genetics, pathogenicity, and clinical features of COVID-19, as well as current therapies to combat this disease. Methods & Materials This is a systematic review study on articles published from 2010 to 2020 by searching in reputable databases such as PubMed, Scopus, Google Scholar, Web of Science, and ScienceDirect. Ethical Considerations Ethical principles have been observed in accordance with the guidelines of the National Ethics Committee and the COPE regulations. Results Examining the genome and genetic studies of the virus, it can be said that there are many similarities between different coronavirus types, but there are differences in their genomic and phenotypic structures that can affect their pathogenesis. Re-use of existing therapeutic drugs, previously designed for other infections and viral pathologies is currently the only practical approach to fight COVID-19. The tests for SARS-CoV-2 genome-specific vaccines and the therapeutic antibodies are currently being tested, but they require a long-term process and complete safety testing. Conclusion Rapid diagnosis of SARS-CoV-2 infection is the basis of disease control. There is currently no specific antiviral drug approved for SARS-CoV-2 infection. Therefore, preventive measures are necessary to stop and control the spread of COVID-19, according to genetic studies and the obtaining knowledge of the molecular mechanism of this virus.

Background and Aim Abortion has always posed challenges in the areas of ethics, law, religion, philosophy, and reproductive health. Some countries have had different approaches to abortion at different times. Today, abortion is a major challenge in Iran. Social developments and increasing level of health literacy, awareness and participation of women in social and economic fields have led to incompatibility of theoretical and practical aspects in these areas. Women sometimes have abortions without attention to the national law. In Iran, the reasons for legal abortion are the life-threatening conditions of the mother and the fetus. During the Coronavirus Disease 2019 (COVID-19) pandemic, some countries have revised their abortion laws and regulations. In some countries, such as France and Finland, these revisions are permanent; in countries such Portugal and Norway, the changes are temporary; and in other countries such as Germany and Belgium, it is unclear whether the changes are permanent or temporary. In this study, we aim to review the abortion laws and regulations in Europe and Iran. Then, by discussing the new guidelines for the COVID-19 pandemic, we evaluate the effects and consequences of this pandemic on abortion. Methods & Materials The search was conducted in PubMed/MEDLINE, ScienceDirect, Scopus and Google Scholar as well as national databases such as SID, MagIran, and IranMedex on studies published from 2002 to 2020 using the following keywords: Abortion, illegal abortion, induced abortion, and COVID-19. Due to the onset of SARS-COV1 epidemic in 2002, all articles published between these two outbreaks were searched. Ethical Considerations All ethical principles were observed in this article. Results During the COVID-19 pandemic, some European countries revised the abortion laws and regulations, mostly due to realize the reproductive health right. It seems that, this revision has not yet been taken place in Iran. Conclusion With the emergence of COVID-19, some countries had revised their abortion laws and regulations to reduce unsafe abortions. It seems that during the Covid19 pandemic, due to changes in lifestyle such as social distancing and economic and social lockdowns, it needs to revise medical laws and regulations in health-oriented and time-dependent areas (such as abortion) so that the principles of medical ethics such as beneficence and maleficent, can be applied. Having COVID-19 and consequently abortion during the pandemic is one of the most challenging issues that should be addressed in terms of ethical, jurisprudential and legal aspects. Development of regulations based on ethical principles during the COVID-19 pandemic is necessary to prevent illegal and unsafe abortions.

Background and Aim Anxiety is one of the clinical signs of viral diseases such as Coronavirus Disease 2019 (COVID-19), which can threaten the immune system. This study aims to investigate the effect of healthpromoting lifestyle and psychological well-being on COVID-19-induced anxiety in non-medical students Methods & Materials This is an analytical/correlational study conducted on 307 non-medical students of Islamic Azad University in Tabriz, Iran, who were participated voluntarily in the study. They completed the Corona Disease Anxiety Scale developed by Alipour et al. (2019), Ryff’ s Scales of Psychological Well-Being (SPWB), and Health-Promoting Lifestyle Profile (HPLP) developed by Walker et al. (1987). The collected data were analyzed in SPSS V. 20 software by using the stepwise regression analysis Ethical Considerations This research conducted based on the Ethical Committee of University of Tabriz (TABRIZU. REC. 1399. 018). Results Two SPWB components of “ personal growth” and “ positive relations with others” were able to predict the COVID-19-induced anxiety, which together explained 72% of anxiety variance in students. Moreover, two HPLP components of “ spiritual growth” and “ responsibility” could predict the COVID-19-induced anxiety and together explained 9% of the anxiety variance. Conclusion Promoting personal and spiritual growth, having positive relations with others, and responsibility can significantly reduce the anxiety induced by the COVID-19.

Background and Aim The recent Coronavirus Disease 2019 (COVID-19) outbreak has caused a lot of stress and anxiety in the world. Given that health care workers are at the forefront of fighting against COVID-19, they are the first to be exposed to this disease. Methods & Materials This is a descriptive cross-sectional study conducted on 402 medical and administrative staff working in hospitals and health centers affiliated to Jahrom University of Medical Sciences in 2020. Data collection tools were a demographic form and the Corona Disease Anxiety Scale (CDAS). Ethical Considerations This study was approved by the Vice-Chancellor for Research of Jahrom University of Medical Sciences (Code: IR. JUMS. REC. 1399. 046). Results The mean score of psychological symptoms of anxiety in the medical staff (46. 91) was higher than in the administrative staff (42. 63). Its physical symptoms were also higher in the clinical staff (12. 80) compared to the administrative staff (10. 94). There was a significant difference between the clinical and administrative staff in terms of anxiety (P=0. 030). Conclusion Medical staff has higher psychological and physical symptoms of anxiety compared to the non-medical staff during the COVID-19 outbreak. Therefore, in order to reduce the anxiety of medical staff, health policymakers should take the necessary measures to take care of this group.

Background and Aim Nurses experience many psychological problems during the Coronavirus Disease 2019 (COVID-19) outbreak. This study aims to investigate the prevalence of depression, anxiety and suicidal ideation in nurses during the COVID-19 outbreak, and compare these problems in nurses based on gender, educational level, marital status and department. Methods & Materials This is a descriptive study conducted on 312 nurses working in hospitals in Malayer, Iran. who were selected using census method. They completed the Beck Depression Inventory, Beck Anxiety Inventory, and Scale for Suicidal Ideation questionnaire. Descriptive statistics and Multivariate Analysis of Covariance (MANCOVA) were used to analyze the collected data in SPSS V. 24 software. Ethical Considerations This study was approved by the Research Ethics Committee of Malayer University (Code: IR. MALAYERU. REC. 1399. 002). Results It was reported that 15. 38% of nurses had moderate-to-severe depression; 46. 47% had moderateto-severe anxiety, 27. 56% had plans for suicide, and 9. 94% had active suicidal desire. The results of MANCOVA showed that depression (P=0. 009) and anxiety (P=0. 001) in female nurses was significantly higher than in male nurses. Depression and suicidal ideation of nurses with bachelor’ s degree were higher compared to nurses with master’ s degree (P=0. 01). Anxiety and suicidal ideation of single nurses were higher compared to married nurses (P=0. 01). Nurses in the emergency department (P=0. 03), ICU/CCU (P=0. 04) were more anxious than the pre-hospital emergency nurses. Conclusion Prevalence of depression, anxiety and suicidal ideation in nurses during the outbreak of COVID-19 in Iran is high. Therefore, it is recommended to use psychological therapies to reduce their depression, anxiety and suicidal ideation during the outbreak.

Background and Aim The new Coronavirus Disease 2019 (COVID-19) outbreak initiated from China in late December 2019, has posed a great global health threat. Since patients with high blood pressure, diabetes, and cardiovascular diseases are at high risk of COVID-19, this study aims to investigate the prevalence, severity, clinical manifestations, and mortality rate in COVID-19 patients with underlying diseases compared to those without underlying diseases. Methods & Materials This study was performed on 1408 patients with COVID-19 admitted to Golestan, Hajar, Khanevadeh and Besat hospitals in Tehran, Iran. Required data including disease prevalence, severity, clinical manifestations and mortality rate in patients with and without underlying diseases were collected and then analyzed using statistical tests in SPSS software, considering a significance level of P<0. 05. Ethical Considerations This study was approved by the AJA University of Medical Sciences (Code: IR. AJAUMS. REC. 1399. 091). Ethical principles have been observed in accordance with the guidelines of the National Ethics Committee and the COPE regulations. Results Patients were 912 men (64. 8%) and 496 women (35. 2%) aged 18-98 years (Mean age= 57. 8 years). Results reported that 27% of patients were intubated and 21. 9% were died. Blood oxygen level in 53. 7% of patients was less than 93 mg/dL; 36. 1% had a history of hypertension, 24. 1% had a history of diabetes, and 21. 7% had a history of cardiovascular disease. Conclusion The severity, clinical manifestations, and mortality rate of COVID-19 patients with cardiovascular disease, diabetes and hypertension are significantly different compared to those without underlying diseases.

Background and Aim The COVID-19 pandemic is capable of severely affecting the mental health of health care workers, who are at the forefront of this crisis; while the official staff of health organizations is facing the same danger. Therefore, monitoring awareness and other mental health issues to understand the mediating factors and awareness of appropriate interventions is a necessary priority. Therefore, the purpose of this study was to compare the level of knowledge, attitude, and practice of medical and administrative staff in facing the COVID-19 virus Methods & Materials This cross-sectional descriptive study was performed on 160 medical and administrative staff of Jahrom hospitals in 2020. Demographic information questionnaire and researcher-made questionnaire of knowledge, attitude and practice of medical personnel about coronavirus (Covid 19) were used to collect information. Data were analyzed using SPSS software version 21 and descriptive and inferential statistical tests Ethical Considerations This study was approved by the Vice-Chancellor for Research of Jahrom University of Medical Sciences (Code: IR. JUMS. REC. 1399. 040). Results 65% of subjects were women and the rest were men. In most of the answers given to each item in both groups, the medical and administrative staff’ s answers were close to each other. In the case of the statement “ I am more likely to get a corona” , 54. 4% of the medical staff chose the strongly agreed option, while this percentage is 16. 5% for the administrative staff. This indicates that the medical staff is very afraid of getting COVID-19. According to the results, the mean knowledge scores of the medical staff (with an average of 94. 35) were significantly higher than the administrative staff (with an average of 87. 75) (t=5. 96, P<0. 001). But the performance of administrative staff (with an average of 93. 14) is significantly higher than medical staff (with an average of 87. 17) (t=-2. 710, P=0. 007). No significant difference was observed between the mean scores of the attitude scores of both groups (P=0. 438). Conclusion The results of this study showed that the level of awareness in the face of corona virus in the administrative staff is significantly lower than the medical staff, but the administrative staff has a better performance in facing of the corona virus than the medical staff. It seems that educational measures are necessary to increase the awareness of these people

Background and Aim Since late 2019, with the emergence of a new type of coronavirus that causes a new respiratory disease called COVID-19, there have been many concerns about the spread of this disease and how to deal with it. Due to the ability of the virus to be transmitted rapidly, diagnosing the infected individuals in the early stages for isolating them is critical. This study aims to evaluate the reliability of Computed Tomography (CT) scan in diagnosing COVID-19. Methods & Materials Participants were 212 patients admitted to hospital with confirmed diagnosis of COVID-19. Demographic information, medical history, symptoms, and the chest CT scan results were collected and analyzed. Finally, the power of CT scans in the diagnosis of this disease was compared with the Real-Time Polymerase Chain Reaction (RT-PCR) molecular test. Ethical Considerations This study received ethical approval from the ethics committee of AJA University of Medical Sciences (Code: IR. AJAUMS. REC. 1399. 091). Results The sensitivity of CT scan in the diagnosis of COVID-19 was relatively high, but its false-positive results were also high. Conclusion CT scan is a relatively sensitive method for diagnosing COVID-19, but caution should be made due to its high false-positive results which can lead to increased financial burden on the health system.

Background and Aim Food security at individual, family, national, regional and global levels can be achieved when all people at all times have physical and economic access to adequate and healthy food to meet their nutritional needs and priorities for a healthy and active life. This study aims to investigate the status of food security and its related socioeconomic factors in households during the Coronavirus Disease 2019 (COVID-9) pandemic in Kerman, Iran. Methods & Materials This descriptive cross-sectional study was conducted on 500 households selected randomly from five comprehensive health centers in five districts of Kerman city in Iran. A demographic/ socioeconomic questionnaires and the Persian version of the 18-item USDA Household Food Security Survey (HFSS) were used for collecting data. Ethical Considerations All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them. Results There was a significant relationship between the socioeconomic factors (household size, house size, and number of amenities) and the food security. There correlation between the household size and food security was positive (R= 0. 142, P<0. 001), while the correlation of house size (R=-0. 093, P<0. 005) and number of amenities (R=-0. 73, P<0. 001) with food security was negative. Conclusion By increasing the awareness of people and improving their economic situation, it is possible to improve the food security situation of households in Kerman city.