JOURNAL OF MILITARY MEDICINE
Year:2020 | Volume:22 | Issue:2 |Papers Count:20

Background and Aim: Advent of COVID-19 attracted the attentions of researchers to develop drugs for its treatment. Besides efforts on developing new drugs, screening available drugs to see their efficacy on COVID-19 could be an urgent action of initiating its pharmacotherapy. In this study, efficacy of HIV protease inhibitors on COVID-19 protease has been examined. Methods: Molecular docking based screening by AutoDock software has been done to examine the efficacy of ligand-receptor interactions. Results: Obtained results of binding energy, inhibitory constant and interactions quality have approved the idea of efficacy of HIV protease inhibitors on COVID-19 protease. Conclusion: Quantitative results indicated different levels of efficacy of investigated ligands for inhibitory activity of COVID-19 and qualitative results indicated various localizations of ligands in the proposed active site of protease. The concluding remarks of this study are to introduce Nelfinavir as the best ligand in quantitative respect and each of Saquinavir, Amprenavir and Fosamprenavir as the best ligands inqualitative respect for possible inhibitory effects on COVID-19 protease.

Background and Aim: Coinciding with the onset of Covid-19, known as Corona in Iran, there have been many scattered reactions from the Iranian health system to the management of the disease. The aim of this study is to identify and categorize the dimensions of the Iranian health system response in order to identify points that have been overlooked and ignored. The results of this study can be used as a primary framework for analyzing the strengths and weaknesses of epidemic management in Iran. Methods: This qualitative study was carried out by content analysis of documents related to SARS-CoV-2 pandemic. First, by reviewing the electronic resources, all existing documents, protocols and guidelines related to the management of corona disease in Iran were identified. All national media files, including audio, text, and video related to Covid-19, were collected over the period from 18 February 2020 to 27 March 2020, by searching the University of Medical Sciences and the Ministry of Health websites. Four JUPP criteria were used to select the documents, and finally 82 documents were selected after multi-stage screening. Document information was coded and analyzed with MAXQDA2018. 2 software. Results: The response of the Iranian health system to addressing the Covid-19 pandemic is in seven main areas of hygiene, treatment, education, logistic, crisis management, research management and the management of communication & information which has been identified and recorded in 46 sub-areas. Conclusion: In the area of crisis management, the issue of contact tracing and control on the chain of disease transmission is still neglected. There are also no comprehensive guidelines for reducing or stopping social contacts and limiting population mobility within urban areas. It is also suggested that comprehensive instructions be developed to monitor the performance of the corona epidemic crisis management in the country.

Background and Aim: Mental stress has always influenced behavioral responses in different life situations, so the purpose of the present study was to investigate the role of perceived mental stress in the health of persons suspected of COVID-19. Methods: This was a descriptive correlational study. The statistical population of the study was all female referrals to Sayyad Shirazi Hospital in Gorgan, Iran with suspected symptoms of COVID-19 such as respiratory disorders, runny nose, dry cough, dizziness, sore throat, myalgia and fever on March 15-18 in 2020. 134 people were selected according to the inclusion criteria. In this study, perceived stress questionnaire of Cohen et al., Goldberg and Hillier health questionnaire and researcher-made questionnaire of demographic information were used. Data were analyzed using Pearson correlation coefficient and linear regression using SPSS22 software. Results: 87 patients had COVID-19 with mean age of 59. 34 years old. There was a significant positive correlation between the level of perceived mental stress with all health subscales at the level of 0. 01. Given the value obtained from Multiple Correlation Coefficient (R2) perceived mental stress is able to predict (0. 425) of health. Also the value obtained from the coefficient (β ) of perceived mental stress (0. 369) effects on health. Conclusion: Overall, this study emphasizes the significant contribution of perceived mental stress to the health of people with suspected COVID-19, which can provide therapeutic implications for therapists.

Background and Aim: Today, risk perception goes beyond the individual subject and has a social, cultural and ideological significance. Since the only way to reduce risk in the community is to increase the risk perception of the majority of the population in the community, this study aimed to investigate the factors influencing Iranians' risk perception of COVID-19 disease. Methods: This cross-sectional descriptive study was conducted using an online questionnaire among Iranian users of social networks. After convenience sampling, data were analyzed by SPSS and Amos software. Results: Out of 1265 observations, 364 people from 20 provinces have completed the questionnaire during the period February 25 to March 2, 2020. The most participants were in the 20-39 age group and 162 (44. 5%) were men. The second-order confirmatory factor analysis test indicated that religious-cultural, political, cognitive, social, and emotional factors influence Iranians' risk perception of Covid-19 disease. Tests also showed that religious and cultural factors had the highest positive correlation and emotional factors had the most negative correlation with Iranians' risk perception of Covid-19 disease. Conclusion: Considering the importance of the role of socio-political and religious factors, it is suggested that the executive and cultural authorities of the country should strive to improve the Iranian risk perception of Covid-19.

Background and Aim: The Covid-2019 is a pneumonia that onset on December 31, 2019 in Wuhan, China, and then swept the world. Following the disease in Iran, people began a new life in quarantine to be safe. Quarantine life is accompanied by psychological, social and economic consequences, and its implementation requires the support, supervision and adherence of the country's medical staff. This phenomenological study was conducted to analyze college students' psychological experiences in home quarantine. Methods: This is qualitative research with an interpretive phenomenological approach. Purposeful sampling was done in Tehran, Iran in 2020. Data were collected through semi-structured interviews. Participants in this study were postgraduate students with a natural experience of living in quarantine. Research data reached a theoretical saturation with 15 interviews. All data were recorded and handwritten and analyzed using the "Van Manen Phenomenology" approach. Results: Data analysis included four main themes, "developing negative emotions, confusion and pessimism", "developing obsessive-compulsive behavior about body and washing", "concerns about family health", "economic and social concerns, fear of tomorrow getting rid of the virus” . Conclusion: The students' experiences of living in quarantine were very unique. Understanding the complexities of their experiences, beliefs, and attitudes about living in quarantine can provide comprehensive plans for decision-makers, health care professionals, and mental health professionals.

Background and Aim: One of the high-risk groups due to the prevalence of COVID-19 are patients with chronic heart disease. The aim of this study was to evaluate the effectiveness of the electronic health care and drug monitoring program to prevent COVID-19 and adherence to therapeutic regimen of patients with chronic heart disease (ischemic heart disease). Methods: This pilot study is a quasi-experimental study with control group. 10 patients with ischemic heart disease were randomly assigned to two groups of 5 individuals (intervention and control). Data collected using demographic questionnaire, Beigi's treatment follow-up questionnaire (2012), and a researcher-made questionnaire for prevention of SARS-CoV-2. Data analyzed with SPSS-22 software. Results: Patients in both groups were matched in age, sex, and BMI (p>0. 05). The adherence to the medication regimen and adherence to diet and physical activity, and adherence to the preventive issues of Covid-19 during 10 training sessions, showed a significant increase in the intervention group (p<0. 005). Conclusion: Electronic services and the use of e-visit in primary health care and adherence to home care regimen, using the mobile phones and the Internet, can enable accurate monitoring of patients' status and help patients at risk to avoid COVID-19.

Coronaviruses belong to the Coronaviridae family and three SARS-CoV, MERS-CoV and SARS-CoV-2 pathogens are found in this family, all of which cause respiratory disorders in human beings. SARS-CoV-2 is a RNA virus of approximately 80-160 nm in size and genomic size of approximately 27-35 kb which causes COVID-19. Symptoms of COVID-19 include fever, dry cough, fatigue and muscle weakness, shortness of breath, sputum, headache, diarrhea and muscle inflammation. It causes death in the elderly, people with hypertension, a history of cardiovascular diseases, people with diabetes, cancer, impaired immune system, transplanted, and all people with immunocompromised weakness. Various studies have shown that three major events are respiratory disorders, lymphocytopenia, and cytokine storm as SARS-CoV-2 is transmitted through the ACE-2 receptor on the surface of alveolar type 2 lung cells; in which case, pneumonia, loss of lung function, acute respiratory distress syndrome (ARDS), shock and even death occur because of the failure in the adjustment of inflammatory responses from immune system and proliferation of cytokines. As the virus enters the cells, receptors of intrinsic immune system-TLR3, TLR7 (endosomal receptors) and RIG-I and MDA-5 (cytosolic receptors) detect the RNA of the virus. Involvement of the receptors ends up with the production of different types of cytokines such as type I interferons and inflammation. In respect of acquired cellular immune system of Th1, Th2, and Th17 lymphocytes with cytokine production, the lymphocytes T CD8+ (CTL) play their part by producing perforin, granzyme and cytokine. Humoral-acquired immune activity can be determined in most patients by producing IgM (9 days after disease onset) and IgG (two weeks after disease onset). SARS-CoV-2 makes use of mechanisms such as disruption in the production of type I interferons, reduction of MHC-I, MHC-II expression, and increase of Tim-3 and PD-1 expression on the surface of CTL cells (T cell exhaustion) in order to evade the immune system. In this paper, we present a review of the most recent data on the immunopathogenic mechanisms of the infection with respiratory viruses, especially SARS-CoV-2.

The widespread outbreak of coronavirus (COVID-19) worldwide has raised concerns about physical activity and exercise. A review of research on physical training and viral infections shows that regular, moderate-intensity aerobic exercise (65-80% VO2max) increases antibody titers, lymphocyte proliferation, gamma interferon, immunoglobulin M, G, and natural killer cells production. It modulates the levels of inflammatory cytokines, chemokines and T cell-mediated immune response to the influenza virus. That is also associated with stronger and longstanding antibody responses to influenza vaccination in adults. Based on the available evidence and similarity of some of the signs and/or symptoms of Covid-19 to the H1N1 virus, it may be recommended to exercise during the outbreak. First, it is reasonable to restrict heavy exercise at this stage, as the open window hypothesis may increase the susceptibility to infection. Second, healthy or asymptomatic individuals can exercise moderately with hygiene guidelines and benefit from improved immune function according to the J-shaped model. Third, people with mild upper respiratory tract symptoms (e. g., runny nose, sinus congestion, mild sore throat) can exercise lightly with precautions. Finally, one suspected of Covid-19 symptoms (e. g., fever, cough, severe sore throat, myalgia, shortness of breath, general fatigue) should avoid exercise.

Covid-19 is an emerging infectious disease caused by SARS-CoV-2 that can be transmitted to humans. There are currently no drugs or vaccines for this disease. In the absence of treatment for this new virus, finding alternative methods to prevent and control the disease is important. Having a well-functioning immune system is essential for the host's defense against pathogenic organisms. Malnutrition can lead to an impaired immune system during life. Even though the immune system response to infection is itself a factor that could lead to nutritional status impairment. Deficiency of some nutrients can lead to disorders of immune system. Adequate intake of vitamins (A, D, Bs, C and E), minerals (selenium, zinc and iron) and omega-3 fatty acids are among the essential factors in proper immune system function. Therefore, it is recommended to follow a healthy diet to prevent Covid-19. It is also suggested to assess the nutritional status of patients before prescribing treatments.

The current epidemic of SARS-CoV-2 is intense and worrying all over the world, and the number of pregnant women with the virus is on the rise. In pregnant women with severe acute respiratory syndrome severe acute respiratory syndrome (SARS) and Middle East severe acute respiratory syndrome coronavirus (MERS), morbidity and mortality are higher than in non-pregnant women. Are Pregnancy and Neonatal Risks Increased in Pregnant Women With Covid-19? And are the clinical symptoms and laboratory results different in pregnant women with Covid-19 compared to non-pregnant ones? For better prevention and treatment of Covid-19 in pregnant women, we reviewed the studies and the evidence and presented the results of studies on clinical symptoms, laboratory results, and complications of pregnancy in pregnant women with the disease. Common manifestations of Covid-19 in pregnant women included fever, cough, and muscle pain. The most common laboratory results are decreased blood lymphocytes and increased blood CRP. Pregnancy and delivery complications in pregnant women included increased preterm labor and increased cesarean delivery.

From the end of December 2019, outbreak of a novel viral disease was reported in Wuhan city of China, which was caused by a novel coronavirus and was officially named as COVID-19 by World Health Organization (WHO). The outbreak of COVID-19 was unique in its rapidity of transmission, which has become a global health emergency within just a few months in all countries worldwide. This disease will not only raise public health concerns but also cause several forms of psychological distress, including anxiety, fear, depression, stigmatization, avoidance behaviors, irritability, insomnia, and posttraumatic stress disorder (PTSD). In this situation, the maintenance of mental health of individuals is very important because people in different parts of society may experience additional stressors during the COVID-19 outbreak. Individuals in different parts of a society may experience the psychological symptoms to COVID-19 during the rising phase of the outbreak, including patients of COVID-19, quarantine individuals, health care workers and family members of medical staffs, children, university students, pregnant women, and families. In this regard, there is the strong evidence that the mental health status of these populations is vulnerable to psychological disorders.

Background and Aim: The most important clinical symptoms in patients with COVID-19 on admission at the hospital are fever and cough. The results of the studies show different levels of prevalence of these two symptoms in patients. The aim of this study was to coordinate the prevalence of fever and cough in patients with COVID-19. Methods: In this meta-analysis study, searching was performed on international databases of Embase, ScienceDirect, Scopus, PubMed and Web of Science (ISI) between October 2019 to March 2020 with keywords, 2019-nCoV, COVID-19, SARS-CoV-2, Fever and Cough. Random effects model was used for analysis and heterogeneity of studies with I2 index was investigated. Data were analyzed using Comprehensive Meta-Analysis (Version 2). Results: In a meta-analysis of 13 articles and 2131 cases, the overall prevalence of fever in patients with COVID-19 on admission at the hospital was 78. 2% (95% CI: 65. 4-87. 2%) and the overall prevalence of cough in these patients was 54. 9% (95% CI: 45. 1-64. 3%). The meta-regression showed that fever and cough increased with age and this difference was statistically significant (P <0. 05). Conclusion: The results of this study indicate that the prevalence of fever and cough is high in identifying patients with COVID-19. Therefore, appropriate solutions should be put in place to improve the aforementioned situation, and to provide feedback to hospitals at all levels.