فهرست مطالب mojtaba sepandi

Various methods have been employed globally to prevent the spread of COVID-19. However, the effectiveness of vaccination in reducing COVID-19 infections requires further investigation. This study aimed to assess the impact of the national vaccination program on the trend of COVID-19 infections in Iran, utilizing an interrupted time series model from February 19, 2020, to March 20, 2022.

In this quasi-experimental study, we employed a regression method based on Newey's Ordinary Least Squares to analyze daily data on COVID-19 infections in Iran, applying the interrupted time series model.

The daily trends of COVID-19 infections were analyzed on two specific dates: September 23, 2021, and November 22, 2021. Prior to the implementation of the vaccination program, the trend of new cases was on the rise on both dates (p<0.0001). However, following the intervention, there was a statistically significant decrease in new cases (p<0.0001).

National vaccination campaigns against COVID-19 have significantly contributed to reducing the incidence of the disease. It is crucial to continue these vaccination efforts to control the spread of COVID-19.

Identifying factors that contribute to the progression of COVID-19 in patients is crucial for preventing fatalities. Mucormycosis is one such influential factor. Hence, this study aimed to conduct a systematic review on the correlation between black fungus infection and COVID 19.

This systematic review followed the PRISMA protocol and utilized international databases.

A total of 161 cases were documented among 7495 COVID-19 patients. The majority of cases were reported in India. Among the case reports, 16 (76%) were male and six (24%) were female. Diabetes mellitus was prevalent in 56% of cases, with hypertension being the second most common comorbidity. Rhinocerebral mucormycosis emerged as the most prevalent clinical form of the disease.

Timely identification of mucormycosis cases, monitoring of hyperglycemia, appropriate use of antibiotics, and corticosteroids can help curb the rising incidence of this fungal infection.

Coronary artery bypass graft surgery is as stressful as any other surgery for the patient. Anxiety, depression, and impaired sleep quality are amongst the most common disorders in these patients. Electrolyte imbalance is also one of the problems after open heart surgery. The aim of this study is to provide a systematic review of the effect of magnesium supplementation on anxiety and depression and sleep quality in patients undergoing open heart surgery.

The present study was conducted using a systematic review method. Data was gathered by searching Persian and English articles with review and analytical inclusion criteria, compliance with the study title, samples receiving magnesium oral supplement and exclusion criteria, low relevance,duplication and overlapping of articles. By searching for the keywords cardiac surgery, anxiety and depression, sleep quality, magnesium and open heart surgery in reputable databases including Magiran, Google Scholar, SID, Iran Medex, PubMed, Ovid, Science Direct, Scopus, the site of the Ministry of Health and dissertations reviewed in the period 2009-2019.

95 articles were found in the initial search using magnesium supplement, anxiety, depression, sleep quality, open heart surgery keywords. From this total, 62 articles were excluded due to lack of relevance and 21 articles were set aside due to duplicate strategy. Finally, 12 articles were reviewed,including 7 articles (58.3%) in published in English and 5 articles (41.7%) Persian.

Due to the effects of magnesium oral supplement in patients after heart surgery, it is recommended that this oral supplement be included in the treatment program of these patients in order to reduce anxiety, depression and improve sleep quality

The prevalence of metabolic syndrome (MetS) is increasing in the world and also in Iran. MetS is associated with an increased risk of cardiovascular diseases and diabetes. There is no study on the prevalence of MetS in families of military personnel. The present study aimed to determine the prevalence of MetS and its components in a military town in Tehran. This cross-sectional study was conducted on 384 participants who were referred to the health center in Shahrak-e- Fajr. MetS components including waist circumference, blood pressure, fasting blood sugar, triglycerides, and high-density lipoprotein-cholesterol (HDL-C) were measured. MetS was diagnosed according to the Iranian National Committee of Obesity criteria. The overall prevalence of MetS was 36.45% (95% CI=31.62%-41.29%); 37.5% and 62.5%% were males and females, respectively. Only 6.25% of the participants did not have any MetS components. The most frequent components were low HDL-C levels (62.23%), and abdominal obesity (49.73%), respectively. Female gender (OR=1.35, 95% CI=0.83–2.19) and age (OR=1.17, 95% CI=1.12–1.22) were associated with increased risk of MetS. According to the results of the present study, the prevalence of MetS and its components is high in Shahrak-e- Fajr, Tehran. It needs to implement MetS prevention programs for the families of military personnel.

Reinfection among COVID-19 patients is still a challenging issue in the medical literature. Therefore, the current meta-analysis was conducted to estimate the pooled incidence rate of reinfection among COVID-19 patients.

A comprehensive search was conducted in PubMed, Web of Science, and Scopus databases from July 1 to October 1, 2021. Original studies which estimated the incidence rate of COVID-19 reinfection were included. CASP (Critical Appraisal skills program) was used to assess the quality of studies. Data were analyzed by STATA statistical software Version 15 (StataCorp, College Station, TX, USA).

A total of 3803 articles were found, of which 16 articles remained after title, abstract, and full text screening. The minimum and maximum incidence rates of reinfection were 0.001 and 0.73%, respectively. The pooled estimated incidence rate of COVID-19 reinfection was 0.11% (95% confidence interval: 0.02-0.20, p< .001, I2 = 100.0). The highest pooled estimated incidence rate of reinfection was observed in people <50 years old (0.14%) (95% CI: 0.001-0.34, p<.001, I2 = 100). Regarding the time elapsed after the first infection, the highest reinfection rate occurred four months after the first infection (0.12%) (95% CI: 0.001-0.27, p< .001, I2 = 100).

The incidence rate of reinfection among COVID-19 patients is expected to be high. However, it seems that the influence of factors including the age of patients and the time elapsed after the first infection must be considered.

Survival rate is one of the main prognostic indicators in cancer related topics. The aim of this study was to investigate the survival rate and related factors in breast cancer patients referred to a military hospital in Tehran, Iran.

In a longitudinal epidemiologic study of a historical cohort type, the recorded data of all women with breast cancer who referred to radiotherapy center of a military hospital between 2012 and 2017 were selected by the census method and were evaluated in terms of five-year survival rate. The survival rate curve was analyzed by Kaplan-Meier statistical method, and Cox-regression was used to examine the variables affecting survival.

In the minimum 6-year follow-up of 249 patients, 237 (95.2%) were alive. The 1-, 3- and 5-year survival rates in all study patients were 100%, 98% and 96%, respectively. There were significant relationships between mortality rate and age, number of children, education, menopausal status, lymphatic involvement, clinical stage and grade, underlying disease, and family history of bearst cancer (p<0.05). Among the variables included in the Cox model, lymphatic involvement and underlying disease had the greatest impact on reducing survival.

Public education at the time of patients’ visits and during the golden times of diagnosis and treatment has been effective in reducing deaths and increasing survival.

Spiritual fitness in combat requires spiritual intelligence to give meaning to life and change the attitude towards crises as a spiritual experience. The purpose of the study was to investigate the effect of the spiritual counseling of the Sound Heart Model on the spiritual intelligence and spiritual experience of military commanders.

The research method was a clinical trial type. The research population consisted of 98 military commanders of the army, who were selected according to the inclusion criteria through available sampling. They were divided into two groups by random group allocation. The intervention for the experimental group was implemented for 51 weeks with model-based multimedia training with the aim of gaining trust, increasing knowledge, developing communication, and motivation, by means of educational software and follow-up in the virtual network. Before and after the intervention, daily spiritual experiences and spiritual intelligence questionnaires were completed by both groups.

The spiritual intelligence of the commanders of the two groups before the intervention had no significant difference (P = 0.80) (intervention 65.39 ± 4.33 - control 65.15 ± 5.38). But after the intervention, a significant difference was created (P<0.001) (intervention 84.16 ± 2.97 - control 65.41 ± 5.82). There was no significant difference in the spiritual experience of the commanders of the two groups before the intervention (P = 0.92) (intervention 48.08 ± 2.13 - control 48.12 ± 2.36). But after the intervention, the difference was significant (P<0.001) (intervention 67.96 ± 4.18 - control 48.37 ± 2.20).

Considering the effect of spiritual counseling on improving the spiritual intelligence and spiritual experience of military commanders, it is recommended to use the "Sound Heart Model" for the spiritual fitness of military personnel.

Monkeypox is a rare zoonotic infectious disease caused by the Monkeypox viruses, a type of Orthopoxvirus of the family Poxviridae, which is endemic to Africa. Monkeypox, which is usually a self-limiting illness, starts with flu-like symptoms (fever, muscle aches, chills, and fatigue). Usually, within 1 to 3 days (sometimes longer) after the onset of fever, the patient develops a rash that often starts on the face and then spreads to other parts of the body. Lesions may appear all over the body. Decreased immunity of populations due to the cessation of smallpox vaccination in the past, has paved the way for Monkeypox. This is shown by the increase in the number of cases as well as the recurrence of the disease in some countries. Due to the importance of the Monkeypox and the limited number of Persian language sources in this regard, the present article aimed to introduce this disease as a zoonotic infectious disease that has recently, been reported in several countries.

Outbreak detection algorithms could play a key role in public health surveillance. This study aimed to compare the performance of three algorithms (EWMA, Cumulative Sum (CUSUM), and Poisson Regression) using the reported COVID-19 data for outbreak detection. Three outbreak detection algorithms were applied to the data of COVID-19 daily new cases in Iran between 19/02/2020 and 20/06/2022, and 344 simulated outbreak days were injected into the data sequences. The Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) and its 95% confidence intervals (95% CI) were also computed. EWMA9 had the lowest AUC (51%). Among the different algorithms, EWMA9 with λ = 0.9 and CUSUM 1 had the highest sensitivity with 100 and 87% (95% CI: 84%-91%), respectively. According to the results, CUSUM, EWMA, and poison regression showed appropriate performance in detecting the COVID-19 outbreaks. These algorithms can be extremely helpful for health practitioners and policymakers in the detection of infectious disease outbreaks.

Oxidative stress (OS) contributes to the development of some disorders, including malignancies, metabolic diseases, Alzheimer's disease, and Parkinson's disease.

The effects of coenzyme Q10 (CoQ10) supplementation on OS parameters have been assessed through an updated systematic review and meta-analysis.

SCOPUS, PubMed, Cochrane Library, EMBASE, and Web of Sciences were used for article searching. Standardized mean difference (SMD) and its standard error were calculated using a random-effects DerSimonian and Laird model. All analyses were done using the STATA software version 16.0 (StataCorp, College Station, TX).

Based on twenty-five studies which remained to be incorporated in the meta-analysis, a statistically significant decrease in malondialdehyde (MDA) (SMD -2.74; 95% CI -3.89, -1.58; I2 = 96.9%) as well as nitric oxide (NO) (SMD -5.16; 95% CI -7.98, 2.34; I2 = 92.5%) was associated with CoQ10 supplementation, and a significant increase in total antioxidant capacity (TAC) (SMD 3.40; 95% CI 1.98, 4.83; I2 = 97.4%) and superoxide dismutase (SOD) activity (SMD 1.22; 95% CI 0.32, 2.12; I2 = 94.32%).

The results showed no significant effect of CoQ10 supplementation on glutathione peroxidase (GPx), catalase (CAT) activities, and glutathione (GSH) levels. CoQ10 supplementation significantly reduced MDA and NO concentrations and increased TAC and SOD activity.

Dietary quality indices are practical as an instrument to investigate the extent of adhering to a special diet to prevent cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Considering the lack of any systematic review with regards to this issue, our aim was to examine observational studies to test the relationship between dietary quality indices and CVD risk factors in T2DM.

Systematic search was performed in Web of knowledge, PubMed, Cochrane, Science direct, Google Scholar and Scopus databases from January 1990 to July 2020. The studies exploring the relationship between dietary quality indices (diet quality score (DQS), dietary diversity score (DDS), healthy diet indicator (HDI), healthy eating index (HEI), diet quality index (DQI), Mediterranean diet score (MDS)) and lipid profile, anthropometric indices, glucose profile as well as blood pressure were eligible to be included in this review. Overall, mean changes, odd ratio (RR), correlation coefficients, and beta coefficient of outcomes were extracted, with the quality assessment of studies performed applying The Newcastle‑Ottawa scale.

From among 1627 papers, 10 articles were included: Eight cross‑sectional and two prospective (cohort) studies. The association between HEI as well as MDS and CVD risk factors was more evident in the included studies. Fasting blood sugar, hemoglobin A1c, body mass index, and waist circumference revealed the greatest inverse significant relationship with dietary quality indices in adults with T2DM.

Overall, the findings of this study suggest that the level of CVD risk factors in T2DM decreases significantly with increase i

Metabolic syndrome is one of the most prevalent health issues in the world and a risk factor for non-communicable diseases, especially cardiovascular disease and diabetes. It is believed that optimal lifestyle improvement can be effective in reducing risk factors.

This study, therefore, aimed to determine the effect of lifestyle modification training on the control of risk factors for metabolic syndrome in nurses.

The present study is a clinical trial study whose research population included nurses working in selected military hospitals during the spring and summer of 2020. The sample was selected through purpose-based sampling and randomly divided into two groups, each consisting of 40 people. For the intervention group, training lifestyle modification was conducted in a combined way, four one-hour face-to-face sessions and text messages, as well as three text messages daily. Data were collected through a demographic information questionnaire, health-promoting lifestyle questionnaire, and laboratory indicators. The control group did not receive any intervention. Data were collected in two stages before and after the intervention and analyzed by the SPSS software (version 19).

There was no statistically significant difference between the two groups in terms of demographic characteristics before the intervention. Additionally, health-promoting lifestyle scores, body mass index, fasting blood sugar, waist circumference, triglyceride, and HDL were not significantly different between the two groups before the intervention; however, the difference was significant after the intervention in the intervention group (P<0.05).

Findings showed that lifestyle modification training was effective in controlling the risk factors for metabolic syndrome among nurses working in selected military hospitals; therefore, it is recommended to periodically assess the lifestyle prevalence of metabolic syndrome among the nursing staff to use lifestyle improvement training programs in continuing hospital education.

Sleep disorders in patients in Intensive Care Units (ICUs) are one of the most important causes of increased length of stay, decreased recovery, delirium and neurological and psychological problems. Nursing interventions can be effective in improving sleep disorders. The purpose of this systematic review is to determine the effect of nursing interventions on the improvement of sleep disorders in patients admitted to ICUs.

This systematic review was conducted in the first half of 2021 by searching Persian and English articles in the period from the beginning of 1980 to the first half of 2021. The search strategy and keywords were defined based on the PICO system and inclusion criteria. Search with a combination of Persian keywords: "sleep disorder", "nursing care", "intensive care unit" and their English equivalents sleep disorder, hyper somnolence, insomnia, dyssomnia, sleep apnea, sleep deprivation, intensive care, critical care, ICU, CCU, nursing intervention nursing care in Persian-language databases Scientific Jihad (SID) and information of national publications (Magiran) and English Scopus, Web of Science, Pub Med, Science Direct and Proquest also performed using Google scholar search engine Has been. Qualitative evaluation of articles was performed with Jadad scale. Of the 18,799 initially retrieved studies, 97 reached the final review stage.

The results showed that reducing ambient noise, leisure time protocol, use of ear and eyeglasses, music therapy, aromatherapy and pharmacotherapy, especially oral melatonin, had the greatest effect on the quality and quantity of sleep. Interventions with less impact and application included massage, acupuncture, physiotherapy, milk and honey combination before bed, cognitive-behavioral therapy, spiritual care, follow-up care model, ventilator modes, relaxation and guided visualization. Also, a variety of pharmacological interventions are used as an alternative or in combination with non-pharmacological interventions.

The findings of this study showed that simple and low-cost interventions such as reducing the number of direct care visits, reducing noise and ambient light and using blindfolds and earplugs are the most effective nursing interventions in improving the quality and quantity of sleep in ICUs. After recognizing the cases that cause sleep disorders in patients admitted to ICUs, nurses can prevent the occurrence of complications of sleep disorders in patients with these interventions.

An essential concept in assessing the extent to which an infectious outbreak spread is the concept of basic reproductive number (R0). The current systematic review and meta-analysis aimed to estimate the R0 of the Delta variant of SARS-CoV-2 based on studies published from 1 January 2021 to 23 September 2021.

International databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched using keywords: "Basic reproduction number, R0, COVID-19, SARS-COV-2, Severe Acute Respiratory Syndrome Coronavirus, NCOV, 2019 NCOV, coronavirus, Delta variant, B.1.617.2". Due to significant heterogeneity, DerSimonian-Laird random-effects model was used to estimate the pooled value of R0.

A total of 245 reports were identified. After assessing the inclusion criteria, three studies were selected. The pooled R0 for the Delta variant was estimated as 5.10 (95% CI, 3.04 to 7.17). (I2 =86.77%, T2:2.68, p-value from the chi-square test for heterogeneity was<0.001).

Considering the estimated value of R0 for the Delta variant of SARS-CoV-2, the amount of vaccine coverage required to achieve herd immunity appears to be higher than previous variants of the virus.

Before interventional clinical studies in humans, researchers usually perform preclinical studies in vitro or in vivo to evaluate the initial efficacy, toxicity, and pharmacokinetics of interventions. Sample size determination in animal studies is necessary both in terms of correct and scientific inference and in terms of ethics. Therefore, the purpose of this paper is a brief description of how to determine the sample size in a study on laboratory animals.

Myocardial infarction (MI) is one of the leading causes of mortality worldwide. This disease imposes a high socio-economic burden on patients. Since the Spatio-temporal analysis of diseases plays an essential role in the design of prevention and management programs. The present study aimed to identify regional clusters of MI and also analyze the time trend of the disease among an Iranian military community.

In this ecological study, all registered cases of MI from different provincial centers of the military community were studied during the period 2015 to 2018. The Getis-Ord Gi statistics were used to identify the hot spots of MI and the Spearman correlation coefficient to the trend of the disease.

The incident cases of MI in military officers and conscripts during the study period were 103 and 4, respectively. Gilan and Golestan provinces (90% confidence level) in 2015, Gilan, Golestan, Semnan, and Zanjan provinces (95% CI) and Isfahan province (90% CI) in 2016, Golestan province (95% CI), and Gilan province (90% CI) in 1396 and Golestan province (95% CI) in 1397 were identified as hot spots of the disease. The results of the temporal analysis also indicated a significant increasing trend of MI in military officers.

The Northern regions of Iran are at high risk of MI, and the trend of the disease also demonstrates a significant increase. The findings of this study can be considered in policymaking in the field of public health of military communities for control strategies and preventive programs. In future studies, the risk factors and non-ecological parameters should be addressed in hotspot regions.

The Covid-19 virus has infected different countries of the world since the end of 2019. To date, more than 208 million people have been infected with the disease, and more than 4 million have lost their lives. While efforts to curb the COVID-19 pandemic continue through vaccination around the world, the incidence and mortality continue to rise. Unfortunately, in the fight against the pandemic, COVID-19 patients are also at risk for some secondary infections such as mucormycosis. Mucormycosis, or black fungal disease is a rare and opportunistic infection that can spread fast in people with COVID-19. The action of this fungus is to invade the body's arteries and create clots in them. As a result of the clot, blood flow to the tissues of the body is stopped, and the tissue becomes necrotic or so-called black. Black fungus has made headlines these days during the Covid-19 epidemic, especially in India. Diabetes mellitus and the use of steroid drugs (which are prescribed to treat severe acute respiratory infections) are important risk factors for COVID-19 patients. Due to the opportunistic nature of this infection, early detection of it can reduce the severity of the disease and consequently reduce the mortality of COVID-19 patients.

An outbreak of COVID-19 in Iran has spread throughout the country. Identifying the epidemiological characteristics of this disease will help to make appropriate decisions and thus control the epidemic. The aim of this study was characterization of the epidemiological features of COVID-19 in Iran.

In this epidemiological study, the epidemiological data related to COVID-19 patients admitted to Baqiyatallah Hospital in Tehran, Iran, from 19 February 2020 to 30 Nov 2021 have been analyzed. Patient variables including gender, age and comorbidities were studied. Case Fatality Rate (CFR) was also determined.

From February 19, 2020 to 30 Nov 2021, 22157 were hospitalized with COVID-19 diagnosis. The average length of stay in the hospital was 5 days. The average age of hospitalized people is 55 years. 65% of cases were men (12,756) and 35% (9,401) were women. The highest number of deaths was in the age group of 60 to 70 years. 2112 deaths due to COVID-19 have occurred until December 9, 1400. Therefore, CFR was calculated as 9.53. CFR in men and women was calculated as 10.77 and 7.85, respectively. Also, the highest CFR was observed in the age group above 80 years (25.30%) and the lowest was observed in the age group of 10 to 20 years.

It is important to pay special attention to male elderly patients with COVID-19. Therefore, it is very important to pay special attention to elderly men with covid-19 in prevention and treatment protocols.

Occupational accidents impose high costs on organizations annually. This study aimed at investigating the factors affecting military work‑related accidents using artificial neural network (ANN) and Bayesian models.

This study was a cross‑sectional survey in a military unit that examined all occupational accidents recorded during 2011–2018. First, we collected the data of the accidents using the accident database in the inspection sector of the Department of Health and the Medical Commission of the Armed Forces. ANN, Bayesian, and logistic regression models were used to analyze the data.

The results of the type of accidents showed that 219 cases of sport accidents (32.8%), 125 cases fall from height (18.7%), and 104 cases of driving accidents (15.6%) were the most common accidents. Based on the results of multivariate regression, accident variables due to fighting (odds ratio [OR] =17.21), injury to the body or back (OR = 122.55), and multiple injuries (OR = 25.72) were considered as influential and significant factors. The ANNs results showed that the highest importance factor was the injury to the body or back, multiple injuries, age, fighting, and finally, driving accident. Furthermore, the Bayesian model showed that the most important factors affecting the death consequence due to accidents were related to injuries to the body or back (OR = 276.23), multiple injuries (OR = 54.98), and accidents due to conflict (OR = 33.69).

The findings show that the most important factors affecting the death consequence due to accidents in the military are the injury to the whole body, multiple injuries, age, fighting accident, and driving accident. The ANN and Bayesian models have provided more accurate information than logistic regression based on the obtained results.

In the present study, the goal was to estimate the hospital length of stay among patients admitted with COVID-19 in a hospital in Tehran.

We used retrospective data on 446 hospitalized patients with COVID-19 who admitted from 7 March to 8 Oct 2020 in a referral hospital in Tehran, Iran. The prognostic effects of variables, including age, gender, comorbidity status, and symptoms were analyzed by using Kaplan-Meier methods and a competing risk analysis. Length of stay in hospital was calculated using time of last status minus time of admission. All analyses performed using SPSS version 22.0 and STATA version 15.

The mean age of cases was 57.09±16.85 years old. The median (IQR) of hospital length of stay among all patients was 7 (11-5) days. The length of Hospital stay, for >80 years’ patients (9days (15-5)) and females (7days (11-5)) was the longest. The most of cases (94 (21.1%)) were in 60–69 age group. In overall 267 (59.9%) of all cases were males and 179 (40.1%) were females. The most common symptom among patients was Respiratory distress 249 (55.8), Cough 233 (52.2) and fever 209 (46.9) respectively. Regarding having any comorbidities, 106 (23.8%) of COVID-19 cases had Cardiovascular disease, 114 (25.6%) had diabetes and 100 (22.4%) had hypertension. Most of deaths (21 (32.3%)) occurred in 70-79 years’ age group. The overall Case Fatality Rate (CFR) in under-studied cases was 14.6%.

Although the result of the present study showed that hospital length of stay in Iran is not higher than in other countries, but by applying some measures including the early detection of suspected cases and timely treatment and necessary funding on preparing required facilities, medicine and equipment, it could be shortened or at least prevented from increasing.

Chronic low back pain is one of the most common musculoskeletal disorders in the world. This study aimed at evaluating the risk of non-specific chronic low back pain and related cognitive risk factors.

This descriptive analytic study was performed in 162 patients in a military hospital in Tehran, Iran 2020. Data were collected using the STarT Back Screening Tool, Fear-Avoidance Beliefs Questionnaire, Patient Health Questionnaire, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia. Data analysis was carried out in SPSS V25 using independent samples t-test, Chi-square, and multiple logistic regression.

Among the patients, 23.40% and 25.84% had sub-acute and acute low back pains, respectively, and were at high risk for chronic low back pain. Fear-avoidance belief, fear of movement, catastrophizing the pain, and depression were found to be the major risk factors for chronicity risk of acute and sub-acute non-specific low back pain.

Most of the patients studied were at moderate and high chronicity risk for low back pain. Therefore, determining the risk levels of chronic back pain in acute and sub-acute pains and considering all parameters affecting the chronicity of low back pain, e.g. individual and cognitive factors at the beginning of treatment are of great benefit in creating a suitable algorithm for treatment.

The present study aimed to examine The effect of Merrill instructional design model in the form of multimedia education on nurseschr('39') creativity

Creativity is one of the most important skills needed by nurses and this skill can be improved through designed training such as multimedia training The present study was a quasi-experimental or pretest-posttest design with a control group. The statistical population of this study included all nurses of Baqiyatallah hospital in Tehran. The data collection tool was Abedichr('39')s patient creativity test. Simple random sampling method was used to select 80 individuals who were divided into experimental and control groups. The creativity test was performed on nurses before the start of the course, and then the experimental group was trained for 7 weeks on a multimedia design based on the Merill model. Two groups were used and data were collected and analyzed by SPSS 21 software.

The results showed Merrill instructional design model in the form of multimedia compared with traditional methods had significant impact on Nurses creativity(F=12.174,p=0.01). The results  also showed Merrill instructional design model in the form of multimedia compared with traditional methods had significant impact on  Subscales of originality, flexibility, elaboration  and  Subscale fluency(P <0.05).

The results showed that the use of Merrill instructional design model in the form of multimedia had a significant effect on nurseschr('39') creativity

Epidemic curves are a type of time series data consisting of the number of events that occur over a period of time. The time unit in this data can be a day, a week, or a month, etc. 

In the current letter, the authors tried to explain the growth factor and its effect on epidemic curves by using some literature. 

In the outbreaks setting, the number of cases can increase with different patterns. When the number of cases is increasing exponentially, it means that the number of cases is increasing at a certain speed, which is determined by a factor called an exponential growth factor. When this factor is greater than one, it means that the cases are increasing exponentially, and when this coefficient is equal to 1, it means that we have reached an inflection point that we will face a change in the growth rate of the cases. 

Some factors such as reducing the contact between infected and healthy people, run the social distancing program, and so on can have an effective role in decreasing epidemic growth factor and controlling the epidemic.

Identifying the factors that affect the mortality of COVID-19 patients can play an important role in preventing death in these cases. Para clinical factors can be one of the effective factors on COVID 19 patientschr('39') mortality. Due to the presence of controversy between studies, this study aimed to determine the role of Para clinical factors on the mortality of COVID-19 patients in a systematic review and meta-analysis.

The current systematic review and meta-analysis were performed using PRISMA protocol in international databases including Medline / PubMed, Scopus, Google scholar. Due to the presence of heterogeneity between studies, the random effect model (95% CI)-was used to calculate the pooled odds ratio (OR) and the risk ratio (HR). Data were analyzed using Stata11 software. The Heterogeneity was assessed using Cochranchr('39')s Q indicators, I2 index, and T2 test.

the serum Creatinine, OR:1.95 (1.54-2.47), serum Bilirubin OR: 3.07(1.10-8.57), and urea Nitrogen, OR: 3.52 (1.11-10.09) increase significantly the risk of death from COVID 19(P<0.05), However, Lymphocyte count and serum Albumin didn’t show a significant relationship with the mortality of COVID-19 patients(P>0.05).

it seems some Para clinical factors, such as serum creatinine, serum bilirubin, and high levels of urea nitrogen, are associated with COVID-19 mortality. Therefore, paying attention to these factors can play an important role in reducing the mortality of these patients.