alireza ansari-moghaddam

Following the announcement of the Coronavirus disease 2019 (COVID-19) pandemic in 2020, numerous questions arose about this virus, including how long it remains active in the human body. Human coronaviruses can survive on inanimate surfaces for 2 hours to 9 days.

The study aimed to determine whether severe acute respiratory syndrome (SARS)-CoV-2 remains in corpses after death.

This cross-sectional study investigated the epidemiological status of 810 deceased individuals referred to forensic medicine regarding infection with SARS-CoV-2, based on rapid diagnostic tests (RDTs) from March 21 to September 22, 2021. The tool for collecting information was a checklist created by the researcher. Information related to the history of hospitalization, infection with COVID-19, and vaccination of individuals was collected through the medical care monitoring center (MCMC) system, the standard forms of the COVID-19 epidemic management and control plan notified by the Ministry of Health, and the university's written list of COVID-19 patients.

Of the 810 deceased cases, 584 (72.1%) were men, and 226 (27.9%) were women. The average age of the deceased referred to forensic medicine was 39.5 years. Among the referred deceased, 123 individuals (15.2%) had at least one crucial underlying disease. Among all the deceased, 36 individuals (4.4%) had a positive test. The average interval between death and sampling in positive cases was 32.6 hours (ranging from 2 to 240 hours).

Considering the persistence of the virus for more than a week in the deceased, all individuals who deal with the deceased in any way should use less invasive methods during epidemics and appropriate personal protective equipment (PPE).

 Different instruments are employed to assess public behavior and understanding of COVID-19. The World Health Organization Survey Tool for Behavioral Insights on COVID-19 (WHO-STBIC) is an appealing and adaptable instrument for evaluating population behavioral insights. This research sought to translate, adapt, and content validate the Persian version of WHO-STBIC.

 Forward-backward translation of the English WHO-STBIC to Persian was done by four English language experts. The back-translated version was compared with the original version and disagreements were resolved by a team encompassing four translators and two experts in the field. To investigate the content validity of the preliminary Persian version, nine experts were invited to assess the tool through a content validity form. The internal consistency was evaluated using Cronbach’s alpha.

 A shortened through adaptation version Persian version of WHO-STBIC (90 items in 17 subscales) was derived with minor adaptations from the original version. In terms of content validity, the modified kappa (mK) index was calculated as excellent for 86 percent (n=78) of items (mK>0.9). The mean Content validity Index (CVI) of the whole scale was 0.87 ranging from 0.46 to 0.86 for 17 subscales. Cronbach’s alpha was calculated to be 0.86.

 The Persian version of WHO-STBIC was adapted and validated with minimum modifications to be used in Iran. It was hard to say that this tool is a fast one. So, the shortened through adaptation Persian version was developed. Researchers can use these tools to ensure culturally appropriate, relevant, valid, and reliable data collection.

The caregivers of stroke patients experience a sense of confusion and stress after the patients are discharged from the hospital. Such that after a while, they experience a sense of inability to provide care and an increased caregiving burden. Therefore, this research aims to study the effects of a supportive training program on the caregiving burden of stroke patients’ caregivers after discharge from the Intensive Care Unit (ICU).

In this randomized clinical trial, the study population consisted of 60 caregivers of stroke patients. The sampling method was purposive based on the inclusion criteria. The intervention was performed in 6 supportive training program sessions. Data were collected using demographic questionnaires and the Novak and Guest Caregiver Burden Inventory. Data were analyzed using the paired t-test, independent t-test, and ANCOVA.

There was no significant difference in the caregiving burden before the intervention between the two groups (intervention: 81.13 ± 13.99, control: 70.66 ± 14.61, P value= 0.030). After the post-test, the caregiving burden reduced significantly in the intervention group compared to before the intervention (56.46 ± 10.52) and compared with the control group (72.33 ± 15.86, (P value< 0.001).

According to the findings, the caregiving burden of stroke patients' caregivers can be alleviated through the intervention of supportive training, which is an effective and cost-effective method. As nurses play a key role in training and supporting these patients as primary caregivers, they should take this program seriously.

To perform effective prevention programs, we need to know how well people follow prevention protocols, like mask use and social distancing, measuring using standard tools. This study aims to develop and validate a brief questionnaire to assess the compliance with prevention protocols against infectious respiratory diseases pandemics including COVID-19 in pedestrians. This cross-sectional study was conducted using convenience sampling method in May and June 2021. Construct validity of the questionnaire was assessed using Exploratory Factor Analysis (EFA). Content validity was evaluated by quantitative method, thus, Content Validity Ratio (CVR) and Content Validity Index (CVI) were calculated. For reliability of the questionnaire, the internal consistency using Cronbach’s alpha, and test-retest reliability using Spearman-Brown correlation coefficient were assessed. A total of 324 persons from three provinces of Iran participated in this study. The mean age (SD) of participants was 41.5 (16.7). The CVR values resulted in the elimination of two questions. The Scale level CVI/Average (S-CVI/Ave) was equal to 0.992; and Scale level CVI/Universal Agreement (S-CVI/UA) was 0.889. One factor with five items emerged from principal component factor analysis accounting for 51.99% of the variance. Cronbach’s alpha coefficient equal to 0.76 indicated an acceptable internal consistency and the Spearman-Brown correlation coefficient of 0.939 depicted stability of the questionnaire. This questionnaire is a brief tool with acceptable validity and reliability to evaluate the compliance with preventive protocols during infectious respiratory diseases outbreaks in order for policy-makers to make effective interventions to slow down the spread of disease.

 Annually, 3-8 million infants are born with congenital anomalies worldwide, ranging from 3% to 7% of births in different countries. This study aimed to investigate the nationwide epidemiological features of birth defects in Iran.

 This cross-sectional study was conducted in six major regions across Iran. The data sources were the maternity facilities affiliated with regional universities of medical sciences. All children were examined by obstetricians, pediatricians, or midwives at birth, and newborns were followed until discharge from the facility for health status, maturity, and congenital defects.

 A total of 138,643 births were registered in the maternity facilities across the study regions. Among these newborns, 3,458 cases were diagnosed with congenital anomalies, representing an overall prevalence rate of 249.4 per 10000 births (95% CI: 241.2-257.8). Genital organ anomalies exhibited the highest rates of defects in the country with 92.7 per 10000 births (95% CI: 86.4-98.9), followed by limb anomalies at 83.3 per 10000 births (95% CI: 77.4-89.3). The prevalence of respiratory system, chromosomal, and urinary tract anomalies was less than 10 per 10000 births.

 Until a national registry for congenital anomalies is established, this study provides essential data on the magnitude of the health problems caused by congenital anomalies in Iran. The findings would be vital for planning and evaluating antenatal screening for birth defects, particularly for high-risk groups and regions in the country.

Health-promoting environments are a key focus of the Ottawa Strategic Charter, which aims to enhance health in the workplace and reduce unhealthy behaviors among employees.

This study aimed to evaluate the effectiveness of health-promoting interventions on the habits of university staff in Southeastern Iran.

This semi-experimental study was conducted from 2020 to 2021 in Zahedan, Southeastern Iran. A total of 254 administrative staff from the University of Medical Sciences and Sistan & Balochistan University were selected using available randomized methods and divided into control and intervention groups. The study instrument was a researcher-designed questionnaire, which demonstrated a content validity ratio (CVR) of 0.8, a Content Validity Index (CVI) ranging from 0.83 to 0.97, and an internal consistency with a Cronbach's alpha of 0.85. The questionnaire was distributed online via the Porsline platform. For the intervention, training sessions were conducted online, and the session files and training booklet were made available to intervention group staff through the university's education system. A post-test was administered one month after the pretest. Data were analyzed using SPSS 21 software, with pretest results adjusted using chi-square and ANCOVA statistical tests.

The study found that the mean age of participants was 40.5 ± 7.4 years. Scores for employee knowledge, attitude, and behavior were 80.0 ± 16.4, 86.6 ± 22.8, and 80.8 ± 17.6, respectively. The most significant factors influencing attitudes were education (P < 0.001) and health status (P = 0.001). Type of employment (P = 0.025), work experience (P = 0.017), and health status (P = 0.037) were also significantly associated with behavior. After adjusting for pretest results, there were significant differences between the intervention and control groups in terms of scores for knowledge, attitude, and behavior (P < 0.001).

The study concluded that employees with correct attitudes and healthy behaviors reported better health outcomes. Additionally, educational interventions effectively improved staff knowledge, attitudes, and behavior. To enhance health status, reduce employee disability, decrease absenteeism, and increase organizational productivity, it is recommended to plan and implement workplace health promotion programs focused on employees.

To adapt to the changing conditions and respond to the needs of society, health systems need continuous changes and reforms in their structure and performance, and subsequently, they need to evaluate their indicators. Therefore, this study aimed to investigate the impact of the health system transformation plan (HTP) on the functional indicators and efficiency of hospitals in a country in the Middle East region (Iran). A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‑Analyses) guidelines using the online databases Medline, EMBASE, Scopus, Pubmed, SID, Magiran, and Medlib from 2013 to 2022 using a combination of medical subject heading terms (‘health system transformation plan [Mesh] OR ‘health reform [Mesh] OR implementation of the health transformation plan [Mesh] ‘’AND (‘performance indicators’ [Mesh]) ‘’AND (‘Iran’ [Mesh]). STATA version 11 were used for data analysis. A total of 20 reports (cross‑sectional, cohort, and case‑control) were identified for this study. The results showed that after the HTP, the indices of bed occupancy rate and bed turnover rate have increased and the index of bed turnover distance has decreased. On the other hand, after the implementation of this plan in hospitals, the average of patients’ length of stay has increased. The implementation of HTP has improved most of the performance indicators of hospitals and has generally led to an increase in the productivity of hospitals compared to that before the implementation of the plan. However, efforts to strengthen weak performance indicators and identify effective indicators along with adopting correct policies to increase the overall efficiency of hospitals can be effective in improving HTP.

In a crisis, rumors often get started, and societies use them to cope with ambiguous situations. Southeastern Iran, with its high rate of homeless addicts per population, is a suitable area to examine the accuracy of the rumor about the positive effect of addictive substances on preventing COVID-19.

This cross-sectional study aimed to investigate the abundance of COVID-19 infection among homeless drug abusers in this area.

For each participant, the health experts completed a questionnaire including demographic characteristics,symptoms and type, frequency and methods of drug abuse. For a definite diagnosis of COVID-19, a combined oropharyngeal/nasal sampling method was used in the laboratory under standard polymerase chain reaction (RT-PCR). Data was analyzed with SPSS v. 19. The chi-square test was used to compare COVID-19 cases across substance types, abuse methods, and consumption frequencies.

In total, 295 homeless drug abusers participated, and positive COVID-19 was recorded for 21(7.1%). Most participants were waste pickers (60.5%), and 3.9% had COVID-19. The statistical analysis showed no significant difference in the number of positive COVID-19 cases between narcotics, stimulants, and both combinations. Our study also did not prove the positive effect of drug abuse methods and the frequency of daily drug abuse on the incidence of this disease.

During the COVID-19 pandemic, unreliable, incorrect, and incomplete information on its prevention spread in societies. It is recommended that health-related rumors be investigated and officials publicly announce the results.

 Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country.

 We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards.

 We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients.

 The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.

Masks play a crucial role in preventing and controlling viral epidemics transmitted predominantly through the air. This study aimed to develop and validate a tool to measure people’s attitudes and behaviors related to mask usage during highly contagious viral epidemics.

In this psychometric study, the initial questionnaire was developed and face validity and content validity were assessed by 17 experts and three lay experts. Reliability was evaluated through internal consistency using Cronbach’s alpha and test-retest reliability using the Intraclass Correlation Coefficient (ICC). Construct validity was measured using exploratory factor analysis (EFA) with the principal component extraction method and Varimax rotation.

Based on a review of previous studies, an initial 27-item questionnaire was crafted. During the face validity stage, two items were excluded. Through calculating the Content Validity Ratio (CVR) and the Content Validity Index (CVI), three and one items respectively removed. The average scale level content validity index (S-CVI/Ave) was 0.95. Cronbach's alpha coefficient was found to be 0.76 for attitude and 0.66 for practice sections; the ICC was equal to 0.873. EFA revealed two factors explaining 63.98% of the total variance.

This questionnaire demonstrated sound reliability and validity in Persian, providing an effective means to assess attitude and behavior related to mask usage during highly contagious viral epidemics. It stands as a valuable tool for use in Iran and other countries.

 The study aims to determine the age- and sex-adjusted prevalence of refractive errors and its related factors among the adult population of southeastern Iran.

 The current study included 9280 individuals aged 35 to 70 years using a multistage random sample method from October 2015 to January 2019 as a part of a Persian cohort study in Zahedan. Uncorrected and corrected vision, objective noncycloplegic, and subjective refraction were measured, with all participants undergoing ophthalmoscopy, slit-lamp biomicroscopy, fundoscopy, refraction, and retinoscopy. Data were analyzed using SPSS version 23.0 statistic software and described as percentage, odds ratio, and 95% confidence interval. Comparisons between groups and relationships among risk factors and refractive errors were performed with chi-square, nominal, and multiple regression analysis.

 The prevalence of low and moderate myopia, high myopia, low and moderate hyperopia, high hyperopia, low and moderate astigmatism, and high astigmatism was 24.2 (95% CI: 22.40 - 25.90), 1.5(95% CI: 0.00 - 3.53), 16.1(95% CI: 14.20 - 17.90), 1.3(95% CI: 0.00 - 3.30), 35.6 (95% CI: 33.90 - 37.30), and 3.8 (95% CI: 1.80 - 5.70) percent, respectively. The prevalence of refractive errors significantly varied across different age groups overall and by sex (P = 0.01). The proportion of refractive errors also significantly differed by education (P = < 0.001). The prevalence of against the rule, with the rule, and oblique astigmatism was 32.8 % (95% CI: 31.10 - 34.20), 42.1% (40.50 - 43.60), and 24.9% (23.10 - 26.60), respectively. The risk of astigmatism was significantly lower in men than in women (OR = 0.75; 95 % CI: 0.60 - 0.90). Based on multiple regression, the risk of myopia (OR = 2.07; 95 % CI: 1.60 - 2.60) and hyperopia (OR = 25.38; 95 % CI: 18.70 - 34.3) was higher in the age group 65 to 75 years compared to the younger group.

 The present study provided valuable information on the prevalence of refractive errors in the adult population in south-eastern Iran. The findings underscore the need for comprehensive eye care services, particularly for older individuals and those with lower education levels. Further prospective research is warranted to explore the factors contributing to refractive errors and to develop effective strategies for its prevention and management.

 Celiac disease (CD) treatment is based on life-long adherence to a gluten-free diet (GFD). Some patients with CD experience persistent symptoms despite adhering to a GFD. This condition is defined as a nonresponsive CD.

 The present study aimed to investigate the prevalence and cause of persistent symptoms in pediatric patients with CD adhering to a GFD in Sistan and Baluchestan province, southeastern Iran.

 This descriptive cross-sectional study was conducted on 112 patients with CD selected from all diagnosed CD patients receiving a GFD for 6 months and newly diagnosed cases studied within one year. Gastrointestinal (GI) and extraintestinal (EI) symptoms were recorded on a questionnaire at the onset and during treatment. Data were analyzed by SPSS16 software, independent t-test, univariate t-test, and analysis of variance (ANOVA).

 A total of 46.43% of our sample were boys, and 53.57% were girls (mean age = 82 ± 4.43 months). Abdominal pain and constipation symptoms were reported more frequently at the time of diagnosis and following one year of treatment. The most commonly observed EI symptoms at the time of diagnosis and during treatment were weight loss and growth failure, respectively. The percentage of treatment non-response in patients with a positive family history was significantly greater than in those with a negative family history.

 The results showed that GFD had a significant effect on the reduction of GI and non-GI symptoms, but the effect of this regime on insignificant symptoms, particularly at older ages, is negligible.

The prevalence of coronary heart disease has affected education systems around the world, including higher education in Iran. The aim of this study was to determine the quality of virtual education system in Zahedan University of Medical Sciences from the perspective of students.

A descriptive-analytical study was conducted in 2016 at Zahedan University of Medical Sciences. The study population in this study included all students studying at Zahedan University of Medical Sciences, of whom 537 completed a questionnaire. A standard electronic questionnaire with the dimensions of quality of educational content presentation, virtual education infrastructure, quality of online classes and quality of virtual tests was used to collect data. SPSS software and descriptive and analytical statistical tests (One way annova, etc.) were used to analyze the data.

From the studentschr('39') point of view, the highest mean score was related to the virtual education infrastructure dimension (2.97) and the lowest mean score was related to the response dimension (2.01). In terms of accountability, 35% of students rated the appropriate response to student problems by the schoolchr('39')s EDO expert as very poor. There was no significant relationship between gender and indigenousness and the quality dimensions of e-learning. There was a significant relationship between the quality of content presentation, online class, response, virtual test with colleges (P> .001). There was a significant relationship between all dimensions of virtual education and educational level (P> .001).

Creating readiness in various human dimensions and equipment requires careful and appropriate planning. Given the current situation and increasing the use of virtual education system, it is necessary to take a big step towards the development of education systems by strengthening the necessary structures and technologies and reforming educational processes and evaluation and training of professors and students.

One of the effective indicators used to determine the efficiency and optimal use of hospital re-sources is the length of stay (LOS). Then, we aimed to determine LOS and its related factors in Iran.

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, PubMed, SID, MagIran, and Medlib from 1995 to 2022 using a combination of medical subject. STATA ver-sion 11 used for data analysis.

Overall, 75 (cross-sectional, cohort, and case-control) reports were identified. The average length of stay in Iranian hospitals was 6.7 (95% CI: 5.32 -7.74) d. There was a significant relationship between the length of stay in the hospital and different wards of hospital (P=0.001). The average of men’ LOS was longer than women were [6.9 (95% CI: 5.32 -7.74) vs. 3.9 (95% CI: 1.67-9.41)]. Moreover, the average LOS before and after the Health Transformation Plan (HTP) in Iran has changed, so that it has increased from 5.8 (95% CI: 4.39 -7.86) to 7.1 (95% CI: 5.59 -9.25) d after HTP (P=0.30).

The average length of stay of patients in Iranian hospitals is more than the expected index of the Ministry of Health and Medical Education and is in the unfavorable range (> four days). Moreover, considering the direct effect of the type of departments on LOS; therefore, hospital managers should pay more attention to hospital processes using new process-oriented and customer-oriented management approaches.

The coronavirus disease 2019 (COVID-19) pandemic is an emerging global threat to public health.

This study examined the epidemiological and clinical characteristics and death-related factors of COVID-19 in inpatients in Zahedan, Iran.

This multicenter study included all COVID-19 patients admitted to Zahedan hospitals within February to April 2020. Demographic, epidemiological, and clinical characteristics were extracted from medical records. Bivariate and multivariate logistic regression models were used to examine the risk factors associated with inpatient mortality.

Of 425 patients in this study, 237 and 188 were male and female, respectively. Moreover, 31 (7.29%) patients died. The patients with a severe stage of pneumonia and those with a severe/critical condition of COVID-19 were 35.8% and 35.1%, respectively. The most prevalent symptoms were cough (70.8%), shortness of breath (62.1%), fever (34.1%), bruising (28.7%), and shivering (28.5%). The most prevalent underlying diseases were hypertension (23.3%), diabetes (16.7%), cardiovascular disease (13.2%), chronic pulmonary disease (9.6%), and asthma (5.4%). Adjusted odds ratio (OR) of in-hospital mortality increased for patients with older age (OR = 3.74, 95% CI: 1.39 - 10.32), at least one underlying disease (OR = 1.16, 95% CI: 1.01 - 1.32), severe disease (OR = 30.9, 95% CI: 4.01 - 239.09), and critically severe disease (OR = 736.5, 95% CI: 74.75 - 7256.1) compared to mild/moderate disease.

This study showed that older age, disease severity, and underlying diseases were mortality risk factors due to COVID-19 infection. This finding indicates that priorities for hospital admission must be given to patients with a higher risk of mortality due to limited facilities, especially in less privileged areas.

Breast cancer patients experience physical and emotional distress due to their diagnosis and treatment of their disease.

This study aimed to assess the quality of life (QOL), social support and coping strategies, illness adjustment among breast cancer patients, and the type of breast surgery.

We conducted a cross-sectional study at hospitals in Zahedan, Iran, in 2020. We recruited 120 patients with breast cancer by census method. Data collection tools were the breast cancer-specific module (QLQ-BR 23), The adjustment to illness measurement inventory for Iranian women with breast cancer (AIMI-IBC), and the multidimensional scale of perceived social support (MSPSS) questionnaires. We performed the statistical analysis in SPSS software version 19.0.

The mean age of patients in this survey was 47.35 ± 10.67 years. 53.3% of patients underwent a mastectomy, 34.2% had a lumpectomy, and 12.5% of patients had not been surgery. Patients on the functioning scale reported high scores for body image (78.61 ± 26.69) and future perspective (55.27 ± 26.71). Patients on the symptom scale had a high score upset by hair loss (49.16 ± 38.88). Also, the mean score of total social support was 45.71 ± 9.92. in addition, they used the reasonable efforts coping strategy (4.07 ± 0.35), and the mean score of illness adjustment was 150.91 ± 16.29.

The results of this study indicated that breast cancer patients received a high social support level, especially from family members, and had a high degree of adjustment to their illness. Also, patients were more upset about their hair loss and body image. Therefore, early disease detection can improve breast cancer women's quality of life and disease adaptation.

The aim of this study was to evaluate the relationship between serum C-reactive protein (CRP) levels and the mortality rate of patients who were admitted to the intensive care unit (ICU), starting from the time of discharge until two months later. In this study, 125 patients admitted to the ICU were studied. The patients’ demographic data and physical examination, particularly the exact level of CRP obtained through questionnaires. All discharged patients were followed for 60 days. All data were analyzed with SPSS. The mean CRP was higher in ICU patients who died until two months after discharge (p

Diabetes is the most common endocrine disease in pregnancy and identifying the risk factors for gestational diabetes helps to identify women who are at risk for type 2 diabetes in the future. The present study was performed aimed to determine the relationship between maternal hemoglobin concentration in the first trimester of pregnancy and gestational diabetes in pregnant women.

This retrospective study was performed on 300 cases of pregnant women who referred to medical centers of Zahedan in 2017-2019. The information checklist was used to collect demographic characteristics of research samples such as age, height, weight and number of pregnancies and deliveries, maternal hemoglobin and FBS concentrations at the first visit to the relevant centers and GCT levels in 24 to 28 weeks of pregnancy. Data were analyzed by SPSS statistical software (version 25) and Independent t-test and ANOVA tests. P<0.05 was considered statistically significant.

Out of 300 women in the statistical population, 113 (37.7%) had gestational diabetes and 187 (62.3%) were healthy in terms of diabetes. Of the subjects, 103 (34.3%) had hemoglobin concentrations greater than 13, 42 (14%) had hemoglobin concentrations 12.4 to 13, 79 (26.3%) had hemoglobin concentrations between 11.6 to 12.3, and 76 (25.3%) had hemoglobin concentrations less than 11.5. The mean hemoglobin level in diabetic pregnant women was 13.71 ± 0.61 g/dl and in healthy women was 11.80 ± 0.52 g/dl, and the difference was statistically significant (P <0.001). There was also a positive and significant correlation between hemoglobin and fasting blood sugar levels (P <0.001).

High hemoglobin level (more than 13 g/dl) in the first trimester of pregnancy is significantly and directly related to gestational diabetes, therefore it can be considered as a risk factor for gestational diabetes.

COVID-19 has become a global problem. In this case study, the experiences gained from disease control in rural areas are reported.

An observational study was done in 2020 in Sistan and Balochestan, the largest province with most rural areas in the southeast of Iran.

After identification of the first patient of Covid-19 in a rural area, three measures were taken including: 1. Diagnosis, screening and treatment of the disease (Incident command post was established and the village was completely quarantined, etc.; 2. Intersectoral coordination for epidemiological management (limiting traffic for people and any gathering); and 3. Identification of any Covid-19 positive cases. The results of these measures showed that after quarantining the village and performing the mentioned actions, the number of patients decreased, and the disease was controlled.

Quarantine of the contaminated rural area and people’s traffic routes is one of the most important measures in controlling Covid-19.

Following the global outbreak of severe acute respiratory syndrome coronavirus 2 in different communities, hemodialysis patients have not been spared by this viral infection.

This study evaluated the clinical symptoms laboratory and imaging findings in patients undergoing hemodialysis and compared these characteristics with the control group.

The study was performed on 72 patients with positive COVID-19 polymerase chain reaction test, of whom 36 cases had endstage renal disease undergoing hemodialysis and the remaining had no history of kidney diseases. After matching the two groups in terms of age, sex, and other underlying diseases, the clinical, laboratory, and chest computed tomography (CT) scan findings were compared between the case and control groups.

The mean age of dialysis patients was 42.52 ± 12.10 years and 48.58 ± 17.35 years in the control group. The study results revealed that hemodialysis patients had less fever, cough, and shortness of breath than the control group (P-value < 0.05). Hemoglobin, lymphocyte, and platelet counts were significantly lower in hemodialysis patients in comparison to the control group (P-value < 0.05). C-reactive protein was significantly higher in patients undergoing hemodialysis (P-value = 0.01), and ground-glass opacification was observed more in patients undergoing hemodialysis compared to controls, but this difference was not statically significant (P = 0.07).

Hemodialysis patients had fewer initial clinical symptoms but more abnormalities in laboratory findings and ground-glass opacities on chest CT scans and a higher mortality rate.

Cardiovascular diseases are the leading causes of mortality all around the world. Patients with Ischemic heart disease (IHD) are at an increased risk of ischemic events; therefore, secondary prevention measures should continue for these patients. Although Cardiac rehabilitation (CR) is one of the secondary prevention measures for IHD patients which has favorable clinical outcomes, only 50% of patients are referred and among them, a small percentage attends CR. Therefore, other strategies should be considered, one of which is home‑based cardiac rehabilitation.

A multicenter, parallel‑group randomized controlled trial has been conducting in three hospitals in Isfahan and patients have been assigned into a 1:1 ratio for the evaluation of the effectiveness of home‑based cardiac rehabilitation versus usual care. Psycho‑educational consultation based on the Health Action Process Approach including heart‑healthy diet, stress management, lifestyle changes, smoking cessation, and physical activity has been performed. Primary outcomes, including the quality of life, psychological and smoking status, body mass index, blood pressure, blood cholesterol level, and physical activity level have been measured at 6 months after the randomization and intervention. One year after the intervention, primary and secondary outcomes, including cardiovascular events, the frequency of hospital admissions, and the death rates due to cardiovascular reasons will be assessed.

HBCR program can increase patient accessibility to CR services its implantation can be reduce burden IHD.

Medical errors and their consequences are one of the most important factors threatening patient safety in the health system of all countries, the incidence of which is increasing alarmingly (3, 4). Today, reducing the incidence of medical errors has become a global challenge (5). Despite all efforts to improve and maintain the safety of patients due to medical errors, various communities suffer a lot of financial and human costs and losses every year (6). In the global classification of causes leading to death, medical errors are one of the top ten causes (7). So that one out of every ten hospitalized patients is injured due to medical errors while receiving health care; about 7% of them lead to death (8). Therefore, considering the importance of the issue, this study was conducted with the aim of systematically reviewing, identifying and collecting information about the occurrence of various medical errors in physicians in Iran as an example of a developing society.

This systematic review study in 2019 using search tools in SID, Magiran, Iran Doc, Scopus, Proquest, Pub Meb, web of science, Springer, Cochrane, Elsevier, Science Direct and Google scholar databases has systematically reviewed the studies conducted on the types of medical errors in Iranian physicians from the beginning of the establishment of each of the above scientific bases until August 1, 2019. The search strategy was retrieved and prepared for related studies using PICO-related search terms (patient or population, intervention, control, or comparison and results). In the article search process, MeSH-compliant keywords including Prevalence, error(s) or mistake(s), prescription, physician(s), Surgery or Surgeons, physician(s) error(s) or mistake(s), surgical error(s) or surgeon(s), administration(s) error(s) or mistake(s), medication or drug error(s) or mistake(s), prescribing error(s) or mistake(s), wrong dose(s), wrong medication(s) and Iran or Iranian and Persian equivalent keywords were used. The Cochrane Handbook for Systematic Reviews for Intervention Studies and the PRISMA statement were used to design this study and refine the articles (51). To collect information from the considered articles, Cochran data extraction form for systematic review was used which included the first author, year of publication, nationality of researchers, study design, type of research, sampling method, sample size, research tool and summary of important study findings. An Excel-designed form was used to collect data. Data according to their nature were analyzed and written in a narrative and thematic manner. The following selection criteria were used to find related articles from databases: 1) articles that had full text and were written in Persian or English, 2) articles were published in the field of medical errors only in physicians and the factors affecting it. Of course, it is worth mentioning that in articles in which medical error was simultaneously examined in physicians and nurses, information about physicians was extracted. Gray resources related to unpublished results in dissertations and articles published in low-credit sources were not reviewed due to access problems and insufficient credit. Also, articles on meta-analysis, systematic review, quality, posters, speeches and letters to the editor that were found in the field of various medical errors were excluded from the study.

A total of 15 articles were found, including: 3 Persian articles and 12 English articles. According to the findings of the present study, the prevalence of medical errors in Iranian physicians ranged from 38.1 to 65% (3, 9, 16-18). The most common types of medical errors were prescription error with 17.3% and medication error with 1.98 errors per patient, respectively (4, 28). The most important factors affecting the occurrence of medical errors include:  the education level and type of specialization of physicians (2), low number of physicians and high number of patients (10), lack of proper training of medical staff (9), staff performance, management levels and executive shortcomings (4), long night shift (17), physicians 'handwriting and how to record patients' information in medical records (8), lack of cooperation between physicians in different wards (10), employment in overcrowded hospital wards (4) and the lack of comprehensive treatment guidelines and violations of existing laws (23,10). The results of this systematic review showed that various interventions have been performed to reduce the incidence of medical errors, which can be divided into three areas: the study of the intervention role of clinical pharmacists (18, 28), the use of software for recording clinical prescriptions systematically by a physician or nurse (25,29,30) and other types of interventions (23). Use of clinical prescription registration software by the nurse can increase the acceptability of physicians' performance by warning and recommending and significantly reduce the medication dose error in the neonatal ward compared to the computer recording of information by a physician. In care systems where the physician opposes the implementation of computerized clinical information recording software by himself but nurses tend to computerized clinical information registration and have the necessary ability to implement it, computer software for recording patient information by the nurse can Should be considered as an appropriate alternative method for entering patient information in hospitals (29).

This systematic review showed that in general, the incidence of medical errors in Iranian physicians during the clinical care process is high. Also, the most common type of medical errors in our country's hospitals is the error of a doctor's prescription and then medication errors (9, 17). Unfortunately, despite all the efforts of the Iranian health system to reduce the occurrence of medical errors, the incidence rate is still significant, although it seems lower than the global rate. Of course, the lower rate of medical errors in Iran than the global rate can also be due to under-reporting of errors (9). Therefore, in order to reduce the incidence of medical errors, preventive approaches such as paying more attention to the importance of the interventional role of clinical pharmacists and providing conditions for their wider productivity (18, 28), using more efficient techniques to predict, diagnose and reduce the incidence of medical errors such as Sherpa technique (3,10) as well as the use of intelligent electronic technologies to reduce clinical errors such as systematic registration of clinical information by physicians and nurses (25,29,30) and design, implementation and evaluation of more appropriate intervention approaches to improve the reporting status of medical errors in physicians (9).

 Depression is common in patients with cardiovascular disease (CVD). Home-based cardiac rehabilitation (HBCR) is a program that alleviates depression. This study aimed to determine and compare HBCR programs and usual care (UC) effects on depression control in patients with ischemic heart disease (IHD).

 This clinical trial study was performed on 259 patients with IHD that were randomly allocated to the HBCR and UC groups for stress management. Data were collected using the "Beck Depression Inventory" (BDI) at baseline and 6 and 12 months. Generalized estimating equation (GEE) models were applied to examine the associations between times of the groups and changes in outcomes over the study times. Data analysis was done in SPSS softwareat the significance level of 0.05.

 A total of 247 participants with a mean age of 55.22 ± 7.40 years participated in this study, and 209 (84.6%) of the study participants were men. Among patients, 128 patients in the UC program and 119 patients in the HBCR program attended at least one of the pre-determined visits (months 6 and 12). The patterns of change of the depression parameter were similar through the course of the study between the two groups (P = 0.04). In the HBCR group, the depression reduced continuously from baseline to 6 months, baseline to 12 months, and 6 to 12 months (P < 0.05). In the UC group, depression was significantly reduced from baseline to 6 months and from baseline to 12 months.

 HBCR was effective in continuous reducing of depression scores in long-term follow-up of patients with IHD. These findings suggest that HBCR can alleviate depression in patients who do not participate in hospital-based cardiac rehabilitation (CR).

Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran.

A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms (‘Nosocomial infection [Mesh] OR ‘’ Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh]  OR Healthcare-associated infection ‘’AND (‘Iran’ [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis.

A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively.

The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

Repair of broken bones due to physiological or pathological factors has always been important for researchers. In this regard, this study aimed to evaluate the effect of a combined extract on the osteogenic process in the experimental fracture created in the femoral of rats as laboratory models.

This experimental study was performed on 21 rats. After induction of general anesthesia to each mouse, a 3-cm incision was made in the femoral bone and it was broken with a special hammer. After surgery, the control group did not receive any extract, while the three experimental groups received 200, 500, and 1000 mg/kg PO, respectively. In the next step, 21 days after surgery, euthanasia was performed and bone sections were prepared and stained in the fracture site. Next, histopathological and histomorphometric studies were carried out for the evaluation of bone healing in rats. The collected data were analyzed in SPSS software (version 21).

According to the pairwise comparison test, the mean difference of variables, namely bone marrow, woven bone, and lamellar bone of the third group of the test was significantly different from those of the other groups (P<0.05). This indicated that receiving the extract in the experimental groups with an increased dose led to a decrease in the mean bone marrow and woven bone which, in turn, increased the mean lamellar bone

The results showed that the combined extracts of mummy, Withania coagulans, and turmeric can stimulate osteogenesis in rats and be considered as a candidate for fracture treatment.