فهرست مطالب

Medical Council - Volume:4 Issue: 4, Autumn 2021

Journal of Iranian Medical Council
Volume:4 Issue: 4, Autumn 2021

  • تاریخ انتشار: 1400/11/09
  • تعداد عناوین: 21
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  • Ahmad Shamabadi, Shahin Akhondzadeh * Pages 193-196

    Depression is a debilitating psychiatric disorder that affects more than 264 million people worldwide and is one of the main contributors to global Disability-Adjusted Life Years (DALY) (1). Limitations in psychosocial functioning, propensity to use drugs and alcohol, reduced quality of personal and professional life, and suicide in patients are alarming (1,2). The economic costs of the disorder and its individual and social effects in the United States are more than $ 200 billion annually (3).The combination of psychotherapy and pharmacotherapy is the first line of treatment for depression (2). Tricyclic Antidepressants (TCAs) and Mono Amine Oxidase Inhibitors (MAOIs) are the first generation of antidepressants introduced in the 1950s. The second generation of antidepressants is Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs). Because of the reported efficacy and tolerability, SSRIs are the first line of pharmacotherapy, and TCAs and MAOIs are in the second and third lines, respectively (2,3).

  • Maryam Mehrpooya * Pages 197-208

    A theory of the epidemiology of population change was first raised  by Abdel R. Omran in 1971 (1-3) and it had originated from the demographic transition model (4,5). Before that, it was suggested other disciplines like fertility, mortality, and migration are influencing factors for population change (6). But progression in science particularly health and deep recognition of diseases demonstrated that epidemiology is remarkably influenced by distribution of disease and death also their outcomes in population groups (1,7,8).

  • Ashraf Rouhbakhsh, Mohammad Arbabi, AliAkbar Nejatisafa, Sayedeh Elham Sharafi, Farnaz Etesam, Nazila Shahmansouri, Fahimeh Bagheri Amiri, Rahim Badrfam *, Ahmad Ali Noorbala Pages 209-220
    Background

    In this study, screening of mental health problems among Health Care Workers (HCWs) was performed in order to assess the prevalence and severity of depression, anxiety, and perceived stress at Iran’s largest teaching hospital during the COVID-19 pandemic.

    Methods

    In this cross-sectional study, HCWs who were working professionally in specific wards for COVID-19 patients were selected by availability sampling. The patients who met the inclusion criteria and answered the submitted questions were included in the study. Next, two instruments including HADS (Hospital Anxiety and Depression Scale) and PSS-4 (Perceived Stress Scale-4) were used.

    Results

    The study was conducted on 306 HCWs. The mean score and standard deviation of depression, anxiety, and perceived stress were 6.33±4.10, 8.33±4.29, and 6.88±2.90, respectively. Fifty-four percent and 36.6% of the participants showed some degree of anxiety and depression, respectively. 

    Conclusion

    It is necessary to use screening methods for psy-chological disorders among HCWs, along with psychosocial support and appropriate psychological interventions in this field.

    Keywords: anxiety, COVID-19, depression, Health care workers, mental health
  • Razieh Malmir, Mehrnoosh Jafari *, Ali Maher, Seyed Mojtaba Hosseini, Khalil Alimohammadzadeh Pages 221-231
    Background

    Outpatient services constitute a major part of healthcare services. Fair access to these services plays an important role in promoting the community health status. Therefore, the purpose of the current study was investigating the factors affecting fair and equitable access to outpatient services in the Iranian healthcare system. 

    Methods

    This applied study was descriptive using a mixed method (qualitative-quantitative) approach. Semi-structured interviews and a pairwise comparison matrix were used to collect data. The validity and reliability of the interviews were obtained through Lincoln and Guba methods and the validity and reliability of the pairwise comparison matrix were determined based on the inconsistency rate which was less than 0.1. In the first phase, research population included policy makers and health professionals, and in the second phase, hospital managers and faculty members, who were selected by purposive sampling method. The data collected in the first phase were prioritized using MaXQDA software and coding method and in the second phase, using Excel software and Dematel approach. 

    Results

    Based on the findings of the study, the following indicators had the highest to lowest significance in the fair access to outpatient services in the Iranian healthcare system, respectively. They were physical (effective), financial (effective), manpower (influential), demographic (influential), facilities and equipment (influential), political (influential) factors. 

    Conclusion

    Policymakers, managers, and planners need to pay special attention to the development of physical infrastructure and the allocation of adequate funding to the outpatient services in the public sector.

    Keywords: Public Sector, Iran, public health, Delivery of Health Care, Outpatient Services, Fairness, Access
  • Pegah Mirzapour, Firoozeh Zangeneh Motlagh, Seyedahmad Seyedalinaghi *, Esmaeil Mehraeen Pages 232-243
    Background

    The purpose of the present study was to compare the effectiveness of positive thinking group training and acceptance and commitment therapy on psychological well-being and risky behaviors of patients with HIV.

    Methods

    A quasi-experimental pretest-posttest research method was used with a control group. Accordingly, 45 HIV patients, referring to Imam Khomeini Hospital in Tehran, were selected and randomly assigned to groups 1-3, including positive thinking (n=15), ACT (n=15), and control (n=15) groups, respectively. Scales of Psychological Well-being by Ryff (1989) and Risk Behaviors Standard Scale (2010) were administered for all three groups (pretest). Subsequently, the participants of the experimental groups attended eight 90-minute sessions of group training.  The posttest was performed two weeks after training. Multivariate and univariate analyses of variance (MANCOVA and ANCOVA) were used to analyze the data.

    Results

    The results showed that positive thinking group training was effective in promoting psychological well-being and reducing high-risk behaviors. The results also demonstrated that acceptance and commitment therapy was effective in promoting psychological well-being and reducing high-risk behaviors. According to the findings, there was no significant difference between the effectiveness of positive thinking group training and acceptance and commitment therapy on psychological well-being and risky behaviors of people living with HIV (p >0.05).

    Conclusion

    Both educational interventions (positive thinking and ACT approach) can increase psychological well-being and reduce high-risk behaviors of HIV+ patients, and there was no significant difference between the two intervention approaches. Therefore, both approaches have beneficial effects on improving the quality of life among people living with HIV.

    Keywords: Acceptance, Commitment Therapy, HIV, positive thinking, Risk Taking, Social Behavior
  • Rahmatollah Jowkar, Maryam Sharyf Pour Delavari, Mohsen Mohammadi *, Somayeh Oladi Pages 244-248
    Background

    Limping is a common complaint of children presenting to the emergency departments of hospitals; therefore, it is important to identify its causes and avoid unnecessary measures. In this study, common etiologies for limping in children presenting to the emergency department of Pediatric Hospital of Amirkola in Babol, Iran were evaluated.

    Methods

    All children under 15 years of age presented to the emergency department of Pediatric Hospital of Amirkola, during 2017-2018, with complaints of acute limping were retrospectively evaluated. Initially, 71 patients were found among whom 53 were selected based on inclusion and exclusion criteria of the study. The census method was used to obtain the required samples. Patient information including demographic data, clinical signs, and symptoms at admission were gathered. Statistical analysis was done using SPSS v22 software (IBM, USA), and p<0.05 was considered statistically significant.

    Results

    Of 53 children, 33 (62.3%) were boys and 20 (37.7%) were girls. The mean age of participants was 4.53±2.79 years old, and the mean length of hospital stay was 10.5±7.2 days. Inflammation and infections were the most common etiologies with a cumulative prevalence of 58.49 and 28.30%, respectively. Transient synovitis was the most common differential diagnosis with a prevalence of 43.4%, and the most affected joints were hips with a prevalence of 73.5% (p-values=0.001).

    Conclusion

    Most of the diseases for acute limping in children are self-limited, but this should not lead to disregard for infection as a differential diagnosis.

    Keywords: Child, Emergency Service, Hospital, Iran, Tenosynovitis
  • Mona Sharifi Fardshad, Sheida Sodagar *, Maryam Bahrami Hidaji, Peyman Hassani Abharian, Saeid Malihialzackerini Pages 249-256
    Background

    The quality of elderly people’s life is one of the challenges of the 21th century. Therefore, determining factors that affect quality of life in elderly people is important. This study was designed to establish a life quality model among elderly.

    Methods

    In this study, a quality of life model was designed based on cognitive status and  social capital with the mediating role of resilience among older adults. For this reason, 243 subjects over 60 years old living in Tehran were chosen through convenient sampling d in 2020-2021. The specified information was collected utilizing the World Health Organization Quality of Life (QOL) questionnaire to determine the quality of life, Onyx and Bullen’s social capital scale to assess the social capital, Mini Mental State Examination (MMSE) to evaluate the cognitive impairment and Connor-Davidson resilience scale to assess the level of resilience. The obtained data were statistically analyzed by confirmatory factor analysis using AMOS software v24. 

    Results

    Results showed a significant positive relationship between cognitive status and quality of life (β=0.474, p<0.01), between social capital and quality of life (β=0.245, p<0.01), and also between resilience and quality of life (β=0.400, p<0.01) among subjects. Results also confirmed the mediating role of resilience in the relationship among cognitive status, social capital, and quality of life (β=0.102, p<0.01 & β=0.170, p<0.01). 

    Conclusion

    For the promotion of quality of life among subjects, certain interventions must be designed by policy makers to improve social capital, cognitive status, and resilience.

    Keywords: cognition, Mental status, Quality of Life, Social Capital
  • MohammadReza Mohammadi, Seyed Ali Mostafavi *, Payam Hosseinzadeh, Mandana Nojoumi, Fatemeh Asadian Koohestani Pages 257-265
    Background

    Children with Attention Deficit Hyperactivity Disorder (ADHD) treated with methylphenidate may lose their appetite and body weight. In this study, an attempt was to compare the effects of folic acid with cyproheptadine on appetite, weight, and symptoms of attention deficit and hyperactivity in children with ADHD who are taking methylphenidate. 

    Methods

    This was a randomized clinical trial performed on 7-12 year old children who were diagnosed with ADHD, treated with methylphenidate, and complained of appetite loss. In the first visit, anthropometric measurements were performed and then mothers completed the ADHD rating scale, Sleep Disturbance Scale for Children, and visual analogue scale for appetite. Then, the participants were randomly assigned to receive either cyproheptadine (4 mg/day), or folic acid (1 mg/day). All assessments were repeated after 8 weeks. 

    Results

    Twenty-four children in the cyproheptadine group and 23 in the folic acid group (19 boys in each group) completed the study and statistical analyses were performed. The hyperactivity score significantly decreased in the folic acid group compared with the cyproheptadine group (p=0.035). However, the change in attention deficiency scores between groups was not significant. During the study, only girls in the folic acid group had significant body weight increase in contrast to other subgroups. 

    Conclusion

    Improving hyperactivity symptoms in the folic acid group along with better growth especially in girls reveals the clinical superiority of folic acid over cyproheptadine.

    Keywords: appetite, Attention Deficit Disorder with Hyperactivity, body weight, children, Cyproheptadine, Folic acid
  • Masoomeh Yarahmadi, Fariba Hafezi *, Behnam Makvandi Pages 266-273
    Background

    Based on the proven role of sleep quality in promoting health, the treatment of insomnia should be premised on identification of characteristics and severity of insomnia symptoms. This study aimed to investigate the effectiveness of Cognitive-Behavioral Therapy for Insomnia (CBT-I) in improving sleep quality and reducing  insomnia severity among the afflicted patients. 

    Methods

    This was a semi-experimental study with a pre-test, post-test, and follow-up design and control group. The statistical population included all patients visiting the Sleep Disorder Clinic of Rasoul Akram Hospital and two private psychiatric clinics, selected using convenience sampling in Tehran in 2020. Twenty out of 60 patients with insomnia disorder, diagnosed based on the Diagnostic and Statistical Manual for Insomnia, were randomly selected using a lottery method. The participants were divided into the experimental and control groups. In the cognitive-behavioral group, each participant individually received a 6-week treatment intervention. All participants in both groups were evaluated at the beginning of the treatment, at the end of the treatment, and one month after the treatment. The Pittsburgh Sleep Quality Index (PSQI) and  Insomnia Severity Index (ISI) were used for data collection. 

    Results

    The results showed a significant between-group difference in the scores of sleep quality and insomnia severity at post-test stage (p<0.05). Moreover, the follow-up test results suggested the stability of the effect of treatment interventions on sleep quality and insomnia severity among the experimental and control groups relative to their pre-test scores (p<0.05). 

    Conclusion

    The results indicated that CBT-I could improve sleep quality and insomnia severity in afflicted patients.

    Keywords: Cognitive-behavioral therapy for insomnia (CBT-I), sleep, Sleep initiation, maintenance disorders
  • Houman Teymourian, Nima Saeedi * Pages 274-279
    Background

    Spinal anesthesia is commonly used for orthopedic surgeries. The most important issue to improve outcome is patient cooperation to have a proper position for reducing pain during spinal anesthesia procedure. However, any change in position is painful which leads to sympathetic activation, tachycardia and hypertension, which may put patients with ischemic heart disease at risk. Peripheral nerve block is a safe and reliable alternative to systemic analgesia. Using the ultrasound-guided method reduces local anesthetics’ amount and side effects. 

    Methods

    In this study, 53 patients who came to the operating room with femoral fracture as candidates for spinal anesthesia were enrolled and received ultrasound-guided Femoral Nerve Block (FNB) (10 ml Lidocaine 1.5%). Before and after receiving the nerve block, the patients were asked about the severity of their pain using the Numerical Rating Scale (NRS). Both groups of patients and physicians were asked about their satisfaction according to a 5-point Likert scale. 

    Results

    Mean pain intensity in the NRS score at the time of admission to the operating room was 7.6±0.8, which was reduced to 1.8±1.5 after blockade. In this study, 39 (73.5%) patients were very satisfied (Likert scale 5), 10 (18.8%) were satisfied (Likert scale 4), 2 (3.7%) had no opinion (Likert scale 3), 2 (3.7%) were not satisfied (Likert scale 2), and no one was very dissatisfied (Likert scale 1). There was significant difference in physician’s satisfaction. 

    Conclusion

    Ultrasound-guided nerve block is a safe and effective method to be used for positioning during spinal anesthesia procedure.

    Keywords: Femoral Nerve Block, Pain management, Trauma, Ultrasonography
  • Fatemeh Shomali, Gholamabbas Roustaei, Hemmat Gholinia, Setare Shomali, Seyed Ahmad Rasoulinejad * Pages 280-290
    Background

    Age-Related Cataracts (ARC) is a multifactorial ocular dysfunction resulting inblurred lens, visual reduction, and blindness. Various underlying diseases are involved in increasing the risk of ARC. The purpose of this study was to investigate the association of underlying diseases and related medications with ARC in Iranian patients. 

    Methods

    In this case-control study, 353 patients (age between 40 to 70 years) with ARC were referred to Rouhani Hospital, Babol, Iran, and 343 control individuals (age between 40 to 70 years) participated. The history of underlying diseases of participants was collected by history-taking and self-expression. The cataract intensity and type determination was based on the Lens Opacities Classification System III (LOCS Ш). 

    Results

    Our results show that obesity (p <0.001), diabetes mellitus (OR = 0.422, 95% CI [0.285, 0.625], p<0.001) ,and hypertension (OR = 0.518, 95% CI [0.378, 0.712], p<0.001) are associated with prevalence of ARC (more prevalent in ARC patients compared to controls). The posterior subcapsular ARC is more prevalent in asthmatic ARC patients compared to non-asthmatic ARC patients (p=0.019). The prevalence of cortical ARC is higher in anemic ARC patients compared to non-anemic ARC patients (p=0.031). Cortical and posterior subcapsular ARC prevalence is higher in rheumatic ARC patients than non-rheumatic ARC patients (p=0.006). Also, atorvastatin use plays a preventive role in ARC (p=0.031). 

    Conclusion

    Our results established that obesity, diabetes mellitus, hypertension, and asthma are associated with the prevalence of ARC. Also, atorvastatin, as a routine medication, plays a preventive role in ARC. Furthermore, asthma, anemia, and rheumatism are involved in prevalence of certain types of ARC.

    Keywords: Age-related cataract, Diabetes Mellitus, Hypertension, Asthma
  • Asaad Moradi, Neda Rahimian, Zahra Shekofteh, Behnam Shakiba *, Amirhosein Soleimani, Robab Maghsoudi, Reza Dehghaniathar Pages 291-295
    Background

    The purpose of the current study was to investigate Lower Urinary Tract Symptoms (LUTS) in patients infected by SARS-CoV-2. 

    Methods

    In this cross-sectional study, 203 patients diagnosed with COVID-19 based on the positive results of Reverse Transcription Polymerase Chain Reaction (RT-PCR) tests of oropharyngeal and nasopharyngeal swabs were enrolled. None of the patients were on diuretic drugs, anticholinergic agents, and alpha blockers. Patients with a history of LUTS, urethral stenosis, neurogenic bladder, urinary tract infection, and Benign Prostatic Hyperplasia (BPH) were excluded from the study. Questions about basic characteristics and de novo LUTS were asked from each patient and the answers were recorded. 

    Results

    De novo lower urinary tract symptoms were identified in 30 (14.7%) patients, 23 males and 7 females indicating a significant difference in terms of sex (p=0.005). The most frequent urinary tract symptom was frequency which was reported in 21 patients. 

    Conclusion

    There is no clear explanation on the relationship between LUTS and SARS-CoV-2. However, the potential ability of the virus for causing viral cystitis may be a reasonable hypothesis. Therefore, still further studies are required to determine the role of COVID-19 virus in urinary tract symptoms.

    Keywords: COVID-19, SARS-CoV-2, Urinary tract
  • Abolfazl Salari, Elnaz Saeedi, Maryam Hadji, Amirmohsen Jalaeefar, Kazem Zendehdel, Mohammad Shirkhoda * Pages 296-302
    Background

    This study aimed to evaluate the role of lymph node ratio (LNR) in the prediction of Overal Survival (OS) of patients with Esophageal Squamous Cell Carcinoma (ESCC).

    Methods

    Patients with ESCC who underwent radical esophagectomy and radical lymph node dissection were entered into the study. The survival rate of patients was determined using the Kaplan–Meier estimator. Also, the effect of LNR and other variables on the OS of patients was assessed applying COX proportional hazards regression model. Based on its mean, LNR was divided into two groups of ≤0.25 and >0.25.

    Results

    In total, 116 patients were entered into the study. The univariate and multivariate analyses showed that LNR was an independent prognostic factor for the prediction of the OS of patients with ESCC. An increase of LNR more than 0.25 led to an increase in the mortality risk by 1.57 times. Also, the five-year survival of patients was 26% with LNR≤0.25 and 5% with LNR>0.25. 

    Conclusion

    LNR can be used as an independent prognostic factor in determining and predicting the OS of patients with ESCC. There was a relationship between the increase of this factor and the worsening of patients’ OS.

    Keywords: Esophageal squamous cell carcinoma, lymph node ratio, survival
  • Ahmad Alibabaei, Alireza Salami, Mohammadreza Hajiesmaeili, Saeedeh Nateghinia * Pages 303-310
    Background

    In the provision of medical facilities, intensive care units are very critical and it seems almost difficult to use the new therapeutic strategies without Intensive Care Unit (ICU). There are two types of ICU structure, known as the open or closed model. The aim of this study was to assess the variables driving the selection of the appropriate ICU management structure and modeling of the appropriate ICU management structure.

    Methods

    This descriptive-exploratory study was performed among all resident doctors, consultants, therapists and neurosurgeons, ICU specialists, internal medicine specialists, respiratory diseases specialists, heads of associated units and head nurses, neurosurgery ICU workers and staff, and doctors of the Loghman Hakim Hospital in Tehran, Iran in 2018. The influence of independent variables on dependent variables and the effect of observed variables on latent variables were tested using the Structural Equation Technique (SEM technique) and the data collected in the LISREL program was analyzed.

    Results

    This research included one hundred persons, including 91 men and 9 women. The factors affecting the performance and structure of the ICU were structural context (including open, semi-closed, and closed structure), organizational context, strategic context, treatment economics context, processes, and quality improvement.

    Conclusion

    There is a good association between quality management and the application of the closed system of the ICU and each of the organizational, strategic, care economics, and processes factors.

    Keywords: Hospital Units, Intensive Care Unit, physicians, quality improvement, specialization
  • Manzar Amirkhani, Shohreh Ghorbanshiroudi *, Mohammadreza Zarbakhsh Bahri, Seyed ahmad Seyedalinaghi Pages 311-321
    Background

    Over the past decade, there has been an increasing interest in exploring self-compassion as a related and complementary construct to mindfulness. Improved self-compassion may predict clinical outcomes after implementing Mindfulness-Based Stress Reduction (MBSR) approach and Compassion-Focused Therapy (CFT). This pilot study compared the impact of MBSR and CFT on self-compassion in people living with HIV, utilizing implicit and explicit instructions, respectively.

    Methods

    The present quasi-experimental study with pre-test, post-test, and follow-up design was conducted among people living with HIV referred to the Voluntary Counseling and Testing (VCT) center of Imam Khomeini Hospital in Tehran, Iran in which 54 patients were selected by convenient sampling. The interventions based on CFT and MBSR were applied to two experimental groups (18 people in each group) while the control group included 18 people who received no interventions and were placed on a waiting list. The experimental groups received the two interventions for 10 weekly sessions. Patients’ self-compassion was assessed at three stages of pre-test, post-test, and follow-up with a self-compassion scale. Descriptive and inferential statistics (analysis of covariance) were used to analyze the extracted data.

    Results

    The results showed that both interventions based on CFT and MBSR were effective in enhancing self-compassion of people living with HIV (p<0.05), and this effect remained consistent even during the follow-up stage (p=0.021). The changes were observable even three months after the treatment (p< 0.05).

    Conclusion

    This study demonstrated that MBSR and CFT can be effective in improving self-compassion among HIV positive patients. Besides, they can be helpful in developing preventive interventions.

    Keywords: counseling, Empathy, HIV, Humans, Mind-fulness, Pilot projects
  • Marzieh Pazoki, Pooya Payandemehr, Mahnaz Montazeri, Samira Kafan, Mehrdad Sheikhvatan, Mehran Sotoodehnia, Ahmad Salimzadeh, Mehdi Ebrahimi, Atabak Najafi, Reza Shariat Moharari, MohammadReza Khajavi, Mohammad Talebpour, Haleh Ashraf, Seyed MohammadKazem Aghamir, Shahrokh Karbalai Saleh, Ali Shakouri Rad, Hedieh Moradi Tabriz, Farhad Najmeddin, Pantea Arya, Niloufar Peirovi, Sina Kazemian, Mehdi Kashani, Sorya Babaei, Azar Hadadi * Pages 322-334
    Background

     Since the outbreak of coronavirus 2019 (COVID-19), identifying risk factors associated with in-hospital mortality has been a global priority. In this study, the purpose was to evaluate the clinical, laboratory, and radiological characteristics of hospitalized patients with COVID-19 to develop a predictive model and scoring system for in-hospital mortality.

    Methods

    In this retrospective cohort study, 611 adult patients with COVID-19, admitted to Sina hospital were enrolled and followed up.

    Results

    Out of the total number of 611 patients, 104 patients (17%) deceased during hospitalization, including 75 (12.2%) deaths in ICU and 29 (4.7%) deaths in the wards. After multivariate logistic regression analysis, several characteristics including age >55 years, previous history of malignancy, history of cerebrovascular accident, tachypnea on admission, CRP>54 on admission, D-dimer>1300, and bilateral pulmonary consolidation on chest Computed Tomography (CT) were shown to be the main determinants for stratifying the risk for in-hospital death. The factors were finally considered for introducing a new predictive scoring system for COVID-19 related death. 

    Conclusion

    In-hospital mortality rate in patients with COVID-19 is estimated to be 17%. A new scoring system for predicting in-hospital mortality in such patients was structured based on determinant factors of advanced age, history of malignancy, cerebrovascular accident, tachypnea, raised CRP, raised D-dimer on admission, and bilateral pulmonary consolidation on chest CT scan.

    Keywords: COVID-19, mortality, risk factors, SARS-CoV-2
  • Rahim Badrfam, Atefeh Zandifar * Pages 335-337

    Since schizophrenia was called the “disease of civilization” at the dawn of the 20th century, there has been controversy over its incidence and prevalence in low- and middle-income countries (1). Schizophrenia, as a highly disabling and under-recognized psychiatric disorder, puts a heavy economic burden on different societies. Inadequate health care services are often provided to patients with the disease and their families (2). Some schizophrenia researchers point to the need for reexamination in results for better prognosis of the disease in low- and middle-income countries due to methodological limitations in related studies, lack of evidence for the positive effects of some socio-cultural factors on the prognosis of the disease, and rapid socioeconomic changes in these countries in recent years that impaired the traditional family care system for people with schizophrenia (3).With the global spread of COVID-19, serious concerns have been raised about the possible increase in the prevalence of the disease in the coming decades for a variety of reasons (4). This point highlights the need to pay more attention to this severe mental health disorder and the need to increase vigilance for the symptoms of psychosis among people with COVID-19 (5).

    Keywords: COVID-19, Developing countries, Research, Schizophrenia
  • Homa Mohammadsadehi *, Seyed Vahid Shariat, Behnam Shariat, Mehrdad Eftekhar Ardebili, Somayyeh Tat Pages 338-341

    At early stages of COVID-19 pandemic in Iran, it became clear that due to first reports of significant mortality rate of patients (1), the whole society and especially health care system workers were facing an unprecedented situation in modern medicine era caused by a contagion. With regard to medical job settings, along with physical burdens, conditions made by new environmental threats during the pandemic can increase the perceived and felt stress by health care workers at a rate and intensity possibly higher than for other job settings (2).Common examples are fear of contracting the disease or death (For the individual or close relatives), feeling of loneliness in quarantine and discomfort arisen from uncertainty of adopting appropriate treatment and caring procedures (in case of responsibility for COVID-19 patients).

  • Shahriar Mousavinejad, Mehrzad Kiani, Shabnam Bazmi * Pages 342-343

    The onset of COVID-19 disease at the end of 2019 and its spread around the world as a pandemic caused special problems for countries and governments. According to Article 29 of the Constitution and considering the structure of Iran’s political economy, the government is considered the main responsible body for health policy (1). In this regard, the government has fully mobilized resources such as governmental hospitals and medical universities to treat affected patients. However, according to the news from Ministry of Health and Medical Education, about 80% of outpatient services and about 20% of inpatient services are provided by the private treatment sector (2). With this statistics, the need to involve private treatment sector in controlling the disease is felt and in most countries, such as the United Kingdom, Germany, India, the Lombardy region of Italy, South Africa ,and Peru, governments have reached out to the private sector to support and control the disease; however, of the incidence of COVID-19 in Iran and severe shortage of Personal Protective Equipment (PPE) such as masks, gloves, disposable guns and disinfectants such as alcohol at early onset of COVID-19 in Iran, the private medical sector had a severe problem with providing these devices. It was expensive and the government did not provide any facilities and did not make them available. While The World Health Organization (WHO) had warned of a pandemic, the government was expected to make arrangements for the production and storage of such devices.

  • Parsa Mohammadi, Hesam Aldin Varpaei, Mostafa Mohammadi * Pages 344-346

    Since the announcement of the COVID-19 pandemic by the world health organization, various issues concerning COVID-19 patients have been analyzed. However, some simple issues like exercise (1) and nutrition support in COVID-19 patients are yet to be discussed. It has been revealed that malnutrition is associated with the poor prognosis of critically ill patients (2). According to the early evidence from China (3), the prevalence of malnutrition in COVID-19 patients was 52.7%, accounting for more than half of the patients. Also, the high prevalence of malnutrition among COVID-19 patients supports the idea that malnutrition is a frequent problem among them and can be considered a prognostic factor (4,5).

  • Zahra Hosseinnia, Seyyed Taha Yahyavi * Pages 347-348

    COVID-19 is a highly contagious infectious disease caused by a new coronavirus, first time detected and reported in Wuhan, China that very soon became pandemic. In the recently passed outbreak, all the Iranian health systems were involved. Doctors with different specialties like sport medicine, surgery or gynecology were obliged to involve the covid-19 treatment. The hospitals were highly crowded and many of the “not well” patients were managed as outpatients. In this letter to the editor, we want to highlight the psychiatric side effect of routine management for covid-19.