Journal of Iranian Medical Council
Volume:6 Issue: 1, Winter 2023

Psychiatric disorders are a major health problem in individual and societal aspects, due to their considerable prevalence and burden and treatment issues (1-3). Estimates indicated that about 792 million people, equivalent to 10.7% of the world population, had mental health disorders in 2017 (4). In 2019, mental disorders were among the top ten causes of burden worldwide, as before, and the Disability-Adjusted Life-Years (DALYs) attributed to them was 418 million (16% of global DALYs) (5,6). The associated economic costs have been estimated at $4.7 trillion – even up to $10 trillion (6). These statistics are related to disorders whose medications and alternative treatments have incomplete efficacy and debilitating side effects that result in limitations in both therapy and compliance so that only one-third of patients with major psychiatric disorders achieve complete and stable symptom remission (7). These data make access to a predictive tool of treatment response crucial and desirable. The uniqueness of each person along with the heterogeneity of diseases is the basis of the concept of personalized medicine, in which personalized psychiatry pursues the trends (8,9). Genetics is responsible for 20 to 95% of the variation in medication disposition and pharmacodynamics in the central nervous system (7). Each patient’s unique phenotype, comorbidities, dietary habits, and medication habits can potentially cause changes in the pharmacokinetics and pharmacodynamics of medications. Personalized psychiatry was presented to provide an individually adapted approach for prevention, diagnosis, treatment, follow-up, and rehabilitation. Parts of these depend on developing pharmacogenomics and pharmacogenetics (8,9). The study of the genetic causes of variation among patients in response to medications and the study of the simultaneous effects of multiple mutations in the genome determining the response to medications are called pharmacogenetic and pharmacogenomic, respectively. However, there is no consensus on the difference between the two, and in practice, they overlap (9). Personalized psychiatry that relates the response to medication to its pharmacokinetic and pharmacodynamic changes as a result of the patient’s genotype, in principle, indicates the application of pharmacogenetics in treatment. The primary focus of the pharmacogenetic-psychiatry link has been the YP2D6, CYP2C19, and CYP3A4 enzymes in the liver because of their responsibility for the metabolism of most antidepressants and antipsychotics (7,8). The translation of pharmacogenetic evidence into clinical practice is an important endeavor that began a few years ago. An example of the application of pharmacogenetic information to guide pharmacotherapy in psychiatry is using genetic information on CYP2D6, CYP2C19, CYP1A2, SLC6A4, and HTR2A for dosing, which increased the number of responders to antidepressants in a pioneering study. Overall, pharmacogenetically supported depression improvement was reported to be 1.71 times better than usual. Similarly for antipsychotics, the association of CYP2D6 genotype and risperidone in order to individualize dosing has been shown in a large-scale study. This evidence has grown and matured to the point where guidelines for implementation have been provided. Its psychiatry examples are the Dutch Pharmacogenetics Working Group recommendations regarding CYP2D6 and CYP2C19 genotypes for antidepressants and antipsychotics and the guidance for using genetic information in pharmacotherapy for psychiatry published by The Clinical Pharmacogenetic Implementation Consortium (7,10). In the application of pharmacogenetics in personalized medicine, attention to cost-effectiveness and ethical issues is essential. It seems that having a genetic passport providing polymorphic genes involved in common medications in which dosing is important, after full maturity and reaching the certainty of the evidence, is cost-effective. In other words, in this case, an advantage of integrating pharmacogenetics and psychiatry would be to reduce costs (7). In regard to ethical issues, the guidelines and instructions should be complied in a way so that ethical obstacles such as privacy and confidentiality and knowledge gap and informed consent are overcome, a balance between social and individual interests is established, and ethical decisions are also personalized (11,12). In conclusion, beneficial and adverse effects are intrinsic properties of medications, and pharmacogenetics can increase the possibilities of improving effectiveness and reducing risk. As a result, although the risk-benefit ratio cannot be guaranteed in a patient, it improves in the population. Moreover, determining the patient’s genotype may reduce the time needed to identify the correct medication and its dosage and minimize exposure to ineffective medications. Although the clinical applications of pharmacogenetics are certain, the use of all currently proposed genes is not consensus. In the future, pharmacogenetics can be extended to other genes, encoding enzymes, transporters, receptors, and other downstream molecules. Keywords Behavioral science, Cost effectiveness, Ethical issue, Genetics, Mental disorder, Personalized medicine, Pharmacogenomics, Precision medicine Acknowledgements This paper did not receive any specific grant from public, commercial, or not-for-profit funding agencies. Conflict of Interest The authors had no competing interests.

Community-based interventions can be effective due to the active participations of communities in pre- and post-disaster planning and management. Effective community-based disaster management for health promotion can be achieved by learning from the successful local and international experiences of community participations. Thus, this study is aimed to identify the community active participation approaches which were effective in promoting the health of disaster-affected communities.

This systematic review was conducted and reported based on PRISMA guideline. Web of Sciences, PubMed and Scopus were searched using the selected keywords. The inclusion criteria were all forms of published articles which studied the approaches of community active participations for improving their health in disasters. The selection of articles was conducted using the titles and abstracts. Data analysis was done based on the categorization of different community-based disaster management approaches. 

10 articles were finally selected out of 2843 documents generated by initial search. Asian countries considered community involvements in disaster management the most (40%). The most community active participations in disaster management were conducted in the recovery phase (80%). Approaches of community-based disaster management for the health promotion were two-way university-community participation, focusing on empowering specific community groups, governance, and localizing community participation as well as strengthening social networks.

Considering the capacities of academic institutions for active participation in community-based disaster management according to the Yokohama, Hyogo and Sendai Framework is highly suggested. Further research is needed to explore the challenges of community communication and information in disasters.

Poisoning is a substantial type of unintentional injury in children that is associated with significant mortality and morbidity. 

This study reviewed the patterns of poisoning in children in Iran. 

Based on the results of the studies, the prevalence of poisoning is higher in boys and the most poisoned children were in the age group of 1 to 3 years. Drugs were the main toxic factors, followed by narcotics and opium. The rate of poisoning was higher in urban areas. Neurological symptoms were the main signs and symptoms in poisoned children. Most patients were completely cured and the mortality rate was about 2%. Family addition, unsafe storage of drugs, and lack of parental supervision over children were the main risk factors for poisoning among children.

Unintentional poisonings are still common among children in developing countries. Drug poisoning is the main cause of poisoning in children. Therefore, increasing knowledge and awareness about the types of poisoning and how to prevent it is very important in preventing childhood poisoning.

During COVID-19 pandemic, most studies have focused on sampling technique in adults. Considering the need to be aware of the effectiveness and evaluation of sampling methods in children, we have motivated a search for introducing and performing sampling techniques, especially upper respiratory tract sampling in children. We systematically reviewed the literature to understand the performance of different sampling methods in children in COVID-19. 

We systematically reviewed PubMed, Google Scholar, medRxiv, and bioRxiv (last retrieval August 1st, 2021) for comparative studies of deferent sampling techniques by using the search keywords including: children, pediatric sampling, nasopharyngeal, COVID-19, oropharyngeal, swabs, SARS, CoV2. 8 relevant manuscripts were sourced from a total of 4852 search results.

Nasopharyngeal (NP) swabs testing significantly had higher positivity rate over oropharyngeal swab in detecting SARS-CoV-2. Nasal swab has a low sensitivity in detecting SARSCoV-2 in children when referred to the Nasopharyngeal Aspiration (NPA), whereas its specificity is high. Therefore, NPA can be as the gold standard for detection of SARS-CoV-2. 

Saliva is not a useful for diagnosing COVID-19 in children. Negative nasopharyngeal and oropharyngeal swabs do not rule out COVID-19 and in patients with strong clinical suspicion, and Bronchoalveolar lavage (BAL) can be helpful.

Testosterone is necessary for general well- being, mental and physical health. Testosterone level decreases with age. Women also benefit from testosterone therapy. Testosterone therapy improves mood, mental and physical health. Testosterone therapy mitigates risk of cardiovascular event and improves measures of body habitus and can be considered as an adjuvant therapy for weigh loss. Pre-treatment with testosterone seems promising to improve the success of In-vitro Fertilization (IVF) in patients with ovarian failure. Transdermal testosterone use by postmenopausal woman does not influence mammographic density leading to probable misdiagnoses. The only evidence-based indication for testosterone therapy for women is for the treatment of Hypoactive Sexual Desire Disorder (HSDD). No female testosterone product has been approved by national regulatory authority due to the lack of data concerning efficacy and safety of these preparations in women.

Congenital Heart Disease (CHD) is the most common congenital malformation in infants. The burden is defined as the perceived caregiver’s sufferings of their emotional or physical health, social and financial life as a result of caring for loved ones. Lifelong CHD endures significant burdens on patients, families, and society. Parents of children with chronic illnesses such as CHD are more likely to be challenged than other parents. Furthermore, evidence shows the impact of this burden on parents’ health. Therefore, this study aimed to evaluate the burden on caregivers of patients with CHD.

In this cross-sectional study, 72 caregivers of patients with CHD in the Children’s Medical Center, Tehran, Iran were recruited. Face-to-face interviews with caregivers had been done. The demographic and disease-related data were collected. Zarit Burden Interview (ZBI) was applied for disease burden assessment. Statistical analysis was performed in SPSS version 22.

In the present study, most caregivers 34 (47.2%), suffered from moderate to severe burden. The mean caregiver burden score was 42.78 which is categorized as a moderate to severe burden score. The siblings’ number and level of caregivers’ education had a significant association with the caregiver’s disease burden.

CHD is associated with a significant caregivers’ disease burden. Although the disease-related factors were not related to disease burden, the higher caregivers’ education was related to fewer caregivers’ disease burden. Therefore, paying attention to the caregiver’s burden is an important clinical issue.

The coming various disasters, especially probable pandemics, will need a large number of volunteers with different capabilities. Motivation of volunteers, as a driving force, will be very important for future pandemic disaster planning. The aim of this study was to determine the enablers and barriers to the engagement of healthcare professionals in voluntary activities during the COVID-19 pandemic.

This cross-sectional study was conducted at the General Internal Medicine Departments of Imam Khomeini Hospital Complex in Tehran, Iran. A 44-item questionnaire was designed based on the Literature Review and Experts Panel. Items were scored on a 5-point Likert scale, ranging from “strongly disagree (1)” to “strongly agree (5)”. Content validity and face validity of the questionnaire were checked by 10 experts and 10 respondents, respectively. Cronbach’s alpha of the items of stimulating and inhibitory factors’ section was calculated 0.83 and 0.92, respectively. A self-administrated paper-based questionnaire has been distributed among healthcare team members. 

Out of 105 health care professionals, 80 (76.2%) were female and 41 (39%) were married. The most significant demographic predictor of willingness to volunteering was having no child (p-value=0.001). History of infection, admission, or death of family members or friends in the current pandemic was an important factor to reduce the desire to voluntary activities significantly (p-value=0.019). Depressive disorders and using antidepressants had no relation with the attraction to volunteering, but anxiety disorders had a significant relation with the willingness to be a volunteer (p-value=0.04).

The most important demographic variables influencing the unwillingness to participate in voluntary activities during the COVID-19 crisis are parenting role, history of anxiety disorders, and history of hospitalization or death of relatives or friends. Furthermore, the voluntary participation of healthcare professionals is influenced by facilitating factors such as giving rewards, reducing the period of obligatory military service, having a sense of altruism, and helping others.

Daily life functioning refers to the skills needed to independently perform day to day routines and deficits of daily life functioning common among people living with HIV. This study aimed to investigate the role of immunologic, virologic, cognitive functioning, and demographic variables to predict daily life function in HIV-infected individuals.

We recruited 67 HIV-positive individuals who were under the treatment of Anti-Retroviral Therapy (ART) in Imam Khomeini hospital, Tehran, Iran, in 2016. Prospective-retrospective memory questionnaire (PRMQ), Instrumental Activities of Daily Living interview (IADLs), and flow cytometry test to assess CD4 count were used. The data were analyzed with stepwise regression analysis using SPSS-22 software.

The results of stepwise regression analysis showed that the prospective/retrospective memory complaints are predictive of daily functioning in people living with HIV (p<0.001, F (1,42) =26.86, R2 adj=0.381). Our results also indicated that CD4 cell count, viral load, age, gender, and education do not predict instrumental activities of daily living scores among HIV-infected individuals (p>0.05).

Future studies should focus on the effects of prospective/retrospective memory rehabilitation to improve the daily function of HIV-infected individuals. Future studies should also focus on the mediating role of muscle mass decreases between the association of daily life functioning with CD4 and viral load.

The coronavirus disease 2019 (COVID-19) global pandemic is a life-threatening condition with high morbidity and mortality rate in Iran. Based on several studies, COVID-19 clinical outcomes are associated with co-morbidities, such as Cardiovascular Diseases (CVD). It appears that there is a relationship between the COVID-19 prognosis and the existence of CVD-related risk factors, for instance hypertension, obesity, diabetes, etc. 

A descriptive-analytical cross-sectional study was designed to investigate the relationship between CVD risk factors and COVID-19 with a total of 100 participants in Imam Khomeini hospital, Tehran, Iran. A checklist of anthropometric and prognostic information was filled for each patient and finally the data were analyzed. 

There was a statistically significant dependence between hospitalization in ICU, reservoir bag-mask, intubation, life-threatening complications, and the final outcome (p<0.01). However, there was no significant correlation between CVD risk factors and prognostic parameters like length of Intensive Care Unit (ICU) hospitalization, the requirement to reserve bag-mask oxygenation, etc. 

In this investigation, no significant association was observed between CVD-related risk factors and COVID-19 prognosis among Iranian adult COVID-19 cases.

Chronic Obstructive Pulmonary Disease (COPD) is a lifestyle-related chronic inflammatory pulmonary disease and a major cause of morbidity and mortality globally. In this study, we evaluated the prevalence and associated factors of osteopenia and osteoporosis in COPD patients.

A total of 91 COPD patients were recruited from October 2017 and December 2018. Lung function test, CAT score, 6-minutes’ walk test, Modified Medical Research Council (MMRC) dyspnea score and body mass index, air flow obstruction, dyspnea, and exercise capacity (BODE index) were evaluated in the patients. Bone Mineral Density (BMD) measurements of the femoral neck, total femur (including femoral neck, trochanter, and intertrochanter area), and lumbar spine were conducted using dual-energy X-ray absorptiometry. A T-score which was 2.5 standard deviations (SDs) below the average value was indicative of osteoporosis, in accordance with the World Health Organization criteria. We excluded COPD patients who had asthma, malignancy, and fracture.

There were 86 males (mean age±SD: 66.49±9.40 years) and 5 females (mean age±SD: 65.40±12.40 years). Among all the patients, 46 (51.1%) patients had osteopenia and 36 (40%) had osteoporosis. Comparing COPD grades showed grade 2 was a more prevalent grade (41.1%). There was no statistically association between femoral neck T score (mean±SD: -2.21±0.89) and COPD grade (P=0.58), while lumber spine T score (mean±SD: -2.13±1.11) was statistically decreased with increasing severity of COPD (p= 0.02).

The results of our study demonstrated that osteoporosis is common among COPD patients. Moreover, we found significant correlations between BMI, walking test, FEV1, MMRC, and BODE index.

Evolving evidence indicates the role of vitamin D deficiency in the progression of IBD and its impact on the severity of the disease, but it remains unclear whether vitamin D deficiency causes IBD or vice versa.

This cross-sectional study was conducted to determine the serum levels of vitamin D and its effects on the severity of disease in patients with inflammatory bowel disease in the Imam Khomeini Hospital complex. A questionnaire containing demographic information, records on the use of supplements and medications, disease complications, and criteria for determining the severity of the disease based on the Mayo score and Crohn’s Disease Activity Index (CDAI) and 25 hydroxy vitamin D levels was completed and evaluated.

Of the 101 participants, 21 were with Crohn’s disease and 80 had ulcerative colitis. The mean age of Crohn’s patients was 33.80±9.5 years and ulcerative colitis was 38.43±10.2 years. Among patients with ulcerative colitis, 37 (46.8%) had a mayo score less than 3 and 42 (53.2%) were 3 and more. Mean vitamin D in the mayo score less than 3 was 32.14 and the mayo score 3 and more was 23.99. Of the Crohn’s patients, 12 (57.1%) were in the recovery phase and 9 (52.9%) were in a non-recovery phase. The mean of vitamin D in the recovery phase was 29.10 and in the others was 27.04

There is a significant relationship between the level of vitamin D supplementation, the final value of CDAI, and the identification of the patients with the Mayo score.

 This research adds to the growing body of work demonstrating the vital role of image categorization in the medical sector. The efficiency of illness diagnosis is being greatly enhanced using image classification. A brain tumor is a collection of abnormal cells in the brain. Diagnostic precision is required when looking for a tumor in the brain because even the smallest error in human judgement can have disastrous results. To get around this problem, the medical community has implemented an automated brain tumor segmentation system. A variety of methods are employed to segment a brain tumor, but the results are inconsistent. To improve the quality of MRI images, we present our findings in this paper. Deep learning methods for image segmentation and classification are discussed in this paper. 

 In this paper we a very robust deep learning method for image segmentation and classification. For image classification, we are employing the enhanced faster R-CNN method. The ResNet50 model is used to differentiate between tumor and non-tumor images. The next step in this framework is to use Deep Residual UNET for segmentation. RESUNET is an FCNN that maximizes efficiency. The proposed method works well in terms of its ability to find and classify things accurately.

 The accuracy rate for identifying tumours in MRI scans using the proposed technique is 94.23%. Using transfer learning with Resnet50 as the base model and the use of discriminative learning rates, our model achieved superior results than other recent models.

 Within the scope of this study, we have integrated the residual networks with the U-Net to make the network stronger. This strategy improves the efficiency of classification and segmentation tools. To achieve a higher level of accuracy, the model may be trained further, or additional data may be applied in the training process.

 Idiopathic Pulmonary Fibrosis (IPF) is the most common form of lung fibrosis. This chronic and lethal disease is characterized by the gradual progression of fibrosis in the lung and decreased lung oxygen exchange capacity. This study aimed to evaluate the effect of pirfenidone on pulmonary parameters such as TLC, FVC, DLCO, 6-Minute Walk Distance (6MWD), and SPO2 has been done. 

 In this study, 40 patients with IPF participated in two groups. Pulmonary indicators such as TLC, FVC, VC, and DLCO by wind box and the SPO2 index were calculated by pulse oximetry. The variable of 6MWD is the distance traveled in meters in 6 min. Variables such as age, sex, height, weight, and hospitalization were obtained through interviews with patients. The indicators were reviewed in both groups at 3 and 6 months. 

 Data analysis showed that there was no significant difference (p>0.05) between the two groups. The mean reduction in these indexes was lower in the pirfenidone group and the decrease was significant over time. Also, the mean increase in the percentage of distance traveled in the 6MWD in the group of patients receiving pirfenidone was 53.53 and in the placebo group, it was 20.3%, which had a significant difference between the group receiving the drug and placebo was observed.

 The results of this study demonstrated that pirfenidone is considered as a preferred drug in all phases of the treatment of IPF disease and it has more therapeutic effects than other medicines.

 Skin diseases have many negative effects on self-esteem and quality of life. Psoriasis has several psychological and social impacts on self-esteem. This study was performed to compare the effects of psoriasis on Self-Esteem Status before and after the treatment with biological drugs.

 In this prospective cross-sectional descriptive study, patients with psoriasis referred to two hospitals in Tehran, Iran, were studied. Demographic data were recorded, and disease information was collected through the Psoriasis Area and Severity Index (PASI) score. The self-esteem status was determined using the standardized Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck questionnaires. Data were analyzed by Pearson correlation and t-score tests. 

 The severity of the disease decreased significantly after treatment with biological drugs. Scores related to depression, anxiety, somatization, interpersonal sensitivity, hostility, morbid anxiety, paranoid thoughts, and psychosis decreased after treatment. Self-esteem increased after treatment. The more severe the disease, the less the patients’ self-esteem increased after treatment with biologic drugs (p<0.000). According to the Eysenck measurement index, people with higher socioeconomic levels significantly increase self-esteem after treatment with biological drugs. According to the General Symptom Index (GSI), socioeconomic status has no significant effect on self-esteem.

 Treatment of psoriasis patients with biologics can reduce the severity of their disease and improve mental disorders in these patients. This treatment also increases their self-esteem and generally improves their quality of life of these patients.

 The body’s ability to fight the infection in the vicinity of implants decreases, resulting in an increased risk of local infection around the implants. According to importance of this issue, this study investigates the antibacterial properties of implants coated via silver-PVP nanocomposite. 

 In this research, silver nanoparticles have been synthesized by green synthesis method and using the coffee powder. The X-ray Diffraction (XRD) pattern confirms the formation of metallic structure of silver nanoparticles. Particle size has been studied by Transmission Electron Microscopy (TEM) and Digital Light Scattering (DLS) analysis, showing that the average particle size is about 17 nm. The implants have been coated via silver-PVP nanocomposite using deep coating method at different concentrations of Ag nanoparticles, and antibacterial properties of these samples have been investigated. The obtained results demonstrate a very large non-growth halo in the presence of silver-PVP coating. Also, the repeatability of non-growth halo test, toxicology analysis and pull off adhesion of samples have been studied and analyzed. 

 According to the MTT results, the appropriate concentration of silver-PVP nanocomposite without cell toxicity has been obtained equal to 118.6 µg/ml. At this concentration, the non-growth halo for both types of bacteria is clearly visible. By repeating the antibacterial test after 5 days, it was observed that the non-growth halo of implants is lasting. 

 Overall, it can be stated that this study presents a simple, operational, repeatable, and large-scale method for coating the implants and medical equipment that prevents the development of infection in the vicinity of implants.

Rhabdomyolysis is a clinical syndrome that occurs due to the damage to striated muscles after various conditions, one of the most common of which is drug poisoning. This study examined rhabdomyolysis in all types of poisoned hospitalized patients and its relationship with paraclinical variables, such as Creatine Phosphokinase (CPK) and the patients’ level of creatinine, blood urea, and liver enzymes (alanine aminotransferase and aspartate aminotransferase). 

 A total of 105 patients suffering from rhabdomyolysis caused by poisoning were enrolled. The necessary information of the patients was extracted from their records, recorded in the research questionnaire, and analyzed using SPSS. Descriptive statistics indicators and Pearson’s linear correlation coefficient were used for statistical analysis. 

 The prevalence of rhabdomyolysis was 7.2%. Ninety-seven (92.4%) and 8 (7.6%) poisoned patients suffering from rhabdomyolysis were male and female, respectively. The most prevalent poisoning resulting in rhabdomyolysis was methadone poisoning (31.42%). There was a significantly positive correlation between CPK and urea, Cr, and AST; i.e., by increasing CPK level, urea, Cr, and AST levels also increased, and by decreasing CPK level, urea, Cr, and AST levels also decreased. The incidence of an abnormal aminotransferase in the setting of rhabdomyolysis was high. In addition, the frequency of Acute Kidney Injury (AKI) ranged from 10.9 to over 16.9%.

 Xenobiotics (e.g., opioids, drugs, alcohol, and poisons), xenobiotic-induced coma, and/or xenobiotic-induced seizure are the causes of rhabdomyolysis in the present study. Briefly, the research findings revealed the highest prevalence of rhabdomyolysis in male youth poisoned by narcotics.

 During the COVID-19 pandemic, different environ-mental stressors and the difficult lockdown conditions exacerbated the signs and symptoms of Obsessive-Compulsive Disorder (OCD). The aim of this study is to qualitatively investigate and deeply understand the experiences of patients during the epidemic and its effect on the exacerbation of their symptoms to help plan the treatment of OCD during these kinds of periods.

 This was a descriptive phenomenological study using Colaizzi’s approach, conducted on OCD patients who visited Tehran Psychiatric Institute. Semi-structured interviews were conducted with the patients and continued until reaching saturation. Lincoln and Guba’s trustworthiness criteria for qualitative research (credibility, dependability, transferability, and confirmability) were used to ensure the accuracy and precision of the findings.

 Fourteen participants with a mean age of 30.3 years took part in this study. The data analysis revealed three themes: the pandemic disrupting OCD patients’ mental structure (OCD exacerbation, increased tensions in interpersonal relationships, mental exhaustion), rationalization of OCD symptoms in the context of COVID-19 (not feeling excluded, conflict resolution with the family, theoretically taking revenge on others), and the assimilation of COVID-19 within OCD (adaptation of the mental world to the world of COVID-19, altered content of obsession, and altered pattern of obsession).

 The stress induced by the COVID-19 pandemic can impact OCD in different ways, mostly by exacerbating the symptoms, adding new symptoms, and altering the type of obsession. The stress of infection is the most important factor in OCD exacerbation.

 The lack of any definitive treatment of COVID-19 has caused a great deal of stress in communities, especially for those fighting in the front line. In the present study, job stress of medical staff working in Intensive Care Units (ICUs) of patients with COVID-19 was evaluated and compared with staff working in non-COVID-19 ICUs.

 This study was performed in Iran with a study population of 80 staff members including nurses, paramedics, supervisors and other medical staff working in ICUs of COVID-19 and non-COVID-19 patients. The Osipow questionnaire was used to assess the job stress level. 

 The mean age of medical staff was 29.72±7.58 years old. The stress score of the male medical staff of ICUs of patients with COVID19 was significantly higher than the female staff and the average stress of employees in night shifts (190.60) was significantly higher than those in the morning and afternoon shifts. In the dimension of responsibility for COVID-19 ICU employees, working in the service department, having a history of COVID-19 infection, working in the NICU and having first-degree relatives with COVID19 caused significantly higher job stress levels. In the dimension of responsibility for non-COVID-19 ICU employees, working in the clinical ward and in the role of boundary dimension, being a supervisor caused significantly higher job stress levels compared to the rest of the staff.

 It can be concluded that ICU staff are under high pressure during the COVID-19 pandemic in different hospitals of Iran and they need more support to improve their mental health.

 This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients. 

 In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed.

 Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups. 

 The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma.

 Retroperitoneal schwannoma is a rare tumor rising from Schwann cells in peripheral nerve sheaths. Retroperitoneal schwannoma is really infrequent and has nonspecific symptoms and imperfect radiologic features, and is often identified histologically after surgery.

Case Report: 

We report the case of a 73-year-old man presented with flank mass. Imaging shows a hypoechoic macro lobulated solid cystic mass in retroperitoneum. Intraoperatively, after complete resection of retroperitoneal mass, a suspected lesion in upper pole of right kidney was observed. Histopathology evaluation after surgery shows coexistence of a large retroperitoneal schwannoma and papillary renal cell carcinoma, type 1.

 Schwannoma should be considered in the differential diagnosis of retroperitoneal spindle cell tumor. Schwannoma coexisted with renal cell carcinoma in a patient is an unusual event. Thus, it can show the importance of appropriate evaluation before any surgery.

Complementary and Alternative Medicine (CAM) is a vast area of medicine that includes both diagnosis and therapies using conventional medicine; and in this type of medicine, the principle is to maintain human health first, and then to cure diseases. Despite a huge range of advances in modern medicine, there has been surprisingly an increasing interest in CAM within recent years. Thus, it is somehow recognized as a serious, worldwide public health concern (1). One in three people uses the CAM treatments in his/her lifetime, especially for the common ailments such as backache, headache, anxiety, and depression. Many medical schools in the world have included CAM in their curriculums. For example, at the National Center for Complementary and Alternative Medicine in the United States (2), CAM covers for some educational materials in homeopathy and naturopathy courses. It is also significantly integrated in the alternative medicine systems in ancient countries such as Iran, India, and China. CAM is patient-centered and claims to facilitate patients’ self-healing process. According to the theories of this medicine, human body has innate mechanisms for maintaining health and, of course, curing illnesses. The major goal of CAM is to activate such mechanisms and mobilize the emotional and spiritual forces of each individual to fight the diseases (3). We know that CAM is basically based on empirical studies. Many researchers have reported that the social components of the tendency for complementary medicine fall into two main categories including repulsive and attractive factors. The repulsive factors are “iatrogenic effects of conventional medicine” and “superior position of the physician,” and the attractive factors consist of “systemic approach,” “socio-cultural attitude,” and “economic advantage of CAM” (4). This letter attempts to show that the reasons can be more than those factors. We believe that the reasons for the growing public tendency for CAM also consist of “Holistic factor, which means CAM relies on the body’s healing power instead of treating symptoms using medication. Thus, with this holistic belief that is spiritually, psychologically and socially more attractive to the believers, therefore, accordingly this belief increases patients’ satisfaction. Another major component of CAM is based on lifestyle modification, therefore, most of CAM methods have five common principles for a better lifestyle including proper management of stresses; spiritual approaches; exercises; removing/reducing any type of addiction (especially smoking and alcohol); and dietary recommendations. Most people believe in spirituality, so as a consequence of lacking this factor in classical medicine, CAM looks more attractive to people. CAM claims that by strengthening the immune system via self-medication methods, patient’s body is able to achieve a desirable result; thus, such an approach causes interest of patients. On the other hand, economic issues also play another major role in making CAM more interesting to the public, especially in lower socio-economic level. For example, a study indicated that about 80% of people from the Southern Hemisphere were more interested in CAM than modern medicine due to the financial issues and the lower cost of CAM treatments. Dissatisfaction with current modern drugs and the bad attitude of health care providers play another important role in higher public interest in CAM. In developing countries, over a third of the population does not have access to the basic medical facilities, so better and easier accessibility to CAM makes it more feasible and attractive in such societies.