Social Mobilization in the Wake of Coronavirus Disease-19: A Brief Report of a Planned Approach to Community Health in Iran

BACKGROUND: Several plans have been taken by health system to deal with COVID-19. The rapid spread of the virus and the special care that critical patients need put a major pressure on the healthcare system, which may not be able to compensate for its dimensions in various aspects. Therefore, the participation and cooperation of the society in the form of mobilizing the society with the health system will be effective in controlling and preventing this disease. AIM: The overall purpose of this study is to design a community mobilization framework based on the PATCH Model to prevent the spread and control of coronavirus disease. METHODS: This community-based research is a type of health system research (HSR) which designs the community mobilization framework based on the PATCH Model RESULTS: In this project, the community mobilization framework is in the form of the PATCH Model. In this study, interventions and activities will be performed based on the PATCH Model in the neighborhood. Health volunteers consist of popular volunteers, Basij, clerics, neighborhood trustees, donors. After training and issuing the identification card, Corona Anti-Corruption Assistant will start operating. Activities will be purposeful in three areas: education and information, neighborhood surveillance, and disinfection. CONCLUSION: Community mobilization for disease prevention and control in the neighborhood using the PATCH model as presented will be effective

Primary pleural lymphoma of T cell origin in a paediatric patient with a focus on radiological findings : a case report and review of literature

Purpose: Pleural lymphoma is a medical condition characterised by shortness of breath and obscure chest pain, which may be a diagnostic challenge, especially when it occurs in children. Plain chest X-rays and computed tomography (CT) scan are the main imaging techniques and are the initial diagnostic methods utilised. Case report: A four-year-old boy was admitted to the emergency ward with pain in the right thoracoabdominal region, which had persisted for two months. Physical examination revealed reduced respiratory sounds in the right chest, but with no other significant findings. The patient underwent chest X-ray and CT scan, which showed right sided pleural thickening coupled with a massive pleural effusion. The patient underwent pleural biopsy, and a diagnosis of T-cell primary pleural lymphoma was made. The patient underwent treatment with BFM-NHL and was followed for three years, during which the patient remained disease free. Conclusions: Pleural lymphoma is a rare diagnosis especially in children and could have overlapping clinical manifestations with more common conditions. Imaging techniques are the main route of clinical work-up towards final diagnosis. Here, we present a rare paediatric patient with no significant past medical history, who underwent imaging and was diagnosed with T-cell primary pleural lymphoma, a very rare subtype of primary pleural lymphoma

Breast artery calcification as a predictor of coronary artery calcification : a cross-sectional study

Introduction: Coronary artery disease is the main cause of burden of disease in the world. Coronary calcification is seen as an aetiopathological event in the pathogenesis of cardiovascular diseases. Studies have shown that breast artery calcification, which is routinely found in mammography of elderly women, could be predictive of coronary artery calcification. Material and methods: In this cross-sectional study, 60 women over 40 years of age were included. All of these patients had undergone mammography after having an indication to undergo a computed tomography-angiography. Breast arterial calcification and calcium scores were determined for each patient, and the paired-t test was used to analyse the data. Results: The mean age of patients was 49.52 ± 8.83 years. Of these 60 women, 50% were postmenopausal and 50% were not. In 37 (61.7%) cases, mild to severe coronary calcification was observed, and 50 (83.3%) had mild to severe breast arterial calcification. There was a significant correlation between coronary calcification and breast artery calcification (p = 0.001), and there was also a significant relationship between coronary calcification and postmenopausal calcification (p < 0.001). Conclusions: Breast artery calcification can be a suitable predictor for coronary artery calcification and is a valid method for predicting cardiovascular disease probability in the future

Clinical and radiological characteristics of pediatric patients with COVID-19: focus on imaging findings

Purpose: CT imaging has been a detrimental tool in the diagnosis of COVID-19, but it has not been studied thoroughly in pediatric patients and its role in diagnosing COVID-19. Methods: 27 pediatric patients with COVID-19 pneumonia were included. CT examination and molecular assay tests were performed from all participants. A standard checklist was utilized to extract information, and two radiologists separately reviewed the CT images. Results: The mean age of patients was 4.7 ± 4.16 (mean ± SD) years. Seventeen patients were female, and ten were male. The most common imaging finding was ground-glass opacities followed by consolidations. Seven patients had a single area of involvement, five patients had multiple areas of involvement, and four patients had diffuse involvement. The sensitivity of CT imaging in diagnosing infections was 66.67. Also, some uncommon imaging findings were seen, such as a tree-in-bud and lung collapse. Conclusion: CT imaging shows less involvement in pediatric compared to adult patients, due to pediatric patients having a milder form of the disease. CT imaging also has a lower sensitivity in detecting abnormal lungs compared to adult patients. The most common imaging findings are ground-glass opacities and consolidations, but other non-common imaging findings also exist. © 2020, Japan Radiological Society

Comparison Between Effect of Letrozole Plus Misoprostol and Misoprostol Alone in Terminating Non-Viable First Trimester Pregnancies: A Single Blind Randomized Trial

Objective: To evaluate the effect of letrozole plus misoprostol to terminate non-viable pregnancies in first trimester compared with the use of misoprostol alone. Materials and methods: In a single-blind clinical trial, 128 women over 18 years old referred to Educational-Medical centers of Tabriz University of Medical Science (Tabriz, Iran), for abortion in first trimester of non-viable pregnancies, were randomly selected in two intervention and control groups using Rand list (version 1.2) software. To complete abortion both groups received 600 mcg of misoprostolorally. The intervention group received letrozole 10 mg daily for 3 days before receiving misoprostolorally. Complete abortion rate and the side effects of both groups were recorded. Results: Mean pregnancy age based on LMP in intervention group and control group were 7.74 ± 0.95 and 8.52 ± 1.29 weeks respectively. Complete abortion rate in the intervention group was 93.7%, and in control group was 68.7% which was significantly higher in intervention group (p = 0.001). Abdominal pain in the intervention group is also significantly lower than that of the control group (p = 0.013). Intervention group also had significantly lower duration of bleeding rather than control group (p = 0.006). Conclusion: Based on the findings of this study, letrozole pretreatment with misoprostol for first-trimester medical abortion can increase complete abortion rate significantly without increasing side effects compared to use of misoprostol alone

Late presentation of pregnant women with chromosomal abnormalities: A barrier to legal and safe abortions in Muslim majority countries

Introduction: In Islamic countries, the prenatal diagnostic procedures are planned considering legal and religious limitations. We aimed to evaluate the indications of presentation and problems related to religious and legal limitations for presentation of Muslim parents for prenatal screening of chromosomal abnormalities. Methods: A cross-sectional study was performed on consecutive 920 pregnant women presenting for screening of congenital and chromosomal anomalies to Educational Medical Centers of Tabriz University of Medical Sciences, Tabriz, Iran, between 2011 and 2015. Previously prepared questionnaire forms were utilized for collection of information from patients and their medical records. Results: In total, 153 cases had an indication for amniocentesis, and this procedure revealed that 141 fetuses (92.2%) did not have any congenital abnormalities, but 12 cases (7.8%) had some sort of abnormality, requiring pregnancy termination. These cases included 8 fetuses (5.2%) with trisomy and four (2.6%) with single gene diseases. Of 12 patients, the justifications for pregnancy termination were issued for 7 women by the provincial Legal Medicine Organization. However, the remaining 5 patients could not obtain legal justifications for termination of their pregnancies, mostly because of late presentation, obligating them to choose illegal methods for pregnancy termination. Conclusion: Regarding the legal and religious limitation of pregnancy termination after 18th week in Islamic countries, it is highly recommended that the first trimester screening programs be performed in Islamic countries in order to obtain early decision-making

Diagnostic accuracy of twinkling artifact sign seen in color doppler ultrasonography in detecting microlithiasis of kidney

Background: Ultrasonography (US) is a safe and cost-efficient modality which is used to assess patients with urinary tract lithiasis. Objectives: In this study, we aimed to evaluate the accuracy of the twinkling artifact of color Doppler sonography in detecting renal stones smaller than 4 mm in diameter. Methods: Of all patients referring to a tertiary medical center with a probable diagnosis of urolithiasis during April 2019 to Septem-ber 2019, 99 patients with a renal stone smaller than 4 mm in non-contrast computed tomography (CT) scan entered our study. Both gray scale and color Doppler US were performed to assess the presence of any renal stones, the accompanying posterior shadowing, and the twinkling artifact for all patients. Results: Of 99 patients with confirmed renal stone on non-contrast CT scan, 91 patients had an echogenic focus on grayscale (sensi-tivity = 91.9), 70 patients had posterior shadowing sign (sensitivity = 70.7), and 76 patients had twinkling artifact on color Doppler US. The sensitivity, specificity, positive predictive value, and negative predictive value of this imaging finding for detecting renal stones smaller than 4 mm were 76.8, 100, 100, and 32.4, respectively. Conclusions: Our study revealed that twinkling artifact on color Doppler US is a reliable sign for detecting renal stones smaller than 4 mm. However, the sensitivity of this sign could be increased in combination with gray scale findings (echogenic focus and posterior shadowing). © 2020, Author(s)

Epidemiological study of pregnant women admitted to the emergency department

Objective: Pregnancy is an important psychological and biological phenomenon in women’s life. Pregnancy has many complications jeopardizing the well-being of the mother and the child. Methods: In this retrospective study, the data including demographic information, chief complaint, the initial diagnosis, referral decision, final diagnosis, hospitalization outcome and pregnancy outcomes were studied on 239 pregnant women admitted to the emergency departments of the general hospitals of East Azerbaijan province. Results: The average age of patients was 27.54 years. The time period from the initial presentation to completely leave the emergency department was reported to be 3.66 hours on average. In this study, most patients (74.5%) did not have a history of abortion. Exploring the time of admission for all cases, most patients were admitted from 8 pm to 8 am (67.8%), and 32.2% were referred from 8 am to 8 pm. Concerning the time of pregnancy, 46.4% were at their second trimester of pregnancy. Most of the patients were admitted in cold seasons of the year. The most common chief compliant was abdominal pain with 32.2% frequency. In addition, the most frequent primary diagnoses were an acute abdomen and trauma at 25.5% and 14.2% respectively. Conclusion: Abdominal pain and acute abdomen have the most frequency as the chief compliant and initial diagnosis especially during the second trimester of pregnancy. In this regard, appropriate training and skillful staff are needed to deal with the complaints and complications of abdominal pain. More than half of pregnant women referred to the emergency departments were hospitalized or admitted to the intensive care unit (ICU). This signals the necessity of adequate facilities to provide proper care for this group

Prevalence and predictors of low back pain among the Iranian population: Results from the Persian cohort study

Background and objectives: Low back pain (LBP) is a common health condition in populations. Limited large-scale population-based studies evaluated the prevalence and predictors of LBP in developing countries. This study aimed to evaluate the prevalence and factors associated with LBP among the Iranian population. Methods: We used baseline information from the Prospective Epidemiological Research Studies in Iran (PERSIAN), including individuals from 16 provinces of Iran. LBP was defined as the history of back pain interfering with daily activities for more than one week during an individual's lifetime. Various factors hypothesized to affect LBP, such as age, sex, marital status, educational status, ethnicity, living area, employment status, history of smoking, body mass index (BMI), physical activity, sleep duration, wealth score, history of joint pain, and history of morning stiffness in the joints were evaluated. Results: In total, 163770 Iranians with a mean age of 49.37 (SD = 9.15) were included in this study, 44.8% of whom were male. The prevalence of LBP was 25.2% among participants. After adjusting for confounders, the female gender [OR:1.244(1.02-1.50)], middle and older ages [OR:1.23(1.10-1.33) and OR:1.13(1.07-1.42), respectively], being overweight or obese [OR:1.13(1.07-1.19) and OR:1.21(1.16-1.27), respectively], former and current smokers (OR:1.25(1.16-1.36) and OR:1.28(1.17-1.39), respectively], low physical activity [OR:1.07 (1.01-1.14)], and short sleep duration [OR: 1.09(1.02-1.17)] were significantly associated with LBP. Conclusion: In this large-scale study, we found the lifetime prevalence of LBP to be lower among the Iranian population in comparison to the global prevalence of LBP; further studies are warranted to evaluate the causality of risk factors on LBP

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions