The COVID-19 vaccination acceptance/hesitancy rate and its determinants among healthcare workers of 91 Countries: A multicenter cross-sectional study.

The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While 'Perceived benefits of the COVID-19 vaccination' (OR: 3.82, p-value<0.001) and 'Prosocial norms' (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, 'The vaccine safety/cost concerns' with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine

J-shaped relationship between cardiovascular risk and efficacy of intensive blood pressure reduction: A post-hoc analysis of the SPRINT trial.

BackgroundIn the 2017 ACC/AHA hypertension guidelines, a 10-year risk of more than 10% is considered for initiation of intensive blood pressure reduction. The current study aimed to determine which cut off limit of cardiovascular risk for starting intensive blood pressure reduction is beneficial.DesignA Secondary Analysis of Systolic Blood Pressure Intervention Trial (SPRINT).MethodsData from the SPRINT Trial was obtained from the NHLBI Data Repository Center. In the SPRINT, non-diabetic participants with SBP of ≥ 130 mmHg were randomly assigned to intensive and standard treatment arms with SBP targets of ResultsIn the analysis, 4292 patients were enrolled. The results demonstrated a clear J-shaped relationship between the effect of intensive blood pressure control and the risk of CVD events and 10-year Framingham cardiovascular risk levels at a cut-off limit of approximately ConclusionsThis post-hoc secondary analyses of the SPRINT trial showed that a cut off value of more than 7% may be useful in selecting patients suitable for initiation of blood pressure reduction

Adjunctive hemoperfusion with Resin Hemoadsorption (HA) 330 cartridges improves outcomes in patients sustaining multiple Blunt Trauma: a prospective, quasi-experimental study

Abstract Background Multi-organ dysfunction syndrome and multi-organ failure are the leading causes of late death in patients sustaining severe blunt trauma. So far, there is no established protocol to mitigate these sequelae. This study assessed the effect of hemoperfusion using resin-hemoadsorption 330 (HA330) cartridges on mortality and complications such as acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) among such patients. Methods This quasi-experimental study recruited patients ≥ 15 years of age with blunt trauma, injury severity score (ISS) ≥ 15, or initial clinical presentation consistent with SIRS. They were divided into two groups: the Control group received only conventional acute care, while the case group received adjunctive hemoperfusion. P-values less than 0.05 were statistically significant. Results Twenty-five patients were included (Control and Case groups: 13 and 12 patients). The presenting vital signs, demographic and injury-related features (except for thoracic injury severity) were similar (p > 0.05). The Case group experienced significantly more severe thoracic injuries than the Control group (Thoracic AIS, median [IQR]: 3 [2–4] vs. 2 [0–2], p = 0.01). Eleven and twelve patients in the Case group had ARDS and SIRS before the hemoperfusion, respectively, and these complications were decreased considerably after hemoperfusion. Meanwhile, the frequency of ARDS and SIRS did not decrease in the Control group. Hemoperfusion significantly reduced the mortality rate in the Case group compared to the Control group (three vs. nine patients, p = 0.027). Conclusions Adjunctive Hemoperfusion using an HA330 cartridge decreases morbidity and improves outcomes in patients suffering from severe blunt trauma

Basics of Developing a COVID-19 Reopening Roadmap: A Sys-tematic Scoping Review

Abstract Background: The necessity of easing pandemic restrictions is explicit. Due to the harsh consequences of lockdowns, governments are willing to find reasonable pathways to reopen their activities. Methods: To find out the basics of developing a reopening roadmap, on 6th-10th July 2020, we conducted a systematic search on PubMed, Scopus, and Web of Science to review the databases; and Google by manual to review the grey literature. Two independent authors extracted the data, and the senior author solved the discrepancies. Results: Sixteen documents were included. Data categorized into four sections: principals, general recommendations for individuals, health key metrics, and in-phases strategy. The number of phases or stages differed from three to six, with a minimum of two weeks considered for each one. Health key metrics were categorized into four subsets: sufficient preventive capacities, appropriate diagnostic capacity, appropriate epidemiological monitoring, and sufficient health system capacity. These metrics were used as the criteria for progressing or returning over the roadmap, which guarantees a roadmap's dynamicity. Noticeably, few roadmaps did not mention the criteria that may alter the dynamicity of their roadmap. When some areas face new surges, the roadmap's dynamicity is essential, and it is vital to describe the criteria to stop the reopening process and implement the restrictions again. Conclusion: Providing evidence for policymaking about lifting the COVID-19 restrictions seems to be missed in the literature should be addressed more, and further studies are recommended

Primary hydatid cyst of the thyroid glands: two case reports and a review of the literature

Abstract Introduction Although hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts. Case presentation A 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up. Conclusion It is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact

Topical Bambusa vulgaris Extract Enhances Wound Healing in Cutaneous Leishmaniasis

Background. Bambusa vulgaris (Tabashir) has been shown to have antimicrobial, antioxidant, and anti-inflammatory effects due to the presence of ascorbic acid, vitamin B2, flavonoid, and phenolic compounds which can be beneficial in the process of wound healing. The current study aimed to evaluate the effects of topical Tabashir extract on cutaneous leishmaniasis (CL) caused by Leishmania major in BALB/c mice. Methods. Twenty-eight female BALB/c mice (4 weeks old, 18 ± 4 grams) were injected subcutaneously in tail-base with L. major amastigotes. Treatment started when the CL lesions were appeared and continued for 21 days. Mice were then divided into four groups: E1, treated daily with 5% of Tabashir extract gel; E2, treated daily with 10% Tabashir gel; C1, irrigated daily only with normal saline; and C2, received vehicle gel daily. The wounds’ sizes were measured every 3 days, using vernier caliper. The volume densities of vessels, collagens, and hair follicles, vessels’ length density, and mean diameter were soteriologically determined. Results. Tabashir enhanced wound closure rate through increasing the number of fibroblasts, collagen bundles, and vessels, according to histomorphometric evaluation while it did not affect the parasitic load. Findings of the in vitro study revealed that the extract has substantial mortality for the Leishmania promastigotes. Conclusion. Topical Tabashir showed promising effects on the healing process of skin wounds caused by CL in this experimental study. Further studies are suggested to find out the molecules which are involved in the healing process

Establishment of a novel triage system for SARS-CoV-2 among trauma victims in trauma centers with limited facilities

Objectives The triage of trauma patients with potential COVID-19 remains a major challenge given that a significant number of patients may be asymptomatic or pre-symptomatic. This study aimed to compare the specificity and sensitivity of available triage systems for COVID-19 among trauma patients. Furthermore, it aimed to develop a novel triage system for SARS-CoV-2 detection among trauma patients in centers with limited resources.Methods All patients referred to our center from February to May 2020 were enrolled in this prospective study. We evaluated the SARS-CoV-2 triage protocols from the WHO, the Iranian Ministry of Health and Medical Education (MOHME), and the European Centre for Disease Control and Prevention (ECDC) for their effectiveness in finding COVID-19 infected individuals among trauma patients. We then used these data to design a stepwise triage protocol to detect COVID-19 positive patients among trauma patients.Results According to our findings, the WHO protocol showed 100% specificity and 13.3% sensitivity. The MOHME protocol had 99% specificity and 23.3% sensitivity. While the ECDC protocol showed 93.3% sensitivity and 89.5% specificity, it did not prioritize patients based on traumatic injuries and unstable conditions. Our stepwise triage protocol, which prioritizes traumatic injuries, had 93.3% sensitivity and 90.3% specificity.Conclusion Our study shows that the triage protocols from the WHO, MOHME and ECDC are not best equipped to diagnose SARS-CoV-2 infected individuals among trauma patients. In our proposed stepwise triage system, patients are triaged according to their hemodynamic conditions, COVID-19 related clinical states, and COVID-19 related laboratory findings. Our triage model can lead to more accurate and resource-effective management of trauma patients with potential COVID-19 infection.Level of evidence Level Ⅲ

Thoracic imaging of coronavirus disease 2019 (COVID-19) in children: a series of 91 cases

Background: Pulmonary infection with SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2; COVID-19) has rapidly spread worldwide to become a global pandemic. Objective: To collect paediatric COVID-19 cases worldwide and to summarize both clinical and imaging findings in children who tested positive on polymerase chain reaction testing for SARS-CoV-2. Materials and methods: Data were collected by completion of a standardised case report form submitted to the office of the European Society of Paediatric Radiology from March 12 to April 8, 2020. Chest imaging findings in children younger than 18 years old who tested positive on polymerase chain reaction testing for SARS-CoV-2 were included. Representative imaging studies were evaluated by multiple senior paediatric radiologists from this group with expertise in paediatric chest imaging. Results: Ninety-one children were included (49 males; median age: 6.1 years, interquartile range: 1.0 to 13.0 years, range: 9 days–17 years). Most had mild symptoms, mostly fever and cough, and one-third had coexisting medical conditions. Eleven percent of children presented with severe symptoms and required intensive unit care. Chest radiographs were available in 89% of patients and 10% of them were normal. Abnormal chest radiographs showed mainly perihilar bronchial wall thickening (58%) and/or airspace consolidation (35%). Computed tomography (CT) scans were available in 26% of cases, with the most common abnormality being ground glass opacities (88%) and/or airspace consolidation (58%). Tree in bud opacities were seen in 6 of 24 CTs (25%). Lung ultrasound and chest magnetic resonance imaging were rarely utilized. Conclusion: It seems unnecessary to perform chest imaging in children to diagnose COVID-19. Chest radiography can be used in symptomatic children to assess airway infection or pneumonia. CT should be reserved for when there is clinical concern to assess for possible complications, especially in children with coexisting medical conditions