Epidemiology of West Nile Virus in the Eastern Mediterranean region: A systematic review

Background: West Nile Virus (WNV), a member of the genus Flavivirus, is one of the most widely distributed arboviruses in the world. Despite some evidence for circulation of WNV in countries summarized by the World Health Organization as the Eastern Mediterrian Region Office (EMRO), comprehensive knowledge about its epidemiology remains largely unknown. This study aims to provide a concise review of the published literature on WNV infections in the Eastern Mediterranean regional office of WHO (EMRO). Methodology/principal findings: A systematic review of WNV prevalence studies on humans, animals and vectors in the EMRO region was performed by searching: Web of Science, Science Direct, Scopus, PubMed, Embase and Google Scholar. Finally, 77 citations were included, comprising 35 seroprevalence studies on general population (24460 individuals), 15 prevalence studies among patients (3439 individuals), 22 seroprevalence studies among animals (10309 animals), and 9 studies on vectors (184242 vector species). Of the 22 countries in this region, five had no data on WNV infection among different populations. These countries include Kuwait, Bahrain, Oman, Syria and Somalia. On the other hand, among countries with available data, WNV-specific antibodies were detected in the general population of all investigated countries including Djibouti (0.3-60), Egypt (1-61), Iran (0-30), Iraq (11.6-15.1), Jordan (8), Lebanon (0.5-1), Libya (2.3), Morocco (0-18.8), Pakistan (0.6-65.0), Sudan (2.2-47), and Tunisia (4.3-31.1). WNV RNA were also detected in patient populations of Iran (1.2), Pakistan (33.3), and Tunisia (5.3 -15.9). WNV-specific antibodies were also detected in a wide range of animal species. The highest seropositivity rate was observed among equids (100 in Morocco) and dogs (96 in Morocco). The highest seroprevalence among birds was seen in Tunisia (23). In addition, WNV infection was detected in mosquitoes (Culex, and Aedes) and ticks (Argas reflexus hermanni). The primary vector of WNV (Culex pipiens s.l.) was detected in Djibouti, Egypt, Iran and Tunisia, and in mosquitoes of all these countries, WNV was demonstrated. Conclusions: This first systematic regional assessment of WNV prevalence provides evidence to support the circulation of WNV in the EMRO region as nearly all studies showed evidence of WNV infection in human as well as animal/vector populations. These findings highlight the need for continued prevention and control strategies and the collection of epidemiologic data for WNV epidemic status, especially in countries that lack reliable surveillance systems. © 2019 Eybpoosh et al

Modelling the COVID-19 pandemic in context : An international participatory approach

Funding RA is funded by the Bill and Melinda Gates Foundation (OPP1193472). LW is funded by the Li Ka Shing Foundation. CF is funded by grant #2017/26770-8, São Paulo Research Foundation (FAPESP). The CoMo Consortium has support from the Oxford University COVID-19 Research Response Fund (ref: 0009280). Scientific writing assistance and editorial support was provided by Adam Bodley, according to Good Publication Practice guidelines.Peer reviewedPublisher PD

Potential health and economic impacts of dexamethasone treatment for patients with COVID-19

Acknowledgements We thank all members of the COVID-19 International Modelling Consortium and their collaborative partners. This work was supported by the COVID-19 Research Response Fund, managed by the Medical Sciences Division, University of Oxford. L.J.W. is supported by the Li Ka Shing Foundation. R.A. acknowledges funding from the Bill and Melinda Gates Foundation (OPP1193472).Peer reviewedPublisher PD

Nosocomial infection surveillance system in iran: Structures, processes and achievements

Background and Objectives: This article provides an overview of the national nosocomial infection surveillance system in Iran and its current status, achievements, and challenges.   Methods: All relevant reports, documents, and program guidelines, as well as published literature and surveillance data related to the nosocomial infection surveillance system in Iran were critically reviewed. Opinions of the key informants at local and governmental levels were also reviewed.   Results: The program was launched in 2006 covering 100 volunteer hospitals. Since 2016, participation in the program is obligatory, leading to the participation of 555 hospitals with >100 beds (56%). Major data collected in the program include demographic characteristics, infections and related risk factors, pathogens and their antimicrobial susceptibility/resistance, and patient outcome. Recently, device-associated infection rates are also calculated in the program. Since its establishment in 2006, the program has improved in terms of case finding and coverage. Implementation of the program has also had positive impacts on the stakeholders’ knowledge, attitude, and practice.   Conclusion: Although the number of identified cases and program coverage have improved, a considerable proportion of the infected cases still remain undiagnosed. Implementation of the program has also improved the stakeholders’ awareness, attitude and practice. The program faces a number of challenges, including lack of appropriate scientific support from academics and executive issues. Integration of active and sentinel surveillance in selected hospitals, persuasion of physicians to actively participate in the program, and conducting incidence and prevalence surveys would help the program to better detect nosocomial infection cases

Identify of barriers to research utilization in the nursing clinical practice, in Iran

Background and objective: The significance of knowledge transfer and research utilization for health care decision makers in developed and developing countries have been paid more attention recently. Literature emphasizes that nursing practice should be based on utilizing of research. The aim of this study is to identify barriers of research utilization in Iranian clinical nurse's practice. Methods: The Funk Research Utilization Barriers Questionnaire including 29 items in 4 domains (organization barriers and limitations, quality of research, nurses' values, awareness and skills and communication of research) was employed in this study. Results: Three main barriers to research utilization were identified: 1) the nurse does not have time to read research, 2) the nurse does not feel she/he has enough authority to change patient care procedures, and 3) the facilities are inadequate for implementation. Conclusion: Considering the organizational barrier, it is recommended that academic organizations should support and adopt to utilize research findings particularly in nursing practice in Iran

Severity and mortality of COVID-19 infection in HIV-infected individuals: Preliminary findings from Iran

Background: Higher mortality due to coronavirus disease 2019 (COVID-19) is reported among some immunocompromised patients; however, the relation between immunosuppression due to HIV infection and severity of COVID-19 infection remains unclear. We aimed to investigate the severity and mortality of COVID-19 infection in HIV-infected patients. Methods: This was a retrospective cohort study on all COVID-19 suspected and confirmed cases hospitlized in Iran between Febuary 19 (epidemic onset date) and April 8, 2020, whose data were recorded in the national database for Medical Care Monitoring Center. Hospitalized patients were followed from admittion to death/discharge. Patients� HIV status was recorded based on their self report. Logistic and Cox regression models were used to evaluate the association between HIV infection and the severity (according to the Glascow-Coma Scale situation, need for intubation and hypoxemia) and mortality of COVID-19 infection, respectively. Analyses were performed separately for COVID-19 suspected and confirmed cases. Results: Out of 122 206 severe acute respiratory infection (SARI) cases, 90 were HIV-positive (0.07), with a similar mean age (Pttest= 0.750) and distrubtion of gender (PChi-square= 0.887) and nationality (PChi-square= 0.202) as HIV-negative patients. A comparable proportion of HIV-positive and HIV-negative cases were tested for COVID-19 (p= 0.170); however, the frequency of positive results was lower among HIV-positives (p= 0.038). The frequency of COVID-19 and HIV coinfection was lower than expected among confirmed cases (adjusted OR= 0.54; 95 CI: 0.29-1.02) and suspected cases (adjusted OR= 0.68; 95 CI: 0.45- 1.02), which means that the frequency of COVID-19 infection was lower among HIV-positive cases. HIV infection decreased the risk of death among confirmed (adjusted HR= 0.33; 95 CI: 0.05-2.32), suspected cases (adjusted HR= 0.81; 95 CI: 0.33-1.94), and among SARI cases (adjusted HR= 0.73; 95 CI: 0.35-1.54). Conclusion: Our findings support the concept that HIV infection was not a risk factor to increase the severity and risk of death among COVID-19 infected patients. Copyright© Iran University of Medical Science

Hiv/aids surveillance system in the islamic Republic of Iran: History, structures and processes

Background and Objectives: Iran is one of the Middle Eastern countries that implemented the HIV / AIDS control and surveillance program many years ago. The purpose of this study was to review the HIV / AIDS surveillance system in Iran.   Methods: This was a review research to assess the processes, structures and achievements of the HIV/AIDS surveillance system in Iran. The information sources of this study included data from the surveillance system, reports and documentation, and published guidelines, reviewing existing structures and views of managers and practitioners of the HIV/AIDS surveillance system in Iran.   Results: In Iran, all cases with HIV / AIDS as well as people with high risk behaviors are referred to behavioral disease counseling centers in order to receive health care services. Harm reduction in people with risky behaviors in the form of counseling centers, drug addictschr('39') centers, and womenchr('39')s counseling centers in collaboration with governmental and non-governmental organizations, and attention to the second generation of HIV/AIDS surveillance, particularly conducting behavioral studies, are other components of the HIV / AIDS surveillance system in Iran   Conclusion: Although the HIV / AIDS surveillance system in Iran has a large structure with many achievements in reducing new HIV cases, especially in some high-risk groups such as injecting drug users, as well as reducing HIV transmission from infected mothers to their children, strengthening this surveillance system, especially for sexual high-risk groups, is essential for controlling HIV/AIDS in the country