Call interview for early detection and appropriate treatment to decrease COVID-19 pandemic burden

One of the most important concerns during the covid-19 pandemic is an imbalance in health services. Considering significant mortality among hospital staff and the general population, a great apprehension was raised in society. Consequently, many patients with symptoms were rushed to hospitals. In this regard, to keeping clinics away from overcrowding, call interview with patients plays a crucial role in not only patients screening but also treatment approach. &nbsp

Impact of Cardiopulmonary Resuscitation on Cardiac Transplantation outcome

Introduction: Donor heart shortage limits heart transplantations programs while the number of patients waiting for cardiac transplant continues to increase. Optimizing the use of all available donor hearts is a vital key to reduce waiting list mortality. Among different extended criteria, prolong cardiopulmonary resuscitation (CPR), i.e. more than 20 min, has been considered under doubt to be a selection criterion in donor selection. The aim of this study was to compare the outcomes of heart transplantation from cardiopulmonary-resuscitated donors to those who received hearts from donors who did not require cardiopulmonary resuscitation.Methods: This study was a retrospective analysis of adult heart transplantation program in Masih Daneshvari Hospital in Tehran, Iran from 2010 to 2019. Donors and recipients’ demographics, cause of end-stage heart disease and brain death, duration of hospitalization for both donors and recipients and also the duration of cardiopulmonary resuscitation and other factors related to it were investigated. Qualitative variables were compared using Chi-square test. Quantitative variables were compared using T-test. Patient and graft survival rates were calculated using the actuarial method and compared using Wilcoxon's test.Results: Among 92 recipients, 39 were transplanted with cardiac grafts from CPR-suffering donors. There were no significant differences regarding sex, age, donor and recipient hospitalization periods, early rejection and 1-year-survival rate considering CPR and non-CPR grafts. However, we detected a strong negative correlation between the duration of CPR and 3-year-survival rate (P = 0.02 and R-value = -0.62) and also its association with post-transplant arrhythmias (P = 0.04).Conclusion: There is a negative possible influence of long-lasting CPRs (especially more than 20 minutes) in midterm survival and post-transplant complications

Diagnostic values of bronchodilator response versus 9-question questionnaire for asthma

Introduction: Several studies have investigated different tools for asthma diagnosis in order to reduce the cost and improve its early recognition. The goal of this study is to establish a short questionnaire to be used in practice for asthma screening and compare diagnostic values between this method and spirometric response to bronchodilators.Material and method: 208 patients presenting with chronic stable dyspnea (> 6 months) and definite clinical diagnosis of chronic obstructive pulmonary disease, bronchiectasis, pulmonary fibrosis or asthma, were enrolled. 9 questions out of 43 based on the literature search were selected by regression analysis. Patients were asked to complete the questionnaire and then their spirometric responses to bronchodilators were evaluated. Results: Of all, 53.8% of cases were diagnosed clinically to have asthma. For establishing diagnosis of asthma, the bronchodilator test had 48.2% sensitivity, 78.1% specificity, 72% positive, 56.4% negative predictive values, 2.2 positive, 0.66 negative likeli-hood ratios, and false positive, false negative and accuracy of 21.9%, 51.8% and 62.01%, respectively. The revised 9 questions from the questionnaire had 97.3% sensitivity, 77.1% specificity, 83.2% positive, 96.1% negative predictive values, 4.24 positive,  0.03 negative likelihood ratios, 22.9% false positive, 2.7% false negative and 87.98% accuracy.Conclusions: The 9-question questionnaire had better diagnostic values in defining asthma in patients with chronic dyspnea than reversibility of airway obstruction to salbutamol and can be used as a useful screening test for diagnosis of asthma in clinical practice and for investigational purposes

Ameliorative effects of omega-lycotoxin-Gsp2671e purified from the spider venom of Lycosa praegrandis on memory deficits of glutamate-induced excitotoxicity rat model

Memory impairment is one of the main complications of Alzheimer’s disease (AD). This condition can be induced by hyper-stimulation of N-Methyl-D-aspartate receptors (NMDARs) of glutamate in the hippocampus, which ends up to pyramidal neurons determination. The release of neurotransmitters relies on voltage-gated calcium channels (VGCCs) such as P/Q-types. Omega-lycotoxin-Gsp2671e (OLG1e) is a P/Q-type VGCC modulator with high affinity and selectivity. This bio-active small protein was purified and identified from the Lycosa praegrandis venom. The effect of this state-dependent low molecular weight P/Q-type calcium modulator on rats was investigated via glutamate-induced excitotoxicity by N-Methyl-D-aspartate. Also, Electrophysiological amplitude of field excitatory postsynaptic potentials (fEPSPs) in the input–output and Long-term potentiation (LTP) curves were recorded in mossy fiber and the amount of synaptophysin (SYN), synaptosomal-associated protein, 25 kDa (SNAP-25), and synaptotagmin 1(SYT1) genes expression were measured using Real-time PCR technique for synaptic quantification. The outcomes of the current study suggest that OLG1e as a P/Q-type VGCC modulator has an ameliorative effect on excitotoxicity-induced memory defects and prevents the impairment of pyramidal neurons in the rat hippocampus

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

The effects of Vitamin D supplementation on thyroid function in hypothyroid patients: A randomized, double-blind, placebo-controlled trial

Background: Data on the effects of vitamin D supplementation on thyroid function in hypothyroid patients are scarce. Objective: This study was done to evaluate the effects of vitamin D supplementation on thyroid function in hypothyroid patients. Material and Methods: This randomized double-blind, placebo-controlled trial was conducted on 201 hypothyroid patients aged 20–60 years old. Subjects were randomly assigned into two groups to intake either 50,000 IU vitamin D supplements (n = 102) or placebo (n = 99) weekly for 12 weeks. Markers of related with thyroid function were assessed at first and 12 weeks after the intervention. Results: After 12 weeks of intervention, compared to the placebo, vitamin D supplementation resulted in significant increases in serum 25-hydroxyvitamin D (+26.5 ± 11.6 vs. 0.0 ± 0.0 ng/mL, P < 0.001) and calcium (+0.4 ± 0.7 vs. 0.1 ± 0.6 mg/dL, P = 0.002), and a significant decrease in serum thyroid-stimulating hormone (TSH) levels (−0.4 ± 0.6 vs. +0.1 ± 2.0 μIU/mL, P = 0.02). A trend towards a greater decrease in serum parathyroid hormone (PTH) levels was observed in vitamin D group compared to placebo group (−3.8 vs. +1.9, P = 0.07). We did not observe any significant changes in serum T3, T4, alkaline phosphatase (ALP) and albumin levels following supplementation of vitamin D compared with the placebo. Conclusion: Overall, the current study demonstrated that vitamin D supplementation among hypothyroid patients for 12 weeks improved serum TSH and calcium concentrations compared with the placebo, but it did not alter serum T3, T4, ALP, PTH, and albumin levels

Study of the evolution of geodesic domes from the point of view of the structures of dome spacecraft

Today, with the advancement of science and technology, there are new needs and demands in the field of structural engineering. The time factor in constructing structures has doubled, and this has increased the tendency towards prefabricated structures. Also, with the increase in human populations, there has been a strong interest in having large spaces without the presence of middle pillars. In this regard, from the beginning of the century, a number of experts were attracted to the unique capabilities of spacecraft. With the publication of these results, the field was welcomed more and more day by day, with the passing of several decades, the study of space structures is still at the center of the experts and students of civilization. If the grid is curved in two directions, it is called a dome. Perhaps a dome is a part of a sphere or a cone with multiple joints. In general, domes are highly rigid structures. Examples of domes can be diamonds and gyodecic domes. In this paper, geodesic domes have been analyzed from the point of view of the discussion of structures of dome space spaces in the geodesic dome. A geodesic dome (or a dome constructed with geometric surfaces) has a spherical or semi-spherical shell structure or a grid shell based on a grid of large interconnected (geodesic) loops on its surface. Geodesic domes are formed by subdivisions. Polygons are more stable because they form triangles at any time. The geodesics cut each other to form triangular elements to increase their internal strength and also increase the power of distribution of stress at the level of their structure. With more divisions on the surface, the dome gets smoother and more flexible

The Study the Effect of Vitamin D on Hypothyroidism

Background: Vitamin D deficiency or insufficiency is a common worldwide problem. The association between hypothyroidism and vitamin D deficiency is controversial. We aimed to study the effect of vitamin D on thyroid function in hypothyroid patients. Material and Methods: In this case-control randomized clinical trial study, 201 hypothyroid patients reffered to endocrinology clinics in Arak, were randomly classified into two groups.&nbsp; All patients were taking levothyroxine. Case group received vitamin D 50000 unit weekly and control group received placebo in addition to levothyroxine. After three months, thyroid function tests were repeated and compared with the results of the beginning of the study both intra groups and inter groups by student t test and paired t test analysis. Results: Male/Female ratio in both case and control groups were 0.24 and 0.15 respectively (P=0.1). The prevalence of vitamin D deficiency and insufficiency were 68.7 % (138) and 93.5% (188) and after vitamin D taking were 70% (34.8) and 51.2% (103) respectively.Student t test showed that TSH level in people who received vitamin D had a significant decrease in comparison to the people who received placebo (P<0.05). There were a significant change of TSH level between two groups at vitamin D level 10-30 ng/ml. Conclusion: Most of hypothyroid patients had vitamin D deficiency and vitamin D taking improved thyroid function by TSH suppression in these patients. We recommend the screening for vitamin D deficiency in hypothyroid patients. Although, more researches are needed to clarify molecular explanations of this hypothesis

Prophylactic Recommendation for Healthcare Workers in COVID-19 Pandemic

During COVID-19 pandemic, it seems that healthcare workers (HWs) are more prone to the infection than general population. Indeed, a high viral load atmosphere and infected medical equipment are sources for spreading the disease. Many HWs should care for patients in the intensive care units (ICUs) which are one of the most contaminated areas. However, despite the adequate protections, HWs are still exposed to the coronavirus. Moreover, some procedures such as tracheal intubation increase the risk of infection. Overall, the probability of contamination in HWs is three times more than that of other people. According to Keshavan et al., about 3300 Chinese HWs have been infected by COVID-19, with a mortality rate of 0.4%. In Iran, we have a large number of affected HWs, with 69 registered deaths until late March 2020. Most of them were young with no previous medical history. So we have to improve protection and plan additional arrangements against COVID-19. There are several mechanisms for the antiviral activity of hydroxychloroquine. This drug is a weak base that concentrates on the intracellular sections including endosome and lysosome; so, viral replication in the phase of fusion and uncoating will be stopped.&nbsp; Also, hydroxychloroquine can change the ACE2 glycosylation and inhibits both S-protein binding and phagocytosis. The last mechanism would be the suppressing effect on cytokine production and the immunomodulatory effect of the drug. Based on in-vitro studies of chloroquine on SARS-CoV-1, its effective role as a prophylactic agent and a post-infection treatment has been raised. According to another cell-culture study, the preventive effect of the drug is estimated to be 24 hours before and 5 hours after the contamination. The weekly dose of 500 mg chloroquine, which is used for malaria prophylaxis, will result in a concentration below the EC50, which is not enough for inhibition of the novel coronavirus. But the minimum dosage, which is used for rheumatoid arthritis treatment (250mg daily) will result in plasma concentrations higher than EC50, which may be sufficient in this regard.&nbsp;Regarding this pharmacokinetics and in-vitro investigations a double-blind, randomized, placebo-controlled trial using chloroquine as a prophylactic agent for SARS-CoV-2 infection is ongoing. The recommended dose is a loading dose of 10 mg/kg from base drug followed by 150 mg daily (250 mg chloroquine phosphate salt). Subsequently, the number of infected patients will be assessed after 3 months. Another running clinical trial is a phase III triple blinded one employing hydroxychloroquine with 200mg daily dose for 60 days and the outcome as well as the rate of symptomatic infected patients will be evaluated. There is also another ongoing study on hydroxychloroquine as a COVID-19 post-exposure prophylactic agent prescribed within 3 days of either a HWs or household contact. The recommended dose is 800mg once, followed by 600 mg during 6 to 8 hours, then 600mg once a day for 4 consecutive days. Finally, the rate and severity of COVID-19 infections are compared. The study could probably show that 200-400mg of hydroxychloroquine per day is a reasonable prophylactic regimen for the exposed HWs. To be more precise, our experience on the rheumatologic patients who tool 200 mg per day hydroxychloroquine, as well as the medical workers who received the same dose for prophylaxis against the novel coronavirus showed that hydroxychloroquine with a 200 mg/day dose can have a relative prophylactic effect on COVID-19. According to our data, the few cases who received 200mg of hydroxychloroquine per day, showed mild to moderate symptoms with no severe manifestations. However, the prophylactic dose of 400mg per day may be accompanied by some drug interactions and adverse effects in the long term; so 200mg of hydroxychloroquine is a rational prophylactic dose for practitioners who are exposed to the high viral load environment