Epidemiological and Clinical Aspects of COVID-19; a Narrative Review

There are significant misconceptions and many obstacles in the way of illuminating the epidemiological and clinical aspects of COVID-19 as a new emerging epidemic. In addition, usefulness of some evidence published in the context of the recent epidemic for decision making in clinic as well as public health is questionable. However, misinterpreting or ignoring strong evidence in clinical practice and public health probably results in less effective and somehow more harmful decisions for individuals as well as subgroups in general populations of countries in the initial stages of this epidemic. Accordingly, our narrative review appraised epidemiological and clinical aspects of the disease including genetic diversity of coronavirus genus, mode of transmission, incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance, clinical case management and also successful measures for preventing its spread in some communities. Keywords:COVID-19; severe acute respiratory syndrome coronavirus 2; epidemiology; public health; communicable diseases; emergin

Estimating the effects of body mass index and central obesity on stroke in diabetics and non‐diabetics using targeted maximum likelihood estimation: Atherosclerosis Risk in Communities study

Summary Objectives The association of body mass index (BMI) with the risk of cardiovascular disease among diabetic patients is controversial. This study compared the effects of BMI and central obesity on stroke in diabetics and non‐diabetics using targeted maximum likelihood estimation. Materials and methods This analysis included 12 725 adults aged 45–75 years, after excluding prevalence cases and participants with missing data, from the Atherosclerosis Risk in Communities study. Obesity was defined with BMI, waist circumference, waist‐to‐hip ratio (WHR), waist‐to‐height ratio (WHtR), body shape index (BSI) and body roundness index (BRI), which categorized all participants as obese and non‐obese. Generalized linear models and TMLE (with the tmle package) were used to estimate risk ratio (RR). Results During 27 years of follow‐up, 1078 (8.47%) cases of stroke occurred. After adjustment for demographic, behavioural, biologic and central obesity variables, the effect of BMI decreased in both diabetics and non‐diabetics. The effect of BMI in diabetics was more attenuated, in full model, (RR: 1.04 [0.90, 1.20]) rather than non‐diabetics (RR: 1.11 [1.00, 1.24]). This attenuation was more related to biologic variables in non‐diabetics and central obesity in diabetics. With respect to central obesity, BSI (RR [95% CI]: 1.15 [0.96, 1.38]) and WHR (RR [95% CI]: 1.15 [0.87, 1.52]) had strongest and marginally significant effects for diabetics and BSI (RR [95% CI]: 1.10 [1.02, 1.20]) for non‐diabetics. Conclusions Among diabetics, BSI and WHR indices were associated with a higher incidence of stroke. Future studies should consider how central obesity affects higher incidence of stroke among diabetics stratified by sex and age groups

A Systematic Review and Meta-analysis of Toxocariasis in Iran: Is it Time to Take it Seriously?

Background: Toxocariasis is one of the neglected zoonosis with considerable public health importance around the world. The current study aimed to elucidate the overall prevalence of Toxocara infection in human and definitive hosts and also the contamination of soil and raw vegetables with the ova of these parasites, in Iran, using systematic review and meta-analysis. Methods: Six English and Persian databases were explored from 2000 to 2017 using the terms toxocariasis, Toxocara spp., visceral larva migrans, Iran, epidemiology, and prevalence. This meta-analysis conducted using STATA, and for all statistical tests, a p value less than 0.05 was considered significant. The random-effects model was used to the report of the pooled prevalence with a 95% confidence interval (CI). Results: The pooled prevalence of toxocariasis in human was calculated as 11% (95% CI 8–13%). In terms of definitive hosts, the pooled prevalence of Toxocara infection in dogs and cats were calculated as 17% (95% CI 14–20%) and 37% (95% CI 26–48%), respectively. Also, the pooled prevalence of Toxocara spp. eggs in the soil and raw vegetable samples were calculated as 18% (95% CI 13–23%) and 2% (95% CI 1–3%), respectively. Conclusions: The results of current study demonstrate that toxocariasis should be taken more seriously by health authorities. Implementing an appropriate control program is necessary to reduce the incidence of this disease in Iran