Social determinants of adherence to COVID-19 preventive guidelines: a comprehensive review

Adherence to coronavirus disease 2019 (COVID-19) preventive guidelines (ACPG) is an important strategy to control the COVID-19 pandemic effectively. The present study aimed to identify and summarize the social determinants of ACPG among the general population. A comprehensive review was performed from December 2019 to February 2021 through searching electronic databases. Two independent reviewers assessed and selected relevant studies. Next, the characteristics and main findings of the included studies were summarized. Finally, the World Health Organization’s conceptual framework of social determinants of health was used to synthesize the identified social determinants of ACPG. Forty-one of 453 retrieved articles met the inclusion criteria. The study results showed different patterns of ACPG among various communities. Furthermore, 84 social determinants were identified and categorized into structural and intermediary determinants. ACPG is a set of complex behaviors associated with different individual sociodemographic and behavioral characteristics; living and working conditions; COVID-19 knowledge, attitudes, and risk perceptions; exposure to sources and information level; leisure activities; social support; trust; social norms; psychosocial well-being; socio-economic position; and the socio-economic and political context. Interventions to promote ACPG among the general population should consider the identified social determinants of ACPG.

Acute hydrocephaly following methadone intoxication in a child

Infantile methadone intoxication has been on the rise since the usage of methadone in opioid detoxification programs. We report a 30-month-old child with encephalopathy and acute hydrocephaly following methadone intoxication

[Evaluation of the frequency of polyneuropathy based upon the clinical and paraclinical findings in diabetic patients]

Peripheral neuropathy has been known as the main cause of diabetic foot ulcer and limb amputation. Early diagnosis of this complication can prevent more severe morbidity as well as enormous economic costs. Based on the duration of the disease, 110 diabetic patients were divided in two groups of less than 10 and more than 10-year history. After taking complete history about the symptoms of neuropathy, the patients were examined neurologically. Then, electrodiagnostic studies were performed on the patients. 96 patients [87/2%] had diabetic neuropathy. The prevalence of neuropathy had a significant relationship with the duration of the disease [P value= 0.004]. 61 patients [55/4%] complained of neuropathic symptoms. The results of the neurological exams were abnormal in 65 patients [59.09%]. The most common symptom was paresthesia [50% of patients] and the most frequent sign was abnormal Achilles' reflex. 77 patients [70%] had abnormal indices in nerve conduction studies the most common of which was decrease amplitude of peroneal and sural nerves. 16 patients [14/5%] showed alterations in NCS in the absence of clinical signs or symptoms and 19 patients [17/2%] had normal NCS indices despite the presence of signs or symptoms of neuropathy. High sensitivity of taking history and a careful neurological examination in the diagnosis of diabetic neuropathy necessitates physicians to pay more attention to clinical examinations and patient complaints, and avoid costly electrodiagnostic investigations. Thus, early diagnosis of sub-clinical neuropathy in these patients and providing them with necessary recommendations, irreversible complications such as amputation can be prevented

[Vertebrobasilar dolichoectasia: a case report]

Vertebrobasilar dolichoectasia is defined as a prominent elongation, dilatation and tortuosity of the vertebral and basilar arteries. Ectatic basilar arteries may cause different neurological symptoms by several mechanisms including compressive effects and embolic or ischemic events. In this report we present a 58-year old female patient who was admitted in Dr. Shariati General Hospital in Tehran, Iran with complaints of dysarthria, vertigo, ataxia and nausea. Neuro-imaging procedures [brain CT scan, CT angiography, and an MRI study of the blood vessels or MRA] were performed. Dilation and elongation, as well as tortuosity of the vertebral and basilar arteries revealed the diagnosis of vertebrobasilar dolichoectasia. The patient was discharged from the hospital following the control of underlying diseases and neurological symptoms related to dolichoectasia without undergoing any invasive procedures. Paying attention to any minor or major neurological symptoms, as well as underlying medical conditions along with the conservative control of symptoms can be most helpful. Invasive interventions in a chronically ill patient can be very risky, therefore, medical management including control of associated or underlying diseases is recommended as the first line of treatment

[Permanent epicardial pacemaker generator migration [a case report]]

Pace maker is used to compensate the difficulty in production of heart impulse. Migration of epicardial leads and abdominally placed generators, a very uncommon finding, is a potentially serious complication and has been associated with infection, diarrhea and stimulation of the surrounding structure. We report the case of a 55-year old woman who experienced abdominally migration of an epicardial pacing system after 3 years of implantation and discuss about predisposing factor and outcomes of complications finds in clinic

[Relationship between lumbar spine bone mineral density and mandibular cortical width in post-menopausal women]

Osteoporosis is an asymptomatic disease until it causes fracture. One of the most effective methods for its diagnosis is DEXA test. This test shows BMD and T-Score for selective parts. Osteoporosis also causes some alterations in jaws that are observed by dental practitioners. The aim of this study was to determine the relationship of MCW [Mandibular Cortical Width] with BMD and T-Score. In this analytic cross-sectional study 51 post-menopausal women who had undergone DEXA test from lumbar spine [L2-L4] and panoramic radiography were selected. The subjects were divided into 3 groups according to T-Score and WHO criteria: 1] Normal; 2] Osteopenic; 3] Osteoporotic. MCW was measured at mental foramen area on the panoramic radiographs and analyzed in relation to BMD and T-Score using ANOVA, Scheffe, Pearson's correlation and regression tests. The mean mandibular cortical widths in the normal, osteopenic and osteoporotic groups were 4.8 mm, 3.8 mm and 2.7 mm, respectively. Pearson's correlation coefficients between BMD and MCW, and T-Score and MCW were 0.896 and 0.903, respectively. Regression between BMD, T-Score and MCW was significant [p value < 0.001]. MCW mean differences between normal, osteopenic and osteoporotic women were significant [p value < 0.001]. MCW had a high correlation with BMD and T-Score [about 0.9]. Based on the results of this study, dental practitioners might be the first person to suspect osteoporosis in post-menopausal women from panoramic radiographs and refer them to specialists

Prevalence and predisposing factros of retinopathy of prematurity in very low-birth-weight infants discharged from NICU

Retinopathy of prematurity [ROP] is a disease of the eye caused by disorganized growth of retinal blood vessels resulting in scarring and retinal detachment. All preterm babies are at high risk for ROP, and very low birth weight is an additional risk factor. An increased incidence of ROP is expected in Iran because of improved survival of low birth weight and premature babies, and it is obvious that pediatricians and ophthalmologists are concerned about prevention and timely treatment of ROP in these children. To asses the real situation of ROP in our NICU we studied its prevalence and risk factors. This was a retrospective analysis of premature infants with birth weight of