Forty‐seven year trend of measles in Iran: An interrupted time series analysis

Background and Aim Measles is an acute viral infectious disease usually characterized by erythematous maculopapular rash and sometimes pneumonia, diarrhea, and Central Nervous System disturbance. The current study aimed to describe the trend of measles in Iran before and after the 1978 revolution and COVID‐19 pandemic. Methods In the current quasi‐experimental study, we used annual data on confirmed cases of measles in Iran, from 1974 to 2021. Data were extracted from the World Health Organization website. An interrupted time series model was used to assess the effect of different events on the incidence of measles. Results The trend of new cases increase every year until 1980 according to the preintervention slope of 2040 (95% confidence interval [CI] = −1965–2045;p < 0.31). After Iran's revolution, the occurrence of new cases significantly decreased (−845 [95% CI = −1262 to −432;p = 0.001]). After the COVID‐19 pandemic, the trend of new cases significantly increased (41 [95% CI = 12–70;p = 0.006]). Conclusion It seems that social or health‐related events are among the effective factors on the incidence of measles. But with maintaining vaccination coverage in the community and vaccination of immigrants, this fluctuation in the disease trend can be decreased.

Forty-seven year trend of measles in Iran: An interrupted time series analysis.

Background and Aim: Measles is an acute viral infectious disease usually characterized by erythematous maculopapular rash and sometimes pneumonia, diarrhea, and Central Nervous System disturbance. The current study aimed to describe the trend of measles in Iran before and after the 1978 revolution and COVID-19 pandemic. Methods: In the current quasi-experimental study, we used annual data on confirmed cases of measles in Iran, from 1974 to 2021. Data were extracted from the World Health Organization website. An interrupted time series model was used to assess the effect of different events on the incidence of measles. Results: The trend of new cases increase every year until 1980 according to the preintervention slope of 2040 (95% confidence interval [CI] = -1965-2045; p < 0.31). After Iran's revolution, the occurrence of new cases significantly decreased (-845 [95% CI = -1262 to -432; p = 0.001]). After the COVID-19 pandemic, the trend of new cases significantly increased (41 [95% CI = 12-70; p = 0.006]). Conclusion: It seems that social or health-related events are among the effective factors on the incidence of measles. But with maintaining vaccination coverage in the community and vaccination of immigrants, this fluctuation in the disease trend can be decreased.

SARS-CoV-2 antibody response after BBIBP-CorV (Sinopharm) vaccination in cancer patients: A case-control study.

Background: Long-term safety and efficacy of BBIBP-CorV vaccine especially in individuals with chronic diseases, like cancer, is under investigation. In the present prospective study, we aimed to evaluate severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody response with BBIBP-CorV vaccine in Iranian cancer patients. Methods: All the patients registered to receive BBIBP-CorV (Sinopharm) vaccine were divided into two groups of with (cases = 107) and without (controls = 45) history of cancer. Serum levels of SARS-CoV anti-spike recombinant receptor binding domain (anti-sRBD) and anti-nucleocapsid (anti-N) IgG serum levels were measured on days 0 (phase 0), 28-32 (phase I), and 56-64 (phase II) of vaccination. The data were analyzed using SPSS, version 22. Results: Totally, 152 individuals (67.1% females) with the mean age of 46.71 ± 15.36 years were included. Solid cancers included 87.8% of the cancer cases (46.7% gynecological and 31.8% gastrointestinal cancer). At Phases I and II, positive anti-sRBD IgG and anti-N IgG were significantly lower among the cases in total analysis. Side effects were not significantly different between the cases and controls. The lowest positive anti-sRBD IgG test was observed among the cancer patients who were simultaneously receiving chemotherapy (35.3%). Anti-sRBD IgG and anti-N IgG serum levels significantly increased at phases I and II in total analysis and in each group. In addition, serum anti-sRBD IgG increased during the three phases and it was significantly higher in the control group. Conclusion: Full vaccination of COVID-19 by BBIBP-CorV in immunocompromised patients such as cancer patients is safe and effective and could induce antibody response but in lower levels compared to healthy people. Probable causes to have minor antibody response found in males, older ages, individuals with BMI ≥ 25, those without past history of COVID-19 and with hematologic cancers. No significant side effects after vaccination were seen.

SARS-CoV-2 antibody response after BBIBP-CorV (Sinopharm) vaccination in cancer patients: A case-control study

Background Long-term safety and efficacy of BBIBP-CorV vaccine especially in individuals with chronic diseases, like cancer, is under investigation. In the present prospective study, we aimed to evaluate severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) antibody response with BBIBP-CorV vaccine in Iranian cancer patients. Methods All the patients registered to receive BBIBP-CorV (Sinopharm) vaccine were divided into two groups of with (cases = 107) and without (controls = 45) history of cancer. Serum levels of SARS-CoV anti-spike recombinant receptor binding domain (anti-sRBD) and anti-nucleocapsid (anti-N) IgG serum levels were measured on days 0 (phase 0), 28–32 (phase I), and 56–64 (phase II) of vaccination. The data were analyzed using SPSS, version 22. Results Totally, 152 individuals (67.1% females) with the mean age of 46.71 ± 15.36 years were included. Solid cancers included 87.8% of the cancer cases (46.7% gynecological and 31.8% gastrointestinal cancer). At Phases I and II, positive anti-sRBD IgG and anti-N IgG were significantly lower among the cases in total analysis. Side effects were not significantly different between the cases and controls. The lowest positive anti-sRBD IgG test was observed among the cancer patients who were simultaneously receiving chemotherapy (35.3%). Anti-sRBD IgG and anti-N IgG serum levels significantly increased at phases I and II in total analysis and in each group. In addition, serum anti-sRBD IgG increased during the three phases and it was significantly higher in the control group. Conclusion Full vaccination of COVID-19 by BBIBP-CorV in immunocompromised patients such as cancer patients is safe and effective and could induce antibody response but in lower levels compared to healthy people. Probable causes to have minor antibody response found in males, older ages, individuals with BMI ≥ 25, those without past history of COVID-19 and with hematologic cancers. No significant side effects after vaccination were seen.

Global COVID-19 vaccine acceptance rate: a systematic review and meta-analysis

Aim Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates. Subject and methods International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to pool estimate vaccine acceptance rates. Results The overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1–70.1;P < 0.001, I2 = 99.8). The vaccine acceptance rate in the general population was 68.5 (95% CI 62.5–74.5;P < 0.001, I2 = 99.8) and among healthcare workers (HCWs) was 55.9 (95% CI 47.8–64.1;P < 0.001, I2 = 99.6). The lowest COVID-19 vaccine acceptance rate was in the Middle East (46.1% (35.1–57.0)), and the highest coverage rate was (85% (71–99.1)) in South America. Conclusion COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate.

Hospital length of stay for COVID-19 patients: a systematic review and meta-analysis.

The length of stay in the hospital for COVID-19 can aid in understanding the disease's prognosis. Thus, the goal of this study was to collectively estimate the hospital length of stay (LoS) in COVID-19 hospitalized individuals. To locate related studies, international databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched. The I2 index, the Cochran Q test, and T2 were used to analyze study heterogeneity. The mean LoS in COVID- 19 hospitalized patients was estimated using a random-effects model. COVID-19's total pooled estimated hospital LoS was 15.35, 95%CI:13.47-17.23; p<0.001, I2 = 80.0). South America had the highest pooled estimated hospital LoS of COVID-19 among the continents, at 20.85 (95%CI: 14.80-26.91; p<0.001, I2 = 0.01), whereas Africa had the lowest at 8.56 8 (95%CI: 1.00-22.76). The >60 age group had the highest pooled estimated COVID-19 hospital LoS of 16.60 (95%CI: 12.94-20.25; p<0.001, I2 = 82.6), while the 40 age group had the lowest hospital LoS of 10.15 (95% CI: 4.90-15.39, p<0.001, I2 = 22.1). The metanalysis revealed that COVID-19's hospital LoS was more than 10 days. However, it appears that this duration varies depending on a number of factors, including the patient's age and the availability of resources.

Effect of epidemic management and control plan on COVID-19 mortality in Iran: an interrupted time series analysis.

Background: Globally, several measures have been taken to decrease COVID-19 mortality. However, the effectiveness of preventive measures on the mortality related to COVID-19 has not been fully assessed. Thus, the present study aimed the present study aimed to assess the success of COVID-19 epidemic management and control plan on the mortality associated with COVID-19 in Iran from February 19, 2020, to February 5, 2021. Methods: In the current quasi experimental study an interrupted time series analysis of daily collected data on confirmed deaths of COVID-19 occurred in Iran and in the world, were performed using Newey ordinary least squares regression-based methods. Results: In Iran, the trend of new deaths increased significantly every day until 24 November 2020 according to pre-intervention slope of [(OR 1.14, 95% CI 0.96-1.32,); P < 0.001]. The occurrence of new deaths had a decreasing trend after November 24, 2020, with a coefficient of [(OR -5.12, 95% CI -6.04 - -4.20), P < 0.001)]. But in the global level daily new deaths was increasing before [(OR 18.66, 95% CI 14.41-2292; P < 0.001)] and after the 24 November 2020 [(OR 57.14, 95% CI 20.80-93.49); P: 0.002]. Conclusions: Iranian COVID-19 epidemic management and control plan effectively reduced the mortality associated to COVID-19. Therefore, it is essential to continue these measures to prevent the increase in the number of deaths.

High dose melatonin as an adjuvant therapy in intubated patients with COVID-19: A randomized clinical trial.

Objective: In the COVID-19 pandemic, the SARS-CoV-2 virus has infected millions of people worldwide. Mortality primarily results from the inflammation state and its complications. High-dose melatonin has been established as an anti-inflammatory agent. This study evaluated high-dose melatonin as an adjuvant therapy in critically ill patients with SARS-CoV-2 infection. Methods: We conducted a double-blinded, randomized clinical trial of 21 mg of melatonin per day compared with a placebo in 67 patients with COVID-19. We enrolled patients older than 18 years of age with documented SARS-CoV-2 infection, who were admitted to the intensive care unit and underwent invasive mechanical ventilation. Administration of melatonin and placebo through a nasogastric tube continued for 5 days. The main outcomes were mortality rate, duration of mechanical ventilation, changes in oxygenation indices, and C-reactive protein (CRP) levels. Results: No significant differences were observed in mortality and duration of mechanical ventilation between the control and intervention groups. After 5 days of the intervention, the mean (±standard deviation) CRP and platelet count were 47.28 (±38.86) mg/L and 195.73 (±87.13) × 1000/µL, respectively, in the intervention group and 75.52 (±48.02) mg/L and 149.62 (±68.03) × 1000/µL, respectively, in the control group (P < 0.05). Conclusion: High-dose melatonin in intubated patients with COVID-19 was associated with a decrease in CRP levels. However, this treatment did not apparently affect patient outcomes.

COVID-19: Clinical features, case fatality, and the effect of symptoms on mortality in hospitalized cases in Iran.

Objective: Identifying the epidemiological characteristics of COVID-19 could help to control the pandemic. The aim of this study was to characterize the epidemiological features of hospitalized COVID-19 patients in Iran. Methods: Data were collected on patients admitted to a military referral hospital in Tehran, Iran, from February 8, 2020 to July 28, 2021. Sex, age, clinical symptoms, outcome, type of comorbidities, level of blood Spo2, time of admission, and time of discharge were investigated. Sex ratio, case fatality rate (CFR), and daily trends of hospital admissions and deaths were also determined. Descriptive statistics and multiple logistic regression with 95% confidence intervals were used for data analysis. The statistical significance level was set at 0.05. STATA16.0 and Excel 2010 were used for data analysis. Results: The median hospital length of stay (LOS) was 6 days. The following symptoms were most common: cough (63.5%), fever (50%), respiratory distress (46.1%), and muscular pain (40.8%). Hypertension (29.5%), diabetes (24.7%), and cardiovascular diseases (21.8%) were the most prevalent comorbidities. The CFR was calculated at 8.30%. Respiratory symptoms increased the odds of death by 45% (OR 1.45, 95% CI 1.03-2.06). Gastrointestinal symptoms were associated with a reduction in the mortality of COVID-19 cases, but this association was not statistically significant (OR 0.94, 95% CI 0.73-1.21). Conclusions: The results of this study emphasize higher mortality rates among older age groups, male patients, and patients with underlying diseases.

Factors Associated with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: The current study aimed to identify effective factors on the death among COVID-19 patients. METHODS: All articles published in the period Jan 1, 2020, to Mar 23, 2020, written in English and reporting factors associated with COVID-19 mortality were reviewed. The random-effects model with 95% CI was used to calculate the pooled Odds Ratio (OR) and Hazard Ratio (HR). Data were analyzed using Stata ver.11.0. RESULTS: The older age OR: 1.21(1.10-1.33) and male gender OR: 1.41(1.04-1.89) were most prone to death due to COVID-19. The Comorbidity with some chronic diseases such as Diabetes type2 OR: 2.42(1.06-5.52), Hypertension OR: 2.54(1.21-5.32), Kidney disorder OR: 2.61(1.22-5.60), Respiratory disorder 3.09 (1.39-6.88) and Heart diseases OR: 4.37 (1.13-16.90) can increase the risk of COVID19 mortality. CONCLUSION: Infection with COVID-19 is associated with substantial mortality mainly in older patients with comorbidities. We found the significant effect of age, gender and comorbidities such as Diabetes Mellitus, Hypertension, Kidney disorders and Heart diseases on the risk of death in patients with COVID-19. The factors associated with mortality found in this research can help to recognize patients with COVID-19 who are at higher risk of a poor prognosis. Monitoring these factors can serve to give early warning for the appropriate interventions.

xsGastrointestinal symptoms are associated with a lower risk of hospitalization and mortality and Outcomes in COVID-19.

BACKGROUND: We aimed to find the association between gastrointestinal (GI) and respiratory symptoms with mortality and hospitalization among COVID-19 patients. METHODS: We analyzed the registered data of COVID-19 patients from February 20, 2020, to March 10, 2021. Depending on the patients' disease symptoms, four categories were defined: patients with only GI symptoms, patients with only respiratory symptoms, patients with both symptoms, and patients with other symptoms. Logistic regression analysis was used to assess the association of groups with outcomes. RESULTS: A total of 42,964 patients from 23 hospitals were included, of which 26.5% patients had at least one or more GI symptoms. Of total patients, 51.58% patients were hospitalized among which 22.8% had at least one or more GI symptoms. GI symptoms significantly decreased the odds of mortality (OR 0.72, 95% CI 0.56-0.92), but respiratory symptoms increased the odds for mortality (1.36: 1.24-1.50), compared with patients with other symptoms. Moreover, the odds ratio of patients who had both respiratory and GI symptoms increased (1.52: 1.31-1.78) compared with patients with other symptoms. The same results were observed for hospitalization as the outcome. CONCLUSIONS: Our study showed that the presence of GI symptoms in COVID-19 at the time of admission was associated with a lower odds of hospitalization and mortality; however, this association had higher odds for respiratory symptoms.

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019.

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

Comparing the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID-19 patients.

The purpose of this study was to compare the effectiveness of Atazanavir/Ritonavir/Dolutegravir/Hydroxychloroquine and Lopinavir/Ritonavir/Hydroxychloroquine treatment regimens in COVID-19 patients based on clinical and laboratory parameters. We prospectively evaluated the clinical and laboratory outcomes of 62 moderate to severe COVID-19 patients during a 10-day treatment plan. Patients were randomly assigned to either KH (receiving Lopinavir/Ritonavir [Kaletra] plus Hydroxychloroquine) or ADH (receiving Atazanavir/Ritonavir, Dolutegravir, and Hydroxychloroquine) groups. During this period, clinical and laboratory parameters and outcomes such as intensive care unit (ICU) admission or mortality rate were recorded. Compared to the KH group, after the treatment period, patients in the ADH group had higher activated partial thromboplastin time (aPTT) (12, [95% confidence interval [CI]: 6.97, 17.06), p = <0.01), international normalized ratio (INR) (0.17, [95% CI: 0.07, 0.27), p = <0.01) and lower C-reactive protein (CRP) (-14.29, (95% CI: -26.87, -1.71), p = 0.03) and potassium (-0.53, (95% CI: -1.03, -0.03), p = 0.04) values. Moreover, a higher number of patients in the KH group needed invasive ventilation (6 (20%) vs. 1 (3.1%), p = 0.05) and antibiotic administration (27 (90%) vs. 21(65.6), p = 0.02) during hospitalization while patients in the ADH group needed more corticosteroid administration (9 (28.1%) vs. 2 (6.7%), p = 0.03). There was no difference in mortality rate, ICU admission rate, and hospitalization period between the study groups. Our results suggest that the Atazanavir/Dolutegravir treatment regimen may result in a less severe disease course compared to the Lopinavir/Ritonavir treatment regimen and can be considered as an alternative treatment option beside standard care. However, to confirm our results, larger-scale studies are recommended.

Can laboratory tests at the time of admission guide us to the prognosis of patients with COVID-19?

INTRODUCTION: To enhance the COVID-19 patients' care and to optimize utilizing medical resources during the pandemic, relevant biomarkers are needed for prediction of the disease's progression. The current study was aimed to determine the factors that affect the mortality of COVID-19 patients admitted in Baharloo hospital in Iran. METHODS: in the current retrospective study, 56 survived patients and 56 patients who were died (a total of 112 cases) because of COVID-19 infection were randomly selected from those who were admitted to Baharloo hospital. Each patient who was diagnosed with COVID-19 and had recovered from it matched with each non-survived patient in the term of age. Laboratory tests of all these patients at the time of admission were recorded and compared. All analyses performed using spss version 22 by considering α = 0.05 as a significant level. RESULTS: There was no statistical difference in the age and gender distribution between the two groups (p > 0.05). The prevalence of diabetes among survived patients was 37.5% and among non-survived patients was 26.8% and there was no statistical difference between two groups regarding this comorbidity (p = 0.22). Also, there was no statistical difference in the prevalence of hypertension and coronary heart diseases between two groups (p > 0.05). Lymphocyte percentage, blood oxygen level, and platelet (PLT) count was significantly higher in patients who had recovered (P < 0.05). CONCLUSIONS: LDH level, Lymphocyte percentage, PLT count, and blood Oxygen saturation have associations with severe forms of COVID-19 infection and can be used as predictors to assess the patients who are suspected of infection with COVID-19 at the time of admission.

Case fatality rate of COVID-19: a systematic review and meta-analysis.

OBJECTIVE: The ongoing novel coronavirus disease 2019 (COVID-19) is the leading cause of morbidity and mortality due to its contagious nature and absence of vaccine and treatment. Although numerous primary studies reported extremely variable case fatality rate (CFR) of COVID-19, no review study attempted to estimate the CFR of COVID-19. The current systematic review and meta-analysis were aimed to assess the pooled CFR of COVID-19. METHODS: Electronic databases: PubMed, Science Direct, Scopus, and Google Scholar were searched to retrieve the eligible primary studies that reported CFR of COVID-19. Keywords: ("COVID-19"OR "COVID-2019" OR "severe acute respiratory syndrome coronavirus 2"OR "severe acute respiratory syndrome coronavirus 2" OR "2019-nCoV" OR "SARS-CoV-2" OR "2019nCoV" OR (("Wuhan" AND ("coronavirus" OR "coronavirus")) AND (2019/12[PDAT] OR 2020[PDAT]))) AND ("mortality "OR "mortality" OR ("case" AND "fatality" AND "rate") OR "case fatality rate") were used as free text and MeSH term in searching process. A random-effects model was used to estimate the CFR in this study. I2 statistics, Cochran's Q test, and T2 were used to assess the functional heterogeneity between included studies. RESULTS: The overall pooled CFR of COVID 19 was 10.0%(95% CI: 8.0-11.0); P < 0.001; I2 = 99.7). The pooled CFR of COVID-19 in general population was 1.0% (95% CI: 1.0-3.0); P < 0.001; I2 = 94.3), while in hospitalized patients was 13.0% (95% CI: 9.0-17.0); P < 0.001, I2 = 95.6). The pooled CFR in patients admitted in intensive care unit (ICU) was 37.0% (95% CI: 24.0-51.0); P < 0.001, I2 = 97.8) and in patients older than 50 years was 19.0% (95% CI: 13.0-24.0); P < 0.001; I2 = 99.8). CONCLUSION: The present review results highlighted the need for transparency in testing and reporting policies and denominators used in CFR estimation. It is also necessary to report the case's age, sex, and the comorbidity distribution of all patients, which essential in comparing the CFR among different segments of the population.

Determine the most common clinical symptoms in COVID-19 patients: a systematic review and meta-analysis.

INTRODUCTION: COVID-19 is an emerging infectious disease. The study about features of this infection could be very helpful in better knowledge about this infectious disease. The current systematic review and meta-analysis were aimed to estimate the prevalence of clinical symptoms of COVID-19 in a systematic review and meta-analysis. METHODS: A systematic review using Medline/PubMed, Scopus, and Google scholar has been conducted. In the current systematic review and meta-analysis, the articles published in the period January 1, 2020, to April 2, 2020, written in English and reporting clinical symptoms of COVID-19 was reviewed. To assess, the presence of heterogeneity, the Cochran's Q statistic, the I2 index, and the tau-squared test were used. Because of significant heterogeneity between the studies the random-effects model with 95% CI was used to calculate the pooled estimation of each symptom prevalence. RESULTS: The most common symptoms in COVID-19 patients include: Fever 81.2% (95% CI: 77.9-84.4); Cough: 58.5% (95% CI: 54.2-62.8); Fatigue 38.5% (95% CI: 30.6-45.3); Dyspnea: 26.1% (95% CI: 20.4-31.8); and the Sputum: 25.8% (95% CI: 21.1-30.4). Based on the meta-regression results, the sample size used in different studies did not have a significant effect on the final estimate value (P > 0.05). CONCLUSIONS: Considering the main symptoms of COVID-19 such as Fever, Cough, Fatigue, and Dyspnea can have a key role in early detection of this disease and prevent the transmission of the disease to other people.

Effect of Social Distancing on COVID-19 Incidence and Mortality in Iran Since February 20 to May 13, 2020: An Interrupted Time Series Analysis.

BACKGROUND AND OBJECTIVE: Numerous actions have been taken to control the COVID-19 pandemic and reduce their morbidity and mortality. One of the most important measures in this regard is social distancing. However, there is limited evidence on the effectiveness of social distancing on COVID-19 incidence and mortality. Thus, the current study aimed to assess the effectiveness of social distancing measures on the COVID-19 incidence and mortality in Iran. MATERIALS AND METHODS: In the current quasi-experimental study, we evaluated the daily incidence cases and the number of deaths of COVID-19 in Iran before and after the implementation of social distancing measures. The segmented regression model was used to analyze the data. We also performed the interrupted time series (ITS) analysis using Newey ordinary least squares (OLS) regression-based methods. RESULTS: After the implementation of social distancing, the trend of both daily new cases and deaths due to COVID-19 was decreasing [(ß = -1.70 (95% CI = [-2.30 - -1.10; P < 0.001])) and (ß = -0.07 (95% CI = [-0.10 - -0.05; P < 0.001], respectively))]. CONCLUSION: Social distancing along with other public health interventions could reduce the morbidity and mortality of COVID-19 to some degrees, and it seems to be crucial to control the pandemic.

Estimate of the Basic Reproduction Number for COVID-19: A Systematic Review and Meta-analysis.

OBJECTIVES: The outbreak of coronavirus disease 2019 (COVID-19) is one of the main public health challenges currently facing the world. Because of its high transmissibility, COVID-19 has already caused extensive morbidity and mortality in many countries throughout the world. An accurate estimation of the basic reproduction number (R0) of COVID-19 would be beneficial for prevention programs. In light of discrepancies in original research on this issue, this systematic review and meta-analysis aimed to estimate the pooled R0 for COVID-19 in the current outbreak. METHODS: International databases (including Google Scholar, Science Direct, PubMed, and Scopus) were searched to identify studies conducted regarding the R0 of COVID-19. Articles were searched using the following keywords: "COVID-19" and "basic reproduction number" or "R0." The heterogeneity among studies was assessed using the I2 index, the Cochran Q test, and T2. A random-effects model was used to estimate R0 in this study. RESULTS: The mean reported R0 in the identified articles was 3.38±1.40, with a range of 1.90 to 6.49. According to the results of the random-effects model, the pooled R0 for COVID-19 was estimated as 3.32 (95% confidence interval, 2.81 to 3.82). According to the results of the meta-regression analysis, the type of model used to estimate R0 did not have a significant effect on heterogeneity among studies (p=0.81). CONCLUSIONS: Considering the estimated R0 for COVID-19, reducing the number of contacts within the population is a necessary step to control the epidemic. The estimated overall R0 was higher than the World Health Organization estimate.

Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study.

BACKGROUND: An outbreak of COVID-19 in Iran has spread throughout the country. Identifying the epidemiological characteristics of this disease will help to make appropriate decisions and thus control the epidemic. The aim of this study was characterization of the epidemiological features of COVID-19 in Iran. METHODS: In this retrospective study, data related to the epidemiological characteristics of COVID-19 patients admitted to Baqiyatallah Hospital in Tehran, Iran, from 19 February 2020 to 15 April 2020 have been analyzed and reported. Patient characteristics including age, gender and underlying diseases were investigated. Data were collected through patient records. Sex ratio, Case Fatality Rate (CFR) and daily trend of cases were also determined. A multiple logistic regression analysis was also performed to assess affecting factors on mortality. RESULTS: From February 19, 2020 to April 15, 2020, 12870 patients referred to the hospital emergency department, of which 2968 were hospitalized with COVID-19 diagnosis. The majority of cases were in the age group of 50 to 60 years of old. The male-to-female ratio was 1.93:1. A total of 239 deaths occurred among all cases for an overall CFR of 1.85% based on the total number of patients (both outpatient and inpatient) and 8.06% among hospitalized patients. Out of all patients 10.89% had comorbidity. Diabetes, chronic respiratory diseases, hypertension, cardiovascular diseases, chronic Kidney diseases and cancer were the most common comorbidities with 3.81, 2.02 , 1.99 , 1.25, 0.60 and 0.57 %, respectively. Male gender (OR=1.45, 95% CI: 1.08-1.96), older age (OR=1.05, 95% CI: 1.04-1.06) and having underlying diseases (OR=1.53, 95% CI: 1.04-2.24) were significantly associated with mortality. CONCLUSIONS: The results of this study showed that Male gender, older age and having comorbidities were significantly associated with the risk of death among COVID-19 patients. It is important to pay special attention to male elderly patients with underlying diseases.