The Impact of COVID-19 Pandemic on the Levels of Physical Activity: A Systematic Review.

INTRODUCTION: Earlier studies demonstrated a decreased level of physical activity (PA) during the COVID-19 pandemic. Therefore, we aimed to systematically review the relevant studies among various age groups and explore the impact on physical and mental health. METHODS: We searched and retrieved all relevant articles using the keywords on the online databases of PubMed, Scopus, and Cochrane from the start of the pandemic until May 3rd, 2021. A two-phase screening process of identified records was carried out to shortlist the most relevant studies. First, the studies were evaluated based on their title/abstract, and then the full-text of included studies was thoroughly read. The eligible studies based on the eligibility criteria were included in this review. RESULTS: A total of 57 studies were included based on the eligibility criteria. Lockdowns and infection with SARS-CoV-2 have led to a decreased level of PA in the general population compared to the prepandemic era. Men had significantly less PA compared to women in some studies, probably due to higher pre-pandemic PA. The level of PA among those with chronic diseases also significantly diminished, putting them at a higher risk of cardiovascular incidents. Sedentary lifestyles have dominated people's life, including adolescents and university students. The increased levels of mental health issues, such as depression, anxiety, and occupational stress, have been suggested to contribute to the decreased PA. On the other hand, the decreased PA appeared to lead to more mental health issues. Fortunately, the decreasing trend of PA seemed to taper towards the end of the quarantines. CONCLUSION: Overall, the COVID-19 pandemic and subsequent quarantines reduced PA among all age groups and both sexes and had detrimental effects on people's physical and mental health. We suggest countries implement strategies to alleviate restrictions and encourage people to exercise in safe environments and prepare healthy routines for themselves.

Evaluating the effects of air disinfectants in decontamination of COVID-19 aerosols.

Introduction: Airborne transmission is the most  crucial mode of COVID-19 transmission. Therefore, disinfecting the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) aerosols float can have important implications in limiting COVID-19 transmission. Herein, we aimed to review the studies that utilized various disinfectants to decontaminate and inactivate the SARS-CoV-2 aerosols. Methods: This study was a review that studied related articles published between December 1, 2019 and August 23, 2022. We searched the online databases of PubMed, Scopus, Web of Science, Cochrane, on August 23, 2021. The studies were downloaded into the EndNote software, duplicates were removed, and then the studies were screened based on the inclusion/exclusion criteria. The screening process involved two steps; first, the studies were screened based on their title and abstract and then their full texts. The included studies were used for the qualitative analysis. Results: From 664 retrieved records, only 31 met the inclusion criteria and were included in the final qualitative analysis. Various materials like Ozone, H2O2, alcohol, and TiO2 and methods like heating and using Ultraviolet were described in these studies to disinfect places contaminated by COVID-19. It appeared that the efficacy of these disinfectants varies considerably depending on the situation, time, and ultimately their mode of application. Conclusion: Following reliable protocols in combination with the proper selection of disinfectant agents for each purpose would serve to achieve desired elimination of the SARS-CoV-2 transmission.

Effects of Exercise on COVID-19 Patients: A Narrative Review

Background: Challenges concerning patient management exist worldwide, particularly in the critical care. In this review, we have summarized some studies regarding respiratory physiotherapy and exercise in COVID-19 patients. Methods: For searching related articles, PubMed, Google Scholar, Embase, and the Web of Science databases were used. Keywords such as "respiratory physiotherapy" and "COVID-19," "exercise," "effect of exercise in COVID-19," and "respiratory physiotherapy for COVID-19 in ICU" were used to identify related papers until December 2021. The s and entire texts were evaluated by 3 separate reviewers. Results: During the symptomatic phase, individuals may benefit from brief durations of bed rest. Exercise appears to provide both emotional and physical benefits for individuals in the early stages of infection. As a result, it may lower viral load, minimize cytokine storm, shorten the acute phase, and expedite recovery. Mild exercise may also increase the autophagy pathway, which improves the immune system function in response to COVID-19 infection. Keeping this in mind, intense activity, especially without the guidance of an expert physical therapist, is not advantageous during the inflammatory period and may even be regarded a second hit phenomenon. Mild exercises during bed rest (e.g., acute phase) may reduce the risk of pulmonary capillary coagulation and deep vein thrombosis. Conclusion: Although respiratory physiotherapy and prone positioning in hospitalized patients, particularly in critical care, can be challenging for medical staff, they are cost-effective and noninvasive approaches for COVID-19 patients. Early physiotherapy and muscle training exercise for patients in the intensive care unit (ICU) seems to be beneficial for patients and may reduce bed rest-induced weakness, improve oxygenation, and reduce length of stay. Finally, breathing exercises can improve some symptoms of COVID-19, like dyspnea and weakness.

Soluble ACE2 as a Risk or Prognostic Factor in COVID-19 Patients: A Cross-sectional Study.

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. The first known receptor for this virus in the human body is angiotensin-converting enzyme 2 (ACE2), the same receptor for the SARS virus. Methods: A total of 38 hospitalized adult (18 years) patients with laboratory or clinically confirmed coronavirus disease 2019 (COVID-19) were identified in the infectious disease ward of Tehran Imam Khomeini hospital complex in this single-center cross-sectional study. A blood sample was taken at the time of hospitalization and a second one was taken 48 hours later. Blood samples are kept frozen at -80 degrees Celsius. After the complete collection of samples, the ACE2 level of the samples was measured using a serum sACE2 detection ELISA kit. The data were analyzed using SPSS v26. P value of 0.05 was considered statistically significant. An analysis of covariance was performed to examine the mean differences in day 7 serum ACE2 concentration among the 2 groups after adjusting for the baseline serum ACE2 concentration. The 1-way multivariate analysis of variance was used to determine whether there were any differences between independent groups (mechanical ventilation yes/no) on serum ACE2 levels at 3 different times. Results: The mean age of patients was 64.13 ± 16.49 years, 21 patients (55.3%) were men, 16 patients (42%) were polymerase chain reaction test positive, and 15 patients (39.5%) died. A total of 35 individuals (92.1%) had chest computed tomography images that indicated lung involvement. A comparison of the 2 groups of patients who died and were discharged revealed that serum ACE2 at the first (p=0.033) and third (7th day) measurements were statistically different (p=0.026). Patients had a mean of serum ACE2. The results indicated that the day 7 serum ACE2 concentration did significantly differ between the 2 groups after controlling for the baseline serum ACE2 concentration (p=0.023). The model explained about 73.61% of the variance in the 7-day serum ACE2 concentration. Specifically, after adjusting for the baseline concentration, survived patients had the lowest level of serum ACE2 concentration (1 ± 0.65) on the 7th day compared with the deceased patient group (2.83 ± 1.12). Conclusion: Soluble ACE2 in the serum of COVID-19 patients who died, later on, was significantly higher than the discharged patients when the samples were taken seven days after admission. It is suggested that serum soluble ACE2 level could be used as a prognostic factor for COVID-19 patients' outcomes and also their need for mechanical ventilation.

Effects of Exercise on COVID-19 Patients: A Narrative Review.

Background: Challenges concerning patient management exist worldwide, particularly in the critical care. In this review, we have summarized some studies regarding respiratory physiotherapy and exercise in COVID-19 patients. Methods: For searching related articles, PubMed, Google Scholar, Embase, and the Web of Science databases were used. Keywords such as "respiratory physiotherapy" and "COVID-19," "exercise," "effect of exercise in COVID-19," and "respiratory physiotherapy for COVID-19 in ICU" were used to identify related papers until December 2021. The abstracts and entire texts were evaluated by 3 separate reviewers. Results: During the symptomatic phase, individuals may benefit from brief durations of bed rest. Exercise appears to provide both emotional and physical benefits for individuals in the early stages of infection. As a result, it may lower viral load, minimize cytokine storm, shorten the acute phase, and expedite recovery. Mild exercise may also increase the autophagy pathway, which improves the immune system function in response to COVID-19 infection. Keeping this in mind, intense activity, especially without the guidance of an expert physical therapist, is not advantageous during the inflammatory period and may even be regarded a second hit phenomenon. Mild exercises during bed rest (e.g., acute phase) may reduce the risk of pulmonary capillary coagulation and deep vein thrombosis. Conclusion: Although respiratory physiotherapy and prone positioning in hospitalized patients, particularly in critical care, can be challenging for medical staff, they are cost-effective and noninvasive approaches for COVID-19 patients. Early physiotherapy and muscle training exercise for patients in the intensive care unit (ICU) seems to be beneficial for patients and may reduce bed rest-induced weakness, improve oxygenation, and reduce length of stay. Finally, breathing exercises can improve some symptoms of COVID-19, like dyspnea and weakness.

Evaluation of the Relationship between Nutritional Status of COVID-19 Patients Admitted to the ICU and Patients' Prognosis: A Cohort Study.

Background: Malnutrition in COVID-19 critically ill patients can lead to poor prognosis. This study aimed to evaluate the association between nutritional status (or risk) and the prognosis of critically ill COVID-19 patients. In this study, prognosis is the primary outcome of "hospital mortality" patients. The second outcome is defined as "need for mechanical ventilation." Methods and Materials: In this single-center prospective cohort study, 110 patients admitted to the Intensive Care Unit of Imam Khomeini Hospital Complex (Tehran, Iran) between April and September 2021 were enrolled. Participants formed a consecutive sample. MNA-SF, NRS-2002, mNUTRIC, and PNI scores were used to evaluate nutritional assessment. Patients' lab results and pulse oximetric saturation SpO2/FiO2 (SF) ratio at the time of intensive care unit (ICU) admission were collected. Patients were screened for nutritional status and categorized into two groups, patients at nutritional risk and nonrisk. Results: Sixty-five (59.1%) of all patients were men. The overall range of age was 52 ± 15. Thirty-six (32.7%) of patients were obese (BMI ≥ 30). The hospital mortality rate was 59.1% (n = 65). According to the different criteria, malnutrition rate was 67.3% (n = 74) (NRS), 28.2% (n = 31) (MNA), 34.5% (n = 38) (mNUTRIC), and 58.2% (n = 64) (PNI). There was a statistically significant association between chronic kidney disease (CKD) and mNUTRIC risk (OR = 13.5, 95% CI (1.89-16.05), P=0.002), diabetes mellitus (DM) and MNA risk (OR = 2.82, 95% CI (1.01-7.83), P=0.041), hypertension (HTN) and MNA risk (OR = 5.63, 95% CI (2.26-14.05), P < 0.001), and malignancy and mNUTRIC risk (P=0.048). The nutritional risk (all tools) significantly increased the odds of in-hospital death and need for mechanical ventilation. The length of stay was not significantly different in malnourished patients. Conclusion: In the critical care setting of COVID-19 patients, malnutrition is prevalent. Malnutrition (nutritional risk) is associated with an increased risk of need for mechanical ventilation and in-hospital mortality. Patients with a history of HTN, CKD, DM, and cancer are more likely to be at nutritional risk at the time of ICU admission.

Public acceptability of COVID-19 vaccines and its predictors in Middle Eastern/North African (MENA) countries: a systematic review .

INTRODUCTION: COVID-19 vaccines emerged as a worldwide hope to contain the pandemic. However, many people are still hesitant to receive these vaccines. We aimed to systematically review the public knowledge, perception, and acceptability of COVID-19 vaccines in the Middle East and North Africa (MENA) countries and the predictors of vaccine acceptability in this region. METHODS: We systematically searched databases of PubMed, Scopus, Web of Science, and Cochrane and retrieved all relevant studies by 5 August 2021. RESULTS: There was a considerable variation in the COVID-19 vaccine acceptance rates, from 12% in a study from Israel to 83.3% in Kuwait, although two other studies from Israel mentioned 75% and 82.2% acceptability rates. Concerns about the side effects and safety of the vaccine were the main reasons for the lack of acceptability of taking the vaccine, which was reported in 19 studies. . CONCLUSION: Several factors, such as age, gender, education level, and comorbidities, are worthy of attention as they could expand vaccine coverage in the target population. .

Mucormycosis infection in patients with COVID-19: A systematic review.

INTRODUCTION: Several reports previously described mucormycosis co-infection in patients with COVID-19. As mucormycosis and COVID-19 co-infection might adversely affect patients' outcomes, we aimed to systematically review the related evidence and the subsequent outcomes. METHODS: We conducted a systematic review of relevant articles searching the keywords in the online databases of PubMed, Scopus, Embase, Cochrane, and Web of Science. All the records from the start of the pandemic until June 12th, 2021 underwent title/abstract and then full-text screening process, and the eligible studies were included. We did not include any language or time restrictions for the included studies. RESULTS: We found 31 eligible studies reporting 144 total cases of COVID-19 and mucormycosis co-infection. The nose, cranial sinuses, and orbital cavity were the most commonly involved organs, although the cerebrum, lungs, and heart were also involved in the studies. Pre-existing diabetes mellitus (DM), as well as corticosteroid use, were the most commonly identified risk factors, but other underlying conditions and immunomodulatory drug use were also present in several cases. Aspergillus was the most commonly reported micro-organism that caused further co-infections in patients with concurrent COVID-19 and mucormycosis. As most of the studies were case reports, no reliable estimate of the mortality rate could be made, but overall, 33.6% of the studied cases died. CONCLUSION: Early diagnosis of mucormycosis co-infection in COVID-19 patients and selecting the right treatment plan could be a challenge for physicians. Patients with underlying co-morbidities, immunocompromised patients, and those receiving corticosteroids are at higher risk of developing mucormycosis co-infection and it is crucial to have an eye examination for early signs and symptoms suggesting a fungal infection in these patients.

Impact of COVID-19 pandemic on routine vaccination coverage of children and adolescents: A systematic review.

BACKGROUND AND AIMS: Scientists and healthcare workers have expressed their concerns on the impacts of the COVID-19 pandemic on vaccination coverage in children and adolescents. Therefore, we aimed to systematically review the studies addressing this issue worldwide. METHODS: We conducted a systematic search of relevant studies using the keywords on databases of PubMed, Web of Science, and Cochrane on May 22, 2021. The identified records were imported into EndNote software and underwent a two-phase screening process consisting of title/abstract and full-text screenings against inclusion criteria. The data of the included studies were summarized into a table and the findings were analyzed in a systematic approach. RESULTS: From 26 eligible studies, 21 studies demonstrated decreased vaccination rates in the children during the COVID-19 pandemic, while three studies found increased or no significant changes only in influenza vaccination. The two remaining studies from Brazil and Sweden also showed no significant changes in vaccination rates in the children during the pandemic. CONCLUSION: Most of the reports worldwide reported a decline or delay in vaccination at the time of the COVID-19 pandemic. A sustained catch-up program seems to be necessary, especially in low-income countries, to avoid any vaccine dose missing. Facilitating the vaccination process is recommended, such as decreasing the waiting time for vaccination at the health center, addressing the fear and concerns related to COVID infection for parents, and enhancing vaccine availability, and promoting access in remote areas. Countries should ensure proper vaccination to prevent future pandemics related to vaccine-preventable diseases.