Telemedicine technologies and applications in the era of COVID-19 pandemic: A systematic review.

INTRODUCTION: Telemedicine services saw substantial surges in their use during the COVID-19 pandemic due to the lockdowns and characteristics of the pandemic. Therefore, the authors aimed to systematically review the telemedicine services provided during the COVID-19 pandemic and their potential applications. METHODS: The authors searched PubMed, Scopus, and Cochrane databases on September 14, 2021. Then, the retrieved records underwent two-step title/abstract and full-text screening processes, and the eligible articles were included for qualitative synthesis. RESULTS: The review of studies demonstrated that the telephone is listed 38 times, making it the most common technology used in telemedicine. Video conferencing is also mentioned in 29 articles, as well as other technologies: Mobile-health (n = 15), Virtual reality (n = 7). According to the findings of the present study, Tele-follow-up (n = 24), Tele-consulting (n = 20), Virtual visits (20), and Tele-monitoring (n = 18) were the most widely used telemedicine applications. CONCLUSION: Telemedicine has been an effective approach to COVID-19 management. Telemedicine technology is going to play a key role in the future of health medicine, patient consultation, and many other extended applications of health care in remote rural locations.

Abortion services during the COVID-19 pandemic: a systematic review.

Evidence suggests that COVID-19 may impair access to sexual and reproductive health services and safe abortion. The purpose of this systematic review was investigating the changes of abortion services in the COVID-19 pandemic era. We searched PubMed, Web of Science and Scopus for relevant studies published as of August 2021, using relevant keywords. RCT and non-original studies were excluded from the analysis and 17 studies of 151 included in our review. Requests to access medication abortion by telemedicine and demand for self-managed abortion were the main findings of identified studies. Women requested an abortion earlier in their pregnancy, and were satisfied with tele-abortion care due to its flexibility, and ongoing telephone support. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced based on the severity of the restrictions, and abortion clinics had less revenue, more costs, and more changes in the work style of their healthcare providers. Telemedicine was reported safe, effective, acceptable, and empowering for women. Reasons for using tele-abortion were privacy, secrecy, comfort, using modern contraception, employing of women, distance from clinics, travel restrictions, lockdowns, fear of COVID-19, and political reasons (abortion prohibition). Complications of women using tele-abortion were pain, lack of psychological support, bleeding, and need to blood transfusions. The results of this study showed that using telemedicine and teleconsultations for medical abortion in the pandemic conditions may be extended after pandemic. Findings can be used by reproductive healthcare providers and policy makers to address the complications of abortion services.Trail registration This study is registered in PROSPERO with number CRD42021279042.

COVID-19 pandemic shocks the international community, especially health policymakers around the world. The most important consequence of this outbreak has been direct and indirect impacts on health service provisions in all parts of the health system, including sexual and reproductive health services. We reviewed numerous studies investigating healthcare related to abortion in the pandemic era that showed women had more requests to access medical abortion, more than surgical. They preferred self-managed abortion process by telemedicine. Presenting telemedicine services without ultrasound has also been reported. Visits to clinics were reduced, and this decrease was reported based on the severity of the restrictions. Abortion clinics had reduced revenue, increased costs, and changed work style of their healthcare providers. Reasons for using telemedicine were fear of COVID-19, travel restrictions, lockdowns, more privacy, secrecy, and comfort. Telemedicine was reported safe, effective, acceptable, satisfying, and empowering for women. Maternal complications using tele-abortion were pain, bleeding, and need to blood transfusions. These findings can be used by policy makers and reproductive healthcare providers to address the complications of abortion management.

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran.

Objectives: Good sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors. Methods: An online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson's correlation analysis and Multivariate logistic regression identified the interactions between these factors. Results: The mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI; 0.032-0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI; 1.003-4.023, P = 0.005), in people who had long shifts (OR:1.757, CI; 1.123-4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI; 1.673-6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI; 0.001-0.244, P = 0.004). Conclusion: The sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

The relationship between sex steroids (E2, progesterone, and AMH) levels and severity and fatality of COVID-19: A systematic review

Sex steroids are powerful modulators of the immune system and they may affect the immune response and inflammatory consequences of COVID-19. This systematic review aims to explore the impact of sex steroids on COVID-19 mortality and complications. We looked up the keywords of the study in Scopus, PubMed, and Web of Science. All related original articles published in English, as of October 16, 2021, were reviewed to be included in our research. Concerns regarding the effect of sex hormones on COVID-19, eight full texts have been identified for the conclusion. In these studies, the relationship between estradiol and COVID-19 mortality has been mentioned. The most significant findings were the higher COVID-19 mortality rate in men, compared to women;also, in menopausal women compared to younger women and who received estradiol. In two studies, oral contraceptive pills had a protective effect on the morbidity of SARS-CoV-2 infection. In a randomized controlled trial, subcutaneous injection of progesterone in hospitalized men significantly reduced their symptoms and need for oxygen therapy. Hormone replacement therapy was positively associated with reducing COVID-19 symptoms. Although the results were insufficient for a conclusion, this study represents estrogen as an appropriate pharmacological method for preventing and diminishing the inflammation related to COVID-19 disease. However, future prospective studies and clinical trials are needed to clarify and approve this protective effect.

Nurses and midwives' sleep quality and its associated factors during the early COVID-19 pandemic in Iran

Objectives Good sleep quality is crucial for medical staff especially nurses and midwives to prevent possible errors and injuries during the providing care. The aim here is to investigate the sleep quality of nurses and midwives during the early corona pandemic and its related factors. Methods An online observational and cross-sectional study included 340 medical staff who engaged in the treatment of patients with COVID-19 infection in 2020. Participants completed questionnaires about working characteristics, Pittsburgh Sleep Quality Index (PSQI), and Social Support Indexes (SSI). Pearson's correlation analysis and Multivariate logistic regression identified the interactions between these factors. Results The mean PSQI and SSI were 8.4 ± 4.46 and 28.6 ± 13.29, respectively, indicating poor sleep quality and moderate social support. The condition of the participants was serious in terms of sleep efficiency, and sleep disturbance. More than half of the participants reported severe and very serious daytime dysfunction. Poor sleep quality was more common, in nurses than in midwives (OR:0.074, CI;0.032–0.098, P < 0.001), nurses working in intensive care units than in other wards (OR:1.082, CI;1.003–4.023, P = 0.005), in people who had long shifts (OR:1.757, CI;1.123–4.323, P = 0.003), and in people working more than 5 years (OR:4.949, CI;1.673–6.023, P = 0.028). Social support has a statistically significant relationship with the quality of sleep (OR:0.013, CI;0.001–0.244, P = 0.004). Conclusion The sleep quality of the medical staff has been impaired during the epidemic period, especially among nurses. Targeting staff who are more prone to sleep disturbance, such as nurses with longer work experience, helps us design an optimal strategy to support them through sleep hygiene education.

Changes in sexual activities, function, and satisfaction during the COVID-19 pandemic era: a systematic review and meta-analysis.

Introduction: Little is known about the impact of the coronavirus on sexual behavior, function, and satisfaction. Aim: The aim of the present study was to systematically review people's sexual function and behaviors and their changes in sexual activities during the COVID-19 pandemic. Methods: Comprehensive searches in PubMed, Web of Science, and Scopus were conducted with keywords in accordance with MeSH terms: COVID-19, SARS-CoV-2, coronavirus, sexual health, sexual function, sexual dysfunctions, sexuality, sexual orientation, sexual activities, and premarital sex. Two reviewers independently assessed full-text articles according to predefined criteria: original design, English studies, and investigating either the general population or sexual minorities. Results: Risk of bias in the studies was assessed by the Newcastle-Ottawa Scale, and data were pooled via random effects meta-analyses. We utilized the standardized mean difference to evaluate the effects of the COVID-19 pandemic on sexual activity, functioning, and satisfaction. We included 19 studies in the analysis and 11 studies in the meta-analysis, with a sample size of 12 350. To investigate sexual activity changes, a sample size of 8838 was entered into the subgroup analysis, which showed a significant decrease in both genders (5821 women, P < .033; 3017 men, P < .008). A subgroup meta-analysis showed that the sexual function of men and women during the COVID-19 pandemic significantly declined (3974 women, P < .001; 1427 men, P < .001). Sexual desire and arousal decreased in both genders, though mainly in women. In investigating sexual satisfaction changes during the COVID-19 pandemic, a meta-analysis with a sample size of 2711 showed a significant decrease (P < .001). The most indicative changes in sexual behaviors during the pandemic were the increase in masturbating and usage of sex toys. Greater COVID-19 knowledge was associated with lower masturbation, oral sex, and vaginal sex. The more protective behaviors were associated with less hugging, kissing, cuddling, genital touching, watching porn with a partner, and vaginal sex. Conclusion: The COVID-19 pandemic led to increased challenges and changes for individuals' sexual behaviors. Efforts for preventive strategies should therefore be concentrated between pandemics, while ensuring that there is information available to the population during a pandemic for help in times of psychological distress or crisis.

The relationship between sex steroids (E2, progesterone, and AMH) levels and severity and fatality of COVID-19: A systematic review.

Sex steroids are powerful modulators of the immune system and they may affect the immune response and inflammatory consequences of COVID-19. This systematic review aims to explore the impact of sex steroids on COVID-19 mortality and complications. We looked up the keywords of the study in Scopus, PubMed, and Web of Science. All related original articles published in English, as of October 16, 2021, were reviewed to be included in our research. Concerns regarding the effect of sex hormones on COVID-19, eight full texts have been identified for the conclusion. In these studies, the relationship between estradiol and COVID-19 mortality has been mentioned. The most significant findings were the higher COVID-19 mortality rate in men, compared to women; also, in menopausal women compared to younger women and who received estradiol. In two studies, oral contraceptive pills had a protective effect on the morbidity of SARS-CoV-2 infection. In a randomized controlled trial, subcutaneous injection of progesterone in hospitalized men significantly reduced their symptoms and need for oxygen therapy. Hormone replacement therapy was positively associated with reducing COVID-19 symptoms. Although the results were insufficient for a conclusion, this study represents estrogen as an appropriate pharmacological method for preventing and diminishing the inflammation related to COVID-19 disease. However, future prospective studies and clinical trials are needed to clarify and approve this protective effect.

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.

The relationship between C-reactive protein and levels of various cytokines in patients with COVID-19: A systematic review and correlation analysis.

Introduction: C-reactive protein (CRP) and cytokines levels could alter in patients with coronavirus disease (COVID-19) due to the inflammatory response caused by the virus. This analysis aimed to assess the relationship between the CRP levels and the levels of various cytokines in COVID-19 patients. Materials and Methods: We searched the databases of PubMed, Cochrane, and Web of Science for relevant articles on May 29th, 2021. Applying the inclusion/exclusion criteria, the retrieved records underwent two-phase screenings; first, a title/abstract screening process, and then, a full-text screening to find the eligible studies. Data for study variables were extracted, including the CRP levels and the levels of all reported cytokines. A strong and significant relationship between Interleukins and CRP was defined as: p ≤ 0.05, 0.7 ≤ r ≤ 1. Results: In this study, 103 studies were included for systematic review and correlation analysis. The aggregate mean and SD of study variables were calculated and reported. The correlation between Interleukins and CRP was measured using correlation coefficient (r). It appeared that interleukin (IL)-10 has a moderate and significant relationship with CRP (p ≤ 0.05, r = 0.472). IL-10 predicted almost 10% of CRP changes. Conclusion: This correlation analysis suggests IL-10 is moderately correlated with CRP levels in patients with COVID-19 infection. A better understanding of the pro-inflammatory markers could contribute to the implementation of therapeutic and preventive approaches. More prospective studies are suggested to explore the relationship between CRP and cytokines as potential markers for the early identification of COVID-19 progression and severity.

COVID-19 mortality and its predictors in the elderly: A systematic review.

Background and Aims: Older people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID-19) patients and its predictors in this age group. Methods: We searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two-step screening process consisting of title/abstract and full-text screenings to identify the eligible studies. Results: Summarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X-ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d-dimer levels, 25-hydroxy vitamin D serum deficiencies, high C-reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin-angiotensin-aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti-CD6 monoclonal antibody) in combination with other antivirals reduces COVID-19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID-19 mortality. Conclusion: Overall, a critical consideration is necessary for the care and management of COVID-19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID-19 is independently associated with the patient's age. Elderly patients with COVID-19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.

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. .

Internet of things in the management of chronic diseases during the COVID-19 pandemic: A systematic review.

Introduction: The use of new technologies such as the Internet of Things (IoT) in the management of chronic diseases, especially in the COVID pandemics, could be a life-saving appliance for public health practice. The purpose of the current study is to identify the applications and capability of IoT and digital health in the management of the COVID-19 pandemic. Methods: This systematic review was conducted by searching the online databases of PubMed, Scopus, and Web of Science using selected keywords to retrieve the relevant literature published until December 25th, 2021. The most relevant original English studies were included after initial screening based on the inclusion criteria. Results: Overall, 18 studies were included. Most of the studies reported benefits and positive responses in the form of patients' and healthcare providers' satisfaction and trust in the online systems. Many services were provided to the patients, including but not limited to training the patients on their conditions; monitoring vital signs and required actions when vital signs were altered; ensuring treatment adherence; monitoring and consulting the patients regarding diet, physical activity, and lifestyle. Conclusion: IoT is a new technology, which can help us improve health care services during the COVID-19 pandemic. It has a network of various sensors, obtaining data from patients. We have found several applications for this technology. Future studies can be conducted for the capability of other technologies in the management of chronic diseases.

Cutaneous adverse reactions of COVID-19 vaccines: A systematic review.

Numerous vaccines are under clinical development and implementation for the prevention of severe course and lethal outcomes of coronavirus disease 2019 (COVID-19). This systematic review aims to summarize and integrated the findings of studies regarding cutaneous side effects of COVID-19 vaccines. This systematic review conducted by searching the scientific databases of PubMed, Scopus, Science direct, and Web of knowledge from the beginning of the COVID-19 to May 10, 2021. Articles were reviewed and analyzed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Seventeen studies on cutaneous side effects of COVID-19 vaccines were included after the screening of search results based on to the eligibility criteria. The results showed that the most common injection site reactions and delayed large local reactions, arising from all vaccine types, were redness/erythema (39%), followed by: itchiness (28%), urticarial rash (17%) on the neck, upper limbs, and trunk, morbilliform eruptions (6.5%), Pityriasis rosea (3%), swelling, and burning, and so forth. Most cutaneous reactions occurred in women (84%), and middle-aged people, after the first dose of vaccine, with the onset ranged from 1 to 21 days after vaccination. In addition, cutaneous reactions were generally self-limiting, and needed little or no therapeutic intervention, that were not regarded as a barrier to injecting a second dose. In conclusion, severe cutaneous side effects are very rare and approved vaccines have satisfactory safety profiles. Therefore, mild or moderate cutaneous reactions should not discourage people from vaccination. In certain groups such as patients with allergies and a history of local injection reactions, pre-vaccination counseling and assurance, also use of appropriate medications may be helpful. However, more studies are needed to investigate the side effect profile of all COVID-19 vaccines.

Prenatal and neonatal complications of COVID-19: A systematic review.

BACKGROUND AND AIMS: The outbreak of coronavirus disease 2019 (COVID-19) over the past year has affected public health worldwide. During pregnancy, the maternal immune system and inflammatory responses are widely suppressed. Pregnancy-related immune system suppression could make the mother vulnerable to infectious diseases like SARS-COV-2. However, current data suggest little to no possibility of COVID-19 transmission in pregnant women to the fetus during pregnancy or childbirth. This systematic review focused on the possible complications of COVID-19 infection in the fetus and newborn babies including the possibility and evidence of vertical transmission by reviewing articles published during the first year of the COVID-19 pandemic. METHODS: We conducted a systematic search using keywords on PubMed, Embase, and Scopus databases. The studies followed a title/abstract and a full-text screening process, and the eligible articles were included in the study. RESULTS: In total, 238 published papers were identified using a systematic search strategy (44 articles met the inclusion criteria and were included in the final review). In all studies, a total of 2375 women with signs and symptoms of COVID-19, who were in the second and third trimester of pregnancy, were assessed mild to moderate pneumonia was one of the most common symptoms. Seventy-three percent of the women did not present any comorbidity, 19% had a fever, 17% had to cough as the most frequent clinical signs and symptoms, 7.5% had pulmonary changes with chest scans, 8% had increased C reactive protein, and 9.4% had decreased lymphocytes (lymphocytopenia). A total of 2716 newborns and fetal were assessed; the delivery method of 1725 of them was reported, 913 (53%) through C-section delivery, and 812 through normal vaginal delivery (47%). Of total newborns, 13 died (five died along with the mother), and 1965 were tested for SARS-CoV-2:118 tested positive. In a study, vertical transmission in seven cases was reported in total of 145 cases assessed. CONCLUSION: It appeared that most pregnant COVID patients were mildly ill, and there is currently no convincing evidence to support the vertical transmission of COVID-19 disease. Therefore, neonates do not represent any additional risk for adverse outcomes neither during the prenatal period nor after birth.

Effects of COVID-19 prevention procedures on other common infections: a systematic review.

INTRODUCTION: Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began, necessary measures to prevent virus transmission and reduce mortality have been implemented, including mandatory public use of masks, regular hand-sanitizing and hand-washing, social distancing, avoidance of crowds, remote work, and cancellation of public events. During and after the introduction of COVID-19 lockout, we performed a systematic review of available published literature to investigate the incidence of seasonal influenza and other respiratory viral infections. METHODS: PubMed, Embase, Web of Science, Scopus, Science Direct, Google Scholar, Research Gate, and the World Health Organization databases and websites were systematically searched for original studies concerning the impact of COVID-19 prevention means and measures on other common respiratory infectious diseases during the pandemic published by March 2021. RESULTS: The findings showed that the adherence to health protocols to prevent COVID-19 could help to reduce the incidence of other infectious diseases such as influenza, pneumonia, and Mycobacterium tuberculosis. CONCLUSION: The implemented prevention measures and protocols might have reduced the incidence of influenza and some other common respiratory infections. However, controversies exist on this matter and future large population-based studies might provide further information to address these controversies.