Changes in clinic visits and diabetes and metabolic control in patients with type 2 diabetes during COVID-19 pandemic: A real world evidence

Purpose The study aim was to evaluate the effects of public lockdown during the covid-19 pandemic on glucose and metabolic parameters as well as body weight control in type 2 diabetic patients. Methods This study was conducted in two outpatient Diabetes Clinics and analyzed data available in database of Diabetes Clinic. Data related to a year before covid-19 pandemic and a year during covid-19 pandemic was collected from the database and analyzed. Patients with type 2 diabetes included in the analysis if they had referred to Diabetes Clinics both before and during covid-19 pandemic. Demographic information and data about metabolic status were collected from the records of previous outpatient Clinic visits and compared Results Finally 9,440 patients with mean age of 61.08±11.62 referred to Diabetes Clinics in both the year before and the year of the corona pandemic. Mean FBS and HbA1c in diabetes patients reduced significantly from 155.37±62.93 and 7.97±1.74 before pandemic, respectively to 138.77±45.39 and 7.54±1.34, respectively during covid-19 outbreak. During covid-19 pandemic, all metabolic parameters including glycemic and lipid profile (except for triglyceride) and BMI (body mass index) reduced significantly statistically, but, these changes were not clinically significant. However, triglyceride level increased statistically significantly but again it was not significant clinically. Conclusion During COVID-19 lockdown, glycemic and metabolic control of diabetes patients have improved significantly except for triglycerides.

The Association Between Antioxidants and COVID-19 Outcomes: a Systematic Review on Observational Studies.

It is proven that the blood concentration of antioxidants can impress the severity of viral infections, including COVID-19. However, the lack of a comprehensive study accumulating existing data regarding COVID-19 can be perceived. Therefore, this systematic review is aimed to report the association between the blood concentration of several antioxidants and the overall health condition of COVID-19 patients. We summarized the available data surrounding the serum antioxidant level in COVID-19 patients and COVID-19 outcomes. A systematic search was performed in PubMed, Scopus, Web of Science, and Cochrane, and studies that evaluated the association between antioxidants and COVID-19 outcomes were included. Of 4101 articles that were viewed in the database search, 38 articles were included after the title, abstract, and full-text review. Twenty-nine studies indicated that lower serum antioxidants are associated with worse outcomes, and one study reported no association between serum zinc (Zn) level and COVID-19 outcomes. In most cases, antioxidant deficiency was associated with high inflammatory factors, high mortality, acute kidney injury, thrombosis, intensive care unit (ICU) admission, acute respiratory distress syndrome, cardiac injury, and the need for mechanical ventilation (MV), and there was no significant association between serum antioxidants level and ICU or hospital length of stay (LOS). It seems that higher levels of antioxidants in COVID-19 patients may be beneficial to prevent disease progression. However, clinical trials are needed to confirm this conclusion.

Changes in Lifestyle Behaviors of Children and Adolescents during the COVID-19 Pandemic and the Impact on the Development of Non-Communicable Diseases: A Narrative Review.

Background: Quarantine restrictions have changed the usual lifestyle habits of children and adolescents. In this review, we summarize how the COVID-19 outbreak changed lifestyle during childhood and discuss potential short- and long-term effects of NCD high-risk behaviors on health outcomes. Methods: literature search was conducted in Medline database (PubMed), Scopus, Embase, Web of Science, and Google Scholar. All studies that assessed the relationship between COVID-19 outbreak and lifestyle changes were included. Results: NCD risk factors such as unhealthy diet, physical inactivity, prolonged screen time and sedentary behavior, disrupted sleep schedules and sleep quality, as well as mental disorders during COVID19 in childhood, may increase the susceptibility to NCDs in adulthood. These changes in lifestyle behaviors have short and long-term cardio-metabolic and psychological health outcomes. Since it is not clear when COVID-19 is completely controlled, assessment of the interactions between COVID-19 and lifestyle activities in the pediatric age group is critical. Conclusion: The pandemic of coronavirus disease 2019 (COVID-19) has greatly influenced all levels of health systems. During the COVID-19 pandemic, prevention and management of non-communicable diseases (NCDs) will need to be prioritized even further.

Changes in clinic visits and diabetes and metabolic control in patients with type 2 diabetes during COVID-19 pandemic: A real world evidence.

PURPOSE: The study aim was to evaluate the effects of public lockdown during the covid-19 pandemic on glucose and metabolic parameters as well as body weight control in type 2 diabetic patients. METHODS: This study was conducted in two outpatient Diabetes Clinics and analyzed data available in database of Diabetes Clinic. Data related to a year before covid-19 pandemic and a year during covid-19 pandemic was collected from the database and analyzed. Patients with type 2 diabetes included in the analysis if they had referred to Diabetes Clinics both before and during covid-19 pandemic. Demographic information and data about metabolic status were collected from the records of previous outpatient Clinic visits and compared RESULTS: Finally 9440 patients with mean age of 61.08 ± 11.62 referred to Diabetes Clinics in both the year before and the year of the corona pandemic. Mean FBS and HbA1c in diabetes patients reduced significantly from 155.37 ± 62.93 and 7.97 ± 1.74 before pandemic, respectively to 138.77 ± 45.39 and 7.54 ± 1.34, respectively during covid-19 outbreak. During covid-19 pandemic, all metabolic parameters including glycemic and lipid profile (except for triglyceride) and BMI (body mass index) reduced significantly statistically, but, these changes were not clinically significant. However, triglyceride level increased statistically significantly but again it was not significant clinically. CONCLUSION: During COVID-19 lockdown, glycemic and metabolic control of diabetes patients have improved significantly except for triglycerides.

Associated factors to insulin adherence in type 1 diabetes in Tehran and Karaj, Iran.

Purpose: Type 1 diabetes mellitus (T1DM) is a chronic metabolic disorder, and its prevalence and incidence are increasing globally. Insulin therapy is the basis of T1DM management that can prevent numerous complications. Identifying and resolving the factors involved in patients' non-adherence can reduce complications, mortality, and economic burden. Methods: In this cross-sectional study, a sample of patients with T1DM were included from Alborz and Tehran cities of Iran in 2020. Patients filled the questionnaires consisting of sociodemographic and diabetes characteristics, weight and height measurements, 8-item Morisky Medication Adherence Scale (MMAS), and barriers to insulin therapy. Patients with < six scores of MMAS were considered to have low adherence, while ≥ 6 scores showed moderate/high adherence. Data were analyzed using SPSS, and a P-value of less than 0.05 was considered statistically significant. Results: 189 patients with T1DM with a mean (± SD) age of 17.95 (± 10.98) years were enrolled in the study, and 73.5% of patients had moderate/high adherence to insulin therapy. Younger age and owning insurance were significantly associated with being classified in the higher adherence group. The barriers that were significantly associated with non-adherence were forgetting to buy, physician inaccessibility, cost, exhaustion from the long-term injection, forgetfulness, injection site reaction, and rebellion against parents in the < 20 years age group. The main barriers in ≥ 20 years age group were forgetting to buy and insufficient injection instruction. Conclusion: The identified barriers to insulin injection would be helpful for policymakers and clinicians to increase insulin adherence among patients with T1DM. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01105-0.

Impact of incentives on COVID-19 vaccination; A systematic review.

Introduction: Although vaccination is the most effective way to limit and overcome the COVID-19 pandemic, a considerable fraction of them are not intended to get vaccinated. This study aims to investigate the existing research evidence and evaluate the effectiveness and consequences of all incentives provided for increasing the uptake of COVID-19 vaccination. Methods: A systematic search in PubMed, Web of Science (WoS), and SCOPUS from 2020 until October 10, 2021, was conducted on experimental studies evaluating the effects of incentives including cash, lottery voucher, and persuasive messages on COVID-19 vaccination intention and uptake. The study selection process, data extraction, and quality assessment were conducted independently by two investigators using Consolidated Standards of Reporting Trials (CONSORT 2010) checklist. Results: Twenty-four records were included in the qualitative analysis. Most of the included studies assessed the effect of financial incentives. In 14 studies (58%) the assessed outcome was vaccination uptake and in nine (37.5%) others it was vaccination intention. One study considered self-reported vaccination status as the outcome. This study shows that high financial incentives and the Vax-a-million lottery are attributed to a higher vaccination rate, while the low amount of financial incentives, other lotteries, and persuasive messages have small or non-significant effects. Conclusion: Paying a considerable amount of cash and Vax-a-million lottery are attributed to a higher vaccination. Nevertheless, there is a controversy over the effect of other incentives including other lotteries, low amount of cash, and messages on vaccination. It is noteworthy that, inconsistency and imprecision of included studies should be considered.

Status of stigma on the health care workers related to COVID-19 at the first wave of the pandemic in Iran: A qualitative study.

Background: Stigma can be seen as a mark of disgrace that can lead to the separation of one person from another. In this qualitative study, we assess the status of stigma among in front-line health care workers (HCWs) during the first wave of the COVID-19 pandemic in Iran. Subjects and methods: The participants were selected from frontline HCWs related to COVID-19 in Imam Ali and Imam Hossein referral hospitals in Alborz province, Iran. Study was conducted between May and June 2020. The 32-item checklist Consolidated Criteria for Reporting Qualitative Research (COREQ) was used to report this qualitative study. Interview questions were prepared based on the grounded theory method. The thematic approach was used to analyze the data content. Data analysis was based on open and axial coding and after implementing the codes in MAXQDA software. Results: The results of this study included 4 themes, 8 categories and 33 sub-categories. Themes included extrinsic and intrinsic elements of stigma, perplexity and stigma removal requirements. Extrinsic elements included "creating blame and shame" and "discrimination" categories. Intrinsic elements included "the desire to be avoidance," "feeling depressed and frustrated" and "feeling anxious and scared" categories. Perplexity included "feeling loss" category. Stigma removal requirements included "factors causing stigma" and "protective agents against stigma" categories. Conclusion: Low public awareness on COVID-19 and inadequate public care, limited personal protective equipment and inadequate facilities for HCWs along with lack of appreciation for their efforts, lack of proper psychiatric/psychological counseling to identify and treat symptoms associated with mental health and the limitations of training to maintain mental health skills are considered to be factors in the formation of stigma among HCWs related to COVID-19. Health policymakers should implement coherent strategies related to increasing public awareness and providing personal protection needs and counseling care for HCWs in relation to COVID-19.

Prognostic comparison of COVID-19 outpatients and inpatients treated with Remdesivr: A retrospective cohort study.

INTRODUCTION: Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks within these years and faced many inadequacies and shortages of resources and hospital beds. Hence the healthcare system started using in-hospital medication such as Remdesivir in outpatients to reduce the load of patients admitted to the hospital. This study aimed to evaluate and compare the reported signs, symptoms, and outcomes of COVID-infected hospitalized and out-patients receiving Remdesivir. METHODS: In this retrospective cohort study, 214 patients (121 outpatient and 93 hospitalized) with moderate levels of Covid infection between October 2021 and February 2022 were studied. Both groups were treated with 200mg of Remdesivir, followed by 100 mg daily intravenous injections for five days; signs and symptoms, such as pain, shortness of breath, cough, fever and etc., of patients at the initiation and the end of treatment were recorded. Moreover, the patients' blood oxygen saturation was assessed two to three times a day, and the mean of the recorded measures was considered as the daily oxygen saturation. The outpatient group had to visit the hospital daily for treatment and assessment. At the treatment's end, mortality rates, disease signs, and symptoms alleviations were compared between the groups. RESULTS: The outpatient and hospitalized group's mean age was 40.30 ± 12.25 and 37.70 ± 12.00 years, and 51.2% and 55.9% were males, respectively. There was no statistical difference between baseline and clinical characteristics in the outpatients and hospitalized groups. After adjusting for oxygen saturation at baseline and gender in the multivariable Cox regression analysis, the risk of death did not statistically differ between the hospitalized and outpatient group (hazard ratio: 0.99, 95% confidence interval: 0.39-2.50)) at the end of the study. CONCLUSION: Based on the results of this study, the outcome, signs, and symptoms of inpatient and outpatient Remdesivir treatment groups did not differ significantly. Hence in COVID-19 surges where we have limitations in admitting patients, outpatient Remdesivir treatment for those without any underlying diseases can be a proper management method.

Eating habits of children and adolescents during the COVID-19 era: A systematic review

The COVID19 pandemic has affected all aspects of people's lives. Eating habit plays a crucial role in children and adolescents' physical and mental development and the impacts might last until adulthood. This systematic review aimed to summarize a comprehensive and updated overview of eating habits changes due to COVID19 confinements among children and adolescents. A systematic literature search was performed in three databases for all the English studies published from the start of the confinements until April 2022. Two researchers screened articles independently and included observational studies which evaluated children's and adolescents' eating habits before and during confinements. The quality of the included studies was assessed by Newcastle-Ottawa Quality Assessment checklists for cross-sectional and cohort studies. Among 2,436 studies, 39 final full-text articles were included. The total participants of this systematic review consist of 157,900 children and adolescents. Seven categories were identified: daily eating patterns, junk food, beverage, fruits and vegetables, milk and dairy, protein-rich foods, and legumes and cereals. In summary, most of the included studies reported a significant increase in consumption of home-cooked meals, amount of food, snack, french fries, sweets, fruits, vegetables, legumes, bread, and bakery products. On the other hand, studies demonstrated significantly lower intake of fast food and soft drink. The studies reported controversial results about breakfast consumption, sugar-added drinks, caffeinated drinks, milk and dairy products, protein-rich foods (including meat, fish, egg and chicken, and poultry), rice, and cereal. Changes in children's and adolescents' eating habits during the COVID-19 era were both positive and negative, for example, a decrease in fast food, fruit, and vegetable consumption vs. an increase in snacking and sweet consumption. Both changes have significant short-term and long-term impacts on population health. This study could provide us with insight into the changes in eating habits in children and adolescents in the COVID-19 era which we can use to limit the negative consequences on health.

The mental health status of offshore oil platform workers during the COVID-19 pandemic.

Background: Previous studies indicated that offshore workers have a high level of work-related stress on an everyday basis. This study aims to assess the prevalence and determinants of mental health conditions in offshore oil platform workers during the COVID-19 pandemic. Methods: Workers of three oil and gas platforms were assessed in this cross-sectional study. Their mental status was evaluated by the Posttraumatic Stress Disorder (PTSD-8) questionnaire, and Depression Anxiety, Stress Scales (DASS) questionnaires. Furthermore, we assessed satisfaction with life (SWL) with a single question. Finally, multivariate logistic regression was used to determine the association of demographic and work-related variables with mental health outcomes. Results: Overall, 278 (Males:197, Females: 81) out of 315 invited workers with a mean age of 35.6 (SD: 7.2) years were included in this study using a random sampling method (participation rate: 88.2%). PTSD symptoms and Insomnia were observed in 9 (3.2%) and 138 (49.6%) of the participants, respectively. The prevalence of stress, anxiety, and depressive symptoms were 72 (25.9%), 70 (24.6%), and 85 (30.5%), respectively. Based on multivariable (adjusted) logistic regression analysis, women had significantly higher odds of stress and anxiety than men; those with an academic education were significantly more dissatisfied with their lives than those without an academic education. Conclusion: Our findings revealed a high prevalence of anxiety, depressive symptoms, and stress among offshore oil platformers during the COVID-19 pandemic, especially in women. Indicating that women and those with a higher education level in the oil platform work settings are more susceptible to stressors.

How did lockdown and social distancing policies change the eating habits of diabetic patients during the COVID-19 pandemic? A systematic review.

Background: After the declaration of the COVID-19 pandemic, governments established national lockdowns and social distancing as an effective plan to control this disease. As a result of the lockdown policies, diabetic patients` access to food products, medication, and routine follow-ups is disrupted, making it difficult for them to control their disease. Methods: International databases, including PubMed/Medline, Web of Science, and Scopus, were searched until April 2022. All observational studies included assessing the impact of lockdown and social distancing on eating habits (as primary outcome), and glycemic and anthropometric indices (as secondary outcomes) of diabetic patients during the COVID-19 pandemic. The Newcastle-Ottawa Quality Scale was used to assess the quality rating of the studies. Results: Overall, 22 studies were included in this systematic review, the results of which varied in different communities. In most studies, consumption of grains, fruits, and vegetables was reported to increase. On the other hand, consumption of snacks and sweets was reported to increase in other surveys. During the COVID-19 lockdown, most diabetic patients preferred to cook meals at home, using less takeout, fast foods, and alcoholic drinks. Although the patients mostly improved their eating habits, the glycemic and anthropometric indices were contradictory in different studies. Studies showed that the eating habits of diabetic patients vary from country to country, even in some cases and studies done in the same country showed different results. For example, all the studies done in Japan showed an increase in the consumption of snacks and sweets, leading to weight gain in the patients. However, conflicting results in eating habits have been observed in studies conducted in India. Conclusion: The lockdown policies have led to a beneficial change in the eating habits of diabetic patients to consume more fruits and vegetables and reduce the consumption of animal protein products and alcoholic beverages. While some diabetic patients have increased consumption of snacks and sweets, leading to a disturbance in their glycemic and anthropometric indices control. Understanding the consequences of lockdown and social distancing of the diabetic patient during the COVID-19 pandemic can help public health authorities make better recommendations to improve glycemic control.

Relationships among COVID-19 phobia, health anxiety, and social relations in women living with HIV in Iran: A path analysis.

INTRODUCTION: The COVID-19 pandemic and its consequences have caused fear and anxiety worldwide and imposed a significant physical and psychological burden on people, especially women living with HIV (WLHIV). However, WLHIV were not studied as well as others during the pandemic. Hence, this study aimed to determine the relationships between COVID-19 phobia, health anxiety, and social relations in WLHIV. MATERIALS AND METHODS: This cross-sectional study enrolled 300 WLHIV who had records at the Iranian Research Center for HIV/AIDS of Tehran University of Medical Sciences. Data were collected using sociodemographic questionnaire, the fear of COVID-19 scale, the social relations questionnaire, the socioeconomic status scale and the health anxiety inventory. Path-analysis was used to assess the direct and indirct associations between variables. RESULTS: Based on the path analysis, among variables that had significant causal relationships with social relations, socioeconomic status (ß = -0.14) showed the greatest negative relationship, and health anxiety (ß = 0.11) had the strongest positive relationship on the direct path. On the indirect path, fear of COVID-19 (ß = 0.049) displayed the greatest positive relationship. The level of education (ß = 0.29) was the only variable showing a significant positive relationship with social relations on both direct and indirect paths. CONCLUSION: Our result showed that increased fear and health anxiety related to a higher social relations score in WLHIV. Hence, due to their vulnerability, these people require more support and education to adhere to health protocols in future pandemics and similar situations.

Impact of incentives on COVID-19 vaccination;A systematic review

Introduction Although vaccination is the most effective way to limit and overcome the COVID-19 pandemic, a considerable fraction of them are not intended to get vaccinated. This study aims to investigate the existing research evidence and evaluate the effectiveness and consequences of all incentives provided for increasing the uptake of COVID-19 vaccination. Methods A systematic search in PubMed, Web of Science (WoS), and SCOPUS from 2020 until October 10, 2021, was conducted on experimental studies evaluating the effects of incentives including cash, lottery voucher, and persuasive messages on COVID-19 vaccination intention and uptake. The study selection process, data extraction, and quality assessment were conducted independently by two investigators using Consolidated Standards of Reporting Trials (CONSORT 2010) checklist. Results Twenty-four records were included in the qualitative analysis. Most of the included studies assessed the effect of financial incentives. In 14 studies (58%) the assessed outcome was vaccination uptake and in nine (37.5%) others it was vaccination intention. One study considered self-reported vaccination status as the outcome. This study shows that high financial incentives and the Vax-a-million lottery are attributed to a higher vaccination rate, while the low amount of financial incentives, other lotteries, and persuasive messages have small or non-significant effects. Conclusion Paying a considerable amount of cash and Vax-a-million lottery are attributed to a higher vaccination. Nevertheless, there is a controversy over the effect of other incentives including other lotteries, low amount of cash, and messages on vaccination. It is noteworthy that, inconsistency and imprecision of included studies should be considered.

Clinical and laboratory findings and PCR results in severe and non-severe COVID19 patients based on CURB-65 and WHO severity indices.

BACKGROUND: The importance of clinicolaboratory characteristics of COVID-19 made us report our findings in the Alborz province according to the latest National Guideline for the diagnosis and treatment of COVID-19 in outpatients and inpatients (trial five versions, 25 March 2020) of Iran by emphasizing rRT-PCR results, clinical features, comorbidities, and other laboratory findings in patients according to the severity of the disease. METHODS: In this study, 202 patients were included, primarily of whom 164 had fulfilled the inclusion criteria. This cross-sectional, two-center study that involved 164 symptomatic adults hospitalized with the diagnosis of COVID-19 between March 5 and April 5, 2020, was performed to analyze the frequency of rRT-PCR results, distribution of comorbidities, and initial clinicolaboratory data in severe and non-severe cases, comparing the compatibility of two methods for categorizing the severity of the disease. RESULTS: According to our findings, 111 patients were rRT-PCR positive (67.6%), and 53 were rRT-PCR negative (32.4%), indicating no significant difference between severity groups that were not related to the date of symptoms' onset before admission. Based on the National Guideline, among vital signs and symptoms, mean oxygen saturation and frequency of nausea showed a significant difference between the two groups (P < 0.05); however, no significant difference was observed in comorbidities. In CURB-65 groups, among vital signs and comorbidities, mean oxygen saturation, diabetes, hypertension (HTN), hyperlipidemia, chronic heart disease (CHD), and asthma showed a significant difference between the two groups (P < 0.05), but no significant difference was seen in symptoms. CONCLUSION: In this study, rRT-PCR results of hospitalized patients with COVID-19 were not related to severity categories. From initial clinical characteristics, decreased oxygen saturation appears to be a more common abnormality in severe and non-severe categories. National Guideline indices seem to be more comprehensive to categorize patients in severity groups than CURB-65, and there was compatibility just in non-severe groups of National Guideline and CURB-65 categories.

Montelukast and Coronavirus Disease 2019: A Scoping Review

Coronavirus disease 2019 (COVID-19) is an emerging worldwide issue, that has affected a large number of people around the world. So far, many studies have aimed to develop a therapeutic approach against COVID-19. Montelukast (MK) is a safe asthma controller drug, which is considered as a potential antiviral drug for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review has a systematic approach to investigate the reports on the use of MK as a part of treatment or a prophylactic agent in COVID-19. The search was conducted in PubMed, Web of Science, and Scopus databases and yielded 35 studies containing the influence of MK on SARS-CoV-2. Ultimately, MK appears to be worth being used as an adjuvant therapeutic and prophylactic drug against SARS-CoV-2. Nevertheless, more clinical trials are required to accurately investigate its effectiveness.

Post-traumatic stress disorder and mental health assessment of seafarers working on ocean-going vessels during the COVID-19 pandemic.

BACKGROUND: There are increasing concerns about mental health consequences of the COVID-19 pandemic among seafarers. This study aims to assess the effects of the current global health pandemic on life satisfaction and adverse psychological outcomes among seafarers. METHODS: In this cross-sectional study, 470 multinational seafarers working on board ships of two international shipping companies were assessed. Mental health outcomes were assessed by the general anxiety disorder (GAD-7) questionnaire, post-traumatic stress disorder (PTSD-8) questionnaire, and patient health questionnaire (PHQ-9) depressive severity score. Multivariate logistic regression was used to determine the association of demographic and work-related variables with mental health outcomes. RESULTS: Overall, 439 out of 470 invited seafarers with a mean age of 34.5 (SD: 8.05) years participated in this study (participation rate: 93.4%). The prevalence of anxiety, depressive, and post-traumatic stress symptoms was 12.4, 14.1, and 37.3%, respectively. In the multivariate model, the current vessel's signing duration was directly associated with the odds of depressive and intrusion symptoms. Moreover, the duration of work per week was inversely associated with hyper-vigilance and avoidance. Also, non-officers, compared to officers, experienced significantly lower anxiety and depressive symptoms, hyper-vigilance, and avoidance. CONCLUSION: The present study revealed a high prevalence of mental health problems among seafarers during the COVID-19 pandemic. We recommend that more evidence is generated regarding psychosocial health issues for this vulnerable occupation.

Olfactory and Gustatory Dysfunction in 2019 Novel Coronavirus: An Updated Systematic Review and Meta-analysis.

BACKGROUND: Evidence showed that partial or complete loss of smell and taste might be a possible primary symptom of the 2019 novel coronavirus (COVID-19). This study aimed to systematically review and pool all available evidence on the olfactory and gustatory dysfunction in COVID-19 patients. METHODS: In this systematic review, a comprehensive search was carried out systematically through e-databases including PubMed, EMBASE, Scopus, and Web of Science (WoS); that was limited to English-language studies published from 2019 up to 6th May 2020. Afterward, all studies reported the taste and smell dysfunction in the COVID-19 patients were included. The quality of the studies was assessed by the Mixed Methods Appraisal Tool (MMAT). The pooled prevalence of olfactory and gustatory dysfunction was estimated using the random effects meta-analysis method. RESULTS: Among 28 eligible included studies in this systematic review, finally, 22 studies met the eligibility criteria and were included in the meta-analysis. According to the random effect meta-analysis, the global pooled prevalence (95% confidence interval) of any olfactory dysfunction, anosmia, and hyposmia was 55% (40%-70%), 40% (22%-57%), and 40% (20%-61%) respectively. The pooled estimated prevalence of any gustatory dysfunction, ageusia, and dysgeusia was 41% (23%-59%), 31% (3%-59%), and 34% (19%-48%) respectively. CONCLUSIONS: Olfactory and gustatory dysfunction is prevalent among COVID-19 patients. Therefore, olfactory and gustatory dysfunction seems to be part of important symptoms and notify for the diagnosis of COVID-19, especially in the early phase of the infection.

The predictive power of serum vitamin D for poor outcomes in COVID-19 patients.

Considering the high prevalence of vitamin D deficiency worldwide and its relationship with immune response to viral infections, this study attempted to identify the predictive power of serum vitamin D for poor outcomes among the COVID-19 patients. This retrospective cohort study included all patients with confirmed COVID-19 hospitalized between February 20, 2020, and April 20, 2020, at a designated COVID-19 hospital, located in Tehran province, Iran. General characteristics, medical history and clinical symptoms were recorded by trained physicians. Blood parameters including complete blood count, creatinine, lactate dehydrogenase, creatine phosphokinase, erythrocyte sedimentation rate, C-reactive protein and vitamin D were tested. This study included 290 hospitalized patients with COVID-19 (the mean age [SD]: 61.6 [16.9], 56.6% males), of whom 142 had vitamin D concentrations less than 20 ng/ml, defined as vitamin D deficiency. COVID-19 patients with vitamin D deficiency were more likely to die (Crude OR [95% CI]: 2.30 [1.25-4.26]), require ICU (2.06 [1.22-3.46]) and invasive mechanical ventilation (2.03 [1.04-3.93]) based on univariate logistic regression results. Although, after adjusting for potentials confounders such as gender and age, the association between vitamin D and need to invasive mechanical ventilation lost its significance, adjusted values for the risk of death and ICU requirement were still statistically significant. Vitamin D deficiency can be considered as a predictor of poor outcomes and mortality in COVID-19 patients. Therefore, checking serum 25 (OH) D on admission and taking vitamin D supplements according to the prophylactic or treatment protocols is recommended for all COVID-19 patients.

Effects of the covid-19 pandemic on neurological diseases.

BACKGROUND: Covid-19 has caused many complications for both the infected and those in need of medical care. This may be due to infection-related prognosis worsening or the patients' avoidance of referring to the hospital for fear of contracting the infection. The decline of acute referral to the ER of many significant conditions with severe results on both the well-being and life-expectancy is a serious concern. To address these concerns, we designed this study to evaluate the recent pandemic's impact on "in-hospital mortality" caused by neurological disorders pre and postpandemic. METHODS AND MATERIAL: The inclusion criteria were any acute neurological condition and the consent of the patients eligible for our study. The definitions of all assessed conditions and the comorbidities are ICD-10 based. Hypertension and diabetes mellitus, due to their high prevalence, were evaluated separately from other internal comorbidities. The total number of the enrolled patients was 1742, 671 of whom had been during the COVID-19 pandemic, and 1071 had attended the ER during the prepandemic era. RESULTS: The overall mortality was significantly higher during the pandemic, and the covid infected had suffered higher mortality rates. (p-value < 0.05) CONCLUSION: During the pandemic, those with minor strokes and other nonlife-threatening ailments had avoided hospital care leading to a significantly higher rate of critical conditions. Increased incidence of strokes and ICHs during the pandemic, too, caused significant increased in-hospital mortality.