Mental Health Care for Medical Staff in Iran during the COVID-19 Pandemic; Different Performance in Alborz Province.

Objective: The mental health status of health care workers (HCWs) related to COVID-19 is of great importance. By designing cross sectional studies, we evaluated disorders related to the mental health of these health workers. Short-term and long-term diagnostic and treatment interventions are other components of this care protocol. Method : This study includes a collection of studies and interventions in the form of analytical cross sectional study at the level of educational hospitals of Alborz University of Medical Sciences. In this study, HCWs were evaluated for mental health disorders in quantitative and qualitative studies. Depression, Anxiety and Stress Scales (DAS), Posttraumatic Stress Disorder (PTSD) questionnaires, and Stigma questionnaire in quantitative studies with thematic approach in qualitative study were used to evaluate and analyze the data. Conclusion: A series of coherent measures have been taken to prevent, screen, and treat mental health disorders of the staff who provide services to patients with COVID-19. We hope the results of these measures will be used as a guide for other professionals and academic and hospital centers in similar conditions to effectively control the disease and improve the mental health of HCWs.

The renin-angiotensin system in cutaneous hypertrophic scar and keloid formation.

Hypertrophic scar and keloid are two types of fibroproliferative conditions that result from excessive extracellular matrix production. The underlying pathological mechanism is not entirely clear. Activation of the renin-angiotensin system (RAS) is associated with fibrosis in various organs. RAS components including angiotensin II (Ang II), angiotensin AT1 and AT2 receptors, and angiotensin-converting enzyme (ACE) are expressed in the skin and act independently from the plasma RAS. AT1 receptors, which are usually the dominating receptor subtype, promote fibrosis and scar formation, while AT2 receptors inhibit the aforementioned AT1 receptor-coupled effects. Elevated angiotensin II (Ang II) levels acting on the AT1 receptor contribute to skin scar formation through increased expression of inflammatory factors such as interleukin-6 (IL-6), angiogenic factors such as vascular endothelial growth factor (VEGF) and fibrinogenic factors such as transforming growth factor-ß1 (TGF-ß1) and connective tissue growth factor (CTGF), while at the same time suppressing the anti-fibrotic tissue inhibitors of matrix metalloproteinase (TIMPs). First, small clinical trials have provided evidence that inhibition of the ACE/Ang II/ AT1 receptor axis may be effective in the treatment of hypertrophic scars/keloids. This review provides a detailed overview of the current literature on the RAS in skin, wound healing and scar formation and discusses the translational potential of targeting this hormonal system for treatment and prevention of hypertrophic scars and keloids.

Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease.

BACKGROUND: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD. METHODS: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: "DM" (having DM with or without other comorbidities), "only DM" (having DM without other comorbidities), "CVD" (having CVD with or without other comorbidities), "only CVD" (having CVD without other comorbidities), and "having any comorbidity". Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities. RESULTS: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95% CI 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p > 0.05). Moreover, "having any comorbidities" increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95% CI 2.09-3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P-values < 0.05). CONCLUSIONS: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.