COVID-19 Preventive behaviors based on social cognitive integrative model among medical students (preprint)

Objective: The COVID-19 outbreak in Iran prompted the investigation of preventive behaviors in vulnerable and key groups. This descriptive and analytical cross-sectional study aimed to determine COVID-19 prevention behaviors among medical students using an integrated social cognition model and identified influencing factors. Results: The results of the study of 650 medical students with a mean age of 24.37±3.78 years showed that the total score of the integrated social cognition model was at a medium level (85.44±8.70). The constructs of attitude (16.14±2.66), subjective norms (5.33±1.30), perceived behavioral control (8.18±1.76), action self-efficacy (8.60±1.66), maintenance self-efficacy (12.29±2.25), intention (8.05±1.55), action planning (8.00±1.62), coping planning (8.08±1.62), and COVID‐19 preventive behaviors (10.78±1.99) were at a medium level. There was a good correlation between the constructs of the integrated model (r = 0.42-0.64, p<0.001). Students who were older, unmarried, had a mother or father with a university education, were nondormitory, were native, at the basic science level obtained higher scores for the model constructs (p<0.001). These findings should be considered to improve health education interventions and encourage COVID-19 preventive behaviors in students.

Assessing the impact of COVID-19 pandemic on the performance indicators of safety management using the analytic hierarchy process (AHP) in an electricity industry.

Introduction: The importance of evaluating the performance of different management systems in industries necessitates examining the performance of the Health, Safety, and Environment (HSE) management system along with other management systems. Particularly during the COVID-19 pandemic, there is a greater need than ever to assess the impact of the COVID-19 spread on the performance of the HSE management system compared to before this pandemic. This research aims to investigate safety performance indicators (SPIs) on the performance of the HSE management system and the impact of the COVID-19 spread on these indicators. Methods: This cross-sectional, descriptive-analytical study was conducted to evaluate the influence of the COVID-19 outbreak on the safety performance to revise the industry safety index in an electricity distribution company using the multi-criteria decision-making method before and after the disease epidemic in three stages. In the first part, the safety indicators were identified according to the comprehensive safety indicators available in the industries and experts' opinions. In the second part, safety indicators were ranked, weighted, and prioritized using the Analytic Hierarchy Process (AHP). In the third part, these indicators were calculated and compared in the periods before and after the outbreak of COVID-19. Results: Two main criteria, namely the "effectiveness criterion" and the "applicability/calculation criterion", were identified for the evaluation and pairwise comparisons of performance indicators. Among these two criteria, the applicability/calculation criterion had higher priority and importance for the evaluation of indicators. Pairwise comparisons of the indicators indicated that the "accident frequency rate" and "safe T-factor" indicators (with weights of 0.238 and 0.023 respectively) had the highest and lowest priorities, respectively, for the assessment of organizational safety performance among the SPIs. Conclusion: Based on the calculations of the indicators and their analyses before and after the outbreak of COVID-19, the current status of the safety performance of the HSE unit was not significantly affected by this pandemic. However, the investigations carried out while collecting the data needed to calculate the indicators and evaluate the performance of this unit demonstrated that some indicators were not considered sufficiently in the studied electricity industry. Since conducting regular performance evaluations greatly impacts the achievement of continuous improvement, more attention should be paid to compiled indicators, which should be periodically assessed in the organization to achieve continuous improvement.

Diazepam and exercise training combination synergistically reduces lipopolysaccharide-induced anxiety-like behavior and oxidative stress in the prefrontal cortex of mice.

Anxiety-related disorders are among the most important risks for global health, especially in recent years due to the COVID-19 pandemic. Benzodiazepines like diazepam are generally used to treat anxiety disorders, but the overall outcome is not always satisfactory. This is why psychiatrists encourage patients with anxiety to change their lifestyle habits to decrease the risk of anxiety recurrence. However, the effect of diazepam and exercise in combination is unknown. This study aimed to investigate the effect of diazepam alone or in combination with swimming exercise on lipopolysaccharide (LPS)-induced anxiety-like behavior and oxidative stress in the hippocampus and prefrontal cortex of mice. Mice were exposed to diazepam and swimming exercise alone or in combination with each other and then received LPS. We assessed anxiety-like behavior using open field and light-dark box and measured oxidative markers including glutathione (GSH), malondialdehyde (MDA), and glutathione disulfide (GSSG) in the hippocampus and prefrontal cortex. The findings showed that LPS increased anxiety-related symptoms and oxidative stress by decreasing GSH and increasing MDA and GSSG levels in the prefrontal cortex but not in the hippocampus. Although diazepam alone did not reduce anxiety-like behavior and oxidative stress, it in combination with exercise significantly decreased anxiety-like behavior and oxidative stress in the prefrontal cortex of LPS-treated mice. This drug and exercise combination also displayed a more effective effect in comparison with exercise alone. Overall, this study suggests that diazepam in combination with swimming exercise has higher efficacy on anxiety-like behavior and oxidative stress than when they are used alone.

Obesity Differs from Diabetes Mellitus in Antibody and T Cell Responses Post COVID-19 Recovery (preprint)

Objective: Obesity and type 2 diabetes (DM) are risk factors for severe COVID-19 outcomes, which disproportionately affect South Asian populations. This study aims to investigate the humoral and cellular immune responses to SARS-CoV-2 in adult COVID-19 survivors with obesity and DM in Bangladesh. Methods: In this cross-sectional study, SARS-CoV-2-specific antibody and T cell responses were investigated in 63 healthy and 75 PCR-confirmed COVID-19 recovered individuals in Bangladesh, during the pre-vaccination first wave of the COVID-19 pandemic in 2020. Results: In COVID-19 survivors, SARS-CoV-2 infection induced robust antibody and T cell responses, which correlated with disease severity. After adjusting for age, sex, DM status, disease severity, and time since onset of symptoms, obesity was associated with decreased neutralising antibody titers, and increased SARS-CoV-2 spike-specific IFN-{gamma} response along with increased proliferation and IL-2 production by CD8+ T cells. In contrast, DM was not associated with SARS-CoV-2-specific antibody and T cell responses after adjustment for obesity and other confounders. Conclusions: Obesity is associated with lower neutralising antibody levels and higher T cell responses to SARS-CoV-2 post COVID-19 recovery, while antibody or T cell responses remain unaltered in DM.

Current and future trends in multiple sclerosis management: Near East perspective.

BACKGROUND: Multiple sclerosis (MS) prevalence is rising in the Middle East. Most MS medications are available in the region, but not all, possibly affecting neurologists' prescribing habits. OBJECTIVES: To provide an overview of the current practices of Near East (NE) healthcare practitioners by probing their prescribing decisions, to report the COVID-19 impacts on neurologists' prescribing habits, and to explore the future relevance of current medication used in MS management among other newcomers. METHODS: A cross-sectional study was carried out using an online survey from April 27, 2022, to July 5, 2022. The questionnaire was designed with the input of five neurologists representing five NE countries (Iran, Iraq, Lebanon, Jordan & Palestine). They identified several factors that play a crucial role in the optimal care of MS patients. The link was shared among neurologists using snowball sampling. RESULTS: The survey included 98 neurologists. Effectiveness and safety balance was the most important factor considered when selecting the MS treatment. Among patients with MS, the most challenging factor for the patients was thought to be related to family planning, followed by affordability and tolerability of side effects. In the treatment of mild to moderate relapsing remitting multiple sclerosis (RRMS) in men, Interferon beta 1a SC, Fingolimod, and Glatiramer acetate were the most commonly recommended treatments. Dimethyl fumarate substituted fingolimod in female patients. Interferon beta 1a SC was the safest treatment for mild to moderate RRMS. Interferon beta 1a SC was preferred over other treatments for patients with mild to moderate MS and planning for pregnancy (56.6%) or breastfeeding (60.2%). Fingolimod was not a choice for these patients. Neurologists seemed to discuss the top three treatments of Natalizumab, Ocrelizumab, and Cladribine with patients with highly active MS. When asked to position future disease-modifying therapies five years from today, more than 45% of physicians expressed a lack of information on Bruton's tyrosine kinase (BTK) inhibitors. CONCLUSIONS: Most neurologists in the NE region followed Middle East North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) recommendations for prescribing treatment. The treatment choice also depended on the availability of disease-modifying therapies (DMTs) in the region. Regarding the use of upcoming DMTs, there is a clear need for real-world data, long-term extension studies, and comparative studies to support their efficacy and safety profiles in treating patients with MS.

Clinical and laboratory features of SARS-CoV-2 variants across multiple rounds of pandemic waves in hospitalized children in an Iranian referral hospital.

BACKGROUND: Since the onset of the COVID-19 pandemic, SARS-CoV-2 has evolved into independent new forms, variants of concern (VOCs). While epidemiological data showed increased transmissibility of VOCs, their impact on clinical outcomes is less clear. This study aimed to investigate the differences between the clinical and laboratory features of children infected with VOCs. METHODS: This study included all cases with SARS-CoV-2-positive nasopharyngeal swabs obtained from patients referred to Children's Medical Center (CMC), an Iranian referral hospital, between July 2021 and March 2022. The inclusion criteria for this study included all patients, regardless of age, who had a positive test anywhere in the hospital setting. Exclusion criteria for the study included those whose data was obtained from non-hospital outpatient settings, or referred from another hospital. The SARS-CoV-2 genome area encoding the S1 domain was amplified and sequenced. The type of variant in each sample was identified based on the mutations in the S1 gene. Demographic characteristics, clinical data, and laboratory findings were collected from the patient's medical records. RESULTS: This study included 87 pediatric cases with confirmed COVID-19, with a median age of 3.5 years (IQR: 1-8.12). Data from sequencing reveals the type of variants as 5 (5.7%) alpha, 53 (60.9%) Delta, and 29 (33.3%) Omicron. The incidence of seizure was higher in patients with Alpha and Omicron infection compared to the Delta group. A higher incidence of diarrhea was reported in Alpha-infected patients, and a higher risk of disease severity, distress, and myalgia was associated with Delta infection. CONCLUSION: Laboratory parameters did not mostly differ among the patients infected with Alpha, Delta, and Omicron. However, these variants may manifest different clinical features. Further studies with larger sample sizes are required to fully understand the clinical manifestations of each variant.

Cardiac Tamponade as a Complication of Microscopic Polyangiitis: A Case Associated With a COVID-19 mRNA Vaccine.

Widespread uptake of the coronavirus disease 2019 (COVID-19) vaccinations has become the world's championed defense against the global pandemic. Four vaccines have been either approved or authorized for emergency use by the FDA, and at this time, over 13 billion doses of these vaccines have been administered around the world. Unfortunately, uncommon and sometimes unforeseen side effects such as small-vessel vasculitis have been reported. In this case report, we present a 74-year-old woman with a history of hypertension, type 2 diabetes mellitus, and hypothyroidism who developed microscopic polyangiitis (MPA) following the second dose of the Pfizer-BioNTech mRNA vaccine for COVID-19. The diagnosis of MPA was confirmed by a kidney biopsy. The autoimmune condition progressed to pericardial effusion and eventual cardiac tamponade, which is occasionally seen in the disease. In this patient's case, we suspect there to be a temporal association between mRNA COVID-19 vaccination and the development of MPA. Direct causation has not been determined.

Application of Artificial Intelligence to Predict CO2 Emissions: Critical Step towards Sustainable Environment

Prediction of carbon dioxide (CO2) emissions is a critical step towards a sustainable environment. In any country, increasing the amount of CO2 emissions is an indicator of the increase in environmental pollution. In this regard, the current study applied three powerful and effective artificial intelligence tools, namely, a feed-forward neural network (FFNN), an adaptive network-based fuzzy inference system (ANFIS) and long short-term memory (LSTM), to forecast the yearly amount of CO2 emissions in Saudi Arabia up to the year 2030. The data were collected from the "Our World in Data” website, which offers the measurements of the CO2 emissions from the years 1936 to 2020 for every country on the globe. However, this study is only concerned with the data related to Saudi Arabia. Due to some missing data, this study considered only the measurements in the years from 1954 to 2020. The 67 data samples were divided into 2 subsets for training and testing with the optimal ratio of 70:30, respectively. The effect of different input combinations on prediction accuracy was also studied. The inputs were combined to form six different groups to predict the next value of the CO2 emissions from the past values. The group of inputs that contained the past value in addition to the year as a temporal index was found to be the best one. For all the models, the performance accuracies were assessed using the root mean squared errors (RMSEs) and the coefficient of determination (R2). Every model was trained until the smallest RMSE of the testing data was reached throughout the entire training run. For the FFNN, ANFIS and LSTM, the averages of the RMSEs were 19.78, 20.89505 and 15.42295, respectively, while the averages of the R2 were found to be 0.990985, 0.98875 and 0.9945, respectively. Every model was applied individually to forecast the next value of the CO2 emission. To benefit from the powers of the three artificial intelligence (AI) tools, the final forecasted value was considered the average (ensemble) value of the three models' outputs. To assess the forecasting accuracy, the ensemble was validated with a new measurement for the year 2021, and the calculated percentage error was found to be 6.8675% with an accuracy of 93.1325%, which implies that the model is highly accurate. Moreover, the resulting forecasting curve of the ensembled models showed that the rate of CO2 emissions in Saudi Arabia is expected to decrease from 9.4976 million tonnes per year based on the period 1954–2020 to 6.1707 million tonnes per year in the period 2020–2030. Therefore, the finding of this work could possibly help the policymakers in Saudi Arabia to take the correct and wise decisions regarding this issue not only for the near future but also for the far future.

Nurses' clinical competency and its correlates: before and during the COVID-19 outbreak.

BACKGROUND: Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic. METHODS: We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered. RESULTS: The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic. CONCLUSION: The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.

Virome diversity of Hyalomma dromedarii ticks collected from camels in the United Arab Emirates.

Background and Aim: Viruses are important components of the microbiome of ticks. Ticks are capable of transmitting several serious viral diseases to humans and animals. Hitherto, the composition of viral communities in Hyalomma dromedarii ticks associated with camels in the United Arab Emirates (UAE) remains unexplored. This study aimed to characterize the RNA virome diversity in male and female H. dromedarii ticks collected from camels in Al Ain, UAE. Materials and Methods: We collected ticks, extracted, and sequenced RNA, using Illumina (NovaSeq 6000) and Oxford Nanopore (MinION). Results: From the total generated sequencing reads, 180,559 (~0.35%) and 197,801 (~0.34%) reads were identified as virus-related reads in male and female tick samples, respectively. Taxonomic assignment of the viral sequencing reads was accomplished based on bioinformatic analyses. Further, viral reads were classified into 39 viral families. Poxiviridae, Phycodnaviridae, Phenuiviridae, Mimiviridae, and Polydnaviridae were the most abundant families in the tick viromes. Notably, we assembled the genomes of three RNA viruses, which were placed by phylogenetic analyses in clades that included the Bole tick virus. Conclusion: Overall, this study attempts to elucidate the RNA virome of ticks associated with camels in the UAE and the results obtained from this study improve the knowledge of the diversity of viruses in H. dromedarii ticks.

Factors contributing to coronavirus disease 2019 vaccine hesitancy among healthcare workers in Iran: A descriptive-analytical study.

Background: Despite the easy availability of coronavirus disease 2019 (COVID-19) vaccination services for healthcare workers (HCWs), some of them hesitate about receiving the vaccine. The aim of this study was to assess the factors contributing to COVID-19 vaccine hesitancy (VH) among HCWs in Iran. Methods: This cross-sectional descriptive-analytical study was conducted in 2021-2022. Participants were 551 HCWs selected through systematic random sampling from four leading university hospitals in Zanjan, Iran. A demographic questionnaire and a 36-item COVID-19 VH questionnaire were used for data collection. Data were analyzed using the SPSS software (v. 20) and through the independent-sample t-test, the one-way analysis of variance, and the multiple linear regression analysis. Findings: Participants' age mean was 34.40 ± 7.77 years and most of them were female (65.9%) and married (70.8%) and had university education (88.6%). The mean score of VH was 96.29 ± 12.88 (in the possible range of 36-180), 79.49% of participants had moderate VH, and 17.42% of them had high VH. COVID-19 VH had significant relationship with organizational role, history of chronic disease, COVID-19-related knowledge, history of COVID-19 vaccination, and history of colleagues' or relatives' death after vaccination (P < 0.05). The significant predictors of COVID-19 VH were COVID-19-related knowledge (ß = -0.113; P = 0.008) and history of COVID-19 vaccination (ß = 0.165; P < 0.001). Conclusion: COVID-19 VH among HCWs is moderate to high, nurses have the highest VH, and the significant predictors of VH are COVID-19-related knowledge and history of COVID-19 vaccination.

The pathogenetic influence of smoking on SARS-CoV-2 infection: Integrative transcriptome and regulomics analysis of lung epithelial cells.

Corona virus disease (COVID-19) has been emerged as pandemic infectious disease. The recent epidemiological data suggest that the smokers are more vulnerable to infection with COVID-19; however, the influence of smoking (SMK) on the COVID-19 infected patients and the mortality is not known yet. In this study, we aimed to discern the influence of SMK on COVID-19 infected patients utilizing the transcriptomics data of COVID-19 infected lung epithelial cells and transcriptomics data smoking matched with controls from lung epithelial cells. The bioinformatics based analysis revealed the molecular insights into the level of transcriptional changes and pathways which are important to identify the impact of smoking on COVID-19 infection and prevalence. We compared differentially expressed genes (DEGs) between COVID-19 and SMK and 59 DEGs were identified as consistently dysregulated at transcriptomics levels. The correlation network analyses were constructed for these common genes using WGCNA R package to see the relationship among these genes. Integration of DEGs with network analysis (protein-protein interaction) showed the presence of 9 hub proteins as key so called "candidate hub proteins" overlapped between COVID-19 patients and SMK. The Gene Ontology and pathways analysis demonstrated the enrichment of inflammatory pathway such as IL-17 signaling pathway, Interleukin-6 signaling, TNF signaling pathway and MAPK1/MAPK3 signaling pathways that might be the therapeutic targets in COVID-19 for smoking persons. The identified genes, pathways, hubs genes, and their regulators might be considered for establishment of key genes and drug targets for SMK and COVID-19.

Central nervous system reactivation of herpesviridae family in patients with COVID-19.

The objective of this study is to describe our COVID-19 patients with herpesviridae reactivation in the central nervous system (CNS). Four patients were described including two with acute encephalitis and two with acute encephalomyelitis. Three of four patients had abnormal findings on neuroimaging studies. One of four patients died, one survived with major neurological sequelae, and two others fully recovered. Herpesviridae reactivation in the CNS in patients with COVID-19 is a rare but serious coincidence. The optimal therapeutic management has not been investigated and until more information is available, it is prudent to treat these patients with appropriate antivirals with or without anti-inflammatory agents.

Aortic dissection and Covid-19; a comprehensive systematic review.

Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased mortality rates worldwide. Although it was initially known as an acute respiratory disease, Covid-19 is accompanied with several extrapulmonary manifestations, of which the cardiovascular ones are of major importance. Among other cardiovascular complications of Covid-19, aortic dissection has been a significant yet underrated problem. The pathophysiology of aortic dissection consists of various inflammatory pathways, that could be influenced by Covid-19 infection. We herein have reviewed articles inclusive of aortic dissection concurrent with Covid-19 infection in a systematic manner, along with the probable similarities in pathophysiology of aortic dissection with Covid-19 infection.

Comparison of hematological and inflammatory markers to predict outcome in COVID-19 in 1st and 4th wave

OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers;neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st wave compared with the 4th wave regarding inflammatory markers;CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7 on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality. CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19.

Comprehending the intention to use branchless banking by rural people during the corona pandemic: evidence from Bangladesh

The banking sector can take advantage of the proliferation of online banking as well as government's reinforcement of cashless transactions to expedite the usage of branchless banking. The prime objective of this study is to examine the factors that affect rural people's bounded rational intention toward branchless banking conduct during this Corona Pandemic in Bangladesh. In doing so, the theory of bounded rational intention was used as its theoretical background. Data (n = 390) were collected from the people residing in the rural areas surrounding branchless banking booths where no branch banking services are available. Data were analyzed employing structural equation modeling by AMOS software. The findings of the study indicate that all factors are positively significant to influence the rural people's bounded rational intention toward branchless banking behavior. The results also show that trustworthiness and normative structure exhibit the highest positive significance to influence people's bounded rational intention. It implies that the agents ought to be trustworthy for popularizing the branchless banking services in the rural areas. The outputs of this study provide insight into branchless banking services which will help banks and financial institutions formulate right policy on branchless banking strategy.

The pathogenetic influence of smoking on SARS-CoV-2 infection: Integrative transcriptome and regulomics analysis of lung epithelial cells

Corona virus disease (COVID-19) has been emerged as pandemic infectious disease. The recent epidemiological data suggest that the smokers are more vulnerable to infection with COVID-19;however, the influence of smoking (SMK) on the COVID-19 infected patients and the mortality is not known yet. In this study, we aimed to discern the influence of SMK on COVID-19 infected patients utilizing the transcriptomics data of COVID-19 infected lung epitheial cells and transcriptomics data smoking matched with controls from lung epithelial cells. The bioinformatics based analysis revealed the molecular insights into the level of transcriptional changes and pathways which are important to identify the impact of smoking on COVID-19 infection and prevalence. We compared differentially expressed genes (DEGs) between COVID-19 and SMK and 59 DEGs were identified as consistently dysregulated at transcripomics levels. The correlation network analyses were constructed for these common genes using WGCNA R package to see the relationship among these genes. Integration of DEGs with network analysis (protein-protein interaction) showed the presence of 9 hub proteins as key so called ”candidate hub proteins” overlapped between COVID-19 patients and SMK. The Gene Ontology and pathways analysis demonstrated the enrichment of inflammatory pathway such as IL-17 signaling pathway, Interleukin-6 signaling, TNF signaling pathway and MAPK1/MAPK3 signaling pathways that might be the therapeutic targets in COVID-19 for smoking persons. The identified genes, pathways, hubs genes, and their regulators might be considered for establishment of key genes and drug targets for SMK and COVID-19.

Medicinal Plants for Viral Respiratory Diseases: A Systematic Review on Persian Medicine.

Introduction: Many medicinal plants have been introduced in Persian medicine references for various respiratory disorders. Considering the growing interest in herbal medicines, this review aimed to introduce medicinal herbs recommended by Persian Medicine (PM) references for respiratory diseases and to discuss their activity against respiratory viruses. Methods: The medicinal plants recommended for respiratory disorders were extracted from the main PM textbooks. Subsequently, their activity against respiratory viruses was systematically investigated via queries of scientific databases. Results: Searching PM references for medicinal plants used in the management of respiratory disorders yielded 45 results. Of them, 18 possess antiviral activity against respiratory viruses. There were 29 in vitro studies (including studies on human cell lines) and 5 in vivo studies. Conclusion: This research demonstrated that many of the medicinal plants mentioned for the respiratory diseases in PM have considerable activity against respiratory viruses. However, human studies regarding the reported medicinal plants are scarce.

Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure.

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.