Introduction: The opinion that latent T. gondii infection is having a broadly asymptomatic projection has now been interrogated, in specific due to the echoed association between the latent infection and an elevated incidence of schizophrenia or even suicide attempts. Notwithstanding conducted studies aimed to understand this feasible link are restricted. Methods: In the present case-control study, we focused to illuminate the relationship between the serological and molecular presence of T. gondii and schizophrenia with or without the suicide attempts by comparing it with healthy individuals. A total of 237 participants (117 in schizophrenia; 120 in healthy control) were included in this study. Results: Overall, latent T. gondii infections were found statistically higher in 63 (53.8%) of the 117 patients with schizophrenia and in 33 (27.5%) of the 120 controls (p < 0.001). In schizophrenia patients, seroprevalence T. gondii was again found to be statistically higher in suicide attempters (59.6%), compared to no history of suicide attempts (48.3%) (p < 0.05). The molecular positivity rate of T. gondii DNA was higher in the schizophrenia group, compared to the healthy control group (p < 0.05), whereas the history of suicide attempts was not statistically associated (p = 0.831) with T. gondii DNA positivity by PCR. Conclusion: This case-control study enlightens additional demonstration to the belief that T. gondii infection would be an underlying component for the pathophysiology of schizophrenia. Regardless of the clarity results of this study, this supposition warrants further endorsement.

Background: To determine the frequency of breastfeeding of mothers working in primary care, the differences between different employment groups, and the effective factors. Methods: This descriptive research study was conducted with a self-report online survey design. The snowball sampling method was used for the sample selection, and 151 family physicians and 126 family health professionals were included in the study during the research period (June 2019-December 2019). A 35-item survey was used to collect data. The response rate was 44.9% (49.5% family physicians/40.3% family health professionals). Results: The mean duration of exclusive breastfeeding was 3.9 ± 2.0 months, and the mean duration of total breastfeeding was 16.7 ± 8.5 months. There was no significant difference between the family physicians and family health professionals in terms of exclusive breastfeeding (P = 0.580) and total breastfeeding (P = 0.325) durations. The most common reasons for weaning was reduced milk supply (25.6%) and not being able to use breastfeeding leave (23.1%) due to problems at work. Of the sample, 41.3% had problems with their co-workers and 41.9% had problems related to patient care when taking breastfeeding leave. Working in a baby-friendly center (P = 0.010), prolonged exclusive breastfeeding (P < 0.001), and increased hours of breastfeeding leave taken (P = 0.001) had a positive effect on breastfeeding for ≥24 months while experiencing problems with co-workers in taking breastfeeding leave (P = 0.023) had a negative effect on this variable. Conclusions: All of the factors that were determined to affect the continuation of breastfeeding for ≥24 months are modifiable. It is very important for relevant authorities to undertake necessary action to improve the conditions of working mothers based on these results. Health professional that can maintain the balance between family and work will work more efficiently.

Background: Denosumab is a monoclonal antibody approved for the treat-ment of postmenopausal osteoporosis. The withdrawal of denosumab produc-es an abrupt loss of bone mineral density and may cause multiple vertebral fractures (MVF). Objective: To study the clinical, biochemical and densitometric characteristics in a large series of postmenopausal women who suffered MVF after deno-sumab withdrawal. Likewise, we try to identify those factors related to the presence of a greater number of vertebral fractures (VF). Patients and Methods: 56 patients (54 women) who suffered MVF after re-ceiving denosumab at least for 3 consecutive years and abruptly suspended it. A clinical examination was carried out. Biochemical bone remodeling markers (BBRM) and bone densitometry at the lumbar spine and proximal femur were measured. VF were diagnosed by MRI, X-ray or both at dorsal and lumbar spine. Results: 56 patients presented a total of 192 VF. 41 patients (73.2%) had not previously suffered VF. After discontinuation of the drug, a statistically signifi-cant increase in the BBRM was observed. In the multivariate analysis, only the time that denosumab was previously received was associated with the pres-ence of a greater number of VF (p = 0.04). Conclusions: We present the series with the largest number of patients col-lected to date. 56 patients accumulated 192 new VF. After the suspension of denosumab and the production of MVF, an increase in the serum values of the BBRM. The time of denosumab use was the only parameter associated with a greater number of fractures.

Background: Obesity is a global issue. Energy density (ED) can influence on body compositions (BCs). Consumption of HED (high energy density) foods can increase body fat mass (BFM) and inflammatory markers. Methods: This study was a cross-sectional research among 391 women. Body composition analyzer (BIA) and food frequency questionnaire (FFQ) was used to assess BCs and food intake of individuals. Blood samples and serum level of high-sensitive C-reactive protein (hs-CRP), plasminogen activator inhibitor- 1 (PAI-1) and transforming growth factor-β (TGF-beta) were collected. ED per one gram of foods were calculated and divided to quartiles. Linear logistic regression tests were used to investigate the association between BCs across quartiles of ED intake. Results: Results demonstrate skeletal muscle mass (SMM), total body water (TBW), intracellular water (ICW), fat free mass (FFM), visceral fat area (VFA) and fat free mass index (FFMI) was seem to be under the effect of hs-CRP among ED intakes. TBW, extracellular water (ECW), FFM with PAI-1, bone mineral content (BMC) with PAI-1 and TGF-beta, and Skeletal lean mass (SLM) with hs-CRP were inversely associated. Fat right arm (FRA), fat right arm (FLA), fat right and left leg (FRL,FLL), fat trunk, TBW, ICW, ECW, BFM, FFM, SMM, SLM, waist circumference (WC), FFMI and FMI were positively under the influence of TGF-beta after following higher ED food intakes. FRA, FLA, FRL, FLL, fat trunk, ICW, BFM, SMM, SLM, WC, FFMI and FMI were positively under the influence of PAI-1. Conclusion: All adipose tissue content of subcategories of BC were strongly associated with ED intake in the mediatory role of PAI-1 and TGF-beta.

Background Pharmacotherapies are widely used for smoking cessation. However, their effect on smoking cessation for people with alcohol dependence remains unclear. Objective This study aimed to explore the effects of pharmacotherapies on smoking cessation for people with alcohol dependence. Methods Five electronic databases were searched in January 2021 for randomized controlled trials (RCTs) reporting the use of pharmacotherapies to promote smoking cessation in people with alcohol dependence. The risk of bias was assessed using the Cochrane tool. RevMan version 5.3 was used to perform meta-analyses of the changes in smoking behavior, and the GRADE approach was used to assess the certainty of the evidence. Results Nine RCTs involving 908 smokers with alcohol dependence were identified. Eight RCTs were published in the United States, and one was from Canada. The risk of bias was rated as low in three studies and unclear in the remaining six. The results of the meta-analysis showed that, compared with the placebo group, Varenicline had a significant effect on short-term smoking cessation (three RCTs, OR = 6.27, 95% CI: [2.49, 15.78], p < 0.05, very low certainty). Naltrexone had no significant effect on smoking cessation in short-term or long-term observations (three RCTs, OR = 0.99, 95% CI: [0.54, 1.81], p = 0.97, moderate certainty), and Topiramate had no significant effect (two RCTs, OR = 1.56, 95% CI: [0.67, 3.46], p > 0.05, low certainty). Only one trial reported that Bupropion had no effect on smoking cessation. Conclusion Varenicline may have a positive effect on smoking cessation in people with alcohol dependence. However, Naltrexone, Topiramate, and Bupropion seem to have no clear effect on increasing smoking abstinence among drinkers. The small number of studies and the low certainty of evidence indicate that caution is required in interpreting the results.

Introduction: Most patients with COVID-19 have mild or moderate manifestations, however, there is a wide spectrum of clinical presentations and even more severe repercussions that require high diagnostic suspicion. Vital sign acquisition and monitoring are crucial for detecting and responding to patients with COVID-19. Objective: Thus, we conducted this study to demonstrate the impact of using a tool called Smart Check on the triage time of patients with suspected COVID-19 and to identify the main initial clinical manifestations in these cases. Methodology: We assessed triage times before and after the use of Smart Check in 11,466 patients. In this group, we identified 211 patients for the identification of COVID-19 clinical manifestations in a case-control analysis. Results: Smart Check was able to decrease the triage time by 33 seconds on average, with 75% of the exams being performed within 5 minutes, whereas with the usual protocol these steps were performed within 6 minutes. A range of clinical presentations made up the COVID-19 initial manifestations. Those with the highest frequency were dry cough (46.8%), fever (41.3%), dyspnea (35.8%), and headache (32.1%). Loss of appetite, fever, and ageusia were the manifestations that had a statistically significant association with the SARS-CoV-2 presence. Conclusions: Smart Check, a simple clinical evaluation tool, along with the targeted use of rapid PCR testing, can optimize triage time for patients with and without COVID-19. In triage centers, a number of initial signs and symptoms should be cause for SARS-CoV-2 infection suspicion, in particular the association of respiratory, neurological, and gastrointestinal manifestations. Keywords: new coronavirus, COVID-19, triage, clinical manifestations

Objectives: Severe disease characterized by interstitial pneumonia may develop in some cases of coronavirus disease (COVID-19). Periostin has been associated with many respiratory diseases. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. Methods: In the study, 32 patients followed up during May–July 2020 due to COVID-19 and 24 healthy controls were included. The patients were divided into two groups, namely, mild/moderate and severe, according to the severity of the disease. Serum periostin and transforming growth factor beta (TGF-β) levels were tested using an enzyme-linked immunosorbent assay (ELISA) method using commercially available ELISA kits. Results: It was observed that the periostin level was significantly higher in both mild/moderate cases and severe cases compared to the control group at first presentation. However, TGF-β levels at first presentation were similar between the groups. Conclusions: Our study is the first study to investigate periostin levels in patients with COVID-19, and we believe that periostin can be used as a new biomarker. Keywords: COVID-19, Periostin, TGF-β, Pneumonia, New Biomarker Coronaviruses are among the main pathogens that mainly target the human respiratory system. Severe disease characterized by interstitial pneumonia develops in 10-20% of patients. Periostin has recently been shown to be an indicator of disease progression in idiopathic pulmonary fibrosis and asthma. In this study, we aimed to investigate whether periostin could be a useful new biomarker in the follow-up and severity assessment of the disease in patients with COVID-19 pneumonia. This article demonstrated that periostin is a useful new biomarker for disease follow-up and severity in patients with COVID-19 pneumonia. It is also the first study on periostin levels in patients with COVID-19

Introduction: Many patients with chronic diseases often use the traditional medicine approach in addition to conventional medicine. The aim of this study was to evaluate the epidemiological factors of patients with dermatologcal conditions referring to traditional Persian Medicine (TPM) clinic. Materials and Methods: In this cross-sectional study, we reviewed all the patients’ medical documents with dermatological conditions referred to the TPM clinic at Shiraz, Southern Iran in 2018. Then, the epidemiological factors of the patients were recorded to a researcher-made data collection form. SPSS software version 22 was conducted to data analysis. Results: Overall, 631 patients consist of 151 (23.9%) male individuals and 580 (76.1%) female individuals were enrolled to the study. Most of the patients were aged between 31 and 40 years, and 347 (55%) patients were married, and most of them were housewives. The frequency of patients in spring was higher than other seasons. Furthermore, the most of the patients were university educated. Acne, eczema and hair loss were the three most complaints of the patients referring to the traditional medicine clinic. 301(47.7%) patients reported gastrointestinal problems as another complaint concomitant with their skin problems. Conclusion: It seems that women with skin problems, including acne, eczema, and hair loss, were more likely to refer to the TPM clinic. Therefore, development of TPM clinics in dermatology field as a scientific and academic approach can be effective in the treatment of patients with dermatological condition accompanied by traditional medicine.

Objectives The aim of the present study is to develop and validate the COVID-Q, a novel symptom questionnaire specific for COVID-19 patients, to provide a comprehensive and standard clinical evaluation. A secondary goal of the present study was to evaluate the performance of the COVID-Q in identifying subjects at higher risk of being tested positive for COVID-19. Material and methods 460 subjects (230 COVID-19 cases and 230 healthy controls), answered the COVID-Q. Parallel Analysis and Principal Component Analysis were used to identify clusters of items measuring the same dimension. The IRT-based analyses evaluated the functioning of item categories, the presence of clusters of local dependence among items, item fit within the model and model fit to the data. Results Parallel analysis suggested the extraction of six components, which corresponded to as many clinical presentation patterns: asthenia, influenza-like symptoms, ear and nose symptoms, breathing issues, throat symptoms, and anosmia/ageusia. The final IRT models retained 27 items as significant for symptom assessment. The total score on the questionnaire was significantly associated with positivity to the molecular SARS-CoV-2 test. Subjects with multiple symptoms were significantly more likely to be affected by COVID-19 (p < .001). Older age and male gender also represented risk factors. None of the examined comorbidities had a significant association with COVID-19 diagnosis. Conclusion The application of the novel COVID-Q to everyday clinical practice may help identifying subjects who are likely to be affected by COVID-19 and address them to a nasopharyngeal swab in order to achieve an early diagnosis.

Objective: We hypothesized that omega-3 fatty acids would be an appropriate adjunct therapy for alleviating the inflammatory response and clinical manifestation in hospitalized patients with covid-19 disease. Methods: This was a single-blind randomized controlled trial in Amir-Alam hospital in Tehran. Thirty adult men and women diagnosed with covid-19 were allocated to either control group (receiving Hydroxychloroquine) or intervention group (receiving Hydroxychloroquine plus 2 grams of DHA+EPA) for 2 weeks. Primary outcome of the intervention including CRP, ESR as well as clinical symptoms including body pain, fatigue, appetite and olfactory and secondary outcomes including liver enzymes were determined at the baseline and after omega-3 supplementation. Clinical signs were measured using self-reported questionnaires. There were commercial kits for determination of CRP and liver enzymes concentrations in the serum of patients. For determination of ESR automated hematology analyzer was applied. Results: In comparison to control group, patients receiving omega-3 indicated favorable changes in all clinical symptoms except for olfactory ((p<0.001 for body pain and fatigue, p= 0.03 for appetite and p=0.21 for olfactory). Reducing effects of omega-3 supplementation compared to control group were also observed in the levels of ESR and CRP after treatment (p<0.001 for CRP and p=0.02 for ESR). However, no between group differences in the liver enzymes serum concentrations were observed after supplementation (p>0.05). Conclusion: Current observations are very promising and indicate that supplementation with moderate dosages of omega-3 fatty acids may be beneficial in the management of inflammation-mediated clinical symptoms in covid-19 patients. Key words: Covid-19, omega-3, inflammation, clinical symptoms

Background/Aim: The purpose of this article is to review the published literature on single-port laparoscopic (SPL) ovarian cystectomy and to assess whether the reduced port number affects the ovarian reserve in comparison with the conventional multiport laparoscopic (MPL) ovarian cystectomy. Materials and methods: Serum anti-Müllerian hormone (AMH) had been proposed as the most accurate marker of ovarian reserve. A review of the current literature was performed based on the preoperative and postoperative AMH after SPL and MPL ovarian cystectomy in adult patients with benign ovarian cysts. Results: Ovarian cystectomy causes a non-statistically significant reduction in AMH levels four weeks postoperatively in the SPL group compared to MPL group[MD=0.11, 95%CI (-0.01, 0.24), p=0.07] . Operative time was significantly longer and blood loss was significantly higher in SPL group. No difference was found to major or overall postoperative complications between the two groups Conclusion: SPL cystectomy recommended as a safe surgical choice for patients who want to preserve their fertility.

Methods: We systemically and comprehensively retrieved the eligible study evaluating clinical difference between severe versus non-severe Covid-19. Main effect sizes were demography characteristics, comorbidities, signs and symptoms, laboratory findings as well as radiological features in chest CT. Results: 14 studies with a total of 2,566 individuals (771 in Severe group and 1,795 in Non-severe group) were eligible for this meta-analysis. It was demonstrated that older and male person was more susceptible to severe Covid-19. Patients with underlying comorbidity, such as hypertension, diabetes, heart disease and COPD were associated with significantly increased susceptibility of severe Covid-19. Patients with dyspnea were more likely to be severe illness. Depressed total lymphocytes were observed in this article. Meanwhile, although reticulation (30.8%), intrathoracic lymph node enlargement (56.4%) and pleural effusions (30.8%) were relatively rarely seen, meta-analysis revealed that patients with these presentations in chest CT were associated with increased risks of severe Covid-19. Conclusions: There are significant differences in clinical characteristic between the severe and non-severe Covid-19 patients. Many factors are related to the severity of the disease, which can help clinicians to differentiate severe patient from non-severe patient.

Background: Community pharmacists are one of the most accessible healthcare practitioners worldwide used by a large proportion of the population. Expanding the roles of community pharmacists could contribute to reducing pressure on general health practice and other areas of the health services. This research aimed to evaluate the contribution of community pharmacists in the provision of public health services and to investigate the perceived barriers for the provision of these services in Saudi Arabia. Materials & Methods: This study followed a cross-sectional design using an online anonymous self-administered questionnaire. The study took place in Asir region, Saudi Arabia, between September 2019 and February 2020. A convenience sampling strategy was used to select and recruit the study participants. The questionnaire was adapted from previous research and involved three sections: demographics, involvement in public health services, and barriers for practising public health roles. Results: The total number of respondents was 193. The proportion of respondents who reported that they were “very involved” or “involved” in each service was 61.7% for weight management, 60.6% for sexual health, 57.5% for healthy eating, 53.4% for physical activity promotion, 51.3% for dental health, 46.1% for smoking cessation, 39.4% for screening for diabetes, 35.7% for screening for hypertension, 31.1% for alcohol dependence and drug misuse counselling, 30.6% for screening for dyslipidaemia, and 21.8% for vaccination and immunisation. Most of the barriers in the current research were rated as having low relevance to the provision of public health services. Conclusion: Findings in the current research suggest that community pharmacists in Asir region have intermediate to minimal engagement in practicing their public health roles. Further research needs to be undertaken to understand the barriers to the provision of public health services and what strategies would be beneficial for enhancing the public health role of community pharmacists in Saudi Arabia.

Introduction: The current study aims to evaluate the relationship between C-reactive protein (CRP) levels, thorax CT findings and CT-SS in patients presenting to the emergency department with COVID-19. Methods: Patients diagnosed with COVID-19 by nasopharyngeal rt-PCR (+) in the emergency department were included in the study. In addition to the CRP, ferritin and D-dimer examinations of patients at admission, thorax CT involvement findings and CT-SS results were recorded. The relationship of CRP value with CT-SS and clinical outcome was evaluated. Results: A total of 974 COVID-19 patients, 572 males (58.7%) and 402 females (41.3%), with a mean age of 59.64±17.34 years, were included in the study. The CRP values of the patients who needed intensive care and needed respiratory support were also significantly higher at admission (95.1 mg/dL vs. 31.05 mg/dL) (p<0.001). The CRP values of the patients who developed any complications during the treatment of COVID-19 were higher (79.9 mg/dL vs. 41.85 mg/dL) (p<0.001). In the case of CRP >124.5, a thorax CT density score 7.35 times higher was determined to be severe. In addition, it was determined that there was a 9.09-fold increase in the incidence of negative imaging findings in terms of COVID-19 in cases where the CRP value was <12.5 mg/dL. Conclusion: The CRP levels of COVID-19 patients measured upon admission to the emergency room are correlated with the severity of lung involvement and are an important predictor of clinical outcomes.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in profound health challenges across the globe. Pharmacists’ readiness to cope with the pandemic is critical in supporting and sustaining the healthcare workforce to meet the challenges.Objective This study aims to examine community pharmacists’ views on their work environment, policies, and preparedness for safe retail patronage to prevent the transmission of COVID-19 and assess the variables influencing coping strategies during the pandemic.Setting An online survey of pharmacists practicing in community pharmacy setting in Malaysia.Method A questionnaire-based, cross-sectional study was conducted in Malaysia to evaluate coping strategies of community pharmacists and pharmaceutical services provided during COVID-19 pandemic. Between May 1 and July 31, 2020, the questionnaire was distributed to pharmacists working in community setting nationwide utilizing a snowball sampling method. Main outcome measure Community pharmacists’ perceptions on safety, resilience, organizational support, and pharmaceutical services offered during COVID-19 pandemic.Results A total of 217 pharmacists participated in the study. The vast majority of community pharmacists reported a positive outlook and were able to balance working with self-care during this period. Most reported to have access to personal protective equipment such as gloves and hand sanitizers. A large proportion of community pharmacies also installed physical barriers in doorways or in front of the counter, put markings on the ground to section areas to ensure physical distancing, and controlled the number of customers who could access the pharmacy during this period. Innovations reported to be implemented included teleconsultations and providing curb-side or drive-through delivery and pickup services.  Conclusion The findings suggest the frontline and essential roles of community pharmacists in delivering pandemic responses, creating the opportunity to determine areas where community pharmacy services can be incorporated to strengthen the public health system and improve patient health outcomes.

Objectives. Fifteen potentially low value practices in adult orthopaedic trauma care were previously identified in a scoping review. The aim of this study was to synthesize the evidence on these practices. Methods. We searched four databases for systematic reviews, randomized controlled trials (RCTs), cohort studies and case series that assessed the effectiveness of selected practices. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews version 2 (AMSTAR-2) for systematic reviews and the Critical Appraisal Checklist for Case Series. We evaluated risk of bias with the Cochrane revised tool for RCTs and the risk of bias in non-randomized studies of interventions tool for observational studies. We summarized findings with measures of frequency and association for primary outcomes. Results. Of the 30,670 records screened, 70 studies were retained. We identified high-level evidence of lack of effectiveness or harm for routine initial imaging of ankle injury, orthosis for A0-A3 thoracolumbar burst fracture in patients < 60 years of age, cast or splint immobilization for suspected scaphoid fracture negative on MRI or confirmed fifth metacarpal neck fracture, and routine follow-up imaging for distal radius and ankles fractures. However, evidence was mostly based on studies of low methodological quality or high risk of bias. Conclusion. In this review, we identified clinical practices in orthopedic injury care which are not supported by current evidence and whose use may be questioned. In future research we should measure their frequency, assess practice variations and evaluate root causes to identify practices that could be targeted for de-implementation.

COVID-19 is a disease which is sweeping the globe, often with devastating consequences. The more we understand, the more it appears that infection has a very wide clinical spectrum from totally asymptomatic to life threatening. Without widespread community testing it is impossible to ascertain true infection rates and develop strategies which reduce or prevent transmission without the need for on-going draconian measures such as complete national lockdown. These measures are mandatory at the time of writing, however widespread adoption of face masks has been shown to help prevent transmission of other respiratory pathogens, and also infections acquired by healthcare staff. Combining mass testing with a combination of social distancing and face mask use might offer a way forward until a mass COVID-19 vaccination programme can be established.

Aim: The COVID pandemic is caused by infection with the SARS-CoV-2 virus. The major mutation detected to date in the SARS-CoV-2 viral envelope spike protein, which is responsible for virus attachment to the host and is also the main target for host antibodies, is a mutation of an aspartate (D) at position 614 found frequently in Chinese strains to a glycine (G). We sought to infer health impact of this mutation. Result: Increased case fatality rate correlated strongly with the proportion of viruses bearing G614 on a country by country basis. The amino acid at position 614 occurs at an internal protein interface of the viral spike, and the presence of G at this position was calculated to destabilize a specific conformation of the viral spike, within which the key host receptor binding site is more accessible. Conclusion: These results imply that G614 is a more pathogenic strain of SARS-CoV-2, which may influence vaccine design. The prevalence of this form of the virus should also be included in epidemiologic models predicting the COVID-19 health burden and fatality over time in specific regions. Physicians should be aware of this characteristic of the virus to anticipate the clinical course of infection. What is known about this topic? Nothing is known about the health significance of the D614G SARS-CoV-2 variant. What does this article add? A molecular clue to viral molecular pathogenesis of COVID-19 disease.