Afghan refugees in Iran, estimated at over 5 million, represent a large vulnerable population whose attitudes towards COVID-19 vaccination are crucial to understand. This cross-sectional study was conducted in Shiraz, Iran, in 2023. Adult Afghan refugees with children aged 5–17 were recruited using a snowball sampling method. A previously validated survey tool was adapted for the Afghan population in this study to assess underlying sociodemographic and psychosocial factors influencing the COVID-19 vaccine acceptance. Among 400 participants, 79

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Background Multi-organ dysfunction syndrome and multi-organ failure are the leading causes of late death in patients sustaining severe blunt trauma. So far, there is no established protocol to mitigate these sequelae. This study assessed the effect of hemoperfusion using resin-hemoadsorption 330 (HA330) cartridges on mortality and complications such as acute respiratory distress syndrome (ARDS) and systemic inflammatory response syndrome (SIRS) among such patients. Methods This quasi-experimental study recruited patients ≥ 15 years of age with blunt trauma, injury severity score (ISS) ≥ 15, or initial clinical presentation consistent with SIRS. They were divided into two groups: the Control group received only conventional acute care, while the case group received adjunctive hemoperfusion. P-values less than 0.05 were statistically significant. Results Twenty-five patients were included (Control and Case groups: 13 and 12 patients). The presenting vital signs, demographic and injury-related features (except for thoracic injury severity) were similar (p > 0.05). The Case group experienced significantly more severe thoracic injuries than the Control group (Thoracic AIS, median [IQR]: 3 [2–4] vs. 2 [0–2], p = 0.01). Eleven and twelve patients in the Case group had ARDS and SIRS before the hemoperfusion, respectively, and these complications were decreased considerably after hemoperfusion. Meanwhile, the frequency of ARDS and SIRS did not decrease in the Control group. Hemoperfusion significantly reduced the mortality rate in the Case group compared to the Control group (three vs. nine patients, p = 0.027). Conclusions Adjunctive Hemoperfusion using an HA330 cartridge decreases morbidity and improves outcomes in patients suffering from severe blunt trauma.

In Brief In this Letter to the editor, we address the current debates considering to use of serum level albumin the as an indicator of nutritional status among geriatric trauma patients.

In a rapidly changing environment, healthcare systems in polar regions face increasing pressures imposed by climate change, burgeoning tourism, and potential ramifications for future space exploration. The urgency to reevaluate health stewardship and governance in these areas is driven by unique challenges, including geographical barriers and scarce resources. Further accentuated by the ongoing COVID-19 pandemic and the anticipated boom in the polar tourism industry, the need for robust emergency, trauma, and surgical care is highlighted. The objective of this paper is to address these challenges and advocate for a unified health governance approach. Adopting measures like artificial intelligence, telemedicine, and advanced technologies is suggested to promote the effectiveness of remote care, considering the distinct limitations of these regions. Moreover, research focused on the human health impact of these extreme conditions is paramount for formulating adequate responses, thereby improving the overall readiness and resilience of the healthcare systems in these regions.

Background: Carpal tunnel syndrome (CTS) is a common work-place musculoskeletal disorder, and dentists are a high-risk group due to their work conditions. This study aims to obtaining a full understanding of knowledge, attitude and practice (KAP) of CTS among Dentists in Shiraz, Iran. Methods: Between Jun,2019 and Dec,2019; A researcher-made questionnaire was developed for this cross-sectional pilot study in order to evaluate the KAP of dentists regarding CTS. Participants were recruited to fill out the questionnaire. The participants were recruited using convenient sampling from dentists working. A 51 dentists were completed the survey. Ethical approval to conduct this study was obtained. Results: About 31 (60.8%) respondents were female and 20(39.2%) were male. 54.9%. of the participants were aged below 33 years. 66.7%. of dentists had less than 10 years of work experience. No statistically significant correlation was observed between age, and number of years of work experience and KAP scores. But there was significant correlation between gender and knowledge (p =0.04). The mean scores of knowledges were 3.7 ±1.3 which was low to average regarding the prevention and treatment of CTS. The mean scores of attitudes and practice were 10.9 ±3.2 and 7.9 ± 2.1, respectively. Which represent a positive attitude and practice towards regarding the prevention and treatment of CTS. There was a significant correlation between attitude and practice among dentists with p =0.001 Conclusions: Most dentists in this study had low to average knowledge, high attitudes, and high practice scores of the prevention and treatment of CTS.

Since the pandemic began in December 2019, SARS-Cov2 has accentuated the wide gap and disparities in socioeconomic and healthcare access at individual, community, country, and regional levels. More than two years into the current pandemic, up to three-fourths of the patients are reporting continued signs and symptoms beyond the acute phase of COVID-19, and Long COVID portends to be a major challenge in the future ahead. With a comprehensive overview of the literature, we found that most studies concerning long COVID came from high and upper-middle income countries, and people of low-income and lower-and-middle income regions and vulnerable groups with comorbid conditions have been neglected. Apart from the level of income, there is a significant geographical heterogeneity in investigating the Post-Acute Sequelae of COVID-19 (PASC) or what we call now, long COVID. We believe that these recognizing health disparities is crucial from equity perspective and is the first step toward global health promotion.

The aim of this study was to investigate the COVID-19 vaccination acceptance rate and its determinants among healthcare workers in a multicenter study. This was a cross-sectional multi-center survey conducted from February 5 to April 29, 2021. The questionnaire consisted of 26 items in 6 subscales. The English version of the questionnaire was translated into seven languages and distributed through Google Forms using snowball sampling; a colleague in each country was responsible for the forward and backward translation, and also the distribution of the questionnaire. A forward stepwise logistic regression was utilized to explore the variables and questionnaire factors tied to the intention to COVID-19 vaccination. 4630 participants from 91 countries completed the questionnaire. According to the United Nations Development Program 2020, 43.6 % of participants were from low Human Development Index (HDI) regions, 48.3 % high and very high, and 8.1 % from medium. The overall vaccination hesitancy rate was 37 %. Three out of six factors of the questionnaire were significantly related to intention to the vaccination. While 'Perceived benefits of the COVID-19 vaccination' (OR: 3.82, p-value<0.001) and 'Prosocial norms' (OR: 5.18, p-value<0.001) were associated with vaccination acceptance, 'The vaccine safety/cost concerns' with OR: 3.52, p-value<0.001 was tied to vaccination hesitancy. Medical doctors and pharmacists were more willing to take the vaccine in comparison to others. Importantly, HDI with OR: 12.28, 95 % CI: 6.10-24.72 was a strong positive determinant of COVID-19 vaccination acceptance. This study highlighted the vaccination hesitancy rate of 37 % in our sample among HCWs. Increasing awareness regarding vaccination benefits, confronting the misinformation, and strengthening the prosocial norms would be the primary domains for maximizing the vaccination coverage. The study also showed that the HDI is strongly associated with the vaccination acceptance/hesitancy, in a way that those living in low HDI contexts are more hesitant to receive the vaccine.

With the rapid development of novel surgical devices such as Resuscitative Endovascular Balloon Occlusion of theAorta (REBOA) and the eagerness of clinicians to use them, there is a risk that their usage in clinical practice exceedsthe evidence-based principles required for their introduction. This might be truer in the fields, such as trauma surgery,where the patient population and the disease (injury) burden are very heterogeneous and time-sensitive, and thus not fitting for the more gold standard investigation methods. The studies that are currently being published considering the use of REBOA in clinical settings have significant limitations and raise concerns in terms of the risk of biases that might influence the gold-standard evidence-based synthesis. This paper elaborates on the merits of a Prospective Meta-Analysis (PMA) in reducing such biases.

Background: Transient global amnesia (TGA) is a sudden-onset transient memory impairment along with intact neurologic examinations. Even though it is a benign neurologic condition with many differential diagnoses, the incidence rate of TGA is reported to have increased since the onset of the pandemic. Therefore, this systematic scoping review aims to investigate TGA in that context. Methods: MEDLINE, Scopus, and Google Scholar databases were systematically searched for relevant articles with a string of specified keywords. Results: The primary search yielded 90 studies. After all the necessary screening rounds were carried out, we were left with six included studies. One study was also identified through a search in other relatively relevant databases. Finally, seven case reports were accepted including three TGA patients with positive and one with negative test for coronavirus disease -2019 (COVID-19), respectively. COVID-19 status was unclear in the others. Conclusion: The reported COVID-19 positive cases had presentations similar to those with TGA before the pandemic. Therefore, we think that TGA might occur concomitantly with the COVID-19 infection or due to the psychological impact of the pandemic. In the confirmed cases of TGA and COVID-19, the abnormal findings may be due to COVID-19 infection. However, the reports were not as complete as desired. Therefore, providing the readers with more detailed reports in future cases is recommended.

Background: In the name of extensive vaccine uptake, understanding the public's attitude, perception, and intent toward COVID-19 vaccination is a significant challenge for public health officials. Methods: A cross-sectional survey via an online questionnaire rooted in the Health Belief Model and Integrated Behavioral Model was conducted to evaluate COVID-19 vaccination intent and its associated factors. Factor analysis and multivariate logistic regression were operated to be satisfactory. Results: Among the 4,933 respondents, 24.7% were health care workers, and 64.2% intended to accept COVID-19 vaccination. The adjusted odds (aOR) of COVID-19 vaccination intent was higher for individuals with greater exposure to social norms supportive of COVID-19 vaccination (aOR = 3.07, 95% Confidence Interval (CI) = 2.71, 3.47) and higher perceived benefits of COVID-19 vaccination (aOR = 2.9, 95% CI = 2.49, 3.38). The adjusted odds of vaccination intent were lower for individuals with greater COVID-19 vaccine safety concerns (aOR = 0.28, 95%CI = 0.25, 0.31). Lower vaccination intent was also associated with increasing age ((aOR = 0.99, 95% CI = 0.98, 0.999), female sex (aOR = 0.76, 95% CI = 0.65, 0.88), and working in the health care field (aOR = 0.75, 95% CI = 0.63, 0.9). Conclusions: The odds of COVID-19 vaccination intent were higher three or more times among those with a greater belief in vaccine effectiveness, lower concerns about vaccine safety, and greater exposure to cues to vaccinate, including from doctors. This last finding is concerning as vaccine acceptance was surprisingly lower among health care workers compared to others. The remarkable results of factor analysis and reliability of the questionnaire may encourage local health authorities to apply it to their regional population.

ImportanceAdolescents and young people have been historically understudied populations, and previous studies indicate that during epidemics, these populations, especially in low- and middle-income countries (LMICs), are at high risk of developing mental disturbances.ObjectiveTo identify the existing evidence regarding the association of mental health with outbreaks of the influenza A (H1N1), Zika, Ebola, and SARS-CoV-2 virus in exposed youth and adolescents in LMICs.Evidence ReviewAcross 6 databases (Embase, Cochrane Library, PubMed, PsycINFO, Scopus, and Web of Science), the mental health outcomes of adolescents and youth (aged 10-24 years) associated with 4 major pandemic outbreaks from January 2009 to January 2021 in LMICs were reviewed. A group of 3 authors at each stage carried out the screening, selection, and quality assessment using Joanna Briggs Institute checklists. The social determinants of adolescent well-being framework was used as a guide to organizing the review.FindingsA total of 57 studies fulfilled the search criteria, 55 related to the SARS-CoV-2 (COVID-19) pandemic and 2 covered the H1N1 influenza epidemics. There were no studies associated with Zika or Ebola outbreaks that met screening criteria. The studies reported high rates of anxiety and depressive symptoms among adolescents, including posttraumatic stress disorder, general stress, and health-related anxiety. Potential risk factors associated with poor mental health outcomes included female sex; home residence in areas with strict lockdown limitations on social and physical movement; reduced physical activity; poor parental, family, or social support; previous exposure to COVID-19 infection; or being part of an already vulnerable group (eg, previous psychiatric conditions, childhood trauma, or HIV infection).Conclusions and RelevanceResults of this systematic scoping review suggest that the COVID-19 pandemic and H1N1 epidemic were associated with adverse mental health among adolescents and youth from LMICs. Vulnerable youth and adolescents may be at higher risk of developing mental health–related complications, requiring more responsive interventions and further research. Geographically localized disease outbreaks such as Ebola, Zika, and H1N1 influenza are highly understudied and warrant future investigation.

Background: Lumbosacral spinal stenosis (LSS) is one of the most common causes of back pain and disability. Its treatment varies from conservative and medical to surgical treatment, and the indications for its optimal management are not obviously defined. Epidural steroid injection is commonly used for pain relief in LSS. This study aims to compare the adjuvant efficacy of caudal epidural injection (CEI) of hyaluronidase with steroid versus hypertonic saline with steroid in patients with LSS. Methods: This clinical trial was done in a prospective, randomized, double-blind approach; it was conducted among 30 patients aged between 45 – 75 years who suffered from low back and leg pain in recent 6 months due to LSS. The patients were randomly allocated to two groups. Group A included 15 patients who received fluoroscopically guided CEI containing steroid, local anesthetic, and hyaluronidase, and Group B consisted of 15 patients who received fluoroscopically guided CEI containing steroid, local anesthetic, and hypertonic saline. The outcome measures included the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Quebec Back Pain Disability Scale (QBPDS), which were obtained from patients before the CEI as a baseline and after the second, fourth, and eighth weeks. Results: Before injection, there were no statistically significant differences between the two studied groups, neither in demographic characteristics nor in VAS, ODI, and QBPDS parameters. After injection, the mean of ODI and QBPDS improved from the baseline to the 2nd, 4th, and the 8th weeks in both groups (p < 0.001) without any superiority between the two groups (p > 0.05). However, there was a significant improvement of the mean VAS score through the second and fourth weeks in Group A (p = 0.032, 0.050). VAS score in the eighth week was equal without any superiority in both groups (p > 0.05). Additionally, the mean social life status was significantly improved in group A in the 4th and 8th weeks after the intervention. Conclusions: In short-term follow-up, Caudal epidural injection of hyaluronidase, as well as hypertonic saline, seems to be effective in the management of LSS without any superiority in both materials. However, in the 2nd and 4th weeks after the procedure, better improvement of means VAS score was observed in the hyaluronidase group.

Aalberg, Jeffrey J. MPH; Johnson, Benjamin P. MD; Hojman, Horacio M. MD; Rattan, Rishi MD, FACS; Arabian, Sandra S. MBA; Mahoney, Eric J. MD; Bugaev, Nikolay MD Author Information

Introduction Sexual and Reproductive Health and Rights (SRHR) of young people continue to present a high burden and remain underinvested. This is more so in low and middle-income countries (LMICs), where empirical evidence reveals disruption of SRHR maintenance, need for enhancement of programmes, resources and services during pandemics. Despite the importance of the subject, there is no published review yet combining recent disease outbreaks such as (H1N1/09, Zika, Ebola and SARS-COV-2) to assess their impact on adolescents and youth SRHR in LMICs. Methods and analysis We will adopt a four-step search to reach the maximum possible number of studies. In the first step, we will carry out a limitedpreliminary search in databases for getting relevant keywords (appendix 1). Second, we will search in four databases: Pubmed, Cochrane Library, Embase and PsycINFO. The search would begin from the inception of the first major outbreak in 2009 (H1N1/09) up to the date of publication of the protocol in early 2022. We will search databases using related keywords, screen title & abstract and review full texts of the selected titles to arrive at the list of eligible studies. In the third stage, we will check their eligibility to the included article’s reference list. In the fourth stage, we will check the citations of included papers in phase 2 to complete our study selection. We will include all types of original studies and without any language restriction in our final synthesis. Our review results will be charted for each pandemic separately and include details pertaining to authors, year, country, region of the study, study design, participants (disaggregated by age and gender), purpose and report associated SRHR outcomes. The review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR). Patient and public involvement Patients or public were not involved in this study. Ethics and dissemination Ethical assessment is not required for this study. The results of the study will be presented in peer-reviewed publications and conferences on adolescent SRHR.

The Spanish Flu was one of the disasters in the history of Iran, especially Southern Iran, which led to the death of a significant number of people in Iran. It started on October 29, 1917, and lasted till 1920 - a disaster that we can claim changed the history. In one of the First World War battlefields in southern Iran in 1918, there was nothing left until the end of World War I and when the battle between Iranian warriors (especially people of Dashtestan and Tangestan in Bushehr, Arabs, and people of Bakhtiari in Khuzestan and people of Kazerun and Qashqai in Fars) and British forces had reached its peak. As each second encouraged the triumph for the Iranians, a flu outbreak among Iranian warriors led to many deaths and, as a result, military withdrawal. The flu outbreak in Kazerun, Firoozabad, Farshband, Abadeh, and even in Shiraz changed the end of the war. In this article, we attempt to discuss the role of the Spanish flu outbreak at the end of one of the forefronts of World War I.