COVID-19 has created major health-related, economic, and social challenges in societies, and its high contagion has dramatically altered access to healthcare. COVID-19 management can be improved by the use of telehealth. This study aimed to examine different telehealth technologies in the management of COVID-19 disease in the domains of surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up, and investigate the challenges to the application of telehealth in COVID-19 management. This scoping review was conducted based on Arksey and O’Malley's framework. Searches were performed in Web of Science, PubMed, and Scopus databases to examine the evidence on the effectiveness of telehealth in COVID-19 management. Eventually, 36 articles were selected based on the inclusion criteria. The majority of these studies (33%) were conducted in China. Most services offered via telehealth focused on surveillance, tracking, and follow-up, in that order. Moreover, the most frequently used technologies were social networks, web-based apps, and mobile apps, respectively. The use of telehealth in COVID-19 disease management plays a key role in surveillance, diagnosis, screening, treatment, monitoring, tracking, and follow-up.

Background: Bronchiectasis is a clinical syndrome characterized by chronic cough, sputum production, recurrent respiratory infections, and permanent bronchial dilation.  The association between the level of alpha-1 antitrypsin (AAT) and bronchiectasis is controversial. In this study, we aimed to investigate this association in children with idiopathic bronchiectasis.

Methods:  The study was conducted on 20 patients with idiopathic bronchiectasis as the case group (mean age 15.9±2.1) and 20 healthy individuals as the control group (mean age 14.9±2.6). Serum AAT level was measured using nephelometric analysis (g/L). Other criteria including sex, parent consanguinity, number of hospitalization, age of the first symptom were evaluated in both groups related to AAT level.

Results: The mean serum level of AAT in the case and control groups were 1.3±0.29; 1.5 ±0.59, respectively with statistical significance (P=0.001). There was a significant difference between the two groups in the AAT level distribution, according to AAT normal range (p=0.01). The case group had a more positive attitude toward consanguinity than the control group (66.7% versus 33.3%; P<0.001). The results showed that 80% of patients had the first symptom of disease under 1 year of age, 6.6% 1- 5 years, 6.6% 5- 10 years, and 6.6% in more than 10 years old. In the case group, 53.3% had a history of medical hospitalization for one time, 26.7% two times, while 20% of the patients had no medical hospitalization.

Conclusion: Decreased AAT serum level and high consanguinity rates may be considered as two risk factors for idiopathic bronchiectasis occurrence in children.

Background: continuous body temperature monitoring during anesthesia in children is very important.  Hypothermia in children results in increased morbidity and mortality.

Measurement point of the core body temperature are not easily accessible. the purpose of this study was to measure skin temperature over the carotid artery and compare it with the nasopharynx.

Patients and methods: Totally, 84 patients within the age range of 2 - 10 years, undergoing elective surgery, were selected. Temperature skin over carotid artery and nasopharynx was measured during anesthesia.  Then mean temperature of these points was compared which each other and the effects of age, sex and weight change of temperature during anesthesia were evaluated.

Results. The mean age of patients was 5.4 ± 2.6 years s. 37% of patients were female and 63% were male. The mean weight was 20 ± 7 kg. The mean duration of surgery was 60.45±6.65min. Temperature of skin and nasopharynx was decreased during surgery as after 60 min the deference between skin over carotid artery and nasopharyngeal area was 1^°c.

Variables of the mean nasopharyngeal temperature, mean carotid temperature, age, sex and weight were entered into the regression model. The model’s coefficients for age and sex were not significant. But body weight has a significant effect on carotid skin temperature.

 Conclusion: Skin temperature over the carotid artery, with a simple correction factor of +1 °^C, provides a viable noninvasive estimate of nasopharyngeal temperature in children during elective surgery with a general anesthetic.

Abstract:

Introduction: Osteoporosis is a disease recognized by bone density reduction, and is particularly common among older women which impose them to fractures. The evidence shows that if do not serious conflict with this issue, in the far little future, huge costs will be imposed on individuals, families and the country. In this study we studied the cost-effectiveness of osteoporosis screening in women over 40 years of age in Shiraz in 2016.

Methods: This cross-sectional study was performed on 240 persons who were screened and 240 non-screened persons in bone mineral density ward of Shiraz Namazi Hospital. The costs were identified and from the perspective of the insurer and the payer, which included only direct health care costs. To measure the effectiveness, use of indicators as quality-adjusted life-years (QALY), the expected cost and effectiveness, and the Incremental cost-effectiveness ratio were calculated.

Results: The results showed that non screening is the best strategy. Given that the amount of ICER was obtained at $38484.56 and the threshold. As a result, the non screening method compared to screening is cost-effectiveness.

Conclusion: The relevant authorities and proficients should prevent the progression of disease complications and consequently prevent the increase of the disease cost and improving the quality of life of the patients.

Abstract: SARS-CoV-2 that causes Coronavirus disease 2019 (COVID-19) was first known in Wuhan, China, in December 2019. The aim of this study was to evaluate the level of common hepatic, renal and cardiac diagnostic markers in hospital in patients with severe COVID 19. In this study, 259 patients with symptoms of severe COVID-19 and a positive RT-PCR assay of nasopharyngeal samples were enrolled. Inclusion criteria are positive for COVID-19 patients at the diagnosis of an infectious disease physician. Diagnostic markers of liver, kidney, and heart, were evaluated by age and gender. In this study, 48.3% of patients severe with COVID- 19 were male and 51.7% were female. The mean of markers such as LDH, Direct Bilirubin, SGOT, SGPT, D-dimer, was higher than normal, which was observed in men more than women.  The mean of CK-MB also was higher than normal, which was observed in women more than men. The highest mean of markers was seen in the older ages. The mean of BUN was observed in the age range of 55-64 years and above 65 years above normal. But the mean of CPK, creatinine, potassium, and alkaline phosphatase were normal. The results of the present study showed an increase in the level of some of the most important diagnostic markers of hepatic, renal, and cardiac in patients with COVID 19. This increase was greater in some markers, including SGOT, SGPT, Direct bilirubin, LDH, D-dimer, in men than in women, and more in older patients.

Bachground: The global crisis caused by the SARS Corona virus-2 infection is continuing through 2021, with more than 3.5 million deaths. Several risk factors for this virus’s severity and death were documented, including diabetes, hypertension, and ischemic heart disease.

Objectives: To evaluate the relation between serum vitamin D3 level, the disease severity, and prognosis of the patients with SARS Corona virus-2 infection.

Methods: Patients with COVID-19 were evaluated for serum vitamin D levels and laboratory data. Correlation between vitamin D levels and laboratory data with disease severity and prognosis was assessed. Cox and logistic regression tests as well as ROC curve were used for data analysis.

Results: ninety-eight patients with Corona virus-2 disease (COVID-19) which consisted of sixty patients with moderate COVID-19 in the general wards, and thirty-eight patients with severe COVID-19 in the intensive care unit (ICU) were evaluated. The mean age in the general wards was lower than in ICU (60.96 ± 14.86 compared to 67.94 ± 16.46, P=0.001), and the mean serum vitamin D level in the patients admitted in the general wards was higher than in the ICU (31 ng / mL compared 20.57 ng / mL, P = 0.003). In addition, vitamin D deficiency (25(OH) D < 25 ng/mL) was associated with a significant increase in the risk of severe disease (odds ratio=2.91 , P=0.019) and mortality (odds ratio=3.64 , P=0.026).

Conclusion: Vitamin D deficiency is a risk factor for disease severity and poor prognosis in COVID-19.Vitamin D level of 25 ng/mL can be used as a cut-off value for predicting severity and prognosis.

The most lethal adverse effect of COVID-19 is acute respiratory distress syndrome, which can lead to rapid death. This symptom even causes concern for patients who have recovered and have been discharged. Therefore, it is obligatory to test and monitor variations in their lungs’ function after recovery. In this study we evaluated the pulmonary function of 64 patients with severe COVID-19, 6 weeks to 3 months after discharge. Pulmonary function parameters were measured by spirometry and body box according to the criteria of the American Thoracic Society and under the supervision of an adult pulmonologist. According to the forced expiratory volume (FEV1) /forced vital capacity (FVC) ratio and total lung capacity (TLC) values, it was found that 3.1% of people had obstructive pattern, 40.63% of patients had restrictive pattern and 6.25% of improved individuals showed mixed pattern. Furthermore, the study of diffusion capacity of carbon monoxide (DLCO) index revealed that 13.3%, 25% and 53% of cases had mild, moderate and severe disorders of gas exchange, respectively. In addition, determining the maximum amount of inspiratory muscles (PI max) and expiratory muscles (PE max) disclosed that the rate of these two indicators in 62.5% and 71.88% of the subjects were less than 50%, respectively. In general, the results of the present study suggest that pulmonary function test and follow-up of patients' condition are not only recommended but seems to be essential after recovery due to the large percentage of patients with restricted pattern a few weeks after recovery.

Background: An outbreak of COVID-19 started in December 2019 in the city of Wuhan and is now rapidly spreading across the world.

Methods and Results: We report two cases of confirmed COVID-19 with pre-existing comorbidities who were discharged from the hospital with a good clinical condition and in concordance with interim discharge protocols. However, they were readmitted and died on the discharge day.

Conclusions: Here we discuss the importance of patients demographics in clinical management vs. the resolution of the pulmonary disease alone and raise a question about the impact of comorbidities on discharge protocols.

Abstract

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation.

In this study, a 43-year-oldfemale with a history of right lower quadrant pain and anorexia represented with abdominal tenderness and rebound tenderness in physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged 2 days later in optimal clinical condition.

Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, appropriate diagnosis of diverticular disease before surgery is very important because of the association of the appendiceal diverticular disease with neoplasm and other complications.

Spermatic vein thrombosis is a rare event that mostly affects the left vein thrombosis but in our report it had developed on the right one that requires meticulous physical examination for diagnosis. The purpose of this case report is to introduce an adult patient with right spermatic vein thrombosis in a 30-year-old man admitted to the operating room for hernia surgery. Spermatic vein thrombosis is an unexpected finding in the differential diagnosis of acute testicular pain.