DISCLAIMER This paper was submitted to the Bulletin of the World Health Organization and was posted to the COVID-19 open site, according to the protocol for public health emergencies for international concern as described in Vasee Moorthy et al. (http://dx.doi.org/10.2471/BLT.20.251561). The information herein is available for unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations licence (CC BY IGO 3.0).

Background Although almost a year has passed since the Coronavirus disease 2019 (COVID-19) outbreak and promising reports of vaccines have been presented, we still have a long way until these measures are available for all. Furthermore, the most appropriate corticosteroid and dose in the treatment of COVID-19 have remained uncertain. We conducted a study to assess the effectiveness of methylprednisolone treatment versus dexamethasone for hospitalized COVID-19 patients. Methods In this prospective triple-blinded randomized controlled trial, we enrolled 86 hospitalized COVID-19 patients from August to November 2020, in Shiraz, Iran. The patients were randomly allocated into two groups to receive either methylprednisolone (2 mg/kg/day; intervention group) or dexamethasone (6 mg/kg/day; control group). Data were assessed based on a 9-point WHO ordinal scale extending from uninfected (point 0) to death (point 8). Results There were no significant differences between the groups on admission. However, the intervention group demonstrated significantly better clinical status compared to the control group at day 5 (4.02 vs. 5.21, p = 0.002) and day 10 (2.90 vs. 4.71, p = 0.001) of admission. There was also a significant difference in the overall mean score between the intervention group and the control group, (3.909 vs. 4.873 respectively, p = 0.004). The mean length of hospital stay was 7.43 ± 3.64 and 10.52 ± 5.47 days in the intervention and control groups, respectively (p = 0.015). The need for a ventilator was significantly lower in the intervention group than in the control group (18.2% vs 38.1% p = 0.040). Conclusion In hospitalized hypoxic COVID-19 patients, methylprednisolone demonstrated better results compared to dexamethasone. Trial registration The trial was registered with IRCT.IR (08/04/2020-No. IRCT20200204046369N1).

Background: In March 2020, the WHO declared the novel coronavirus (COVID-19) outbreak a global pandemic. Although the number of infected cases is increasing, information about its clinical characteristics in the Middle East, especially in Iran, a country which is considered to be one of the most important focal points of the disease in the world, is lacking. To date, there is no available literature on the clinical data on COVID-19 patients in Iran. Methods: In this multicenter retrospective study, 113 hospitalized confirmed cases of COVID-19 admitted to university affiliated hospitals in Shiraz, Iran from February 20 to March 20 were entered in the study. Results: The mean age was 53.75 years and 71 (62.8%) were males. The most common symptoms at onset were fatigue (75: 66.4%), cough (73: 64.6%), and fever (67: 59.3%). Laboratory data revealed significant correlation between lymphocyte count (P value = 0.003), partial thromboplastin time (P value = 0.000), international normalized ratio (P value = 0.000) with the severity of the disease. The most common abnormality in chest CT scans was ground-glass opacity (77: 93.9%), followed by consolidation (48: 58.5%). Our results revealed an overall 8% (9 out of 113 cases) mortality rate among patients, in which the majority was among patients admitted to the ICU (5: 55.6%). Conclusion: Evaluating the clinical data of COVID-19 patients and finding the source of infection and studying the behavior of the disease is crucial for understanding the pandemic.

Background In March 2020, WHO has declared pandemic on COVID-19. Although the number of infected cases is increasing, information about its clinical characteristics in the Middle East especially in Iran, a country which is considered as one of the most important foci of the disease in the world is lacking. Till date, there is no available literature on the clinical data on COVID-19 patients in Iran. Method and Material: In this multicenter retrospectively registered study, 113 hospitalized confirmed cases of COVID-19 admitted in university affiliated hospitals in Shiraz, Iran in from February 20 to March 20 were enrolled. Results The median age was 53 years and 71 (62.8%) were males. The most common symptoms at onset were fatigue (75: 66.4%), cough (73: 64.6%), and fever (67: 59.3%). Laboratory data revealed significant correlation between lymphocyte count, partial thromboplastin time, international normalized ratio with the severity of the disease (P value = 0.003, 0.000, 0.000, respectively). The most common abnormality in chest CT scan was ground-glass opacity (77: 93.9%), followed by consolidation (48: 58.5%). Our results revealed an overall 8% (9 out of 113 cases) mortality rate among the patients, in which the majority was among the ICU admitted patients (5: 55.6%). Also, 68 (60.2%) of our patients achieved total recovery and 7 (6.2%) were discharged with follow-up and home isolation. Conclusion In this multi-center study which included 113 hospitalized patients with diagnosis of COVID-19, 9.7% of cases were transferred to ICU and mortality rate was 8%. Furthermore, finding the source of infection and studying the behavior of COVID-19 is crucial for understanding the pandemic.

Background Disease outbreak not only carries the risk of death to the public due to the infection, but it also can lead to unbearable psychological impact on the mental health of the individuals. This study aims to explore and evaluate the burden of psychological problems on the Iranian general population during the outbreak of COVID-19. Method A cross-sectional web-based survey was conducted among the general population of Iran age 15 and above. Demographic variables, depression, and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 and General Anxiety Disorder-7 questionnaires. Results Among the 8591 participants, the mean age was 34.37 (± 11.25) years and 66.4% were female while 33.6% were male. Based on our results, 1295 (15.1%) and 1733 (20.1%) of the general population had clinically significant depressive and anxiety symptoms, respectively. Based on the demographic variables, female gender was associated with a higher risk for developing depression and anxiety symptoms, whereas getting information about the disease from medical journals and articles, being older, and being married were considered as associated protective factors. In terms of depression, being a healthcare worker was an associated risk factor. On the other hand, for anxiety, having higher education was a protective factor while a higher number of individuals in a household was considered as a risk factor. Conclusions This study identified a major mental health problem in the Iranian population during the time of the COVID-19 outbreak. Therefore, establishing a targeted mental health support program during the time of public emergencies, such as the disease outbreak, is advised.

Background School closure is one of the main policies of global health care strategies performed worldwide. Despite all benefits, there might be some threats for younger groups spending their time in quarantine. This study aims to determine the impacts of lockdown and school closure on children’s major lifestyle aspects, especially their leisure and sleep pattern during the COVID-19 pandemic. Methods For the purpose of this study, an online questionnaire was distributed from 14th to 31st of March 2020 among the schools and students from the first grade to the 12th grade (before university) in Fars province, southern Iran. The questionnaire consisted of five sections which included data regarding the students’ general information, activity priorities, adherence to quarantine, attitude toward school closure, and sleep patterns. Results In our study, 20,697 filled questionnaires were received from the participants with an average age of 13.76 years; 29.7% of them were male, 80.6% were from urban areas, and 83.3% were from public schools. The overall first preference of students during school closure was mobile and computer games (30.1%), followed by studying (26.6%) and watching television (13.8%). Our results demonstrated that the majority of students adhered to social distancing and there was also a significant correlation among education levels and desire for schools to be closed till the end of the semester (P = 0.015). Also, regarding sleep patterns, the majority (53.5%) had above 12 h of sleep throughout the day. Conclusion It seems that lockdown following COVID-19 pandemic has changed various aspects of the students’ lifestyle remarkably, especially by increasing screen time and even sleep duration and pattern. We believe that certain strategies should be implemented by the Health and Educational Ministry to control not only the visible side effects of the quarantine period, but also the collateral consequences on their psychological and mental health.

Background Rapid increases in the number of COVID-19 cases have led to the closure of academic institutions including elementary and high schools. The absence from the educational environment can affect the students’ emotions towards education and school attendance. In this study, we aimed to evaluate the students' attitude and emotions towards the sudden closure of schools during the COVID-19 pandemic. Methods By utilizing a modified version of the Achievement Emotions Questionnaire, a web-based cross-sectional study was conducted to evaluate the students' positive and negative emotions towards schools during the early phases of the COVID-19 pandemic. Results Questionnaires were filled by 20,697 participants with an average age of 13.76, and 70.3% of them were females. Also, 83.3% were from public schools and 80.6% from urban areas. Based on the questionnaire, for positive attitude a median of 31 (IQR 26–35) and for negative attitude a median of 25 (IQR 19–32) were obtained. Conclusion Our findings demonstrated a satisfactory level of students' emotions regarding schools and education during the closure of schools and institutions. This indicates that despite the imposed situation, students showed enthusiasm towards learning and schools.

Stem cell therapy has been used to treat several types of diseases, and it is expected that its therapeutic uses shall increase as novel lines of evidence begin to appear. Furthermore, stem cells have the potential to make new tissues and organs. Thus, some scientists propose that organ transplantation will significantly rely on stem cell technology and organogenesis in the future. Stem cells and its robust potential to differentiate into specific types of cells and regenerate tissues and body organs, have been investigated by numerous clinician scientists and researchers for their therapeutic effects. Degenerative diseases in different organs have been the main target of stem cell therapy. Neurodegenerative diseases such as Alzheimer's, musculoskeletal diseases such as osteoarthritis, congenital cardiovascular diseases, and blood cell diseases such as leukemia are among the health conditions that have benefited from stem cell therapy advancements. One of the most challenging parts of the process of incorporating stem cells into clinical practice is controlling their division and differentiation potentials. Sometimes, their potential for  uncontrolled growth will make these cells tumorigenic. Another caveat in this process is the ability to control the differentiation process. While stem cells can easily differentiate into a wide variety of cells,  a paracrine effect controlled activity, being in an appropriate medium will cause abnormal differentiation leading to treatment failure. In this review, we aim to provide an overview of the therapeutic effects of stem cells in diseases of various organ systems. In order to advance this new treatment to its full potential, researchers should focus on establishing methods to control the differentiation process, while policymakers should take an active role in providing adequate facilities and equipment for these projects. Large population clinical trials are a necessary tool that will help build trust in this method. Moreover, improving social awareness about the advantages and adverse effects of stem cell therapy is required to develop a rational demand in the society, and consequently, healthcare systems should consider established stem cell-based therapeutic methods in their treatment algorithms.