---

Background and purpose: COVID-19 is an emerging viral disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Bacterial or fungal superinfections of the lung may cause complications in clinical manifestations, treatment, and increase the mortality rate. In this article, we reviewed previous studies on invasive aspergillosis (IA) in viral infections and in adjustment with COVID-19. Also, the necessity of IA diagnosis to increase the survival rate in involved patients is discussed.
Materials and methods: Electronic databases, including Pubmed, Google Scholar, and Web of Science were searched using the following keywords: COVID-19, SARS-CoV-2, influenza, invasive aspergillosis, and invasive fungal infections.
Results: Reports from China showed 3.2% to 27.1% fungal co-infection in COVID-19 patients. Patients with COVID-19 who developed severe pneumonia were found with considerably higher rates of viral, bacterial, and fungal co-infections than those with mild pneumonia. Also, intestinal normal fungal flora was reported to be significantly different between COVID-19 patients and normal subjects.
Conclusion: While the main focus of physicians is on bacterial superinfection control in COVID-19, ignoring life threatening fungal infections may increase the mortality rate. Therefore, we profoundly recommend early diagnosis of invasive fungal infections in COVID-19 patients.

---

 Modes of transmission of the COVID-19 virus are still unclear. The virus could spread through direct routes, including aerosols and saliva, and indirect transmission through contaminated surfaces. Dental practitioners produce airborne infectious particles especially when using rotary instruments during treatment. Oral fluids, blood, and oral mucosa are also sources of infection, so dentists are exposed to coronavirus more than other medical staff. Indeed, designing appropriate protocols and prevention strategies are highly important. In this review paper, we will explain and review the transmission pathways of the coronavirus, clinical signs of infected patients, dental office infection control, and dental treatment considerations.

---

 Background and purpose: The recent Coronavirus (SARS-CoV-2) has resulted in a sudden outbreak which has significantly affected various aspects of daily lives. This study was carried out to determine self-care barriers in prevention of Covid-19 according to healthcare experts and laypersons.
Materials and methods: A qualitative-quantitative based cross-sectional research was designed. To perform the qualitative phase, group discussion with faculty members and managers in Isfahan University of Medical Sciences and phone interviews with laypersons were carried out. Then, data extracted in this phase were used to design a 40-item questionnaire which was found to be reliable (Cronbach’s Alpha: 0.90), to be completed by Iranian citizens in four days via social networks. In this survey, 1056 people participated. Data analysis was done in SPSS V21.
Results: Self-care barriers according to the qualitative phase of the study included social barriers, psychological barriers, religious barriers, political and management barriers, healthcare system barriers, and information barriers. Political and management barriers (mean score=78.87) and psychological barriers (belief, behavior, personality) (mean score=70.01) were found to be the major self-care barriers. The mean self-care score was 8.5 (in a scale of 0 to 10). The mean self-care scores were significantly higher in women (P<0.0001) and in people with higher levels of education (P=0.007). No significant difference was observed in mean self-care score based on marital status (P=0.61) and occupation (P=0.052).
Conclusion: Health care managers and policymakers could guide people towards more efficient self-care by planning to reduce and overcome barriers identified in this study.

---

Background and purpose: In 2019, the world has witnessed the emergence of a virus that caused acute respiratory distress syndrome in human with high mortality rates (approximately 3.7%). So far, no effective treatment has been proven against COVID-19. This study aimed at designing a multi-epitope vaccine combining several T-cell and B-cell epitopes of the SARS-CoV-2.
Materials and methods: Based on immunoinformatics strategies, B-cell and T-cell epitopes were predicted using immune Epitope Database and Analysis Resource (IEDB). Then, the appropriate predicted epitopes were joined to each other by suitable linkers, and the multi-epitope vaccine constructed was suggested as a vaccine candidate against SARS-CoV-2.
Results: In this study, 28 B-cell epitopes and 33 T-cell epitopes were predicted. Then, to design the multi epitope vaccine, 5 epitopes were used from the virion surface of spike protein and one epitope was used from intravirion region of the Envelope, Membrane, and Nucleocapsid proteins that later on were joined with flexible glycine linker.
Conclusion: Based on the immunoinformatics results obtained, it seems that different epitopes from SARS-CoV-2 structural proteins have high ability to stimulate humoral and cellular immune responses, so the multi-epitope vaccine designed with these epitopes, can help to accelerate the production of effective vaccines against COVID-19.

---

Background and purpose: Coronavirus disease (COVID-19) is an infectious disease caused by the new corona virus. The disease has led to high death toll and extensive damage throughout the world. The aim of this study was to determine the predictors of COVID-19 preventive behaviors in Iranian population based on the Health Belief Model.
Materials and methods: A descriptive-analytical cross-sectional study was carried out in 400 individuals older than 18 years of age in Mazandaran Province, Iran 2020. They were selected using convenience sampling in social networks. Data were collected by a researcher-made scale based on Health Belief Model. Data analysis was done applying Pearson correlation coefficient and linear regression.
Results: There were significant positive correlations between preventive behaviors of COVID-19 and perceived susceptibility (r=0.2, P=0.000), perceived benefits (r=0.127, P=0.011), perceived barriers (r=0.189, P=0.000), and perceived self-efficacy (r=0.302, P=0.000). The Health Belief Model constructs predicted 26% of variance for preventive behaviors of COVID-19, among which, perceived self-efficacy (β=0.220) was the most powerful predictor.
Conclusion: This study confirmed the predictive role of self-efficacy in COVID-19 preventive behaviors according to the Health Belief Model. Thus, providing ways to increase self-efficacy such as verbal persuasion, increasing awareness about people abilities, and providing them with suitable models could promote preventive behaviors toward COVID-19.

---

Background and purpose: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the new corona virus. The aim of this study was to determine the predictors of COVID-19 prevention behaviors in an Iranian population based on the health belief model.
Materials and methods: This descriptive analytical (cross-sectional) study was performed in 1020 people older than 15 years of age in Iran in 2020 selected via convenience sampling. Data were collected through an online survey using a researcher-made questionnaire based on the health belief model. Data analysis was done in SPSS applying correlation coefficients and linear regression tests.
Results: Frequent prevention behaviors of COVID-19 included using personal items at home and work (83.7%), following the precautionary measures presented in mass media (80.2%), and not leaving the house except in necessary cases (67.6%). There were significant correlations between all constructs of health belief model and performance, except for perceived barriers and perceived severity) (P<0.01).
Conclusion: According to the predictive role of prevention behaviors of COVID-19 based on health belief model, this model can be used in educational and interventional programs. 
 

---

  Background and purpose: Gastrointestinal symptoms along with respiratory symptoms recorded in patients with Covid-19 indicate the role of microbiota in this disease. The purpose of this scientometric study was to assess the articles published on the relationship between microbiota and Covid-19 in order to control the pandemic by reaching new strategies.
Materials and methods: Relevant articles were searched in Scopus database by titles and abstracts, published from January 1 to October 15, 2020. Data analysis was performed by analysis tools available in Scopus database, SPSS and VOSviewer network analysis version 1.6.15.
Results: Overall, 87 papers were included. The most productive time was July in which 20 articles were published. The top subject area was medicine (n=66 papers). The first productive country was the USA (24.14%), and the top institute was the Chinese University of Hong Kong (8.54%) in China. The top source was the Lancet Gastroenterology and Hepatology journal that published 8.05% of the articles. Total number of citations were 401 and their H‑index was 9. Top author and top country in the co-authorship network assessment or international collaboration were from China and the USA, respectively. From the Middle East, six articles were published on microbiota and Covid-19 by Iran, Jordan, Qatar, and Turkey and the highest cited article (5 times) was  from Jordan.
Conclusion: Some research has been carried out to investigate the role of microbiota in developing Covid-19. However, further studies are needed to clarify this role.
 

---

Background and purpose: Self-efficacy is central to behavior, especially preventive behaviors of Coronavirus Disease 2019 (Covid-19). Identifying the factors that lead to increased self-efficacy in individuals can pave the way for necessary decisions to change the behavior of the society. This study aimed at determining the relationship between people’s self-efficacy and perceived severity and sensitivity to preventive behaviors of Covid-19 in Sari, Iran.
Materials and methods: This descriptive-analytical study was performed in 268 patients attending certain health centers in Sari, 2020.The subjects were selected using convenience sampling. To collect the data, a researcher-made questionnaire was administered online consisting of three sections.
Results: The mean age of the study population was 36.81±8.6 years and 17.5% of the patients were confirmed cases of Covid-19. Among the people studied, 81.3% used soap and water to disinfect their hands. There were significant correlations between self-efficacy and perceived severity (B: 0.163, CI 95%: 0.068-0.257) and perceived sensitivity (B: 0.164, CI 95%: 0.060-0.267). Perceived sensitivity and severity also predicted 10% of the variance in self-efficacy.
Conclusion: Perceived severity and sensitivity to Covid-19 preventative behaviors could affect people’s self-efficacy.

---

 Background and purpose: The outbreak of Coronavirus Disease 2019 (COVID-19) pneumonia is a major threat to global public health because it is very contagious and spreads quickly by human-to-human transmission. This study aimed to investigate the clinical characteristics and outcome of patients infected with COVID-19 in Saveh, Iran.
Materials and methods: A descriptive-analytical study was conducted in 1537 patients with suspected or confirmed COVID-19 from 18 February- 2 June 2020. Medical records were studied and a researcher-made questionnaire consisting of demographic information, epidemiological, and clinical manifestations were used to collect the data.
Results: There were significant differences between patients tested positive and negative for COVID-19 in terms of gender, age, duration of hospitalization, and contact with a patient with confirmed COVID-19 (P<0.05). The main symptoms of patients included cough (43.8%), fever (41.4%), and dyspnea (40.3%). The most common chronic diseases in these patients were cardiovascular disease (12.9%), diabetes (11.5%), and hypertension (9.7%). The mean age of death due to COVID-19 was 70.2±15.6 years and higher rate of mortality was seen in men (66.2%).
Conclusion: While responding to COVID-19, health authorities should consider vulnerable groups (older patients and those with underlying diseases) and provide them with more information on the modes of transmission of COVID-19 and the risks of infection.

---

 
Background and purpose: In many universities, the physical presence of dental students is required to learn the theoretical sciences and clinical skills. These students are at a high risk to get infected with Coronavirus disease 2019 (COVID-19) because aerosol production and close contact with patients is inevitable. In this review study, the challenges in educating dental students during the COVID-19 pandemic and related solutions are discussed.
Materials and methods: MEDLINE, Scopus, Ovid, and Google scholar databases were searched for relevant articles published in English until September 7, 2020. Articles with the target population of specialty/general dentistry students were included and studies associated with graduate dentists or other pandemics were excluded. After quality assessment, 49 studies were included in current review.
Results: The COVID-19 pandemic caused disruption in traditional face-to-face dental education which was replaced by synchronous learning. This type of learning is faced with some challenges, including lack of sufficient facilities and lack of familiarity of involved people. In this situation, teaching and assessment of theoretical modules should continue virtually with high quality. Clinical units should also be organized by grouping students in smaller numbers and more shifts while adhering to new infection control protocols. Research can also be continued on animal models and COVID-19-related subjects.
Conclusion: Improving the structure of theoretical and clinical education in dentistry is recommended to deal with similar crises in the future.

---

Background and purpose: The global prevalence and morbidity of Coronavirus disease 2019 (COVID-19) are high. Preventive behaviors are proven to reduce the damage caused by the disease. There is a paucity of information on determinants of preventive behaviors in response to COVID-19 in Mazandaran province, north of Iran. So, we aimed to evaluate protection motivation theory (PMT) in promoting preventive behaviors of COVID-19 in Mazandaran province.
Materials and methods: In this descriptive cross-sectional study, 1220 individuals participated. They were selected via social networks using convenience sampling in 2020. Data were collected online using a demographic questionnaire and a valid and reliable scale based on PMT. Data analysis was done using Pearson correlation coefficient and linear regression in SPSS V24.
Results: Mean age of the participations was 39.34±8.74 years. Regression model showed perceived threat (ß =0.033, P =0.007), perceived costs (ß=0.039, P=0.045), perceived self-efficacy
(ß =0.116, P>0.001), and perceived fear (ß=0.131, P>0.001) as the significant predictors of COVID-19 preventive behaviors. This model accounted for 78% of the variance in these behaviors.
Conclusion: According to constructs of the PMT associated with protection against COVID-19, educational programs and health promotion based on the theory and benefiting from social networks could be helpful in increasing the motivation of people towards protective behaviors of COVID-19.
 

---

Background and purpose: Vitamin D deficiency is highly prevalent in Iran. Death toll due to the Coronavirus Disease 2019 (COVID-19) is high in this country. The purpose of the present investigation was to provide more information on the relationship between serum levels of vitamin D in confirmed cases of COVID-19 in north of Iran.
Materials and methods: This cross-sectional descriptive study was performed in COVID-19 patients (n=80) attending Sari Imam Khomeini Hospital, Iran 2020, who were confirmed for COVID-19 infection with CT-Scan or RT-PCR. Seventy healthy individuals were also examined as the control group. SPSS V19 was applied for data analysis.
Results: In this study, 80 patients with COVID-19 (mean age: 57.22 ± 17.44 years old) and 70 healthy individuals (mean age: 48.69 ± 12.99 years) were studied. There were 38 and 35 males in these two groups, respectively. Serum Vitamin D levels were significantly lower in patients with COVID-19 than those in the control group (18.72 ± 12.53 vs. 30.86 ± 15.19 ng/ml, P< 0.001).
Conclusion: This study showed that serum levels of Vitamin D were lower in patients with COVID-19 than healthy individuals and frequency of Vitamin D deficiency was higher in these patients. Hence, further studies are needed to clarify the role of serum Vitamin D concentrations in patients with COVID-19 infection.

---

 Identifying and determining the origin of the first human case of COVID-19, which has caused pandemic will be of great benefit in preventing and controlling next epidemics and pandemics. The first confirmed case of COVID-19 was reported in December 2019 in China. This article reports three cases of pneumonia compliant with COVID-19 admitted to Qaemshahr Razi Hospital in Mazandaran province, Iran before the first official report of confirmed case of the disease (November-December 2019). The pattern of radiological involvement was completely consistent with COVID-19 in all three patients. Two patients died of acute progressive respiratory failure despite supportive respiratory therapy and systemic corticosteroids, and the other patient recovered. Study of these cases highlights the fact that emerging and re-emerging diseases should be considered in management of patients with infection and unusual symptoms.

---

Background and purpose: Hospitals are one of the vital pillars of the health system. Hospital preparedness in epidemics is a dynamic, complex and multidimensional process that shows the developed capacities and capabilities of the hospital in predicting, reducing the effects, resistance, response, and recovery in the face of biological events. The aim of this study was to investigate the readiness of hospitals in response to the pandemic of COVID-19 disease in Mazandaran province, Iran.
Materials and methods: This cross-sectional study was performed in April 2020 using the standard checklist of the Pan American World Health Organization (PAHO 2019). The checklist consists of ten components: incident management system (7 items), coordination (2 items), information management (2 items), logistics (7 items), finance and administration (1item), detection (3 items), diagnosis (3 items), isolation (3 items), cases management (4 items), and prevention and infection control (10 items). Data were analyzed applying Kruskal-Wallis test in SPSS V18.
Results: We studied 39 hospitals in the province, including university hospitals (n=26), social security hospitals (n=4), and private hospitals (n=9). Social security hospitals showed the highest level of readiness (mean score= 82 out of 84), university hospitals had moderate level of readiness (mean score= 72.72 out of 84), and private hospitals had the lowest mean score for readiness (72.5 out of 84). According to the total scores, operational readiness was at a good level.
Conclusion: The readiness of the hospitals in the face of the COVID-19 pandemic was at a good level in Mazandaran province. However, due to the prolonged pandemic and uncertainty about when it comes to an end, monitoring the key components is essential to maintain high level of preparation.
 

---

 Background and purpose: At the beginning of 2020, Covid-19 disease spread rapidly in most parts of the world. Meanwhile, medical staff experienced a lot of stress due to the high disease transmission rate and considerable rate of morbidity and mortality. The aim of this study was to explain the psychological experience and psychological needs of nurses working at frontline of treatment of patients with Covid-19.
Materials and methods: We performed a phenomenological qualitative research in Sari, Iran May and June 2020. The participants included 9 nurses selected via convenience sampling. Data were collected using in-depth and semi-structured interviews by a psychiatrist. Finally, Data were coded and analyzed using MAXQDA-2020 software.
Results: According to findings, three main themes were extracted, each theme was formed from categories and each category included some codes. Emotional experiences, expectations from superiors, and the need for psychological interventions were the main themes.
Conclusion: In this study, nurses reported different emotions such as satisfaction, anger, and worries about being at risk of infection and transmitting the disease to their family. The needs of nurses included psychological and financial supports and appreciation and empathy from the authorities, workplace security, and in-person psychological interventions.

---

Background and purpose: Coronavirus Disease-2019) COVID-19) is a respiratory infection which was recognized as a pandemic by the world health organization on march 11, 2020. This study aimed to evaluate new treatment modalities therapy in management of COVID-19.
Materials and methods: A descriptive-analytical, retrospective study was performed in patients over 17 years of age with suspected COVID-19 admitted to Qaemshahar Razi Hospital in March and April 2020. The case group included patients treated with methylprednisolone, intravenous immunoglobulin (IVIg), Beta Interferon, Ribavirin, Arbidol, Remdesivir, Favipiravir and Hydroxychloroquine and lopinavir/ritonavir. The control group was selected from hospitalized cases who were treated only with lopinavir/ritonavir and Hydroxychloroquine. This study evaluated the efficacy of these drugs. Data was analyzed in SPSS V18.
Results: The mean ages of case group (n=217) and control group were 54.23±16.64 (17-88) years and 53.8±16.23 (19-80) years, respectively. The need for ICU admission and mechanical ventilation were significantly different between the two groups (P<0.05) but no significant difference was seen on mortality rate (P>0.05).
Conclusion: Using anti-inflammatory and anti-viral drugs in hospitalized patients seems reasonable until widespread vaccination and development of effective drug.

---

 Background and purpose: Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome (SARS-CoV-2). Rapid spread of the virus around the world shows that identification of transmission routes and preventing environmental contamination, especially in healthcare settings plays a vital role in controlling the disease. In this study, air and surface contamination with SARS-CoV-2 were evaluated in different wards of Hajar Hospital in Shahrekord.
Materials and methods: In current study, 13 samples of different surfaces and 15 air samples were taken using sterile swabs impregnated with VTM and standard impinger, respectively. Detection of SARS-CoV-2 was performed using RT-PCR.
Results: Findings showed that 46.15% of surface samples and 26.66% of air samples were positive for SARS-CoV-2 RNA. These contaminations were detected only in areas which were in close contact with COVID-19 patients.
Conclusion: This study confirmed the contamination of air and surface with SARS-CoV-2 in COVID-19 admitting wards. Therefore, personal precautionary measures, including frequent hand-washing, timely changing of face mask, and using more protective equipment are highly recommended in healthcare settings. Moreover, cleaning and regular disinfection of surfaces and equipment and appropriate ventilation of wards are crucial for preventing the disease transmission.

---

 Background and purpose: The association between ABO blood types and Coronavirus disease 2019 (COVID-19) have been investigated in several studies but there are inconsistencies in results. The purpose of this study was to investigate the association between ABO blood types and COVID-19 infection based on serologic results.
Materials and methods: A cross-sectional seroepidemiologic study was carried out in 1504 people living in Mazandaran province, north of Iran. Blood samples were drawn to determine blood groups. Also, IgG and IgM antibodies were measured by ELISA. Data analysis was done using Chi-square, Fisher’s exact test, univariate and multivariate logistic regression analyses in SPSS V25.
Results: The frequency of IgG positive among blood groups A, B, AB, and O was 12.7%, 11.8%, 9.4%, and 9.6%, respectively. After adjusting for suspicious confounding factors, the odds ratio of COVID-19 infection was 1.19 (95% CI:0.85-1.67) in blood group A, 1.33 (95% CI:0.94-1.87) in blood group B, 0.82 (95% CI:0.44-1.55) in blood group AB, and 0.70 (CI 95%:0.50-0.98) in blood group O based on serologic results (IgG+/IgM+).
Conclusion: The odds ratio for COVID-19 was significantly lower (30%) in blood group O compared to other blood groups, so blood group O can be considered as a protective factor against COVID-19.

---

 Background and purpose: The Coronavirus Disease 2019 (COVID-19) was first observed in December 2019 and caused a global pandemic. The aim of this study was to evaluate the clinical features and paraclinical findings in patients who died of COVID-19 in Sari Imam Khomeini Hospital, February 2020- May 2020.
Materials and methods: A cross-sectional descriptive and retrospective study was done by reviewing the medical records of 149 patients who died of Covid-19 whose diagnosis was confirmed by chest CT scan or PCR-RT. Independent sample t test was used to compare quantitative variables and Chi-square test was used for analyzing qualitative variables.
Results: The mean age of death from Covid-19 was 63.36±15.26 years and 58.1% were male. The most common clinical complaints were cough, fever, and dyspnea. The most common manifestation of chest CT scan was bilateral involvement. Among the dead cases of COVID-19, 13.5% had myocarditis and 4.7% developed respiratory complications (such as pneumothorax). According to findings, 54.1% died of cardiac arrest and 44.6% died due to respiratory arrest.
Conclusion: Many ambiguities of SARS-CoV-2 still remain that require extensive studies and research in various aspects. Evaluation of demographic, radiological, clinical complications, and laboratory features can help physicians in finding ways to reduce mortality, perform more effective treatments, and use predictive tools.

---

Background and purpose: In addition to public health concerns, coronavirus disease 2019 (COVID-19) pandemic has caused psychological disorders such as anxiety, fear, depression, stigma, etc. The present study aimed at examining the perceived stress levels of people in COVID-19 pandemic, their coping strategies and the efficacy of each strategy in reducing stress.
Materials and methods: This mixed-method online survey was performed in 246 Iranians aged 15-65 years old. In quantitative part, the level of stress was assessed and in qualitative part, coping strategies were examined through open-ended questions. Quantitative data were analyzed in STATA software and qualitative data were analyzed by content analysis.
Results: Moderate levels of perceived stress were seen in all samples (19.56±4.56). According to qualitative analysis, coping strategies included two themes: general coping and religious-spiritual coping. Generally, 67% of the participants reported using spiritual coping strategies during COVID-19 outbreak. The degree of efficacy of each coping strategy was estimated using a 1-10 scale which showed a significant difference between general coping (5.94±2.61) and spiritual coping (5.06±3.19) (P <0.05).
Conclusion: Understanding coping strategies used by different age groups in both sexes and using them in public mental health programs helps policymakers not only in the COVID-19 pandemic but also in future outbreaks.