anahita sadeghi

 Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) marked by rectal and colon inflammation, leading to relapsing symptoms. Its prevalence is increasing, particularly in developed nations, impacting patients’ health. While its exact cause remains unclear, genetic and environmental factors are implicated, elevating the risk of colorectal cancer (CRC). Colectomy, though declining, is still performed in select UC cases, necessitating further study.

 We analyzed data from the Iranian Registry of Crohn’s and Colitis (IRCC) to examine UC patients undergoing colectomy. We collected demographic and clinical data from 91 patients, focusing on dysplasia. Statistical analyses assessed dysplasia risk factors.

 Patients with dysplasia were older at diagnosis and surgery compared to those without dysplasia. Age emerged as a significant risk factor for dysplasia in UC patients undergoing colectomy. No significant associations were found between dysplasia and other factors.

 Age plays a crucial role in dysplasia risk among UC patients undergoing colectomy. Older age at diagnosis and surgery may indicate a higher risk of dysplasia and CRC. Clinicians should consider age when managing UC patients and implementing screening protocols. Further research with larger samples is needed to confirm these findings.

Iatrogenic colonic perforation (ICP) is a rare but serious complication of colonoscopy, with an incidence ranging from 0.016% to 8% depending on the type and purpose of the procedure. Several patient-related, endoscopist-related, and procedure-related factors increase the risk of ICP, which most commonly occurs in the sigmoid colon. Following specific guidelines for colonoscopy performance and quality can help prevent ICP. Early diagnosis is essential, and imaging modalities such as radiography or CT scan may be needed to evaluate the extent of damage. The management of ICP depends on the size and location of the perforation, the presence of peritonitis or sepsis, the underlying colon pathology, and the patient's general condition. Endoscopic, surgical, or conservative methods may be used, but surgical consultation should always be sought urgently. Surgery is usually indicated for large perforations, signs of peritonitis, inadequate bowel preparation, severe comorbidity, failure of conservative treatment, underlying colon disease requiring surgery, transplant recipients, or immunocompromised patients. Laparoscopic-assisted exploration is the preferred surgical technique for ICP. The timing of a follow-up colonoscopy depends on the indication for the initial colonoscopy that led to ICP.

It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients.

This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn’s and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes.

From 10 048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn’s disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients (P < 0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P = 0.001), immunomodulators (44.9% vs 25.2%, P < 0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P = 0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P = 0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P < 0.001), immunomodulators (58.7% vs 41.8%, P = 0.005) and anti-TNF (49.6% vs 35.4%, P = 0.006).

Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use.

Irritable bowel syndrome is a chronic and debilitating digestive disorder that is more common in people with psychological disorders than in the general population. This study is aimed at the effectiveness of cognitive-behavioral therapy in the mitigating of chronic pain and cognitive-emotional regulation in patients with Irritable bowel syndrome.  This study investigates the efficacy of cognitive-behavioral therapy on chronic pains and cognitive emotion regulation in patients with IBS. The research method is quasi-experimental with a pretest-posttest and control group and a six-month follow-up. All patients with IBS who had presented to the Shariati Hospital of Tehran and Masoud Gastroenterology and Liver Clinic from autumn 2019 to winter 2020 comprised the statistical population. The sample size was 48 people selected by convenience sampling, then divided into an experimental group and a control group using a block randomization procedure (with each group containing 24). Chronic Pain Grade Scale and Cognitive Emotion Regulation Questionnaire were the research tools provided to the two groups. However, the control group remained on the waiting list and received no interventions. The cognitive-behavioral therapy intervention was performed for the experimental group for eight 90-minute sessions. Descriptive statistics and Repeated Measures analyzed research data. Findings indicated that cognitive-behavioral therapy reduced chronic pain and increased cognitive regulation (p>0.01). This efficacy remained stable until a six-month follow-up (p>0.05). This finding can also be associated with reducing and improving cognitive emotion regulation within psychological interventions planning vision among patients with IBS, and thus have clinical usages.

 Colorectal cancer (CRC) is the third most common cancer in Iran, where there is no organised CRC-screening programme. This study aimed to evaluate feasibility of CRC screening using a qualitative fecal immunochemical test (FIT) among Iranian average-risk adults.

 In this feasibility study, 7039 individuals aged 50–75 years were invited by community health workers (CHWs) in southern Tehran and its suburban districts between April 2018 and November 2019. The CHWs performed a qualitative FIT with cut-off level 50 ng Hb/mL buffer and referred those with positive-FIT for colonoscopy to the endoscopy center of Shariati hospital in Tehran. Outcomes included acceptance rate, FIT positivity rate, colonoscopy compliance, detection rates and positive predictive values (PPVs) with 95% confidence interval for CRC and advanced adenomas (AAs).

 Acceptance rate at initial invitation was 71.7%. From 4974 average-risk adults (1600 males and 3374 females) who were offered FIT, 96.8% (n=4813) provided valid samples, of whom 471 (9.8%) tested positive. Among FIT-positive participants, 150 (31.8%) underwent colonoscopy; CRC was detected in 2.0% (n=3) and adenomas in 27.3% (n=41). Detection rate of CRC and AAs per 1000-FIT-screened participants was 0.6 (0.1–1.8) [males: 0.7 (0.01–3.6), females: 0.6 (0.07–2.0)] and 4.2 (2.5–6.4) [males: 5.9 (2.6–11.0), females: 3.4 (1.7–6.0)], respectively. PPVs were 2.0% (0.4–5.7) for CRC and 13.3% (8.3–19.8) for AAs. There was no association between gender and the studied outcomes.

 Our results partially support the feasibility of scaling up organized CRC-screening through the existing healthcare system in Iran; it remains to be discussed carefully to ensure the capacity of healthcare system for adequate colonoscopy services.

 There is evidence that irritable bowel syndrome (IBS) can be a chronic and prevalent condition that is more common in individuals with psychological disorders than in the general population.

 This study aimed to compare the effectiveness of hypnotherapy and cognitive-behavioral therapy (CBT) in mitigating chronic pain and cognitive-emotional regulation in patients with IBS.

 In this three-arm randomized clinical trial, participants who were adults with refractory IBS were screened. Co-primary outcomes were chronic pain indices and cognitive emotion regulation at a six-month follow-up. The statistical population of this study was all patients with IBS referred to Masoud Clinic and Shariati Hospital from May 2019 to February 2021 in Tehran, Iran. Twenty-four patients were calculated for each group, and 72 were for two experimental and one control group using convenience sampling. Seventy-two patients with IBS were accessible to us after the inclusion and exclusion criteria. They were selected and randomly assigned to either interventions or the control group (n = 24). The demographic checklist, Chronic Pain Grade Questionnaire (CPGQ), and Cognitive Emotion Regulation Questionnaire (CERQ) were used in three periods.

 Data were analyzed by repeated-measures analysis of variance. Preliminary findings showed that the effectiveness of both treatments on chronic pain indices and cognitive emotion regulation in the post-test stage was significant (P < 0.05). Secondary results showed that treatment efficacy remained stable until the follow-up stage.

 This study revealed hypnotherapy and cognitive-behavioral therapy could effectively treat patients with irritable bowel syndrome. Patients with IBS could benefit from psychological intervention based on these findings.

Pharmacotherapy with biologics and small molecules, as the more effective therapies for moderate to severe ulcerative colitis (UC) and Crohn’s disease (CD), is complex. Choosing the best methods for their utilization in order to induce and maintain remission are critical for practicing gastroenterologists. We aimed to develop an Iranian consensus on the management of inflammatory bowel disease (IBD) patients with biologics and small molecules.

A Delphi consensus was undertaken by experts who performed a literature summary and voting process. Quality of evidence was assessed using the Grading and Recommendations Assessment, Development, and Evaluation; and an additional risk of bias-protocol.

Following an extensive search of the literature, 219 studies were used to determine the quality of the evidence. After three rounds of voting, consensus (defined as ≥ 80% agreement) was reached for 87 statements.

We considered different aspects of pharmacotherapy in this consensus. This guideline, along with clinical judgment, can be used to optimize management of IBD patients.

Global warming and climate change are important worldwide issues which are a major human health threat. Climate change can affect the gastrointestinal (GI) system in many ways. Increased rainfall events and flooding may be associated with increased GI infections and hepatitis. Climate change could cause changes in gut microbiota, which may impact the pattern of GI diseases. The stress of access to essential needs such as clean water and food, the effects of forced migration, and natural disasters could increase brain-gut axis disorders. The association between air pollution and GI disorders is another challenging issue. There is a lot to do personally and professionally as gastroenterologists regarding climate change.

Development of mental and cognitive skills of students affects their personal, social, and cultural abilities, as well as giving themcomprehensive views. On the other hand, it seems that this important subject has been neglected in most of the educational curricula. Moreover, the current cultural programs which are implemented by the Ministry of Health, Treatment, and Medical Education for students, doesnot fully meet this goal. Accordingly, the present study was conducted to review related evidence and interview experts to provide a policy summary and suggestions for improvement of mental and cognitive skills among health students.

This study was conducted with the aim of investigating the relationship of self-directed learning with metacognitive strategies and happiness of medical students of Mazandaran University of Medical Sciences in 2022.

This descriptive-cross-sectional study was conducted by correlational method. The data collection tool is Williamson's self-directed learning questionnaire with reliability 0.93, Wells and Carteret's metacognition with reliability 0.91, and OHQ with reliability 0.87. The validity of all three questionnaires was approved by experts. The statistical population includes 362 students, 193 of whom were randomly selected from Sari (156) and Ramsar campus (43). The result of the Kolmogorov test showed that all the data of the study were normal, therefore, to determine the status of the variables, the One Sample T Test was used to determine the relationship between them, and the Pearson Correlation Coefficient was used with SPSS software.

The average scores of self-directed learning (3.63) and metacognition (3.33) in students were higher than average, and the level of happiness (1.36) was lower than average. A significant relationship (r=0.493+) was seen between self-directed learning and happiness with a confidence level of 95% and Sig=0.000. Also, there was a significant relationship (r=0.89+) between self-directed learning and metacognitive strategies with Sig 0.0000. In addition, with df=191 and P-Value<0.05, no significant difference was observed in self-directed learning, metacognitive skills, and happiness among the students of Sari College and Ramsar Campus.

The self-directed learning skills and metacognition of medical students are acceptable, but proper planning is necessary to increase their happiness.

Based on previous studies in the sepsis population, Vitamin C could prevent injuries when administered in high doses and before the damage is established. This study aimed to evaluate the protective potentials of high-dose Vitamin C in the progression of coronavirus disease 2019 (COVID-19).

A double-blind, placebo-controlled clinical trial was conducted. Patients with moderate-to-severe disease severity based on the World Health Organization definition were enrolled and received 12 g/d Vitamin C (high‑dose intravenous Vitamin C [HDIVC]) or placebo for 4 days. Sequential Organ Failure Assessment (SOFA) score as a primary outcome, National Early Warning Score, Ordinal Scale of Clinical Improvement, and cytokine storm biomarkers were recorded on days 0, 3, and 5. Survival was also assessed on day 28 after enrollment.

Seventy-four patients (37 patients in each group) were enrolled from April 5, 2020, to November 19, 2020, and all patients completed follow-up. A lower increase in SOFA score during the first 3 days of treatment (+0.026 vs. +0.204) and a higher decrease in this parameter in the last 2 days (−0.462 vs. −0.036) were observed in the treatment group. However, these differences did not reach a significance level (P = 0.57 and 0.12, respectively). Other indices of clinical and biological improvement, length of hospitalization, and intensive care unit admission days were the same between the two groups. Treatment did not affect the 28-day mortality.

Among patients with moderate-to-severe disease of COVID‑19, the use of HDIVC plus standard care resulted in no significant difference in SOFA score or 28‑day mortality compared to the standard care alone.

Immunosuppressive agents used in the treatment of inflammatory bowel diseases (IBDs) could potentially increase the risk of coronavirus disease 2019 (COVID-19). We aimed to compare COVID-19 frequency in patients with IBD with their households and identify the related risk factors.

Firstly, a multi-centered, observational study on 2110 patients with IBD and 2110 age-matched household members was conducted to compare COVID-19 frequency. Secondly, the data of patients with IBD and COVID-19 who had called the COVID-19 hotline were added. Multivariable logistic regression was used to evaluate the effect of age, type and severity of IBD, the number of comorbidities, and medications on the frequency of COVID-19 among the patients with IBD.

The prevalence of COVID-19 in patients with IBD and household groups was similar (34 [1.61%] versus 35 [1.65%]; P = 0.995). The prevalence of COVID-19 increased from 2.1% to 7.1% in those with three or more comorbidities (P = 0.015) and it was significantly higher in those with severe IBD (P = 0.026). The multivariable analysis only showed a significant association with anti-TNF monotherapy (OR: 2.5, CI: 0.97-6.71, P = 0.05), and other medications were not associated with COVID-19.

The prevalence of COVID-19 in patients with IBD was similar to the household members. Only patients with IBD receiving anti-TNF monotherapy had a higher risk of COVID-19 susceptibility. This finding could be attributed to the higher exposure to the virus during administration in health care facilities.

Colonoscopy is generally a safe procedure with a limited number of adverse events. Few studies have addressed the rate of adverse events in teaching hospitals. This study aimed to investigate the rate of complications after colonoscopy performed by gastroenterology fellows in a teaching hospital in Tehran.

A historical cohort study was carried out to link the colonoscopy reports and the hospital information system to identify serious adverse events leading to unplanned hospitalization, unplanned procedures or interventions (e.g. surgery), prolongation of existing hospitalization, or death within 30 days after colonoscopy.

We included 9928 colonoscopies (mean age of the patients 53.0±15.9 years, 52.3% men) in this study. In-hospital patients comprised (34.8%) of the procedures. The indications of colonoscopy included 7137 diagnostic (71.9%), and 2519 screening (25.4%) reasons. Colorectal polyps were found in 2005 (20.2%) patients. Major complications were seen in 17 patients (0.2%), including serious bleeding in seven patients, cardiopulmonary complications in five patients, perforation in four patients, and sepsis in one patient.

Serious adverse events after colonoscopy are relatively rare. The rate of complications does not appear to be higher in an academic teaching hospital when performed by fellows under supervision.

 Most data on the effect of inflammatory bowel disease (IBD) and its treatments on coronavirus disease 2019 (COVID-19) outcomes have not had non-IBD comparators. Hence, we aimed to describe COVID-19 outcomes in IBD compared to non-IBD patients.

 We conducted a prospective cohort study of registered IBD patients with confirmed COVID-19 from six provinces in Iran from February to April 2020. Proven COVID-19 patients were followed up at four weeks and the frequency of outcomes was assessed. Multivariable logistic regression was used to assess associations between demographics, clinical characteristics and COVID-19 outcomes.

 Overall, 2159 IBD patients and 4721 household members were enrolled, with 84 (3.9%) and 49 (1.1%) participants having confirmed COVID-19, respectively. Household spread of COVID-19 was not common in this cohort (1.2%). While hospitalization was significantly more frequent in IBD patients compared with non-IBD household members (27.1% vs. 6.0%, P=0.002), there was no significant difference in the frequency of severe cases. Age and presence of IBD were positively associated with hospitalization in IBD compared with non-IBD household members (OR: 1.06, 95% CI: 1.03-1.10; OR: 5.7, 95% CI: 2.02– 16.07, respectively). Age, presence of new gastrointestinal symptoms, and 5-aminosalicylic acid (5-ASA) use were associated with higher hospitalization rate in IBD patients (OR: 1.13, 95% CI: 1.05–1.23; OR: 6.49, 95% CI: 1.87–22.54; OR: 6.22, 95% CI: 1.90–20.36, respectively). Anti-tumor necrosis factor (TNF) was not associated with more severe outcomes.

 Age, presence of new gastrointestinal symptoms and use of 5-ASA were associated with increased hospitalization rate among IBD patients, while anti-TNF therapy had no statistical association.

 The Coronavirus Disease 2019 (COVID-19) pandemic promptly became a significant public health challenge with extra-pulmonary manifestations, including liver damage. Postmortem examination is crucial for gaining a better understanding of these manifestations and improving patient management. This study summarized the current knowledge of the postmortem liver pathology of patients with COVID-19.

 This review was conducted on studies evaluating the postmortem macroscopic and microscopic findings of the liver in patients with COVID-19. Accordingly, we searched 4 electronic databases (PubMed, Scopus, Google Scholar, & Web of Science) until June 2021. From the 317 screened articles, 16 articles examining a total of 332 patients who had died due to COVID-19 were selected.

 The significant findings of the liver were moderate macro and microvesicular steatosis with mild sinusoidal dilation, active lobular and portal vein thrombosis, mildly-increased lymphocyte filtration in sinusoidal space, and multifocal hepatic necrosis. Additionally, the most common comorbidities were hypertension and other metabolic diseases. In conclusion, liver damage due to COVID-19 infection has various manifestations in patients who have expired due to COVID-19.

 Therefore, monitoring liver function during the course and treatment of this disease is necessary for better patient management and to decrease the COVID-19-induced mortality rate COVID.

Tofacitinib, a selective inhibitor of JAK/STAT pathway, has recently become available in our region. Here, we examined the safety and efficacy of tofacitinib in active ulcerative colitis (UC).

In a prospective, non-randomized, placebo-free, 52-week clinical trial defined in two phases of induction and maintenance, adult patients with active UC and no response or loss of response to previous conventional treatments, or anti-TNF were recruited (IRCT20181217042020N2). Patients received 10 mg/BID of tofacitinib for 8 weeks. Clinically responding patients were entered into the maintenance phase and received tofacitinib 5 mg/BID for 44 weeks. Clinical evaluation, biochemical tests and endoscopy at time points of baseline, 8, 24 and 52 weeks were performed. The primary outcome was clinical remission at 8 and 52 weeks.

Fifty out of 53 enrolled patients completed the induction phase. Clinical response and clinical remission at 8 weeks occurred in 84% and 9.5%, respectively. Forty-two patients who had clinical response entered the maintenance phase. Clinical remission based on the total Mayo score and the partial Mayo score occurred in 38.9% and 55.3% at 24 weeks and in 61.1% and 72.2% at 52 weeks, respectively. There was significant correlation between the total and partial Mayo score with regard to clinical remission in both 24 and 52 weeks. No serious adverse events, no case of herpes zoster, but two cases of deep vein thrombosis were seen.

Our study showed acceptable efficacy and safety for tofacitinib and suggested a correlation between the total Mayo score with partial Mayo score with regard to clinical remission.

Background Lead is a widely distributed metal in the environment and can be toxic to the human body. Lead poisoning has different clinical features. Recently, there have been increasing reports about lead poisoning following oral opium use. We report on a series of patients presented with abdominal pain attributable to lead-contaminated opium. Materials and Methods We recruited all patients presented with abdominal pain and opium addiction, referring to the emergency room of a university-affiliated hospital. Demographic, clinical, and laboratory data, as well as abdominal imaging and blood lead level, were collected for all patients. Results Of 208 patients enrolled, 183 were male (88%), and the mean age was 51.2±14.1 years. They all had a minimum of one-year history of oral opium consumption. 112 (53.8%) patients had a blood lead level of more than 20 μg/dL, and 22 patients (10.5%) had a blood lead level of more than 100 μg/dL. Half of the patients had a history of several hospital admissions for abdominal pain. Among patients with a lead level of more than 20 μg/dL, 87 (78%) had anemia with a hemoglobin level of less than 13 g/dL (mean hemoglobin 11.1 ± 2.5 g/dL). Conclusion Our case series highlights the role of opium administration as a possible emerging cause of acute abdominal pain of unknown cause.

Antimalarial agents, including chloroquine and hydroxychloroquine, have been used for the treatment of various rheumatoid diseases and skin diseases because of their anti-inflammatory and immune-modulating properties. Cutaneous adverse effects such as exacerbation of psoriasis, pruritus, and hyperpigmentation have been reported as side-effects of antimalarial drugs. In this case, we report a middle-aged man with a history of rheumatoid arthritis who was treated with non-steroidal anti-inflammatory drugs and hydroxychloroquine. He complained of hyperpigmentation of the face after one year of initiating the hydroxychloroquine. It was discontinued and methotrexate was started. Skin biopsy was confirmed drug reaction. After more than 10 years of follow up, his skin discoloration had not been improved.

Carbamazepine(CBZ) is an effective first line treatment for trigeminal neuralgia and has an important place in the management of epilepsy and bipolar disorder. The potential for clinically important drug interactions exists because CBZ may induce the hepatic metabolism of other drugs or, conversely, other drugs may induce or inhibit the metabolism of CBZ.CBZ  is including  big group   of antiepileptic drugs that is widely used to prevent and control seizures. It has been associated with several cutaneous side effects, in  this case reported  a young woman who presented  with dyspnea, weight loss, pancytopenia, abdominal pain and oligomenorrhea and two weeks history of hyperpigmented lesions over her face, neck and two hands. She had history of seizures and did well on carbamazepine for 7 months ago, carbamazepine was withdrawn and she was treated with local emollients. The lesions were partially improved in 2 weeks.

BACKGROUND The COVID-19 pandemic has affected the health care infrastructure dramatically, with abundant resources necessarily being redirected to COVID-19 patients and their care. Also, patients with chronic diseases like inflammatory bowel disease (IBD) may be affected in several ways during this pandemic. METHODS We used the Iranian registry of Crohn’s and colitis (IRCC) infrastructure. We called and sent messages to follow-up and support the care of all registered patients. Besides, we prepared and distributed educational materials for these patients and physicians to reduce the risk of COVID-19 infection. We risk-stratified them and prepared outpatient clinics and hospitalization guidance for IBD patients. RESULTS Of 13165 Iranian patients with IBD, 51 have been diagnosed as having COVID-19. IBD patients made 1920 hotline calls. Among the patients with suspicious presentations, 14 COVID-19 infections were diagnosed. Additionally, 1782 patients with IBD from five provinces actively phone-called among whom 28 definite cases were diagnosed. CONCLUSION IBD patients’ follow-up could help in diagnosing the affected IBD patients with COVID-19. Additionally, the performance of protective actions and preparing the patients and physicians for decisive proceedings are the principles of protection of IBD patients.

Medical students need proper education in drug prescription. The aim of the present study is to introduce a course that improves the students’ prescribing skills and also promotes an interprofessional collaboration between medicine and pharmacy schools.

This study was done in a skill laboratory at the pharmacotherapy department of Tehran University of Medical Sciences, Tehran, Iran. The course was an 18‑h interactive workshop in 3 days under the supervision of clinical pharmacists. A total of 18 medical students participated in these classes before their internship. Before and after each class, they were given tests and paired t‑test was done to compare the marks.

A total of 18 medical students participated in this study. The results showed that the knowledge of the students on pharmacotherapy, drug information, and prescribing skills has been significantly improved at the end of the course.

Using clinical pharmacists to the present pharmacotherapy course could be an effective model for medical students to obtain better prescribing skills.

This guideline was developed to assure the highest level of protection against COVID-19 for both patients and health care providers in endoscopy departments while providing high quality and timely gastroenterology care during the current COVID-19 pandemic. We electronically searched the databases of PubMed, Google Scholar, and MedRxiv up to April 10, 2020. Then, a questionnaire was designed based on available documents and international recommendations. Three Delphi rounds were conducted via online forms. Eighteen statements were developed on risk stratification of patients and procedures and recommendations for performing necessary procedures while safeguarding patients, nurses, physicians and other service providers with appropriate use of personal protection equipment, sanitizing of environments and redesigning the endoscopy suits. Considering the dynamic of COVID-19 pandemic in the world and Iran, this guideline will be updated online as needed.