Background Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical studies to clarify the obesity relationship with COVID-19 severity, comorbidities, and discussing possible mechanisms. Materials and methods The electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, were searched and all studies conducted on COVID-19 and obesity were reviewed. All studies were independently screened by reviewers based on their titles and abstracts. Results Forty relevant articles were selected, and their full texts were reviewed. Obesity affects the respiratory and immune systems through various mechanisms. Cytokine and adipokine secretion from adipose tissue leads to a pro-inflammatory state in obese patients, predisposing them to thrombosis, incoordination of innate and adaptive immune responses, inadequate antibody response, and cytokine storm. Obese patients had a longer virus shedding. Obesity is associated with other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, and vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. Reduced physical activity, unhealthy eating habits and, more stress and fear experienced during the COVID-19 pandemic may result in more weight gain and obesity. Conclusions Obesity should be considered as an independent risk factor for the severity of COVID-19. Paying more attention to preventing weight gain in obese patients with COVID-19 infection in early levels of disease is crucial during this pandemic.

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Background: Deep Vein Thrombosis (DVT) is a major problem in hospitalized patients. There is discrepancy between healthcare providers' knowledge and their clinical practice regarding DVT prophylaxis. In this study we aimed to evaluate knowledge, attitude and practices of internal medicine residents at an educational hospital in Tehran. Methods:This cross-sectional study was conducted during December 2015 at Shariati hospital of Tehran, IRAN. A questionnaire covering five domains of clinical scenarios, adherence to guidelines, personal beliefs, practice, preferences and personal beliefs, was distributed between internal medicine residents. Medical records of patients at the internal ward were reviewed to assess the status of DVT prophylaxis in patients, who needed DVT prophylaxis based on American college of chest physicians' (ACCP) guidelines.Results: Overall, 71 residents out of 88 residents returned the questionnaire, and 43.7% were aware of the guidelines. Furthermore, 97.2% thought DVT prophylaxis is clinically important but only 66.90% of the patients, who needed DVT prophylaxis, were receiving DVT prophylaxis. More than 50% of the residents underestimated the incidence of DVT and mortality rate due to pulmonary embolism. The most common reason for not prescribing DVT prophylaxis was concern about bleeding in 53.5% of the participants. Further analysis of different components of the questionnaire showed that there is a significant association between "awareness" and "adherence" scores (P = 0.041) and correct answers to "clinical scenarios" and "practice" (P = 0.012). Conclusions:Although the level of knowledge on these clinical situations is good, underestimation of the risk of DVT development in hospitalized patients needs more attention. This might be due to low levels of awareness of presence and content of DVT prophylaxis guidelines. Programs should be designed to uphold the levels of information of DVT prophylaxis guidelines among internal medicine residents.

Hydatid cyst is a parasitic infection caused by the larvae of Echinococcus granulosus. We report a rare case of primary echinococcal synovitis in a 37-year-old woman who was referred to our clinic with pain and swelling of the right knee.