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Several observational studies investigated the relationship between pre-diagnosis with mental disorders and COVID-19 outcomes. Thus, we have decided to conduct this meta-analysis to explore this relationship. We complied to the PRISMA guidelines in conducting this meta-analysis. PubMed, ScienceDirect, Google Scholar and medRxiv were searched until the 15th of February, 2021. We used the Random effect model in Meta XL, version 5.3 to pool the included studies. Statistical heterogeneity was assessed using Cochran's Q heterogeneity test and I². This meta-analysis included 634,338 COVID-19 patients from 16 studies. Our findings revealed that pre-diagnosis with mental disorders increased the risk of COVID-19 mortality and severity. This increase in the risk of COVID-19 mortality and severity remained significant in the model that only included the studies that adjusted for confounding variables. Furthermore, higher mortality was noticed in the included studies among schizophrenia, schizotypal and delusional disorders patients compared to mood disorders patients. In this meta-analysis we provided two models which both reported a significant increase in the risk of  COVID-19 severity and mortality among patients with mental disorders, and with the upcoming COVID-19 vaccines, we recommend to give this category the priority in the vaccination campaigns along with medical health providers and elderly.

Background: The posture while using smartphone in school-aged children is at risk on occurring musculoskeletal symptoms. The purpose of this study is to study the postures while using a smartphone and the factors related to the abnormalities of the musculoskeletal symptoms of school-aged children. Method: Experimental study is a method of this research. The samples were 233 school-aged children in Nakhon Si Thammarat, Thailand. Multi-stage sampling and data collection consisted questionnaire for the musculoskeletal symptoms by applying from the Nordic Musculoskeletal Questionnaire, ISO 11226: 2000 Ergonomics-Evaluation of static postures, which was a smartphone using posture evaluation form with data analysis using percentage, mean, standard deviation and Chi square. Result: The smartphone usage posture are mostly a lying position, which is 52.4%. 91.5 % of children has unacceptable risky smartphone usage posture. Mostly, the lying position has various organs tilted at angles, compared to the body's symmetrical axis, rather than the sitting position. The school-aged children had a prevalence of musculoskeletal symptoms of 20.2%, with the lying position having a higher rate of musculoskeletal symptoms, which is 10.7%. The smartphone usage posture is statistically signi cant correlated with the symptoms occurring in the head area. The risk of ergonomics and the musculoskeletal symptoms are statistically signi cant. Conclusion: The smartphone usage posture among students is at high risk especially lying position and has a chance of a musculoskeletal symptoms, higher than the sitting position. Educating to provide knowledge about safe use of smartphones to students, parents and relevant government agencies is very important.

Purpose To assess the impact of Jordanian’s Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions. Patients and Methods This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown. Results One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (±9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (±24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045). Conclusion The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome.

Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.