Depression is one of the common mental illnesses. Because it is an important complication of diabetes, its association with changes in insulin levels and insulin resistance, the causative factors of diabetes, has attracted widespread attention. However, the association between insulin and depression has not been systematically studied through bibliometric and visual analysis. This study is based on 3131 publications of Web of Science to identify the current research status and research trends in this field. The results show that since 2010, the number of publications has been growing rapidly. Cooperative network analysis shows that the United States, the University of Toronto and Roger S Mcintyre are the most influential countries, research institutes and scholars, respectively. Insulin resistance, obesity, and metabolic syndrome are hot topics in this field. Analysis of keywords and references reveals that “sex hormones,” is new research area that constantly emerging. As far as we know, this study is the first one to visualize the association between depression and insulin and predict potential future research trends through bibliometric and visual analysis. Depression, a common mental illness that severely reduces the quality of life, is accompanied by a high incidence of suicide. In 2008, WHO predicted that depression would rank first cause of burden of disease worldwide . The keyDiabetes, metabolic disorder caused by insufficient insulin secretion or insulin utilization disorder. Studies have found that insulin deficiency or insulin resistance can also be observed in patients with depression .Insulin, a protein hormone secreted by pancreatic β cell, is the only hormone in the mammal body that could lower blood glucose, and promote the synthesis of glycogen, fat, and protein. Insulin was isolated by Frederick Grant Banting and Charles Herbert Best in 1921 , which iThe mechanism of depression as a complication of insulin deficiency or insulin resistance is not fully clear, however, appears to have a few routes.There is evidence that depression and diabetes could share same symptoms, especially the misalignment of the HPA axis, could cause insulin resistance, cardiovascular disease, depression, type 2 diabetes, and increased mortality . InsulinPublications have proved the connection between insulin and depression. However, as far as we know, no one has systematically analyzed the subject of this field by means of bibliometric analysis. Therefore, study aims to comprehensively analyze current status and development trend on the link between insulin and depression from 2010 to 2020 through bibliometrics. Previous reviews only rely on individuals to study the research through literature summary and extraction, cannot fully reflect the temporal and spatial distribution of researcher, institution, and journal. Moreover, it is difficult to visualize the internal structure of the knowledge base and research focus, and rarely find systematic, comprehensive, and visual research.Bibliometric analysis was proposed in 1969, by Pritchard, and plays an important role in reflecting the characteristic and future trend , 21. In Investigate the output and growth trends of publications in the field of the association between insulin and depression.Investigate the core countries/regions, institutions, authors, and journals.Identify international scientific cooperation network between countries/regions, institutions, and authors.Explore key themes, hotspots, and research trends.Our research aims to fill the gaps and effectively observe the development of this field. The research results are helpful for studying the association between depression and insulin and helping follow-up researchers to determine journal publications and collaborators. Timely analysis of keywords, themes, and research trends could promote the development to the elucidation of the cause, prevention, and treatment of depression.This study uses CiteSpace5.7.R4 (64-bit) to analyze existing research related to insulin and depression, and aims to provide reference, scientific, and intuitive. CiteSpace, a Java application which could perform bibliometric analysis, created by Professor Chen Chaomei  . First, Bibliometric analysis bases on a specific range of database. The database is from: WOSCC. In order to avoid the prejudice caused by the database update, we conducted a literature search from the WOSCC on February 22, 2021.The search time range is from 2010 to 2020. Insulin and depression are included in the search strategy: TS = insulin AND TS = depressions OR depression OR depressive OR depressed OR despondent.In this study, the search criterion in the WOSCC database is as follows:Time frame: 2010 to 2020;Document type: articles and reviews;No species restriction;Language: EnglishA total of 3179 records were retrieved. Then we excluded “BOOK CHAPTER,” “RETRACTED PUBLICATION,” “EARLY ACCESS,” and “PROCEEDINGS PAPER.” Finally, 3,131 documents were determined. The analysis in this study uses WOSCC to analyze the publication output, web of science subject category, publication year, IF and other functions.N = 50.After that, the selected documents were imported into CiteSpace, and time span was 2010–2020. Select the node based on the type of analysis need to perform. The specific parameter settings in CiteSpace are as follows: Time slicing: January 2010–December 2020, Term source: Title, Abstract, Author Keywords and Keyword Plus, Node type: Author, Institution, Country, Keyword, Reference, Cited Author and Cited Journal, Link strength: Cosine, Selection Criteria: Top In the generated map, the color of the circular nodes represents the time when the article was published. The thickness of the node is positively related to the frequency, the thickness of the line describes the strength between the projects, and the color of the line describes the year when the two projects first collaborated. The nodes in the map represent elements such as author, country/region, or institution. The link lines between the nodes indicate the collaboration relationship. The larger the circle, the more articles published. The wider the line, the stronger the relationship. The outermost purple ring represents the center level .After sorting out countries/regions, institutions, authors, and their relationship, researchers could find teams for potential cooperation. A highly concentrated ranking of keywords and references and research on burstness can be used to analyze research status and hotspots, and further explore to future research trends in the field of insulin and depression.The change in the number of papers is an important indicator that can visually show the development trend of the field. From 2010 to 2020, the annual publications on insulin and depression included a total of 3,131 related articles. The distribution is shown in In 2013 and 2017, publications grew rapidly. In 2017, the number of publications exceeded 300. Although, the number of publications declined in 2014, 2016, and 2020, the number of papers published each year is basically on the rise.Seventy-five countries or regions have contributed to publications in the field of research on the association between depression and insulin. The network diagram of collaboration between countries/regions is shown in From 2010 to 2020, a total of 3,131 institutions in this field published papers. Articles on the association between insulin and depression have been published in 1,125 different journals. Highly cited references refer to publications that are cited a lot and have a wide range of influence. The repetition of the theme in the literature shows that both exercise and polycystic ovary syndrome are research hotspots.Co-occurring keywords can be used for analysis to discover research hotspots. The co-occurring keyword map of this study is shown in As shown in According to Co-occurring keywords and clusters, insulin resistance, diabetes, and metabolic syndrome are all hot research topics. The density of insulin receptors in the amygdala and hippocampus is high, and insulin resistance is highly correlated with cognitive and learning deficits . The earKeyword burstness detection can track hot topics and research trends. The blue line represents the time interval, and the red line represents the duration of the citation outbreak, shows the evolution of hot topics. Hot topics from myocardial infarction, coronary heart disease, growth hormone, energy balance, and so on. Turn to bariatric surgery, oxidativestress, glucose homeostasis, lipid profile, psychological stress, gestational diabete. Keywords that last until 2020 include: meta-analysis, hap axi, cell, lipid profile, psychological stress, gestational diabete, which reflect the latest research trends.According to the results of Experiments have shown that the relief of depression caused by exercise is related to the regulation of HPA axis homeostasis by exercise , 38 and Insulin can also increase the speed of neuronal serotonin synthesis . InsulinAlthough, there is no article explaining the direct relationship between exercise, depression, and insulin. Based on the common mechanism of the effect of insulin on depression and the effect of exercise on depression, it can be speculated that the positive effect of exercise on metabolic homeostasis may be due to the recovery of insulin levels in the body. These publications provide a therapeutic target for future research and the concurrent of diabetic and depression.The explosion of burstness keywords can also be used to analyze the development of research. As the On the other hand, according to the results of P < 0.0001)  . AlthougHyperinsulinemia caused by insulin resistance acts on gonadotropins together with luteinizing hormone (LH) increases androgen production in follicular membrane cells and reduces the production of sex hormone binding globulin in the liver, leading to the body's production of a hyperandrogen state , 54. RapThis study has some limitations. First, our research selected the core database of Web of Science and only selected English articles, which may lead to incomplete research. Second, the quality of articles is not completely guaranteed, and the impact factor is not limited. These reasons may lead to certain deviations in the research results. Third, this article cannot ensure that every publication is fully related to the subject that meets the search criteria. However, we have collected enough publications to reflect the overall state of the field.This study is based on bibliometric analysis and systematically evaluated the association between insulin and depression through 3,131 publications of Web of Science from 2010 to 2020. According to the analysis of the publications and references, it could be found that the study of shared mechanisms between depression and metabolic diseases caused by changes in insulin levels or insulin resistance has attracted widespread attention. Both the United States and China have made significant contributions to the number of publications. Research institutions in the United States, England, and Canada have contributed to the centrality of publications. Combining the burstness analysis of keywords and references, possible directions for future research could be determined. Firstly, future research needs to be no longer limited to the study of the effects of insulin on a single disease, but to link diseases with shared mechanisms to explore in-depth molecular mechanisms and find new directions for disease treatment, such as depression, diabetes, polycystic ovary syndrome. In addition, research on insulin and depression is no longer limited to traditional perspectives such as nutrient metabolism, monoamine neurotransmitters, and HPA axis. Research of the effects of changes of sex hormone and insulin levels in female perinatal and menopausal on depression will increase. This timely review analyzes the results of the association between insulin and depression may promote the development of this field and laying foundation for future research.XZ wrote the first draft of the manuscript. YS provided the critical revisions. Both authors revised the manuscript and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.Lobomycosis is a chronic granulomatous infection caused by the yeast  A Brazilian indigenous male, 83 years old, farmer, from Santa Izabel do Rio Negro, state of Amazonas, Brazil, presented with disseminated skin lesions on his limbs for 30 years. He had a previous history of hypertension and worked with extractivism.Upon physical examination, he had multiple keloid-like nodules on the upper and lower limbs. A vegetating lesion was seen on his right medial malleolus  and the The histopathological examination of these two more recent lesions disclosed a thinned epidermis, hyalinization, and thickening of collagen fibers, in addition to the presence of multinucleated giant cells containing birefringent rounded fungal structures. Grocott staining, depicted these structures more clearly A. DirectHistopathology of the left upper limb tumor showed a dense lymphocytic inflammatory infiltrate, presence of horn pearls and proliferation of squamous cells with moderate pleomorphism, hypertrophic and hyperchromatic nuclei, establishing a diagnosis of squamous cell carcinoma (SCC) B.Immunohistochemistry revealed an infiltrating epithelial neoplasia with squamous differentiation and positivity for P63, CK5/6 and GATA3.The oncological surgeon's opinion was requested, but the surgery for the excision of the SCC would be a large one and contraindicated in this patient due to his age, comorbidities and critical clinical condition. It was decided to implement palliative care and one month after hospital discharge, the patient died.Lacazia loboi, and its highest incidence is found in Central and South America, especially in the Amazon river basin.2Lobomycosis, also called lacaziosis, keloid blastomycosis or Jorge Lobo's disease is a chronic granulomatous infection that can affect humans and dolphins. The etiological agent is the fungus Malignant transformation can occur on chronic ulcers, fistulas, and scars of different etiologies, including infectious ones, such as leprosy, tuberculosis, and lobomycosis. SCC is the most common skin cancer in these cases and results from the malignant proliferation of keratinocytes.There is no description in the literature of the dermoscopy of lobomycosis lesions. The findings of this case show the dermoscopy performed on a nodular lesion on the leg of this patient, with areas of hyperpigmentation interspersed with hypopigmentation, scales, blood crusts, and several black dots. Vascular structures were not observed .Figure 4The choice of treatment is defined by the clinical presentation of the disease. In unifocal and localized forms, the surgical procedure is the most indicated treatment, and it can be associated with oral medications such as clofazimine, dapsone, and itraconazole, aiming to avoid recurrence. The combination of itraconazole and cryotherapy may be helpful in patients with large, multifocal lesions.5Patients with long-term lobomycosis associated whith SCC are rare. An early diagnosis and careful follow-up of these patients are essential to prevent the progression of the lesions and carcinomatous degeneration.None declared.Wanessa da Costa Lima: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Sidharta Quercia Gadelha: Design and planning of the study; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature, critical review of the manuscript.Mara Lúcia Gomes de Souza: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.Virginia Vilasboas Figueiras: Approval of the final version of the manuscript; design and planning of the study; drafting and editing of the manuscript; collection, analysis, and interpretation of data; effective participation in research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the literature; critical review of the manuscript.None declared.


The BRICS Forum, an independent international organization encouraging commercial, political, and cultural cooperation between Brazil, Russia, India, China, and South Africa, was formed in 2011, and these countries have a significant influence on their regional affairs. These nations were hit by COVID-19 at different times, and all adopted home quarantine to reduce the spread of the virus. We present a comparative analysis of actions of psychology and potential outcomes during the COVID-19 pandemic in BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Various types of actions were taken by psychologists in BRICS, with different levels of coordinated cooperation with respective governmental and non-governmental organizations, multiple and parallel efforts from different scientific societies, and professional regulatory agencies. Scientific societies have had an important role in coordinating some of these efforts, especially because they congregate the psychologists from different parts of these countries, improving communication and access to key information. The aim of these actions varies from improving situational skills and competences to increase the accessibility of psychological services and provide psychoeducation and telepsychology. We will consider the social importance of these actions within these countries as a global opportunity for psychology to stage in a complex context involving human health. The way psychology in BRICS will face this challenging situation is likely to produce important regional influence, stimulate scientific contribution, and increase the accessibility of psychology. BRICS is the group composed of five major emerging countries: Brazil, Russia, India, China, and South Africa, which, together, represent about 42% of the population, 30% of the territory, 23% of Global Gross Domestic Product (GDP), and 18% of the global trade. Since 2009, these countries have sought to establish fairer international governance, developed sectoral cooperation in different areas, such as science, technology and innovation, economics, finances, business, education, and security , taking into account sociocultural differences and the particular attempt to strengthen health systems in these developing countries.https://www.scimagojr.com/countryrank.php?area=3200&year=2019). If the BRICS were a country , we would be third in the scientific production of psychology, behind the USA and the UK, well-ahead of Germany. Therefore, we present an analysis of actions of psychology and potential outcomes just after the outbreak of COVID-19 in the BRICS nations regarding five aspects: psychology in health policies, social roles of psychology, socioeconomic context, actions for the general population, and health professionals during stage 1 of the pandemic, and possible actions in stage 2. Finally, we consider a comparative analysis of these actions. Before this analysis, we characterize the psychology in the BRICS countries.In this sense, this perspective article discusses the actions of psychology as a science and profession, represented by several scientific societies and councils, governmental and non-governmental organizations, and universities, in combating the pandemic of COVID-19, in the countries that form the alliance of the BRICS. This proposal is important, given that we are among the 25 countries that most produce science in psychology, in a list of 173 countries (http://www2.cfp.org.br/infografico/quantos-somos/), working in individual practice, healthcare, education, organizations, and research. Profession and formation have been regulated by Federal law No. 4,119 since 1962. Federal Council of Psychology (FCP) has been the organization responsible for professional registration and regulation since 1972. Brazilian Society of Psychology (BSP) has congregated all areas of scientific and professional psychology since 1971  with 22,985 enrolled students, after the Higher Education project that intensified the expansion, democratization, interiorization, and internationalization of Higher Education  have become important devices for the integration of professional psychologists in public policies since the 2000s. Both were responsible for the insertion of psychologists to the most diverse municipalities and locations in the country to a contingent, estimated in 8,000 psychologists in Reference Centers for Social Assistance (CRAS and CREAS) and 40,000 psychologists in SUS , one of the oldest psychological societies in the world, which was founded in 1885. The purpose of the creation of RPS was the development of “psychology, in its compositions, applications, and history, and the spread of psychological knowledge in Russia (RPS).” Members of the society were world-famous scientists who have made substantial contribution to the formation and development of psychological science: L. S. Vygotsky, A. R. Luria, A. N. Leontiev, P. Ya. Galperin, and other leading scientists of the Russian Academy of Sciences and the Russian Academy educations, leading psychologists of the largest scientific and educational organizations. Together with the Federal Educational and Methodological Association in the Field of Higher Education, RPS organizes scientific and methodological support for the preparation of federal state educational standards of higher professional education and basic professional educational programs in the field of psychological education.Psychology as a discipline started in 1916 when the first department of psychology was established at the University of Calcutta, India. Later, departments of psychology were established at the University of Mysore in 1924, University of Madras (1943), University of Kerala (1957), Utkal University (1958), University of Bombay (1959), Allahabad University (1961), and the University of Delhi (1964). Psychology was also introduced in the various Indian Institutes of Technology and Management setup later. During the years, various psychology associations were formed, and it is difficult to give the exact number of associations in the country. The Indian Psychological Association was established in 1925, Indian Psychoanalytic Society in 1922, and later on, Indian Association of Clinical Psychology, National Academy of Psychology (NAOP), Indian Academy of Applied Psychology, and several other associations focusing on health, school psychology, community psychology, counseling and guidance, and about 20 regional associations in the different states, besides numerous local chapters. The idea of a federation of associations has been mooted and felt important and announced in 2014, but much needs to be done. The focus of these associations has been more on academic work and awareness generation than psychological services, except for a few. The National Academy of Psychology (NAOP) is a member of the International Union of Psychological Sciences and participates regularly and actively in its programs. It is also a member of the Asia Pacific Association of Psychology and engages in collaborative endeavors, including programs in disaster management.The Rehabilitation Council of India (RCI) regulates the professional programs in clinical and rehabilitation psychology , the first psychology department , the Chinese Psychological Association , and the first research institute (1929), Institute of Psychology, Academia Sinica   in 1980, and the International Association of Applied Psychology (IAAP) in 1984. CPS hosted the 28th International Congress of Psychology, held in Beijing on August 8–13, 2004, under the auspices of IUPsyS. CPS and CAMH, jointly in cooperation with Beijing University (Department of Psychology), held the fifth World Congress of Psychotherapy in Beijing in October 2008. In 2 years, CPS will host the 30th International Congress of Applied Psychology in Beijing, July 2022.Psychology is taught in China at both undergraduate and postgraduate levels, in 815 universities and institutes that offer postgraduate programs, 114 have master programs in psychology  and 30 universities have doctorial level programs in psychology in 2020 (China Education online).In 2002, the China Ministry of Labor and Social Security launched a certification for psychological counselors, based on the National Standards on Psychological Counseling. The new certification was given to 1.2 million counselors who fulfilled the basic requirement, took the training, and passed a national examination. It enables private psychotherapy practice and psychological counseling in general public settings, such as hospitals, universities, primary and secondary schools, entrepreneurs, and communities.Regulation of the practice of medicine and allied professions in South Africa dates back to the late nineteenth century when the then Colonial Medical Council of the Cape Province was established in terms of Section 18 of the Medical and Pharmacy Act of 1891. At that time, the Cape Province was nominally under the British colonial rule, which lasted until 1910, when the Union of South Africa was formed in 1910. In 1928, the South African Medical and Dental Council (SAMDC) was appointed in terms of Act Number 13 of 1928, which was amended in 1974  is the largest of these associations, with over 1,000 members  but did not provide psychological care. Quarantine, lockdown, or other measures of social distancing were recommended at the discretion of governors and mayors but not by the Ministry of Health. In a controversial attitude, the Brazilian president not only did not recommend social distancing but also stimulated social gathering on public appearance in front of the official presidential palace, visiting shops and buying from street vendors in Brasília with national media coverage. These mixed messages concerning the severity of the pandemics were considered as a menace by the international community ; State University of Londrina (www.uelcontracoronavirus.com)]. Federal University of Rio Grande do Sul associated with the Ministry of Health organized a call center to offer psychological support to health professionals involved in COVID-19 (https://sites.google.com/hcpa.edu.br/telepsi/), using an open platform for training and research. In the same way, Oswaldo Cruz Foundation of Brasília (Fiocruz), a research institution linked to Ministry of Health, produced a series of e-books about coronavirus . From this material, an online course was created for several health professional categories, including psychologists. After completing this training, professionals will be allowed to use a telepsychology platform provided by Fiocruz.Universities are providing teleservices . In total, more than 1,000 psychologists participate in the work of hotlines of federal and regional significance.While organizing psychological assistance in the usual ways (in person) is not possible, the possibilities of online counseling are widely used. The Russian Psychological Society, the Russian Academy of Education, Faculty of Psychology, Lomonosov Moscow State University organized several hotlines for psychological assistance [including a united 24/7 hotline on the website of COVID-19, organized by the Russian Government  took an active initiative in extending its services during the time of COVID-19. It was the first professional organization to launch online counseling in the first week of April 2020 for anyone directly or indirectly affected by COVID-19 or the lockdown-related psychological issues. The first initiative was in Hyderabad under the banner of “SERV,” an acronym for “Social Emotional Rehabilitation of Virus Victims.” This was launched in collaboration with UNICEF, Action Aid, Dr. Reddy Foundation-School Improvement Programme, APTS Social Service Forum, and Asha Hospital. Counselors with the highest academic background and years of experience are available on a helpline 24 × 7. Encouraged by the response, the AHP started similar helplines in collaboration with Sri Padmavathy Mahila University Thirupathy, Andhra Pradesh, Orissa Central University, Koraput, Odisha, Calcutta University, West Bengal and Bangalore, Karnataka in collaboration with UNICEF. The counselors attended thousands of calls from different parts of the country as well as a few calls from Indians residing in other countries. In initial months, the calls related to general anxiety of the “fear of unknown”; insomnia; interpersonal conflicts due to home confinement leading to a situation called “home crowding”; the anxiety of frontline health care workers; the psychological distress of people in quarantine centers; panic attacks of people of all ages, gender, and geographical location; anxiety of students due to uncertainty of examination schedule; financial problems; non-availability/accessibility of regular medicines due to lockdown; precipitation of pre-existing mental health problems; issues related to migrant labor; and also calls from victims of domestic violence, to name a few. Apart from COVID-19/Lockdown-related problems, the helpline has been receiving calls related to other psychosocial problems. Because of this, the helplines are continuing through, and the number of COVID-19-related calls has been gradually reducing.Several initiatives were taken by other associations as well (which will be discussed in a later section); however, looking at the population of the country, the problems are immense and can be tackled only with the combined efforts of all. More and more psychologists should be involved by the government in these times as in when there is a second wave of COVID-19 later in the year, mental health concerns are going to become pivotal. Many people have lost their jobs, and as time passes and they do not get economic relief, mental health concerns are going to become acute. It is not to say that mental health concerns are not important now. The concerns because of lockdown are related to fear, anxiety, social isolation, lack of human stimulation, working from home, and making the fine balance between home and work. Once the lockdown is lifted, as no society can be in a state of complete lockdown, the fear is related to a surge in cases of corona infections, disease, death; all of which may lead to serious mental health concerns. Psychology associations should make the government start focusing more on mental health issues of the most vulnerable sections of the society.News items and images not related to COVID-19 times were shared and created fear and panic among citizens. The government is tackling the problem of fake news by requesting social media platforms to remove and not promote messages that will weaken the government's efforts during these times. The media is continuously being requested to play a very responsible role and help in countering fake news. Some news channels are doing a commendable job of alerting people to fake news. In these times, responsible sharing of news has to be followed, but, as is the current situation, fake news is rampant. Irresponsible forwarding of messages on social media should be avoided. The Government of India has recently issued a directive, asking social media companies to voluntarily curb fake news and misinformation related to the coronavirus on their platforms. This is considered as an important step to prevent the community transmission of the disease. A lot of psychology research shows that, in times with a lot of uncertainty, rumors and propaganda of various kinds have easy acceptability among the masses. Stern and prompt actions are needed; otherwise, it will play havoc with people's life and health. Together with the government, it is also important that we, citizens, not only exercise caution but debunk such messages.https://www.gov.br/pt-br/servicos/solicitar-auxilio-emergencial-de-r-600-covid-19).About 13 million Brazilians live in favelas. Hygiene recommendations are near impossible to follow in these environments because of the high demographic density and lack of treated water. Communities in favelas have organized themselves to implement measures on their own , deficient health systems are expected to collapse. This could worsen with a peak in the number of cases since up to 75% of the population in the least developed countries do not have access to hygienic supplies. Other social conditions, such as precarious urban planning and overpopulation, deficient waste management services, and even traffic jams that prevent access to health care, can contribute to drastic growth in the number of cases of COVID-19 .Many private companies have decided to help various segments of society, with hygiene items, food, clothing, and water donations, supported by the tax incentive laws. One example of organized action of the private sector is Todos pela Saúde  to reduce the risk of contagion. People also live in villages and share utensils, which increases the chance of contamination. Indigenous communities also live in areas where there is limited access to healthcare, particularly intensive care beds . If a professional chooses to provide online psychological services, he or she must follow previous guidelines (CFP Resolution No. 11/2018) and register to do so in the respective Regional Psychology Council.https://www.sbponline.org.br). Moreover, links with relevant information about the pandemic from reliable sources were also made available by SBP.The Brazilian Society of Psychology (BPS) constituted a Working Group of professional researchers who sought to base their actions on developing strategies for training and supporting this professional category in coping with the situation of COVID-19. The work was developed using scientific and technical criteria, using evidence to support their decisions and guidelines. The first step was to publish fascicles, available free online at the SBP homepage  and the first psychological aids: welcoming and active listening, psychoeducation, helplessness approach, focuses on despair, coping fear, focus on hope, problem-solving, assessment of ideation, and suicide risk. The fourth topic deals with the stigmatization of health professionals. It contextualizes the problem, defines stigma , and provides management strategies, such as access to information, awareness, and ethical posture. In the fifth topic, recommendations are presented for the on-line and online professional practice of psychology in the face of the COVID-19 pandemic. It addresses the alternatives on how to offer the first psychological help to health professionals working in hospitals. It guides through how to proceed with online, voluntary, in-person, and hospital care. The sixth topic deals with mourning and reviews the concept, demonstrating the physical and emotional reactions experienced in this process and the alternatives for the psychologists to address this theme. In the seventh topic, issues related to the management of conflicts in the family are presented. It discusses how isolation predisposes to the appearance of conflicts and presents strategies for handling the situation, with steps for resolving conflicts. The eighth topic discusses the management of sleep disorders in the context of coping with COVID-19. It demonstrates how the pandemic can predispose to sleep disorders and identifies management strategies. The ninth topic presents the theme of psychological support for parents of children from 0 to 11 years old during the COVID-19 pandemic. It seeks to provide support for the psychologists to work with parents and provides behavioral management strategies during isolation. The 10th topic addresses issues related to violence against women. The different forms, phases, and consequences of this type of violence are defined. Alternative actions are presented, as well as techniques and devices that are usually used in the situation.https://sites.google.com/hcpa.edu.br/telepsi/) is an initiative of the Ministry of Health of the Brazilian Government, in partnership with the Hospital de Clínicas de Porto Alegre, which received the support of several academic institutions and societies, including the Brazilian Society for Psychology. In TelePSI, contracted psychologists and psychiatrists offer psychological and psychiatric consultations to manage stress, anxiety, depression, and irritability in health professionals and students, teachers of all levels of education, and professionals of essential services. They receive specific online training and supervision, and data are collected to compare the effectiveness of different interventions are clinical and scientific supervision group for evaluating different types of psychotherapy for emotional problems during the pandemic, and disseminating psychoeducational materials. Oswaldo Cruz Foundation of Brasília (Fiocruz) planned a similar teleservice provided by trained volunteer psychologists.The TelePSI Project (http://xn--n1abc.xn--p1ai/news/themes/8462/), as well as their promotion through Federal and regional media regularly. During 2 months, representatives of the Russian Psychological Society made more than 150 interviews to the media and more than 30 interviews on Federal and Regional TV channels in the frame of talk shows, expert talks, etc., making recommendations for the public concerning the organization of the daily routine, coping with anxiety and stress, organizing activities for children, and exposing relevant fake news.Psychologists have been actively involved in informing the public about how to organize their lives in conditions of self-isolation with children, the elderly, alone, etc. RPS has elaborated recommendations for various groups of the population on organizing the activities during the period of isolation , Moscow Electronic School (http://mes.mosedu.ru/present-en/), which is an official all-Russian resource for schooling as well as other resources, such as Yandex.Uchebniki (https://education.yandex.ru/home/), ≪Advance≫, ≪iSpring≫, ≪InternetUrok.ru≫, ≪Unicraft≫, etc. The actual collision of the norms of family life and the norms of the school in the situation of the distant organization of the educational process led to conflicts between teachers and parents, and increased stress. RPS has developed relevant recommendations for both teachers and parents to optimize the organization of the educational process and normalize relations between family and school.No less challenging was the situation and the organization of the distant educational process at schools and preschools. The transition to distance learning became possible, thanks to the previously introduced Russian Electronic School .Leading specialists of the Faculty of Psychology of the Lomonosov Moscow State University, the Russian Academy of Education, and the Russian Psychological Society, together with the Federal Medical Biological Agency of Russia, and, personally, its head, Veronika Skvortsova, had developed “psychological thermometers” for adult patients and patient-children and medical staff who provide medical care for patients with COVID-19 , which represents India in the IUPsyS; the Indian Association of Clinical Psychology (ICAP); and Indian Academy of Applied Psychology (IAAP). As discussed by Manickam , togetheIndia's experiences in the pandemic of COVID-19 have shown that a better public health system with special programs based on various sections of the society is needed , as a self-regulated professional organization of clinical and counseling psychology, devoted itself to the psychological aid after the outbreak of the COVID-19 pandemic and explored effective approaches and methods for psychological aid!1. Speak up as professionals. The Registration Work Committee started to work on January 23 and issued a written proposal to all the psychological professionals across the nation on January 26, and advocated that all the psychological aid should be integrated in the national framework in fighting the COVID-19, and underlined the need of multi-department cooperation. It reaffirmed the professional ethics and strongly emphasized that all the psychological aid should be conducted scientific orderly and conform to professional standards.2. Set up an organizational structure. The Registration Work Committee set up the organizational structure on January 25 and established several working groups with different functions to ensure orderly development, including the supervision group, the popular science dissemination, the information resource acquisition, and so on.3. Give full play to the superiority of the Registration System members. A group of 161 registered clinical psychology supervisors, who were willing to supervise, was released to the public on the WeChat Official Account, providing free supervisory resources for counselors, and psychotherapists.4. Enhance the competencies in psychological aid. The sudden outbreak of the COVID-19 emerged in a fast spread and affected widely, and as a result, most psychological aids were conducted through hotlines, including the popularization of the medical knowledge of the COVID-19. The Registration Working Committee decided to work in a pyramid model due to the specialties of the COVID-19, referring to training registered psychology supervisors and providing guidelines and approaches for them to supervise counselors and therapists who work in the front line. From January 28 to May 20, a total of 32 training sessions and supervision have been arranged for registered supervisors with a total of more than 1,600 participants. Nearly 10 million people received training and supervision focused on hotlines, psychological stress, and crisis intervention provided by the trained supervisors.5. Timely release professional guidance documents as a leading professional organization. Guidelines for Psychological Aid Hotline under the Contagion Fight, Guidelines for Online Psychological Aid under the Contagion Fight, Ethics for Psychological Hotline (First Draft), and Ethics for Online Counseling (First Draft) were released continuously from January 31, leading professionals to conduct within competencies and comply with the ethics.6. Cooperate with governmental officials and peer colleagues from other professionals . To cooperate with the National Health Commission, the competent government department for psychological aid during the COVID-19 pandemic. The Registration Work Committee put forward targeted psychological aid policies for the country and the specific population affected by the epidemic, for e.g., timely proposing the overall plan of psychological aid construction for the Arch hospitals built in Wuhan. Besides, it joins hands with other academic organizations, such as the Chinese Association for Mental Health, China Association of Social Psychology, in fighting against the COVID-19 pandemic to share resources and joint proposals.7. Promote the popular science on the major media. Make knowledge dissemination of audio or videos programs on how to promote mental health in the pandemic period and provide the public with knowledge and methods on mental health to adjust the mentality and be positive and optimistic.… an area that has more than 5 infected people per 100,000 people or where the new infections are increasing at a fast pace” . The medical insurance companies have also come out in support of telehealth services by assuring psychologists and other health professionals that they will reimburse the service providers for this alternative service [for e.g., see Discovery Health Due to the restrictions imposed on individuals during the pandemic, the Health Professions Council of South Africa (HPCSA) had to revise its guidelines on the provision of online health services. In its original General Ethical Guidelines for Good Practice in Telemedicine, the HPCSA discouraged health practitioners from routinely servicing their patients virtually , constant monitoring (weekly or fortnightly) by the technicians , weekly individual attendance for severe cases only  (only one patient and one companion at a time) or home care, after screening for COVID-19 symptoms.Health institutions  started to provide psychological care for families of inpatients or those who died as a result of COVID-19 and health professionals who care for these patients. Networks were organized to provide psychological assistance for health professionals by universities, associations, and groups of psychologists. Besides, starting in May 2020, online psychological care by SUS is foreseen for health professionals  to develop evidence-based recommendations to decrease negative effects and increase positive consequences of self-isolation. The results obtained showed no differences in the levels of psychological well-being, significantly lowered levels of depression, anxiety, and stress during the period and higher levels of anxiety and stress during the period. It was shown that studying the impact of the pandemic on the mental health of students requires attention to possible dynamics of their mental state within relatively short periods and gender differences.Representatives of RPS, as well as researchers all over the world, are actively engaged in monitoring the mental conditions of various population groups across Russia, identifying factors that are crucial to the successful accommodation to the period of self-isolation and building strategies for future. RPS, in collaboration with the leading Russian universities supported by The Ministry of Science and Higher Education of the Russian Federation, has started a project “Research at Home.” The purpose of this research is to assess psychological well-being among the student population  Firstly, recruit psychologists with competence. CPS developed competence-enhancement programs for clinical psychologists right after the lockdown, in the end of January. The registration system of CPS has kept training registered psychologists, especially for crisis intervention to improve their competence in providing qualified services for all those in need. (2) Secondly, developing a response system in cooperation with governmental agencies. CPS work together with government agencies, NGOs, and foundations. They try to make sure that the strategic plans are active and sustainable. (3) Thirdly, target key groups in need of psychological service. CPS work with hospitals, schools, and community staff to find the key groups who have psychological problems, mental disorders, or even PTSD.All institutions have voluntarily done their work. Psychologists set up hotlines, sent out teams working on the frontline, especially Wuhan City. And some of them edited books, developed apps and online programs for psychological services and counseling, and online psychotherapy and teletherapy.Psychological services have been mentioned by China President Xi Jin-ping in his talks three times since the lockdown. Psychologists have been integrated in the work team for crisis intervention at both the national level and the provincial level. Medical teams were recruited in other provinces and sent to Wuhan or other cities in Hubei Provinces, and psychologists were included in those teams. Ten psychologists had been recommended and included in the National Team of Crisis Intervention, leading by the China Ministry of Crisis Intervention.Psychological support has been provided in many ways. Counseling or psychotherapy has been provided for free all around China, especially for inhabitants in Wuhan City. Both Division of Personality and Division of Counseling or Clinical Psychology of CPS are affiliated to Central China Normal University, which is located in Wuhan City. Many colleagues working in the School of Psychology there have become the key team members working in the epicenter ever since the lockdown. Almost all universities with a department or school of psychology set up hotlines; for e.g., ShanDong Normal University, located in Ji'nan City, the capital of Shandong province, provides hotline service for the general population in Shandong province. A similar case holds for almost all capital cities of provinces across China.For knowledge dissemination, many books have been edited, and many web pages have been developed. These can provide psychological knowledge and skills, helping people to adjust and cope with the COVID-19 pandemic. Technology was also employed to assist mental health. Different self-help apps have been developed to help general population online. Also, a wearable wristband with real-time physiological data acquisition, was used by nurses and doctors who work in frontline hospitals. The wristband recorded physical health parameters, mental health parameters and physical activity, providing a quick screening assessment of their  health status.The COVID-19 outbreak happened during the spring festival, which is a very unique opportunity for family members gathering together. And family dynamics have become a very strong basis of coping with the pandemic. The interpersonal relationship has never been so intensively tied. In this context, CPS has launched a Peace Mind Program, initiated by the Division of Crisis Intervention and Division of Psychological Institutions, together with the Institute of Psychology, Chinese Academy of Sciences. The Peace Mind Program has begun on January 28, right after the Spring Festival. They provided 94 lectures for either professional psychologists or for common civilians to disseminate psychological knowledge and skills. Online psychological assistance was also provided for different groups and professions, especially for policemen, medical professionals, and social workers in communities. We provide a hotline where people can find help or counseling for themselves or for their relatives.Another initiative, so-called “Thousands of Psychological Institutions for the Peaceful Mind,” is a volunteer recruiting program. The program has recruited about 3,000 psychologists, and more than 400 institutions were involved in the program.Altogether, 454 organizations were recruited in the Peace Mind Program to provide service in different settings. More than 1,300 medical staff received psychological services, including group therapy, an audio program for stress management. Two thousand four hundred sixty-three institutions have been provided psychological counseling services. More than 4,220 counseling sessions have been provided for individuals. Colleagues in China have composed more than 5,330 essays for knowledge dissemination to the public. For hotlines, nearly 100,000 counseling calls have been received; 77,000 online counseling inquiries have been provided. One hundred seventy-five thousand joined the 1-week program through the APP we developed, with 70% of the users finished the whole program. We also developed a self-evaluation questionnaire, and 187,000 individuals finished the online evaluation. For the video and audio program, we published online, there are more than 1 million views for the lectures, and more than two million play for the audio programs.Research and project funding has been provided for those initiatives. All work we have done is to find the key groups in need. We realized that there is, still, a lot of work to be done. We hope that international communication and cooperation will give us more understanding of the mental and behavioral reaction to the COVID-19 pandemic and to the crisis in general.For psychologists, we need to study more on mental and behavioral reactions in a crisis like this and how to provide effective services in the future. For psychologists in China, teamwork, especially work with government agencies and NGOs at different levels from national, provincial, city, and community levels, is very important.Psychology as a profession in China needs legislation. Psychology as a discipline is very well-developed, but the legal status of the professional psychology profession is not quite stable. We have two kinds of mental health services: one is represented by psychiatrists and the other one is represented by clinical psychologists. These two versions of mental health services, of course, differ in many ways.As part of the comprehensive national response, the South African government is implementing an eight-stage process to manage the COVID-19 pandemic see . The eigAs from the beginning of June 2020, the country will transition into Stage 5, which coincides with alert Level 3 of the risk-adjusted response. Looking at COVID-19 provided the context for the first comparative analysis of psychology status in the BRICS nations. As directors of national scientific societies, the authors have worked for the past 3 years to develop BRICS Union of Psychologists, before COVID-19. We have also worked on international communication and cooperation ever since the outbreak of COVID-19. For example, we have participated in the zoom meeting hosted by American Psychological Association at least twice a week, which aims at collecting information from colleagues around the globe.In the comparative analysis of the actions of psychology in the BRICS countries, the first question that stands out is that the political and economic management of each country influenced the modus operandi of each representation of psychology. Psychological societies received support, encouragement, and even a direct political call for public policy actions for crisis management, psychoeducation, first psychological aids, and active listening directed to the public . Moreover, all societies have engaged in confronting COVID-19 in public health at various levels, considering the impacts on mental health.Although psychology acts to promote mental health in BRICS, only in Russia that psychology had a strong role in remote education in these early months of COVID-19. On the other hand, psychology in China was quickly organized, and this will speed up the required legislation and professional preparedness. In China and Russia, the scientific societies worked closer and integrated with the government. In Brazil, psychologists are integrated into the public health system, and a large number of psychologists are registered in a federal regulatory council of their own, but telepsychology is underdeveloped; state governments are working with Federal and State Universities to provide telepsychology during COVID-19. In India and Brazil, there is a prevalent sense of dichotomized world view, in contrast with the strong interpersonal strengthening described in China.Countries with large social inequalities faced more socioeconomic gaps that affect mental health, further straddling the health system weaknesses, as shown by Brazil, India, and South Africa. The interface between the socioeconomic and political moment might have contributed to the exacerbation of mental health issues in the early months of COVID-19. The various psychology organizations in these countries have tried to organize themselves independently or seeking to sensitize governments to articulate actions in favor of minority groups . In general, interventions introduced included payment of a social relief grant or of a distress grant to the unemployed and an increase in the social grant amount paid to the indigent. Also, technological and/or socioeconomic inequalities in countries like Brazil, India, and South Africa did not allow online services  to reach everyone , in contrast to online education in Russia and hotlines, apps and wearables in China.Despite this deficient access to online services in some of the BRICS nations, the expanded and extensive insertion of the telepsychology happened in all of them. The guidelines on this modality of online intervention were different for each nation and had to be reformulated due to the situation. In Brazil and South Africa, there were regulations being discussed under pressure, reformulated and adapted to the context of COVID-19.Psychology has different roles in their societies, and the pandemic exacerbated the strengths and exposed some of the weakness. In a long and continuous tradition of Russian psychology, the government actions have a place for education, mental health, and refined identification, and intervention is possible, for instance, in emerging cyberbullying. China, the first country of the epicenter of the pandemic, has been working in this crisis, using previous experience and an organized psychological intervention in many levels of psychological care contextualized, with the support of integrated and expanded political and economic management that helped in facing the emotional issues. India has a prolific amount of actions and a recent mental care policy that will probably catalyze the experiences during the pandemic into better mental health services. Psychology in South Africa has a strong regulatory link with other health professions; as a result, the strategies were set for all health professions, and psychology benefited from that despite the low contingent of psychologists. In contrast, despite of the high contingent of psychologists in Brazil, telepsychology was not stimulated, and the strong public health system did not offer telepsychology to the general population; universities and scientific societies are leading the actions in mental health during COVID-19 in independent initiatives amid a complex political context. In general, psychology in BRICS has been making pioneer contributions during COVID-19 times.Psychoeducation of the general population and building competencies of psychologists to work during and after the crisis are the main aims in BRICS. The different approaches of each country are related to the role of psychology in society, equity, and social context. The use of digital platforms and telepsychology has been one important resource that gives visibility to psychology and expands mental health care. In general, it is expected that there will be an increased role of psychologists in providing cultural sensitive intervention and information on socioemotional skills.KA and LB: design, integration of the authors' comments, and final manuscript. KA, LB, MM, MS, AP, MT, JM, AV, PS, BH, and TS: writing the draft. All the authors contributed to manuscript revision, read, and approved the submitted version.AP was employed by Bee Touch. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


This manuscript is a brief biography and reminiscence of Dr. Robert H. Heptinstall, a preeminent nephropathologist who had a major and formative impact on the field of nephropathology, and on nephrology in general. In his tour-de-force textbook of renal pathology, he brought the assessment of diseases of the kidney into the modern era. This textbook, now Heptinstall’s Textbook of Renal Pathology, will extend his seminal influence well into the future. Dr. Robert Hodgson Heptinstall, one of the founding fathers of modern renal pathology, passed away on January 5, 2021 at the age of 100. “Heppy” was born in Keswick, Cumberland, England and received his medical education at Kings College London, Charing Cross Hospital Medical School, and London University. As a young physician, from 1944 to 1947 he served in the Royal Army Medical Corps in India, Burma, Siam and the Dutch East Indies as infantry medical officer and operational medical officer for special forces. During this time, he cared for prisoners of war, and was profoundly affected by this experience. In 1947 he returned to Charing Cross Hospital where he had initially trained as a surgeon. However, he decided to change his focus to pathology, a decision which led him to seek pathology training at St. Mary’s Hospital , the International Society of Nephrology (ISN), and was a founding member of the Renal Pathology Club, now the Renal Pathology Society (RPS). Heppy was president of the RPS from 1980 to 1983. He was also an honorary member of the American Society of Clinical Pathology, and the Danish Society of Nephrology.Heppy was the compleat academic pathology. He founded the renal biopsy service at Johns Hopkins, had an active research laboratory, and also loved to teach. Arguably his crowning contribution to education in renal pathology and nephrology was his textbook, The Pathology of the Kidney, first published in 1966. The book was a major advance in the field, as it incorporated the findings from clinical biopsies of the kidney as well as surgical and autopsy specimens. The writing of this text was a Herculean effort, occupying evenings and weekends for a long period of time. The book was extremely well-received, and a second edition followed, incorporating findings from immunofluorescence and electron microscopy as well as routine histology. This text, now called Heptinstalls Pathology of the Kidney, is in its seventh edition, with multiple editors and chapter authors, a vibrant part of Heppy’s legacy.While Heppy was a dedicated renal pathologist, he was also very influential in the broader nephrology community. As noted, he served on editorial boards of a number of influential nephrology journals. In addition, he was active in professional nephrology societies. He held a number of offices in the American Society of Nephrology, and served as president of the ASN from 1972 to 1973. He was also active in the International Society of Nephrology, serving as vice-president of the society from 1981 to 1984. His high profile in the field, and his textbook, which is a major resource for nephrologists as well as pathologists, helped establish the close relationship between the two disciplines that continues to the day.Another important part of Heppy’s life was his family. He married Ann Porter in the years after the war, and she was his life companion. Together they had seven children. Ann, as well as three of their children, predeceased him. The remaining children, Jonathan, James, Caroline and Gillian were very supportive in his later years. He also enjoyed his eight grandchildren and one great- grandchild. In retirement, Heppy lived independently until late in life, and remained active and engaged, avidly following medicine, sports and politics, and reading history. He retained a phenomenal memory as well as his wit and sense of humor. He was very convivial and enjoyed visiting with colleagues- he was a legendary story teller. His daughter Caroline Heptinstall Jones and her family provided a home for him in later years, and helped entertain friends and colleagues who came to visit him.In addition to leadership roles in professional societies and journals, Heppy garnered many awards in his lifetime. These include the Gold Medal from the Danish Society of Nephrology, the David M Hume Memorial Award from the National Kidney Foundation, and the Jean Hamburger Award from the ISN. In his honor, in 2011 the Renal Pathology Society named their life-time achievement award in his honor. In 2020, the Johns Hopkins Department of Pathology established a fellowship in his honor. Heppy was truly “one of a kind”- we will not see his like again.


Kawasaki Disease is an acute and self-limited systemic inflammatory and febrile illness, which is the most common cause of acquired heart disease in children in developed countries. The incidence of KD in Asian countries is high. But, data is not available from the Middle East. So, the aim of this study was to develop an MDS to set up a national registry for KD to estimate the burden of disease in Iran.This cross-sectional and descriptive study was conducted in 2020. Literature review, data collection from patients medical records, and expert panel approach were used to design this MDS. Data elements with a Content Validity Ratio (CVR) of more than 0.56 were selected as the MDS of the registry.Overall, 99 data elements were recognized. Of which, 51 and 48 data elements were verified and rejected, respectively. Moreover, 17 data elements were added as required by experts. Eventually, 68 data elements were chosen as the MDS of the national KD registry of IRAN; of which, 17 and 51 data elements were classified as administrative and clinical data, respectively.These precise, integrated, and comprehensive developed data elements and the national KD registry will lead to effective disease management and thus, improve the quality of care and, consequently, improve public health. Kawasaki disease (KD), an acute and self-limited systemic inflammatory and febrile illness occurs generally in children under 5 years old , 2. AlmoKD is the most common cause of acquired heart disease in children in developed countries . The patSince KD is a major cause of acquired heart disease in children, and due to the sudden death because of coronary aneurysms and thrombosis, effective management of KD is significantly beneficial for public health. Active supervision and management could potentially lead to long-term benefits for patients, practitioners, and society by facilitating the recognition, prevention, and treatment of KD cases. It also yields cost reduction at the national level . It has The registry is a database that uses minimum data set (MDS) to accurately analyze the burden of disease , 18. IdeThe aim of the MDS is to determine the data elements that need to be gathered and to develop a database as a comprehensive source of precise information for decision-makers and policymakers . MoreoveThere are some issues in Iran related to the implementation of diseases include data elements duplication in healthcare forms, lack of unified health information systems, and eventually, lack of national standard minimum data sets . Given tThis cross-sectional and descriptive study was conducted in 2020. Literature review, data collection from patients medical records, and expert panel approach were used to design this MDS. In the first phase, a literature review was carried out to specify all possible data elements to be included in the final minimum data set. Articles, forms, guidelines, and reports on the internet were reviewed. We carried out a systematic review of ISI Web of Science, PubMed, Scopus, Google Scholar, and Persian databases to recognize all References related to the MDS of KD which were published until February 2020 . We usedThe search strategy was limited to English and Persian languages. The included criteria were full-text articles, guidelines, forms, and reports from reliable sources published until February 2020. Other types of resources including abstracts without full-text, non-peer-reviewed articles, letters to editors, short communication, even forms and reports from weblogs were excluded. Then, data elements were evoked and recorded into a checklist. In addition, data was collected from patients medical records based on the International Classification of Diseases-10th Revision (ICD-10) related to KD. The final checklist included data elements got from the literature review and patients' medical records. Data elements were split into two categories: administrative and clinical.In the next phase, an expert panel was held to appraise and specify the MDS of KD. Ten pediatric specialists with more than 5 years of experience in KD treatment from different universities of medical sciences participated in this panel. We sent the aim of the study, the process of identifying MDS, and the extracted MDS to all experts, 2 weeks before starting the panel. Experts' initial opinions on the data elements were collected and calculated using the Delphi method. Content Validity Ratio (CVR) of more than 0.62 was considered as a condition of expert consensus on the acceptance of data elements as the final MDS for the KD national registry. Participants were also asked to propose any additional comments on desired MDS such as other data elements that were necessary for the KD registry according to their opinion. After collecting all comments and calculating CVR for each element, we held a focus group and brainstorming sessions for discussing elements which either were scored <0.62 or were proposed by experts. Due to the prevalence of COVID-19 disease, sessions were conducted using Skype software. Sessions continued until panel members reached a consensus to determine the final data elements. After discussion on each identified data element, at the end of the third session, by sending the finalized data elements to each member of the panel, they were asked to announce their decisive agreement with the selected elements to the secretary of the panel in case of final confirmation.The result of the systematic review showed despite the importance of KD, there is no specific registration program for KD in the world. All countries report their statistics based on the cross-sectional surveys, mostly annual, of hospital admission and discharge data. Only some KD case report forms were found in the United States, Korea, and Hong Kong. As a result, in order to develop the minimum data set for the national KD registry in Iran, we used these forms along with the guidelines for diagnosis, treatment, and management of KD found in different countries and the extracted data elements from medical records of patients in pediatric hospitals in Iran.Overall, 99 data elements were recognized. Of which, 51 and 48 data elements were verified and rejected, respectively. Moreover, 17 data elements were added as required by experts. Eventually, 68 data elements were chosen as the MDS of the national KD registry of IRAN entitled (IR-KDMDS). The final minimum data set was divided into administrative and clinical categories with 17 and 51 data elements, respectively. The demographic characteristics of the experts are shown in The administrative data consists of demographic data such as full name, national code, sex, and age. The clinical data elements contain patient's hospitalization data, patient's history data , major criteria of KD, patient′s body organs review, and finally, diagnostic and therapeutic procedures including laboratory tests, other paraclinical evaluations, drug, and surgical treatments. The complete elements of IR-KDMDS are presented in Kawasaki disease is one of the most common childhood vasculitis that can lead to serious complications, considerable morbidity, and mortality. Proper and timely treatment of disease can prevent these complications, and this indicates the importance of early and accurate diagnosis of the disease . Up to nUnfortunately, our review has shown that there is no specific registry for regular data collection of KD patients. Therefore, the minimum data set was designed in this study, and as a result, the KD National Registration System of Iran is the first attempt to collect comprehensive data on KD in the world.Each MDS possesses diverse data elements containing demographic, administrative, and clinical data such as health status, procedures, medications, treatments, and outcomes , 27. BasSome of our data elements, like some demographic and therapeutic procedures data, are common with other registries and guidelines for KD diagnosis, management, and treatment in the world and especially with what had been defined in KD case report forms in the USA, Korea, and Hong Kong –30. AparThe authors' review indicates despite the notable increasing incidence of disease, there is no KD-related registry in the world. Hence, the result of this study is the first effort to design a national KD registry. It is expected that defining precise, integrated, and comprehensive data elements and developing the IR-KDMDS will lead to effective disease management and thus improve the quality of care and, consequently, improve public health.The momentous strength of this project is the process of determining the MDS. IR-KDMDS is the outcome of the brainstorming, negotiation, and consensus of experts in several fields related to KD. Hence, it has been comprehensively containing all aspects of diagnosis, treatment, and management of KD.This article provides the first comprehensive MDS for developing a systematic KD registry in the world. Therefore, it is useful for designing and implementing a nationwide registry with the purpose of gathering all desired data from all patients across the country for determining the burden of disease and making decisions for effective management of the disease.The original contributions presented in the study are included in the article/MR designed the project. ZQ, LS, and MN performed the project. ZQ performed the analytic calculations. ZQ and MR wrote the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The Vaccines journal had the most publications, with 425 articles. The US Department of Health & Human Services granted the most research. In 2019, studies were focused on the topics of COVID-19 virus identification and ways to deal with it; in 2020, studies focused on the topics of COVID-19 and vaccines, whereas in 2021, they focused on the topics of COVID-19 vaccines and their effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions about these vaccines in the social media. Conclusions: Recognition of the most important actors , research trends, and fields of study on the COVID-19 vaccine can be useful for researchers, countries, and policy makers in the field of science and health to make decisions and better understand these vaccines.This study attempted to draw the present and future perspective of the COVID-19 vaccine by identifying the most important scientists and their scientific contexts, trends of research topics, and relationships between different entities. Methods: To achieve this purpose, bibliometric and scientometric techniques were used to analyze 6288 scientific documents contributing to COVID-19 vaccines from the beginning of 2019 to 13 December 2021, indexed in the Web of Science. Results: The United States (US) had the greatest impact by publishing 2104 documents and receiving 32,958 citations. The US and the UK countries had the highest level of scientific collaborations with 192 collaborative studies. The University of Oxford and the Harvard Medical School were the most active institutions, and the University of Oxford and Emory University were the most influential institutions. Pollard AJ and Lambe T had the most publications and the highest citations and h-index. T Lambe, SC Gilbert, M Voysey, and AJ Pollard from the University of Oxford had the highest number of co-authorships. More than 19% of the research was conducted in the field of immunology.  The new coronavirus, or COVID-19, is a deadly virus common between humans and animals . The panHowever, a vaccine is a biological preparation that provides acquired active immunity to a specific disease . The maiIn the section on research and technologies in the field of vaccines, we are witnessing the emergence of interdisciplinary fields, research collaborations, and new research fronts to transform the future of science and technology in this field. Identifying and evaluating research, research areas, and research fronts in COVID-19 vaccines familiarize researchers and related organizations with current and future research trends in this field and help them to better conduct training programs in this field. The present study helps to identify important interdisciplinary topics and research areas resulting from scientific publications, the most prolific and influential researchers, institutions, countries, and journals that publish new research on coronavirus vaccines and develops a plan for future research collaborations.Therefore, considering the importance of using vaccines in the prevention and control of pandemics and following an increase of scientific publications on the COVID-19 vaccine, attention to scientometric studies to assess the research productivity and collaborations of various disciplines, researchers, and institutions of the world in this field have gained a special importance. Therefore, the current research aims to draw the present and future perspective of the COVID-19 vaccine studies by identifying the most important actors and their scientific fields, trends in research topics, and relationships between different entities.Some studies by ,14,18,19According to the objectives of the present research, the method of bibliometric and scientometric analysis was used to analyze scientific publications on the COVID-19 vaccines. The population of this research consists of all documents on the COVID-19 vaccines from 2019 to 13 December 2021 indexed in the Web of Science database. The methodology of this research was divided into two parts, which are described in detail below.The search strategy was such that in the first step, the Clarivate Analytics Web of Science (WoS) Core Collection was selected ,21. Nextwww.track.org was used (19 January 2022) to gather information about the type of vaccine, primary developers, and status of approving countries. Additionally, information on the doses purchased from each vaccine was collected from the app.powerbi.com website. The website www.RAPS.org (accessed on 19 January 2022) was also used to identify vaccine-producing countries.In other words, the website of COVID-19 vaccines All extracted files were analyzed using HistCite , Publish or Perish , VOSviewer , CiteSpace , and Bibliometrix R Package software . The analysis process was such that the capabilities of HistCite software were used to analyze information about authors, institutions, countries, and journals . In addiThe analysis showed that the US, Italy, China, and the United Kingdom (UK) conducted the most research on COVID-19 vaccines, and the height of the countries’ rectangles indicates that. Furthermore, most of the US studies have focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2; these studies have been led by many researchers. Additionally, most Italia research has focused on topics, such as COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, COVID-19 Vaccines BNT162B2, and COVID-19 Pandemic; these studies have been conducted mostly by researchers such as AJ Pollard, T Lambe, L Kilmek, PK Aley, and M Voysey. However, Chinese and UK researchers, similarly to American researchers, focused on COVID-19, COVID-19 Vaccination, COVID-19 Vaccines, Vaccine hesitancy, and COVID-19 Vaccines BNT162B2.Additionally, based on the results of Vaccines, Vaccine, Human Vaccines & Immunotherapeutics.To analyze the bibliographic information from documents on the COVID-19 vaccines, a three-field plot of institutions, keywords, and journals was designed, which allows us to identify institutions that have studied topics on the COVID-19 vaccines and provides the possibility to identify the field of journals that published such studies. As shown in In total, 122 countries contributed to the publication of studies on the COVID-19 vaccine, and the findings of the most active countries are presented in Vaccines journal with 425 articles and the Vaccine journal with 185 articles had the highest number of publications in the field of COVID-19 vaccines. Studies published in the New England Journal of Medicine and the Lancet had the greatest citation impact on the scientific community, receiving 12,861 citations and 6776 citations, respectively, which could obtain significant citations in this field. The results of New England Journal of Medicine with IF 91,245, and the lowest impact factor belongs to the International Journal of Environmental Research and Public Health with IF 3.39. Among them, 10 journals were Q1, 2 journals Q2 and Q3. Furthermore, The results of Vaccines journal has been on an upward trend, which shows the special attention of this journal to the publication of studies on COVID vaccines. Overall, the journal has increased its number of studies from 13 in 2020 to 411 in 2021. It is followed by Vaccine and Human Vaccines & Immunotherapeutics, which were other research channels for researchers to publish studies on the COVID-19 vaccines in these years. These journals published 30 and 29 studies in 2020 and 155 and 145 studies in 2021, respectively.Continuing to review the results of the publication of studies by journals, According to the results presented in Immunology area, which could probably indicate that researchers in this field, in addition to treating and producing vaccines for this epidemic, also examined the types of immune responses to these vaccines. Furthermore, General & Internal Medicine with 1054 and Research Experimental Medicine with 834 studies were other active areas in this field. In total, researchers in these three areas played an influential role in the research outputs on the COVID-19 vaccines by publishing more than 49 percent of the studies. Additionally, the situation of other active and productive areas in this field is presented in The findings of England (the UK) and Germany, on the other hand, are other productive countries in this field, which is in the #1 cluster called the sociodemographic factor. China is also the source of the corona outbreak in cluster #2, and Italy and Russia in clusters #4 and #0 called the effective COVID-19 genomics and COVID-19 vaccines, are paying close attention to aspects of new strains and variants COVID-19 and COVID-19 vaccines.Due to the widespread prevalence of COVID-19 worldwide and its new mutations, many studies have been conducted by researchers on therapeutic and pharmacological methods to treat COVID-19 and to develop a vaccine to control the disease. According to the latest statistics approved by the World Health Organization, the number of patients with “COVID-19” disease in the world has reached 270,791,973 people, and the deaths of 5,318,216 people have been confirmed due to this disease. On 15 December 2021, more than 8,200,642,671 people worldwide had been vaccinated against the virus [The findings related to the trend of publications related to the COVID-19 vaccines indicate a significant increase compared to 2019 and 2020, meaning that more than 90 percent of these publications have been produced in 2021. Therefore, a reason for the significant increase in releasing research related to COVID-19 vaccines in 2021 may be the decline in global resilience faced with this epidemic and a more deadly strain of the virus, which prompted researchers to conduct further studies on the field of making and producing vaccines and finally controlling and eradicating this disease. Overall, the findings of researchers and institutions with the highest number of research publications showed that Pollard AJ and Lambe T of the University of Oxford had the highest number of publications on studies related to the COVID-19 vaccines. The findings from the most active research institutes also indicated that the University of Oxford in the UK and the Harvard Medical School in the US, as the most active institutions, played a more prominent role than other institutes in studies on the COVID-19 vaccines. The above results agree with the findings of Ay et al. .The findings from leading countries in studies on the COVID-19 vaccines showed that researchers from the US published the most publications in this field; the results of Surulinathi et al.  and Ay eVaccines and Vaccine journals published the largest number of studies on the COVID-19 vaccines during the desired period. These journals are published by MDPI and Elsevier publications, respectively, and in terms of ranking of the Web of Science journals, they are ranked Q2 and Q3, respectively, and are in a good position in terms of impact factor. However, a review of support organizations for COVID-19 vaccine studies showed that the U.S. Department of Health & Human Services, with 437 studies, and the National Institutes of Health (NIH) from the US, with 408 studies, provided the most support from published studies on the COVID-19 vaccines. Additionally, the results related to the thematic fields of published studies showed that researchers in the field of Immunology with 1244 studies (19.8%), the field of General & Internal Medicine with 1054 studies (16.8%), and the field of Research Experimental Medicine with 834 studies (13.3%) percentage) had the most scientific publications in this field, which in the study Ay et al. [The results of the journals that published research on the COVID-19 vaccines showed that the researchers published their scientific publications in 1321 journals. Among them, the y et al. , these tThe state of research on the COVID-19 vaccines based on the time zone map showed that the initial studies in 2019 were more focused on identifying the COVID-19 virus and ways to combat it . However, the scientific research of researchers in 2020 has led to topics, such as COVID-19 and vaccines , which indicates their serious attention to the development of vaccines to control and treat the disease. Finally, the research trend of studies in 2021 on topics, such as COVID-19 vaccines and their types and effects, vaccines hesitancy, the role of healthcare workers in COVID-19, as well as discussions on these vaccines on social media has been more than other studies.Findings on the interconnected map of countries and research institutes showed that the US has paid serious attention to scientific activities about the production of COVID-19 vaccine, vaccination, and sociodemographic factor. The universities of Oxford, Harvard Medical School, Tel Aviv, Washington, and the London School of Hygiene & Tropical Medicine have also been major research institutes in the field of COVID-19 vaccines.Generally, this study examined the trend of publications on the COVID-19 vaccines from the perspective of scientometric and depicted the topics and fields of study of countries, institutions, and researchers and the collaboration between them in this field. The findings of this study can be valuable through the identification and analysis of the most important actors , the research process and fields of study in the COVID-19 vaccine for researchers, countries, and policymakers in the fields of medical sciences and health to make better decisions and understand and ultimately progress in this field. There may also be more research in the future on other types of vaccines and comparing their effectiveness on mutated strains of the virus, vaccine acceptance, long-term side effects of these vaccines, COVID-19 vaccination from various perspectives, and other related topics due to the more prominent keywords, such as “COVID-19 vaccine” and “COVID-19 vaccination”, which can also increase the upward trend of publication compared to recent years. Finally, there is a need to increase opportunities for financial support, more scientific collaborations, understanding and analyzing research of leading countries, and emulating them from different angles to make appropriate decisions.