ABSTRACT
Background: Since the initiation of the new coronavirus (COVID-19) in February 2020 in Wuhan, the Health Care System (HCS) has tolerated a lot of morbidities and mortalities all around the world. While the COVID -19 is spreading out the whole world, HCS carries almost all the burden as the first line. However, countries like Iran suffer from a lack of infected Health Care Workers (HCW) population data and statistics, especially the major hospitals for COVID-19 referrals. Methods: In this single-center cross sectional study, we studied the healthcare personnel infected by COVID-19, from February 2020 to August 2020, in a major tertiary hospital of Tehran, Iran. Results: Of total 1595 HCW working in Sina hospital, 389 (24%) with the mean age of 35.43 ± 8.2 years were infected by COVID-19, almost one fourth. 238 (61.2%) were women, though 92.5% of the population used Personal Protective Equipment (PPE). 140 (36%) of them were personnel of the wards assigned to the COVID-19, Personnel went on sick leave for 7.76 ± 4.64 days. 51(13.1%) personnel had an exacerbation of symptoms, and only one of the personnel experienced COVID-19 almost twice in four months. Conclusion: COVID-19 infection risk is considered to be very low for HCWs in case suitable PPE and social distancing are regarded. In our study, more than 92% of the infected personnel utilized PPE, which indicates that they might have failed to use PPE properly or might not have taken hand-hygienic precautions well. It is necessary to limit working hours and prevent excessive workload so that the staff could adhere more to hygienic precautions in hospitals or in society. Copyright 2022, Journal of Iranian Medical Council. All rights reserved.
ABSTRACT
During the coronavirus disease-2019 (COVID-19) pandemic, which was caused by the novel coronavirus, there is an ongoing controversy about the use of corticosteroids. This study aims to investigate the association between Dexamethasone treatment and clinical outcomes in patients with severe COVID-19. In this single-center retrospective cohort study, patients with COVID-19 were enrolled from February 16, 2020, to November 1, 2020. After performing propensity score matching with age, sex, and disease severity. The independent effect of Dexamethasone treatment on in-hospital mortality was evaluated by multivariate proportional hazards regression models. Of 1413 patients with COVID-19 diagnosis, 1172 patients entered the final analysis. 473(40.4%) patients received dexamethasone treatment with a median duration of 6.0[4.0-9.0] days. After matching and adjustment with possible confounders in the multivariate model, administration of dexamethasone significantly increased the survival in severe patients (hazard ratio: 0.25, 95 confidence intervals: 0.16-0.38, P<0.001), but there was no difference in non-severe patients (P:0.888). The administering of dexamethasone was associated with an increased in-hospital survival rate (HR: 0.25 [0.16-0.38]) in severe COVID-19 patients. The survival rate was more significant in severe patients with diabetes mellitus or hypertension after receiving dexamethasone treatment (HR:0.19). On the other hand, patients without severe disease did not benefit from dexamethasone administration.
ABSTRACT
Remdesivir, an antiviral medication, became an early promising therapeutic candidate for coronavirus disease 2019 (COVID-19) due to its ability to inhibit the virus in vitro. Current evidence about remdesivir treatment has been very controversial, so we aim to evaluate remdesivir to improve our knowledge about COVID-19 management and its long-term effects. In this retrospective cohort study using registered data derived from the Sina Hospital COVID-19 Registry with a 9-month follow-up, we enrolled patients receiving remdesivir and then matched a "control group" which did not receive remdesivir based on age, gender, and severity using propensity score matching. We used multivariant Cox regression to evaluate the remdesivir effect on patients' 9-month and in-hospital survival. We enrolled 227 patients, 116 in remdesivir and 111 in the control group. 213(93.8%) patients developed the severe disease, 88(38.8%) died during the 9-month follow-up, and 84(37.0%) died during hospitalization. In multivariate analysis, remdesivir did not affect the 9-month all-cause mortality and in-hospital mortality. Remdesivir was associated with increased in-hospital survival only in severe patients with diabetes (HR: 0.32;95% CI: 0.14-0.75;P:0.008), and there was a trend for better 9-month survival in severe patients with diabetes (HR: 0.47;95% CI: 0.20-1.09;P:0.080). We concluded that remdesivir treatment did not increase the 9-month survival rate either in patients with COVID-19 or patients with severe disease and underlying diseases. On the other hand, we found that remdesivir treatment could increase inhospital survival only in patients with severe COVID-19 and a history of diabetes mellitus.
ABSTRACT
Introduction Coronavirus disease 2019 (COVID-19) is a devastating pandemic that may also affect the nervous system. One of its neurological manifestations is intracerebral hemorrhage (ICH). Data about pure spontaneous intraparenchymal hemorrhage related to COVID-19 is scarce. In this study, we present some patients with COVID-19 disease who also had spontaneous intraparenchymal hemorrhage along with a review of the literature. Methods This single-center prospective study was done among 2,862 patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 1 and November 1, 2020. Out of 2,862 patients with SARS-CoV-2, 14 patients with neurological manifestations were assessed with a noncontrast brain computed tomography scan. Seven patients with spontaneous intraparenchymal hemorrhage were enrolled. Results All seven patients were male, with a mean age of 60.8 years old. Six patients (85.7%) only had minimal symptoms of COVID-19 without significant respiratory distress. The level of consciousness in two patients (28.5%) was less than eight, according to the Glasgow Coma Scale (GCS). Hypertension (71.4%) was the most common risk factor in their past medical history. The mean volume of hematoma was 41cc. Four patients died during hospitalization, and the others were discharged with a mean hospital stay of 42.6 days. All patients with GCS less than 11 died. Conclusion It concluded that ICH patients with COVID-19 are related to higher blood volume, cortical and subcortical location of hemorrhage, higher fatality rate, and younger age that is different to spontaneous ICH in general population. We recommend more specific neuroimaging in patients with COVID 19 such as brain magnetic resonance imaging concomitant with vascular studies in future. The impact of COVID-19 on mortality rate is not clear because of limited epidemiologic studies, but identifying the causal relationship between COVID-19 and ICH requires further clinical and laboratory studies.
ABSTRACT
Background: Since December 2019, an emerging virus called SARS-CoV-2 has spread in Wuhan, China, and has now become a global "pandemic" with the development of a disease called Covid-19. High emission capability and significant mortality of this disease indicate the need for immediate and effective attention to this issue. So far, many efforts have been made to introduce an effective treatment for Covid-19. Due to the contagiousness and high prevalence of the disease, chemoprophylaxis is a topic of discussion that is frequently asked by people and medical staff. The most suitable of the proposed drugs for this purpose are Chloroquine and Hydroxychloroquine which, besides anti-malarial and anti-inflammatory effects, have also antiviral effects. However, for introducing these drugs as prophylaxis, more evidence is needed. Methods: In this study, the existing articles and studies on the use of Chloroquine and Hydroxychloroquine as an effective drug in the prevention of Covid-19 have been studied. References used in this review were identified through a search of PubMed and Google Scholar with keywords of "Hydroxychloroquine", "Chloroquine", "COVID- 19", "COVID 19", "2019-nCoV", "2019-CoV", "coronavirus", " SARS-nCoV-2", "antiviral", and "prophylaxis". Articles obtained from this search and relevant references were reviewed and included. Results: Available studies on the pharmacological effects of Chloroquine and Hydroxychloroquine on SARS-CoV-2 have been performed in the laboratory (In vitro). Till now, 5 clinical trials have been conducted in this field and their preliminary results will be published in the next few months. There are also different prophylactic doses suggested in existing studies. Conclusion: Due to the lack of sufficient clinical evidence and the uncertainty about the dose required to create a prophylactic effect against the disease and due to possible complications, the use of these drugs for prophylaxis is not recommended until the first results of clinical studies are published and then approved by WHO, CDC and FDA. Sufficient attention should be paid to personal protective equipment. © 2020, Journal of Iranian Medical Council.