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The onset of COVID- 19 pandemic has resulted in the transition from the conventional face to face health care strategies to computerized approaches, considering distances, the importance of quarantine, and early diagnosis and management. As far as the rapid management of the infection is concerned, telemedicine has been introduced as a beneficial approach. The use of telemedicine is thought to decrease the risk of cross contamination. Moreover, it provides the access to the health care for remote locations. The health care staff can use the computational analyses to get rapid access to the accurate epidemiological and laboratory data. The risk assessment provided by the mathematical models seems beneficial for decision-making in regards to the prognosis and management. We aimed to explore the breakthrough of telemedicine regarding the pandemic, also attempting to describe the related problems and challenges.
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Background: Coronavirus pandemic has affected a large population worldwide. Currently, the standard care for individuals who are exposed is supportive care, symptomatic management, and isolation. Objectives: This study aimed to evaluate the effects of the combined use of ethanol and dimethyl sulfoxide (DMSO) as a nasal spray in preventing Coronavirus disease 2019 (COVID-19). Methods: This randomized controlled trial was conducted on volunteer healthcare workers of medical centers who were at the forefront of the fight against COVID-19 in Shahroud, Iran. In total, 232 participants were randomly assigned to intervention and control groups to receive DMSO/ethanol or routine care, respectively. The subjects were followed for four weeks to determine the incidence of COVID-19 infection in each group based on the RT-PCR test. Finally, absolute risk difference and relative risk were calculated to evaluate the effect of DMSO on COVID-19 prevention. Results: The results showed that the incidence rates of COVID-19 were 0.07 and 0.008 in the control and intervention groups, respectively. The relative risk was obtained at 0.12 (0.02-0.97) according to the incidence rate in the two groups. Conclusion: Combined administration of DMSO and ethanol by healthcare providers can considerably prevent COVID-19.
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Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Objectives: This study aimed to investigate the efficacy and safety of CP transfusion were investigated in severe/critically ill COVID-19 patients. Methods: This study was performed on 50 consecutive COVID-19 patients with severe/critically ill disease. Severe disease was defined as having at least one of the following symptoms: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≥ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, lung infiltrates > 50% within the last 24-48 h. Critically ill disease was identified by intensive care unit admission, respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as the secondary outcomes. Results: Based on the results, 21 out of 50 consecutive patients were on mechanical ventilation at the time of CP transfusion. In total, 32 patients (64%) survived 30 days after CP transfusion. The survival rates were 74% and 44% in patients who received CP < 7 and ≥ 7 days after admission, respectively. While 92% of patients without mechanical ventilation survived, the survival rate of patients on mechanical ventilation was 29%. Moreover, the CT scan score and some other clinical features were improved in the group that received CP transfusion, and no adverse effects were observed. Conclusion: The CP transfusion is a safe and effective treatment in severe/critically ill COVID-19 patients. The best outcome can be achieved in patients who are not on mechanical ventilation, especially early in the disease course.
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Acute myocardial ischemia during coronavirus disease 2019 (COVID-19) infection can occur in two forms of acute myocardial infarction type І and II. In acute myocardial infarction type І, infection can cause inflammation, and inflammation causes the secretion and increase of cytokines such as interleukin 1, 6, and 8, as well as tumor necrosis factor (TNF) in the circulation. This mechanism causes the secretion of collagenase from activated macrophages, and the results of these reactions is a precursor to plaque rupture, increased coagulation, and thrombus formation. This mechanism causes acute myocardial infarction type І on atherosclerotic plaque. In these patients, primary percutaneous coronary intervention (PCI) is the treatment of choice, contrary to the initial theory that lytic therapy was the main treatment. In COVID conditions, the primary PCI time increases from 120 minutes to 180 minutes, and if the primary PCI takes more than 180 minutes, then lytic therapy is recommended. In acute myocardial infarction type II, patients usually do not have angina clinically, troponin rises slightly (less than 2 times normal), and do not have electrocardiogram changes as a sign of ischemia. However, patients with coronary heart disease have persistent chest pain with or without myocardial necrosis. During COVID-19 infection, due to release of interleukin, tumor necrosis alpha, and catecholamine, as well as hypoxia, acidosis, hypertension and/or hypotension, oxygen delivery and myocardial oxygen demand become disturbed, so acute myocardial infarction type II may occur. Supportive therapies are performed in these patients, and the treatment of acute underlying disease such as treatment with steroidal anti-inflammatory drugs and antiviral drugs is the main treatment. © 2021 Isfahan University of Medical Sciences(IUMS). All rights reserved.
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Background: Hypertension is a critical risk factor in increasing the mortality rate of COVID-19 inpatients. This association can be confounded by a history of consuming some angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs). Objective: This study aimed to assess the COVID-19 prognosis in patients with/without a history of taking ACEIs and ARBs. Methods: This single-center, prospective, observational study was performed on 345 patients with COVID-19 hospitalized in Baqiyatallah Hospital. The patients were categorized into 2 groups: with a history of ACEI/ARB consumption (the case group, n=115) and without such a history (the control group, n=230). Results: After the exclusion of some patients, the COVID-19 prognosis of 294 patients (ncontrol =184, ncase=110, 53% female) at a mean age of 64±9.7 years was evaluated. Unequal variables were adjusted between the case and control groups, and the results showed no significant differences in oxygen saturation, the computed tomography scan score, the erythrocyte sedimentation rate, C-reactive protein, lactate dehydrogenase, D-dimer, the white blood cell count, lymphocytes, hemoglobin, platelets, and mortality between the 2 groups. However, a significant difference in the average length of hospital stay was found between the control (6.55±0.56 d) and case (8.53±0.55 d) groups (P=0.013). Conclusions: The dosage adjustments and changes of ACEIs and ARBs are not recommended due to increased referrals to health centers involved with the COVID-19 risk. The prognosis, safety, and efficacy of ACEI/ARB consumption should be assessed further in larger studies on middle-aged to old patients with COVID-19. (Iranian Heart Journal 2022;23(1): 129-139).
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Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Objectives: This study aimed to investigate the efficacy and safety of CP transfusion were investigated in severe/critically ill COVID-19 patients.
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Introduction and Objectives: The pivotal role of chest computed tomographic (CT) to diagnosis and prognosis coronavirus disease-2019 (COVID-19) is still an open field to be explored. This study was conducted to assess the CT features in confirmed cases with COVID-19. Materials and Methods: Retrospectively, initial chest CT data of 363 confirmed cases with COVID-19 were reviewed. All subjects were stratified into three groups based on patients' clinical outcomes; non-critical group (n=194), critical group (n=65), and death group (n=104). The detailed of CT findings were collected from patients' medical records and then evaluated for each group. In addition, multinomial logistic regression was used to analyze risk factors according to CT findings in three groups of patients with COVID-19. Results: Compared with the non-critical group, mixed ground-glass opacities (GGO) and consolidation lesion, pleural effusion lesion, presence of diffuse opacity in cases, more than 2 lobes involved and opacity scores were significantly higher in the critical and death groups (P<0.05). Having more mixed GGO with consolidation, pleural effusion, lack of pure GGO, more diffuse opacity, involvement of more than 2 lobes and high opacity score identified as independent risk factors of critical and death groups. Conclusion: CT images of non-critical, critical and death groups with COVID-19 had definite characteristics. CT examination plays a vital role in managing the current COVID-19 outbreak, for early detection of COVID-19 pneumonia. In addition, initial CT findings may be useful to stratify patients, which have a potentially important utility in the current global medical situation.
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Background: Covid-19 is known to be diagnosed with clinical manifestations such as dry mouth, fever, respiratory distress, fatigue and tiredness, decreased leukocyte, and pneumonia evidence on CTscan. We aimed to investigate the clinical symptoms of hospitalized patients with and without Covid-19 to develop the required clinical information. Materials and Methods: A retrospective descriptive study was conducted in 200 patients suspected of having Covid-19 infection hospitalized in Imam Reza hospital, one of the Referral Hospitals for Covid-19 patients, Mashhad, Iran. Patients' records were reviewed for demographics and clinical symptoms, and the results of laboratory tests over January and February 2020 were reviewed. The admission criterion was definitive Corona virus infection diagnosis, and the exclusion criteria were suffering from viral hepatitis, chronic liver disease, and liver malignancies. Data were analyzed using SPSS version 16.0. Results: The prevalence of Covid-19 was revealed to be 75% among the suspected patients (71.1% in women and 77.4% in men). The average age of Covid-19 patients was 55.06 17.23, and the average hospitalization period of Covid-19 patients was 8.22 +/- 5.81 days. The most prevalent symptom among Covid-19 patients was fever and cold symptoms (65%), respiratory complications (17.5%), and fever (6%). The most significant laboratory findings regarding Covid-19 patients were their high NET, LDH, and CRP levels. Conclusion: The prevalence of Covid-19 was revealed to be 77.4% among the suspected patients. The average age of Covid-19 patients was 55.06 +/- 17.23 years. Based on the results, laboratory parameters are not sufficient for Covid-19 diagnosis due to their low sensitivity and indication, but can improve the value and diagnostic aspects of the disease if used accompanied by CTscan.
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The bidirectional association between the circadian system and innate-adaptive immune functions has been highlighted in many investigations. Viruses are a submicroscopic infectious agent that activate the immune system after entering the human host cell. A novel virus, socalled Coronavirus Disease 2019 (COVID-19), which has recently emerged, is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Previous investigations show that the factors that are strongly controlled by circadian rhythms, such as clock genes and melatonin, modulate the immune response and may, therefore, influence the healing processes of COVID-19. Moreover, the mechanism of COVID-19 shows that some host cell factors, such as an angiotensin-converting enzyme, exhibit daily rhythms. In this review, we explore key findings that show a link between circadian rhythms and viral infection. The results of these findings could be helpful for clinical and preclinical studies to discover a useful and highly effective treatment for eradicating the COVID-19 disease.
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From February 24, 2020, to April 2, 2020, this study presents a preliminary report on the chest computed tomography (CT) findings of COVID-19 pneumonia at Baqiyatallah Hospital, Tehran, Iran. This study performed on 70 patients with a final diagnosis of COVID-19.