Mapping and Spatial Pattern Analysis of COVID-19 in Central Iran Using the Local Indicators of Spatial Association (LISA).

BACKGROUND: Using geographical analysis to identify geographical factors related to the prevalence of COVID-19 infection can affect public health policies aiming at controlling the virus. This study aimed to determine the spatial analysis of COVID-19 in Qom Province, using the local indicators of spatial association (LISA). METHODS: In a primary descriptive-analytical study, all individuals infected with COVID-19 in Qom Province from February 19th, 2020 to September 30th, 2020 were identified and included in the study. The spatial distribution in urban areas was determined using the Moran coefficient in geographic information systems (GIS); in addition, the spatial autocorrelation of the coronavirus in different urban districts of the province was calculated using the LISA method. RESULTS: The prevalence of COVID-19 in Qom Province was estimated to be 356.75 per 100,000 populations. The pattern of spatial distribution of the prevalence of COVID-19 in Qom was clustered. District 3 (Imam Khomeini St.) and District 6 (Imamzadeh Ebrahim St.) were set in the High-High category of LISA: a high-value area surrounded by high-value areas as the two foci of COVID-19 in Qom Province. District 1 (Bajak) of urban districts was set in the Low-High category: a low-value area surrounded by high values. This district is located in a low-value area surrounded by high values. CONCLUSIONS: According to the results, district 3 (Imam Khomeini St.) and district 6 (Imamzadeh Ebrahim St.) areas are key areas for preventing and controlling interventional measures. In addition, considering the location of District 1 (Bajak) as an urban district in the Low-High category surrounded by high values, it seems that distance and spatial proximity play a major role in the spread of the disease.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients.

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses' statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients' values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients' voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients' values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study.

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU.

BACKGROUND: COVID-19 is known as a new viral infection. Viral-bacterial co-infections are one of the biggest medical concerns, resulting in increased mortality rates. To date, few studies have investigated bacterial superinfections in COVID-19 patients. Hence, we designed the current study on COVID-19 patients admitted to ICUs. METHODS: Nineteen patients admitted to our ICUs were enrolled in this study. To detect COVID-19, reverse transcription real-time polymerase chain reaction was performed. Endotracheal aspirate samples were also collected and cultured on different media to support the growth of the bacteria. After incubation, formed colonies on the media were identified using Gram staining and other biochemical tests. Antimicrobial susceptibility testing was carried out based on the CLSI recommendations. RESULTS: Of nineteen COVID-19 patients, 11 (58%) patients were male and 8 (42%) were female, with a mean age of ~ 67 years old. The average ICU length of stay was ~ 15 days and at the end of the study, 18 cases (95%) expired and only was 1 case (5%) discharged. In total, all patients were found positive for bacterial infections, including seventeen Acinetobacter baumannii (90%) and two Staphylococcus aureus (10%) strains. There was no difference in the bacteria species detected in any of the sampling points. Seventeen of 17 strains of Acinetobacter baumannii were resistant to the evaluated antibiotics. No metallo-beta-lactamases -producing Acinetobacter baumannii strain was found. One of the Staphylococcus aureus isolates was detected as methicillin-resistant Staphylococcus aureus and isolated from the patient who died, while another Staphylococcus aureus strain was susceptible to tested drugs and identified as methicillin-sensitive Staphylococcus aureus. CONCLUSIONS: Our findings emphasize the concern of superinfection in COVID-19 patients due to Acinetobacter baumannii and Staphylococcus aureus. Consequently, it is important to pay attention to bacterial co-infections in critical patients positive for COVID-19.

The COVID-19 Outbreak in Iran; The First Patient with a Definite Diagnosis.

The novel coronavirus, formerly named as 2019 novel coronavirus (2019-nCov) caused a rapidly spreading epidemic of severe acute respiratory syndrome (SARS) in Wuhan, China and thereafter, progressed globally to form a pandemic of coronavirus disease 2019 (COVID-19) in numerous countries; and now confirmed cases are reported from several provinces of Iran. Now various medical centers, clinicians and researchers around the world share their data and experiences about COVID-19 in order to participate in the global attempt of controlling the pandemic. The current report investigates the clinical presentations and paraclinical findings of the first confirmed cases and mortalities in the initiation of the outbreak of COVID-19 in Iran.