Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections in Kurdistan Province, Iran: A Case Series (preprint)

Background: Coronaviruses, including severe acute respiratory syndrome coronavirus (SARS-CoV) and is the cause of an ongoing pandemic, with increasing deaths worldwide. Here in we present the results of the histopathological study of the main organs of 25 patients who died due to confirmed COVID-19.Methods: In this case series, patients base on needle necropsy of multiple organs of dead patients with a positive antemortem SARS-CoV-2 (COVID-19) real time PCR. Needle necropsy of corpses of 25 patients enrolling the study were performed until 3 hours after death in the negative-pressure isolation morgue who hospitalized at Kurdistan University of medical sciences Tohid and Kowsar hospitals with proved COVID-19 infection and were died due to severe disease manifestations.Results: The mean age of the participants in this study was 74.68 ± 9.41 (52–91) years old. The participants included 19 men (76%) and 6 women (24%). In myocardial necropsy, twelve patients were reported to be lymphocytic myocarditis, three of them were reported to have pericarditis as well, and in one case focal visual fibrosis was reported. Histopathological examinations of liver revealed that among twenty-two samples, five cases had acute hepatitis that four of them were mild in type. Steatohepatitis was reported in six cases and two of them were macrovesicular in type. Macrovesicular Steatosis was reported along with steatohepatitis and stage 4 fibrosis through trichrome staining. Muscles necropsy revealed viral myositis for three patients.Conclusions: Our study shows extra-pulmonary multi organ involvement through COVID-19 disease. 77% of patients representing acute or chronic hepatitis and 48% of them revealed lymphocytic myocarditis accompanied with pericarditis in 12% of cases and 12% of patient’s show myositis. It looks diffuse inflammatory disease which attacks to some organs like myocardium, liver and muscles. Broad extra pulmonary pathology and laboratory findings are occurred that all suggestive of multi organ involvement directly or through systemic viremia and immune system response.

Association of olfactory dysfunction with hospitalization for COVID-19: a multicenter study in Kurdistan (preprint)

Objective: To evaluate the association of olfactory dysfunction (OD) with hospitalization for COVID-19. Study Design: Multi-center cohort study. Setting: Emergency departments of thirteen COVID-19-designed hospitals in Kurdistan province, Iran. Subjects and Methods: Patients presenting with flu-like symptoms who tested positive by RT-PCR for COVID-19 between May 1st and 31st, 2020. At the time of presentation and enrollment, patients were asked about the presence of OD, fever, cough, shortness of breath, headache, rhinorrhea and sore throat. The severity of OD was assessed on an 11-point scale from 0 (none) to 10 (anosmia). Patients were either hospitalized or sent home for outpatient care based on standardized criteria. Results: Of 203 patients, who presented at a mean of 6 days into the COVID-19 disease course, 25 patients (12.3%) had new OD and 138 patients (68.0%) were admitted for their COVID-19. Patients admitted for COVID-19 had a higher prevalence of all symptoms assessed, including OD (p<0.05 in all cases), and OD identified admitted patients with 84.0% sensitivity and 34.3% specificity. On univariate logistic regression, hospitalization was associated with OD (odds ratio [OR] = 2.47, 95%CI: 1.085-6.911, p=0.049). However, hospitalization for COVID-19 was not associated with OD (OR=3.22, 95% CI: 0.57-18.31, p=0.188) after controlling for confounding demographics and comorbidities. Conclusion: OD may be associated with hospitalization for (and therefore more severe) COVID-19. However, this association between OD and COVID-19 severity is more likely driven by patient characteristics linked to OD, such as greater numbers of COVID-19 symptoms experienced or high-risk comorbidities.

A model for COVID-19 prediction in Iran based on China parameters (preprint)

Background: The rapid spread of COVID-19 virus from China to other countries and outbreaks of disease require an epidemiological analysis of the disease in the shortest time and an increased awareness of effective interventions. The purpose of this study was to estimate the COVID-19 epidemic in Iran based on the SIR model. The results of the analysis of the epidemiological data of Iran from January 22 to March 8, 2020 were investigated and the prediction was made until March 29, 2020. Methods: By estimating the three parameters of time-dependent transmission rate, time-dependent recovery rate, and time-dependent mortality rate from Covid-19 outbreak in China, and using the number of Covid-19 infections in Iran, we predicted the number of patients for the next month in Iran. Each of these parameters was estimated using GAM models. All analyses were conducted in R software using the mgcv package. Findings: On average, 925 people with COVID-19 are expected to be infected daily in Iran. The epidemic peaks within one week (15.03.2020 to 03.21.2020) and reaches its highest point on 03.18.2020 with 1126 infected cases. Conclusion: The most important point is to emphasize the timing of the epidemic peak, hospital readiness, government measures and public readiness to reduce social contact.