ABSTRACT
The findings of studies on serum 25-hydroxy-vitamin D [25(OH) D] levels in pregnant women with or without coronavirus disease 2019 (COVID-19) were found to be controversial and inadequate. The present study was thus carried out at to fill the gap felt in this regard. In this case-control study, 63 pregnant women with singleton pregnancy who were infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and 62 pregnant women who were matched for gestational age and not infected by COVID-19 were examined. Based on clinical symptoms, the patients with COVID-19 were divided into three groups: mild, moderate, and severe. ELISA method was adopted to measure [25(OH) D] level. The [25(OH) D] means of 23.4 ± 9.2 ng/ml and 31.2 ± 0.15 ng/ml were noted in the case and control groups, respectively (p < 0.001). The [25(OH) D] level of lower than 30 ng/ml was observed in 43.5% of the control group (n = 27) and 71.4% of the case group (n = 45; p = 0.002). Multivariate linear regression analysis to match age, gestational age, [25(OH) D] supplement use, and number of pregnancies showed that [25(OH) D] mean in the case group is 8.2 units lower, compared to the control group (p < 0.001). The [25(OH) D] level in pregnant women with COVID-19 is lower, compared to non-infected pregnant women. However, there is no significant relationship between [25(OH) D] level and disease severity. A sufficient level of [25(OH) D] may protect pregnant women against COVID-19.
ABSTRACT
BACKGROUND: Accurate information on the cost determinants in the COVID-19 patients could provide policymakers a valuable planning tool for dealing with the future COVID-19 crises especially in the health systems with limited resources. OBJECTIVES: This study aimed to determine the factors affecting direct medical cost of COVID-19 patients in Hamadan, the west of Iran. METHODS: This study considered 909 confirmed COVID-19 patients with positive real-time reverse-transcriptase polymerase-chain-reaction test which were hospitalized from 1 March to 31 January 2021 in Farshchian (Sina) hospital in Hamadan, Iran. A checklist was utilized to assess the relationship of demographic characteristics, clinical presentation, medical laboratory findings and the length of hospitalization to the direct hospitalization costs in two groups of patients (patients with hospitalization ≤ 9 days and > 9 days). Statistical analysis was performed using chi-square, median test and multivariable quantile regression model at 0.05 significance levels with Stata 14 software program. RESULTS: The median cost of hospitalization in patients was totally 134.48 dollars (Range: 19.19-2397.54) and respectively 95.87 (Range: 19.19-856.63) and 507.30 dollars (Range: 68.94-2397.54) in patients with hospitalization ≤ 9 days and > 9 days. The adjusted estimates presented that in patients with 9 or less hospitalization days history of cardiovascular disease, wheezing pulmonary lung, SPO2 lower than 90%, positive CRP, LDH higher than 942 U/L, NA lower than 136 mEq/L, lymphosite lower than 20% and patients with ICU experience had significantly positive relationship to the median of cost. Moreover, in patients with more than 9 hospitalization days, history of cardiovascular disease and ICU experience was statistically positive association and age older than 60 years and WBC lower than 4.5 mg/dL had statistically negative relationship to the median of hospitalization cost. CONCLUSION: As the length of hospital stay, which can be associated with the severity of the disease, increases, health systems become more vulnerable in terms of resource utilization, which in turn can challenge their responsiveness and readiness to meet the specialized treatment needs of individuals.