ABSTRACT
Background: Although many aspects of the COVID-19 disease have not yet been clarified, dysregulation of the immune system may play a crucial role in the progression of the disease. In this study, the lymphocyte subsets were evaluated in patients with different severities of COVID-19. Material(s) and Method(s): In this prospective study, the frequencies of peripheral lymphocyte subsets (CD3+, CD4+, and CD8+ T cells;CD19+ and CD20+ B cells;CD16+/CD56+ NK cells, and CD4+/CD25+/FOXP3+ regulatory T cells) were evaluated in 67 patients with confirmed COVID-19 on the first day of their admission. Result(s): The mean age of patients was 51.3 +/- 14.8 years. Thirty-two patients (47.8%) were classified as severe cases, and 11 (16.4%) were categorized as critical. The frequencies of blood lymphocytes, CD3+ cells, CD25+FOXP3+ T cells, and absolute count of CD3+ T cells, CD25+FOXP3+ T cells, CD4+ T cells, CD8+ T cells, and CD16+56+ lymphocytes were lower in more severe cases compared to the milder patients. The percentages of lymphocytes, T cells, and NK cells were significantly lower in the deceased patients. (p= 0.002 and p= 0.042, p=0.006, respectively). Conclusion(s): Findings of this cohort study demonstrated that the frequencies of CD4+, CD8+, CD25+FOXP3+ T cells, and NK cells differed in the severe cases of COVID-19. Moreover, lower frequency of T cells and NK cells could be predictors of mortality in these patients.Copyright © 2022, Shaheed Beheshti University of Medical Sciences and Health Services. All rights reserved.
ABSTRACT
Background and Aim: The COVID-19 disease is an emerging infectious disease that appeared in December 2019 in Wuhan, China. An uncontrolled systemic inflammatory response is one of the primary mechanisms causing death in this disease. In this study, the expression levels of some inflammatory cytokines, vitamin D, and some hematological and biochemical parameters were compared in patients with severe COVID-19 and mild types. Materials and Methods: In this cross-sectional study, 60 blood samples were taken from 30 severe coronavirus patients and 30 mild coronavirus patients. The expression levels of cytokines such as IL (interleukin)-6, interferon (IFN)-α, IL-12, transforming growth factor (TGF) β, IL-8 and tumor necrosis factor (TNF)-α were evaluated using Real-time PCR. A T-test was used for Statistical Analysis. Results: IL-6, IFN-α, IL-12, TGF-β, IL-8, and TNF-α cytokines in the peripheral blood of severe patients, were positive in 28/30 (93.33%), 27/30 (90%), 24/30 (80%), 25/30 (83.33%), 26/30 (86.66%), and 27/30 (90%) respectively. The positive rate of these cytokines in the mild patients were 20/30 (66.67%), 21/30 (70%), 18/30 (60%), 17/30 (56.67%), 19/30 (63.33%), 18/30 (60%), respectively. There was a statistically significant difference between these two groups in terms of cytokines biomarkers. A significant difference was found between both groups in terms of the serum level of lactate dehydrogenase (LDH), the mean number of lymphocytes and neutrophils as well as the mean percentage of neutrophils/ lymphocytes ratio (NLR). Conclusion: The expression of cytokine genes and their release into the peripheral blood was increased in both severe and mild patients with COVID-19. However, they were more intense in patients with severe symptoms than those with mild symptoms and can cause inflammatory and even destructive reactions. Vitamin D deficiency plays no role in causing severe COVID-19 in patients without risk factors. Severe COVID-19 is characterized by elevated serum levels of LDH and NLR≥3.45. © 2022. This is an original open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation.
ABSTRACT
Background: The Coronavirus Disease 2019 (COVID-19) pandemic has caused a severe shock to the world economy and, consequently, healthcare systems. Objectives: The current study aimed to investigate changes in costs and revenues of an Iranian hospital before and after the COVID-19 pandemic to answer the following question: "How can hospital costs and revenues change during the COVID-19 pandemic?" Methods: This descriptive cross-sectional study was conducted retrospectively at the Masih Daneshvari Hospital in 2020. Accounting software available at the hospital (Azarakhsh for salary costs and PMQ for medical equipment costs) was used to collect cost information. Also, the hospital information system software was used to collect revenue information. The 2019 financial year was considered the base year, and the period February-August 2020 was considered the COVID-19 outbreak period. The data were entered into Excel software and analyzed using descrip-tive statistics methods. Results: Before the COVID-19 outbreak, the Masih Daneshvari Hospital was facing many cost problems, and the new crisis added to the severity of the problems. In total, the hospital's revenue declined by 9%, and its costs increased by 70%. Therefore, in the fiscal year ending in March 2020, the hospital balance was reported to be $-607,143 (-68,000 million Iranian Rial). Conclusions: The soaring healthcare expenditures revealed that the hospital was not ready to deal with the disease. As the COVID-19 outbreak grows rapidly in Iran, there is a pressing need to increase medical capacities and inpatient beds to treat infected patients. Hospitals in the country face financial problems and should be supported by the Ministry of Health and Medical Education.
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Background: Telemedicine is considered an innovative approach for management and follow up of communicable diseases, when person to person contact has the risk of disease dissemination, such as the situation being experienced with corona virus infection. The aim of this study was to evaluate the role of telemedicine in patient follow-up and patient compliance in different communication methods. Materials and Methods: All patients discharged from a referral pulmonary hospital dedicated to coronavirus infected patients were given instructions on follow-up of symptoms. One group received messages via short message system regarding the severity of their symptoms. For the other group a mobile application was specially designed for tracking their well-being on a daily basis. Severity of symptoms and course of disease were monitored in each group for a two-month period. Results: A total 1091 patients with mean age of 53.96± 17.95 years were enrolled in the study. In the first group 406 (60.14%) messages were successfully sent, from which 150 (36.94%) patients replied. Also, 243(35%) patients contacted us by making phone calls. Of the total patients in the second group, 153(64%) patients started using the mobile application. Chief complaint of patients was mainly cough, shortness of breath, fatigue, and myalgia. Deep vein thrombosis, hyperglycemia, post kidney transplant patient and bloody diarrhea were among the reported cases. Conclusion: Patient follow-up during epidemics, especially when the disease course is unknown, is an important step in both successful patient management and disease control. This study showed the role of telemedicine for patient follow-up, mostly in detecting special situations. But, in order to be successful patient education and active follow-up are important factors that must be considered. © 2020 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.
ABSTRACT
Background: Coronavirus has become a global concern in 2019-20. The virus belongs to the coronavirus family, which has been able to infect many patients and victims around the world. The virus originated in the Chinese city of Wuhan, which eventually spread around the world and became a pandemic. Materials and Methods: A total of 60 Patients with severe (n=30) and mild (n=30) symptoms of COIVD-19 were included in this study. Peripheral blood samples were collected from the patients. Real-time PCR was used to compare the relative expression levels of Procalcitonin and dipeptidyl peptidase IV (DPPIV) in a patient with severe and mild Covid-19 infection. Results: Procalcitonin and dipeptidyl peptidase IV markers in the peripheral blood of patients with severe symptoms, were positive in 29 (96.60%) and 26 (86.60%), respectively (n=30);however, positive rates in the mild symptoms patients group were 27 (90%) and 25 (83.30%), respectively. There was a statistically significant difference between these two groups in terms of DDPIV and Procalcitonin (p<0.001). Conclusion: Procalcitonin and DPPIV increase in patients with COVID-19 infection, significantly higher in the patients with more severe clinical symptoms than those with milder ones. More studies will be needed to verify the reliability of the current findings.
ABSTRACT
Background and aims: Over the past year, millions of people around the world have infected with the COVID-19 virus. The SARS-CoV-2 replicates efficiently in the human upper respiratory tract. Infected people produce large amounts of the virus in their upper respiratory tract during an introductory period, which leads to more spread of the virus to other people. The World Health Organization (WHO) has suggested that acute respiratory syndrome SARS-CoV-2 is transmitted through person-to-person transmission and contact with contaminated surfaces. However, the rapid spread of the disease suggests that other routes, such as airborne transmission, may play a role. Several research studies have been performed to evaluate the possible transmission of the virus through the air. Although some studies have found no evidence of airborne transmission, recent work has confirmed the presence of SARS-CoV-2 even in public places. Experience and knowledge of the mechanism of similar viruses such as SARS-CoV also support this hypothesis. During COVID-19 pandemic, while the hospitals can be one of the most important centers in providing health care services, due to the inappropriate air ventilation and purification system, high traffic of people;some of them have been introduced themselves as one of the most high-risk sources of SARS-CoV-2 transmission. The present study aimed to assess the SARS-CoV-2 in the air and surfaces of ICU ward in one of the designated hospitals in Tehran. So that, in addition to determining the possibility of inhalation and contact exposure in ICU, which is the main ward for presenting special medical care to patients with severe acute respiratory infections, it aimed to assess a hypothesis of SARS-CoV-2 airborne transmission. Methods: This cross-sectional experimental study was performed on April 29, 2020 in the Covid-19 ICU ward in one of the designated hospitals, Tehran, Iran. The area of ward was 50 m2 and has seven beds, all of which were occupied at the time of sampling, and five medical staff were involving there. All patients were equipped with oxygen masks and all the staff used all conventional personal protective equipment such as Honeywell-75FFP100NL respirators. On average, surface disinfection was performed three times a day. The general ventilation system included the ceiling diffuser to supply fresh air into the room and wall-mounted exhaust vent and did not use natural ventilation (such as opening the window). It should be noted that the exhaust system did not work well at the time of sampling. This study was carried out in two phases including surface and air sampling. Impinger method was applied to air sampling. Thus, at a distance of 1.5 to 1.8 meters from the ground, the air of the ICU ward was passed through a sampling pump with an flow rate of 1.5 l/min into the porous midget impeller-30 ml containing 15 ml of virus transmission medium (PVTM) for 45 minutes. To reverse the presence of SARS-CoV-2 in air samples, the reverse polymerase chain reaction (RT-PCR) reaction method was used. Sampling of surfaces was done with the help of swabs impregnated with the solution of the Viral Transport Medium from a certain area (25 cm2) from the desired part and putting it inside the vial containing the transfer medium (protein stabilizer, antibiotic and buffer solution). They are also were analyzed by RT-PCR technique. Prior to sampling, all laboratory equipment used was sterilized and autoclaved using a 70% alcohol solution according to the US Centers for Disease Control and Prevention (CDC) protocol. The air sampling was done at a distance of 1.5 to 2 meters from the patient's bed. The devices used to measure temperature, humidity and air velocity were multi-purpose anemometer (China BENETE, GM8910,) and air pressure, digital barometer (AIRFLOW, DB2, USA). The mean parameters of weather conditions included: air temperature 24 ° C, humidity 35%, air pressure 1005 mb and air velocity of 0.09 m / s. Results: Of the ten air samples, 6 were positive (60%), with the highest RNA concentrations observed at the point between beds 6 and 7 (3913 copies per ml). Most of the reported negative air samples were from the middle of the ward, which was further away from the patients' beds. The mean RNA concentration of the virus was obtained 820 ± 2601 copies per milliliter. In addition, of ten samples taken from different surfaces of the ward, 4 samples were positive (40%) and the highest concentration (8318 copies per ml) was related to the table next to bed number 3. All positive samples were observed close to the patient's bed, and the mean RNA concentration of the virus was 3227 ± 3674 copies per milliliter. Conclusion: The results of the study indicated that the virus was present in the inhaled air of the ward and its surfaces, especially in areas close to the bed of patients. These findings underscore the airborne transmission of the virus along with other ways of transmission, such as person-to-person contact and contact with contaminated surfaces. Due to the environmental pollution of the studied ICU ward to the SARS-CoV-2 virus, the effective implementation of air isolation methods such as the use of respiratory protection equipment (N95 mask) and powered air-purifying respirator as well as ensuring the correct function of hospital ventilation systems and improving it, is essential for the protection of health care staff. Health care workers need to be continuously monitored and screened from a COVID-19 perspective, and infection prevention and control protocols (IPCs), such as respiratory protection, regular cleaning of the environment, and effective disinfection of areas have been implemented. In the case of the virus, the spread of the disease through both direct methods (drops and person-to-person) as well as indirect contact (contaminated objects and airborne transmission) has almost been proven, which reaffirms the need for precautionary measures regarding airborne isolation against the virus. It has been suggested that in order to more accurately assess the transmission behavior of the virus, similar studies but longitudinal ones have been done from the admission to discharge of the patients in different wards of the hospitals. Moreover, the role of natural and mechanical ventilation systems more comprehensively examined in the presence of airborne virus. © 2020 Iran University of Medical Sciences. All rights reserved.
ABSTRACT
BACKGROUND: A big difficulty in today's world, the Coronavirus has affected all industries and man's life. The disease is caused by a type of the Coronavirus known as COVID-19. A living activated complex, the body is capable of offering various reactions from the defense system against the virus. It should be noted that the most important reaction of the body to the virus involves an activation of the cytotoxic T-shaped cells, which can destroy infected cells as a result of their activity. A more accurate recognition of the cytokine storm mechanism in this disease can greatly contribute to its treatment. In the present study, we investigated the use of IL-10, IL-6, IL-2, and TNF-alpha cytokines in patients with severe conditions at the Intensive Care Unit, and compared that to the real-time PCR method used to relieve the disease in patients. METHODS: We analyzed 30 blood samples from patients with severe conditions and 30 from cured ones using relative real-time RT-PCR, the results of which were subject to statistical analysis using SPSS 20. Moreover, groups of the same age were compared using the t-test. RESULTS: The results showed that age in groups with severe symptoms that were hospitalized in the ICU and people recovering from the disease did not have a significant effect. There was an increase in the expression of IL-10, IL-6, IL-2, and TNF-alpha cytokine genes in the peripheral blood of patients admitted to the ICU compared with those with recovered disease, and there was a significant difference (P value <0.001). CONCLUSIONS: The numerical value of fold change for the cytokine genes of IL-10, IL-6, IL-2, and TNF-alpha in patients admitted to the ICU, compared to recovered patients are 1.28, 1.12, 1.30, 1.22 respectively.
ABSTRACT
The present study aimed to assess the SARS-CoV-2 in the air and surfaces of ICU ward in one of the designated hospitals in Tehran;so that in addition to determining the possibility of inhalation and contact exposure in ICU, which is the main ward for presenting special medical care to patients with severe acute respiratory infections, it aimed to assess a hypothesis of SARS-CoV-2 airborne transmission. This cross-sectional experimental study was performed on April 29, 2020 in the Covid-19 ICU ward in one of the designated hospitals, Tehran, Iran. The area of ward was 50 m2 and has seven beds, all of which were occupied at the time of sampling, and five medical staff were involving there. All patients were equipped with oxygen masks and all the staff used all conventional personal protective equipment such as Honeywell-75FFP100NL respirators. On average, surface disinfection was performed three times a day. The general ventilation system included the ceiling diffuser to supply fresh air into the room and wall-mounted exhaust vent and did not use natural ventilation (such as opening the window). It should be noted that the exhaust system didnchr(chr('39')39chr('39'))t work well at the time of sampling. This study was carried out in two phases including surface and air sampling. Impinger method was applied to air sampling. Thus, at a distance of 1.5 to 1.8 meters from the ground, the air of the ICU ward was passed through a sampling pump with an flow rate of 1.5 l/min into the porous midget impeller-30 ml containing 15 ml of virus transmission medium (PVTM) for 45 minutes. To reverse the presence of SARS-CoV-2 in air samples, the reverse polymerase chain reaction (RT-PCR) reaction method was used. Sampling of surfaces was done with the help of swabs impregnated with the solution of the Viral Transport Medium from a certain area (25 cm2) from the desired part and putting it inside the vial containing the transfer medium (protein stabilizer, antibiotic and buffer solution). They are also were analyzed by RT-PCR technique. Prior to sampling, all laboratory equipment used was sterilized and autoclaved using a 70% alcohol solution according to the US Centers for Disease Control and Prevention (CDC) protocol.
ABSTRACT
The gap in knowledge about the cause, modes of transmission, treatment, and high mortality has increased speculation about COVID-19, further confusing health policymakers and therapists. In addition to the unknown nature of the disease, issues such as high virus transmission rate and lack of facilities such as hospital beds, physician-nurse-to-bed ratio, equipment and care facilities such as personal protective equipment and ventilators, and high elderly populations have posed major challenges for health systems and policymakers. Proper crisis response strategies, including emerging diseases, have a significant impact on hospital readiness and success. In this regard, the Ministry of Health of Iran immediately announced several hospitals in Tehran and other cities as referral hospitals for the admission of COVID-19 patients. One of these hospitals is Masih Daneshvari Tuberculosis and Pulmonary Diseases Hospital in Tehran, which immediately held an emergency meeting. It was announced that the hospital will enter a phase of full preparation for the reception of COVID-19 patients from now. In the first step, all wards of the hospital were evacuated and 301 beds were considered for the admission of suspected patients with COVID-19. Since the characteristics and severity of this disease are unknown and the methods of dealing with it have not been experienced so far, so how to prepare the hospital to deal with it is one of the main challenges. The purpose of this brief report is to provide the experience of Masih Daneshvari Hospital on how to manage, prepare and deal with the epidemic of the COVID-19. © 2020 Baqiyatallah University of Medical Sciences. All rights reserved.