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Background and Objective: At the beginning of the pandemic, Hydroxychloroquine (HCQ) was one of the most widely used drugs prescribed to patients admitted to hospitals with coronavirus disease 2019 (COVID-19). We try to find the effect of HCQ on the severity and mortality of patients who did not receive corticosteroids. Methods: In this retrospective study, patients with COVID-19 disease were collected from February 20, 2020, to July 21, 2020, at Rouhani Hospital in Babol. Patients were followed up until December 6, 2021. In this study, 170 patients in case and control groups were studied. We used logistic and COX regression models to explore the effects of drugs. Data were analyzed by SPSS version 22. Findings: The use of HCQ did not affect mortality (p=0.46, 95%CI= 0.63 to 2.71, OR= 1.31) and final severity (p= 0.75, 95%CI= 0.59 to 2.06, OR= 1.10) at admission time. However, azithromycin remained in the final model but did not have a significant effect (P= 0.08, HR= 0.28, 95%CI= 0.06 to 0.18). Heparin use was not associated with severity improvement (p= 0.06, 95%CI= 0.97 to 2.81, HR= 1.65), while ceftriaxone remained a factor affecting severity in the model (p = 0.03, 95% CI= 0.29 to 0.95, HR = 0.52). Conclusion: In this study, HCQ harmed mortality admission time and was ineffective in the long term. The use of ceftriaxone compared to other drugs showed protective effects against the mortality hospitalization time. Heparin is not recommended without considering the risk of bleeding in COVID-19 patients.
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Background & Aims: In early January 2020, a new corona virus called corona was identified as an infectious agent by the World Health Organization and caused a viral pneumonia outbreak, the first of which was reported in Wuhan, China in December 2019. The virus has so far infected most countries in the world and has become a global problem. By this time in December 2021, about 265 million people in the world have been infected with this virus and 5 million 270 thousand people have died from this disease. According to the World Health Organization, the incidence of this disease is still increasing and will become the third leading cause of death in the world by 2030. This disease has a special complexity and has multiple dimensions and consequences that have caused many problems in the field of health, social and economic as well as psychological for people. The emergence of this disease is now a public health crisis. According to this research, exposure to news and restrictions caused by this disease can lead to many mental health problems. In fact, one of the situations that puts a lot of stress on people during the outbreak of covid 19 disease is the inability to predict and uncertainty about the control and end of the disease. Mental health is defined as a harmonious and harmonious behavior with society, recognizing and accepting social realities, the power to adapt to them and meeting one's balanced needs and is an important factor for the health of society. The prevalence of the disease can also increase feelings of loneliness, decrease social support, feelings of fear and anxiety to clinical stress and anxiety, obsessive-compulsive disorder associated with the disease, and decreased life expectancy. One of the hopeful factors is health and the disease can cause despair, fear and even despair of the patient. The outbreak of a disease has a much deeper and wider impact and affects not only the affected community and relatives, but the entire community. Because everyone finds themselves at risk, and therefore people's feel of safe and healthy changes, and this situation causes people to despair. Hope is the capacity to imagine the ability to create paths to desirable goals and to imagine the motivation to move in those paths. Hope predicts physical and mental health such as positive response to medical interventions, mental health, effective getting along, and health-promoting behaviors. Covid 19 disease can also lead to psychological problems due to its infectious nature and unpredictable nature. In this regard, various researchers consider the implementation of public health policies, including areas related to individual and collective mental health in accordance with the different stages of the epidemic of this disease is very necessary. Mindfulness can be an effective tool for achieving peace of mind and body that helps people become aware of their current feelings. Mindfulness-based interventions are considered as one of the third generation or third wave cognitive-behavioral therapies. Mindfulness is a form of meditation rooted in Eastern religious teachings and rituals, especially Buddhism. Segal has defined mindfulness as paying attention to specific and purposeful ways, in the present time, without judgment or prejudice. Linhan stressed for the first time the need to pay attention to mindfulness as one of the essential components of psychological therapy. Mindfulness requires the development of three components: judgment avoidance, purposeful awareness, and focus on the present moment. Focusing on the present and processing all aspects of the above experience makes one aware of the daily activities and automatic functioning of the mind in the past and future world and he controls emotions, thoughts, and physical states through moment-to-moment awareness of thoughts. As a result, it is released from the everyday and automatic mind focused on the past and the future. Although general vaccination has reduced the virus in some countries, including Iran, and reduced the number of infected people, a large num
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Background: Morning reports were held virtual after the outbreak of the novel coronavirus (COVID-19) in the world and Iran. We used the Skyroom platform, which was not used previously. The novelty of this method caused us to evaluate the learners' opinions about the advantages and disadvantages of the virtual method compared to the classic face-to-face one.Methods: This was a descriptive-analytical cross-sectional study during 2021. The population included the interns and residents of Pediatrics. Their opinions were assessed through a questionnaire at Bahrami Children's Hospitals, Children's Medical Center, and Valiasr Hospitals in Tehran regarding the two methods of holding the morning report. The questionnaires were distributed and completed in a period of 6 months in 2021.Results: A total of one hundred and twelve interns and residents were included. According to them, the virtual method had a higher score in terms of increasing information technology skills and easier interpretation of the paraclinical results. The advantages of the virtual method were: no need for physical presence, availability, ease of use of the application, and time-saving as well as better prevention and protection of COVID-19. The only disadvantage of this method was the occasional low-quality of audio and video. Also, in the virtual method, there was less possibility of participating in the discussion. More than half of the participants wanted to hold face-to-face meetings with the possibility of virtual participation in future. Conclusion: Virtual training platforms have been able to eliminate some of the face-to-face training problems. Online morning reports can be a satisfactory complement to face-to-face ones.
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We assessed the blood levels of the most important factors such as cytokines/chemokines in Coronavirus disease-2019 (COVID-19). PubMed/Medline and Scopus as two important databases were searched up to March 26, 2020. To analyze the data, we used Review Manager 5.3 software. Out of forty-two records retrieved from two databases, 10 studies were involved in the analysis. Thirty-three cytokines/chemokines were checked. The levels of 27 cytokines/ chemokines in COVID-19 patients were higher than the healthy controls, and among 20 cytokines/chemokines;the levels of 10 cytokines/chemokines in severe COVID-19 patients were higher than non-severe COVID-19 patients. Also, out of three cytokines, one had a higher level in the intensive care unit (ICU) patients compared to the non-ICU patients. The findings showed the cytokine storm syndrome in COVID-19 patients, especially in patients with severe disease.
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Background & Objective:) Classroom management is the first level of educational management that affects the quality of education. In fact, classroom management plays a fundamental role in the formation of education structure, teaching process and personality development, and mental, emotional, educational, and training process of learners. The present study aimed to determine the effect of teachers' classroom management style on dental students' responsibility. Materials & Methods:) This was a descriptive and correlational study performed on dental students of Rafsanjan University of Medical Sciences following passing the basic sciences exam. The sample size was estimated at 97 (out of 132) using the Morgan table. In addition, data were collected using a framework by Wolfgang and Glickman (1986) and the Five-Factor Model by Costa & McCrae (1991). Furthermore, data analysis was performed in SPSS version 26 using descriptive statistics and a linear regression model. Results: In this study, the mean score of classroom management and responsibility variables was 4.0±11.36 (out of 5) and 3.83±1.22, respectively. Among the classroom management dimensions, the highest mean estimated was related to behavior management (4.1±29.01). According to the results, education management, individual management, and behavior management had a significant positive effect on dental students' responsibility. Overall, teachers' classroom management style predicted 55% of the responsibility of dental students. Conclusion: According to the results of the study, all three dimensions of education management, individual management, and behavior management had an impact on students' responsibility. In addition, the individual management dimension had the most effect on the responsibility of participants. Based on our findings, dental students will gain more responsibility during the training by benefiting from the guidance and support of teachers. © 2022, Zanjan University of Medical Sciences and Health Services. All rights reserved.
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BACKGROUND: Vascular injuries during inguinal hernia repair are rarely reported. Especially in children, we have little information about vascular management. CASE REPORT: In this article, we present a 6-year-old girl with right iliac vein ligation during inguinal hernia repair who was referred to our center and managed at the day of surgery. We recommended prior surgeon to order therapeutic heparin in dispatch time. The patient was treated with primary anastomosis of iliac vein and was admitted to pediatric intensive care unit (PICU). On the day following the operation, she had minimal dyspnea with low oxygen saturation and the investigations revealed pulmonary micro-embolization. Blood flow in lower extremity was normal and after a few days, she was discharged with good health and oral anticoagulation. CONCLUSION: Any unusual bleeding at the time of inguinal hernia repair should be considered as major vascular injury by the surgeon, and to prevent more injuries, minimum attempt must be performed to control the bleeding.
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Objective: We aim to investigate the prevalence, characteristics and outcomes of COVID-19 patients with neurological manifestations Background: To date, SARS-CoV2 has infected 213 million population worldwide. It is a multisystem disease affecting primarily the respiratory system, but neurological manifestations have been increasingly described in the literature. Design/Methods: Consecutive patients diagnosed with SARS-CoV2 admitted to 5 hospitals in Detroit Medical Center from March 3rd, 2020-May 1st, 2020 were included. Basic demographics and clinical manifestations were included. Relevant laboratory findings and neuroimaging were reported. Results: 413 patients were included in the study. Patients' demographics were as follows: mean age-66 years, 212 (51%) male, 346 (87%) African-American. 219(53%) patients had neurological symptoms at presentation, 32 patients presented purely with neurological symptoms. Other symptoms at onset include-respiratory 312(76%), constitutional 250(61%) and gastrointestinal 104(25%). 121(29%) patients were admitted to ICU, mean days from admission to ICU was 3.14 days. Incidence of neurological presentations were as follows: Encephalopathy 191(46.25%), myalgia 51(12.35%), headache 27 (6.54%), vertigo 20 (4.84%), hypogeusia 14 (3.39%), anosmia 12 (2.9%), stroke 13(3.14%), seizure 11 (2.9%). For patients with encephalopathy, median GCS at the onset of encephalopathy was 13 with IQR4. 94 (49.21%) of these patients were admitted to ICU;53(27.75%) were without coexisting toxic, metabolic or hypoxic factors contributing to encephalopathy. For patients with stroke, 12 patients presented with acute ischemic stroke, 2 with hemorrhagic conversion and 1 patient had cerebral venous sinus thrombosis. Characteristics of stroke were as follows: 8-multiple vascular territory, 11-cryptogenic etiology, 3-concurrent thromboembolic event. Median D-dimer was 5.76mg/LFEU(IQR3.74) and fibrinogen 550mg/dl(IQR 2.1). 2 patients received thrombolysis and 1 underwent thrombectomy. Mortality was 77%, Modified Rankin Scale (MRS)at baseline was 0-2 and all except 1 patient had MRS of 4-6 on discharge. Conclusions: Neurological manifestation is common amongst patients with SARS-CoV-2. Presence of encephalopathy or stroke confers an increased risk of mortality and morbidity.
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The novel coronavirus that swept the world into a pandemic in 2019 has affected many aspects of health care. COVID-19 has infected about 263 million people across the globe and led to the death of 5.2 million people. Its impact on various organs is still vague and requires further research. The increase in hospital visits and administrations has accordingly increased exposure and risk of obtaining the coronavirus. Patients previously hospitalized and being treated with immunosuppressants tend to be very susceptible to serious respiratory infections from the novel virus. Amongst the diseases that require hospitalization are ulcerative colitis and appendicitis. Hospitalization from such diseases inevitably increases the risk and exposure to COVID -19 infection. This study analyzed the management and procedures taken in patients with inflammatory bowel disease and appendicitis during the COVID-19 pandemic. Similarly, the effects of the pandemic on the pediatric ward and admitted children were also discussed and compared.
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Background: A novel Coronavirus first emerging in Wuhan, China, was named severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). The disease caused by SARS-CoV-2 is known as Coronavirus disease 2019 (COVID-19). HIV-1 infected individuals may be at risk of COVID-19. Objectives: This cross-sectional study evaluated the SARS-CoV-2 infection rate and COVID-19 prevalence among Iranian HIV-1-infected people. Methods: The study was conducted on 155 HIV-1-infected patients from June 2020 to October 2020. COVID-19 Ab (IgG) was detected using an enzyme immunoassay in serum specimens. Furthermore, nasopharyngeal and oropharyngeal specimens were collected. Then, the genomic RNA of SARS-CoV-2 was detected using a real-time polymerase chain reaction (RT-PCR). Clinical symptoms of the studied participants with and without COVID-19 were examined. Results: Of 155 HIV-1-infected individuals, 12 (7.7%) had positive real-time PCR results for SARS-CoV-2. Out of 12 (7.7%) patients with COVID-19, four (33.3%) were males. Anti-COVID Ab (IgG) was detected in 10 (6.5%) participants, of whom eight (80.0%) were males. The most common COVID-19 clinical symptoms, including dry cough, fever, runny nose, anosmia, and hypogeusia, were observed in seven (58.3%), five (41.7%), five (41.7%), five (41.7%), and five (41.7%) patients with COVID-19, respectively. Conclusions: A recent study has shown that the risk of SARS-CoV-2 infection in HIV-infected individuals is similar to that in the general population.
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Background: At the end of 2019, the world faced a phenomenon that plunged all human beings into extreme fear and anxiety. A new type of coronavirus began to spread among people around the world, and this was the beginning of one of the greatest pandemics and its problems in the world. Objectives: The present study aimed to study the effect of Emotion-Focused Therapy (EFT) on reducing post-traumatic stress and depression among Covid-19 patients. The statistical population was all English language students at the University of Tehran who had recovered from Covid-19. A total of three students (with a mean age of 22..2 years old) were selected from those who had recovered from Covid-19 using convenience sampling.
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Objective: We aim to investigate the prevalence, characteristics and outcomes of COVID-19 patients with encephalopathy. Other neurological manifestations of COVID-19 were described. Background: SARS-CoV-2 has rapidly spread worldwide and has now affected more than 30 million people. Although respiratory symptoms are the primary clinical manifestations of COVID-19, neurological manifestations of COVID-19 are increasingly recognized. Encephalopathy is reported as a common neurological presentation of COVID-19. The characteristics of patients with COVID-19 associated encephalopathy, including potential confounding toxic/metabolic/hypoxic factors has not been explored. Design/Methods: We retrospectively reviewed all patients consulted to the neurology service at the Detroit Medical Centre, from March 3 , 2020 to May 1 2020 who were tested positive for SARS-COV2. Clinical and laboratory data were recorded. Characteristics of encephalopathic COVID-19 patients with or without confounders were compared. Statistical analysis was performed using SPSS. Results: 49 patients were included, 40 patients (81.6%) had encephalopathy, of whom 21 patients (52.5%) had no confounders. Most common confounders were hypoxia and uremia. Patients with confounders were more likely to have dementia at baseline (p=0.049), significantly elevated inflammatory markers-C-reactive protein (P=0.02), white blood cell count(p=0.019), Ddimer(p=0.015). They were also less likely to be discharged home (p=0.009). Overall mortality is high in patient with encephalopathy (65%). 5 patients had embolic strokes, 5 had new onset seizures and 2 patients had pleocytosis on cerebrospinal fluid examination. Conclusions: We found a high prevalence of COVID-19 associated encephalopathy, independent of confounders. COVID-19 associated encephalopathy can be attributed to stroke, seizure, meningoencephalitis or idiopathic. This early report is part of an ongoing study with a larger cohort of all COVID-19 patients that continue to be admitted to our center to investigate underlying etiological mechanisms of encephalopathy, including long-term follow up of these patients.
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Introduction: New coronavirus or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged in Wuhan, China at the end of 2019. There is not enough data for managing acute myeloid leukemia patients with concomitant infection with SARS-COV-2. This is a report of a unique case with acute leukemia and SARS-CoV-2 infection that recovered from both. Case Presentation: a 44-year man was admitted with fever and sweating. He was treated with broad-spectrum antibiotics. Pan-cytopenia was detected and a bone marrow biopsy revealed acute leukemia. During his management, the patient developed a dry cough. He was transferred to our center for chemotherapy. Chest CT scan revealed bilateral peripheral patchy ground-glass infiltra-tions, indicating SARS-CoV-2 infection. Two weeks later, after antiviral and broad-spectrum antibiotic therapy, he developed severe dyspnea and became bedridden. Modified chemotherapy was started. He was rapidly recovered and developed complete remission. Conclusions: Immune system response to SARS-CoV-2 is under investigation. Cytokine storm was postulated for acute respiratory distress syndrome in these patients. Severe dyspnea in our patient may be due to cytokine storms and some degrees of leukostasis. We presented a successful chemotherapy of an acute leukemia patient that was simultaneously infected with COVID-19.
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In order to control highly-contagious and prolonged outbreaks, public health authorities intervene to institute social distancing, lock-down policies, and other Non-Pharmaceutical Interventions (NPIs). Given the high social, educational, psychological, and economic costs of NPIs, authorities tune them, alternatively tightening up or relaxing rules, with the result that, in effect, a relatively flat infection rate results. For example, during the summer in parts of the United States, daily COVID-19 infection numbers dropped to a plateau. This paper approaches NPI tuning as a control-theoretic problem, starting from a simple dynamic model for social distancing based on the classical SIR epidemics model. Using a singular-perturbation approach, the plateau becomes a Quasi-Steady-State (QSS) of a reduced two-dimensional SIR model regulated by adaptive dynamic feedback. It is shown that the QSS can be assigned and it is globally asymptotically stable. Interestingly, the dynamic model for social distancing can be interpreted as a nonlinear integral controller. Problems of data fitting and parameter identifiability are also studied for this model. The paper also discusses how this simple model allows for a meaningful study of the effect of population size, vaccinations, and the emergence of second waves. IEEE
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) uses the angiotensin-converting enzyme 2 (ACE2) receptor of SARS-CoV for cell entry. We aimed to check the association between ACE2 and COVID-19 (coronavirus disease 2019) in a systematic review. Two databases (PubMed/Medline and Scopus) and bioRxiv were checked for retrieving all types of studies in relation to ACE2 and COVID-19 until March 18, 2020. Forty-one studies were entered to the systematic review. These studies included nineteen original, eight reviews, four letters to the editor, three research papers, one correspondence, one commentary, one mini review, two reports, one opinion, and one perspective. In summary, the results showed that the ACE2 receptor for COVID-19 is similar to that of SARS-CoV. However, its expression was different in various populations as well as in the two genders. ACE2 may be used as a therapeutic target. Patients who take ACE inhibitors may have benefit in severe disease outcomes. Finally, pangolins and snakes and turtles may act as the potential intermediate hosts transmitting disease to humans. © 2020 Houshang Nemati, Mazaher Ramezani, Farid Najafi, Babak Sayad, Mehri Nazeri, Masoud Sadeghi.