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Background and Objectives: COVID-19 pandemic caused a lot of severe problems in the world. This study investigated the epidemiology of the disease in Tehran in the first quarter of the epidemic's beginning. Method(s): The available information recorded for patients from 20 February 2020 to 20 May 2020 in Tehran was used. To prepare disease-related distribution maps, the addresses of patients' residences in Google Earth were called to ARC-GIS version 10-4. The methods used in GIS include IDW, Hotspot and also software development. Result(s): Overall, 3699 individuals whose PCR results were positive in Tehran were included in the study. Out of the total number of them, 550 people died and the fatality rate of the disease in hospitalized patients was 14.9%. One thousand five hundred thirty patients (41.4%) have recovered, and the remaining 1619 patients were under treatment until data collection. Of the total, 1479 confirmed cases were women (40%). The average age was 57.4 years (SD=16.5). The density of cases in areas 4, 8 and 13, and the existence of some cluster diseases in neighborhoods such as Tehran Pars, Ayat and Pirouzi streets are noteworthy points. Conclusion(s): The trend of the COVID-19 epidemic is dire and requires long-term measures. Nevertheless, to control this disease, the health system, the policy of isolating patients and suspicious people, wear masks especially in densely populated areas, are the most important controlling factors.Copyright © 2022 The Authors. Published by Tehran University of Medical Sciences.
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COVID-19 has been distinguished as a zoonotic coronavirus, like SARS coronavirus and MERS coronavirus. Tehran metropolis, as the capital of Iran, has a high density of residents that experienced a high incidence and mortality rates which daily increase the number of death and cases. In this study, the IDW (Inverse Distance Weight), Hotspots, and GWR (Geography Weighted Regression) Model are used as methods for analyzing big data COVID-19 in Tehran. The results showed that the majority of patients and deaths were men, but the death rate was higher in women than in men; also was observed a direct relationship between the area of the houses, and the infected rate, to COVID-19. Also, the results showed a disproportionate distribution of patients in Tehran, although in the eastern regions the number of infected people is higher than in other districts; the eastern areas have a high population density as well as residential land use, and there is a high relationship between population density in residential districts and administrative-commercial and the number of COVID-19 cases in all regions. The outputs of local R2 were interesting among patients and underlying disorders; the local R2 between hypertension and neurological diseases was 0.91 and 0.79, respectively, which was higher than other disorders. The highest rates of local R2 for diabetes and heart disease were 0.67 and 0.55, respectively. From this study, it can be concluded the restrictions must be considered especially, in areas densely populated for all people.
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Background: Job burnout is a prolonged response to chronic emotional and interpersonal stressorsObjectives: This study aimed to evaluate job burnout and identify its effective predictors among health sector employees during the COVID-19 pandemic.Methods: This cross-sectional study encompassed 1898 employees of the Shahid Beheshti University of Medical Sciences in the sum-mer of 2020. Logistic regression was used to determine factors associated with job burnout. The required data were collected elec-tronically using the Maslach Burnout Inventory (MBI) and analyzed with SPSS software version 26 and R4.0.2 software.Results: Of 1898 participants, 74.3% were female. Composite job burnout (CJB), emotional exhaustion (EE), and depersonalization (DP) were the most common at low levels, whereas reduced personal accomplishment (RPA) was the most frequent at moderate levels. In this regard, factors such as female gender, age groups of 40 -49 and >= 50 years, and exposure to COVID-19 were the main independent risk factors for job burnout.Conclusions: Reduced personal accomplishment was moderate despite relatively low levels of job burnout, EE, and DP. Accordingly, effective interventions are suggested to improve different aspects of the work-life with an emphasis on critical situations. Moreover, regarding the significant relationship between job burnout with gender, age, and exposure to COVID-19, it is recommended to in-crease the employees' knowledge about job burnout.
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Background: Limited medications are available for post-exposure prophylaxis of coronavirus disease 2019 (COVID-19) infection. Whether bromhexine can prevent or mitigate symptomatic infection after virus exposure is undetermined. Objective(s): We aimed to evaluate bromhexine's effect on preventing COVID-19 after close contact exposure. Method(s): A multi-center randomized, double-blind, placebo-controlled clinical trial was conducted on 372 adults (>= 18 years) who had close contact within four days with a household member with confirmed COVID-19. They were randomly assigned to receive bromhexine 8 mg (n = 187) or placebo (n = 185) three times a day for two weeks. The primary outcome was the incidence of symptomatic COVID-19. Secondary outcomes included hospitalization or death, confirmed COVID-19 by Polymerase Chain Reaction (PCR) in symptomatic patients, and adverse drug reactions. Result(s): The incidence of symptomatic COVID-19 was significantly lower in individuals who received bromhexine than in those who received the placebo (16 [8.6%] vs. 34 [18.4%], relative risk = 0.47, P = 0.005). PCR confirmation was reported in 13 (7.0%) and 26 (14.1%) individuals in the bromhexine and placebo groups, respectively (P = 0.025), with a relative risk reduction of 50%. The hospitalization rate, death, and medication side effects did not vary significantly between the bromhexine and placebo arms. Conclusion(s): Bromhexine is an effective, non-invasive, affordable agent with a low side-effect profile to prevent symptomatic COVID-19. Early use of bromhexine potentially provides another layer of protection;hence, it can play a role in controlling the pan-demic. Copyright © 2022, Author(s).
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Recent studies have indicated that fungal co-infections have a major impact on the morbidity and mortality of patients with COVID-19. In these patients, the excessive production of inflammatory cytokines and the reduction in CD4 + T and CD8 + T cell count entails susceptibility to fungal infections.1 In addition to impaired cell-mediated immunity, comorbidities and immunosuppressive medications have a significant role in the development of fungal infections and have serious impacts on clinical outcomes.1-3.
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The coronavirus 2019 disease (COVID-19) is an ongoing outbreak of respiratory disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade various tissues and organs, causing multiple organ dysfunctions. Critically ill COVID-19 patients may develop acute respiratory distress syndrome and pneumonia, which are the major causes of hypoxemic respiratory failure and death due to SARS-CoV-2 infection. Thus, ventilation support (invasive or noninvasive), has become a common practice in respiratory treatment of COVID-19 patients. Patients receiving mechanical ventilation usually require sedation to alleviate anxiety, pain and discomfort. On the other hand, current clinical reports have indicated that a significant number of COVID-19 patients require prolonged intensive care unit (ICU) care and ventilation, which increases the risk of delirium. Thus, selection of appropriate sedative medications during this period is of utmost importance. Dexmedetomidine (DEX) is a sedative, anxiolytic and analgesic agent that acts through the α2-adrenoceptor. Its sedative property is notable due to the lack of respiratory depression. In addition, its cytoprotective, immunoregulatory and anti-inflammatory properties have been well established in preclinical settings. Based on these features, a number of recent studies have proposed DEX as a beneficial sedative agent that simultaneously mitigates the excessive inflammation and protects vital body organs in patients with severe COVID-19. In current brief review, we aimed to discuss the therapeutic benefits of DEX in managing different indications of COVID-19. ©2021 The Author(s).
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Background: Coronavirus disease 2019 (COVID-19) has several chest computed tomography (CT) characteristics, which are important for the early management of this disease, because viral detection via RT-PCR can be time-consuming, resulting in a delayed pneumonia diagnosis. The Radiological Society of North America (RSNA) proposed a reporting language for CT findings related to COVID-19 and defined four CT categories: typical, indeterminate, atypical, and negative. Objectives: To retrospectively evaluate the chest CT characteristics of patients with COVID-19 pneumonia. Patients and Methods: A total of 115 hospitalized laboratory-verified COVID-19 cases, underdoing chest CT scan, were included in this study from April 30 to May 15, 2020. Of 115 cases, 53 were discharged from the hospital, and 62 expired. The initial clinical features and chest CT scans were assessed for the type, pattern, distribution, and frequency of lesions. Moreover, the findings were compared between ward-hospitalized, intensive care unit (ICU)-admitted, and non-surviving (expired) patients.
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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is the most important emerging pathogen since it was discovered in late 2019, infecting millions of people worldwide. The human body's defence against this new viral respiratory infection depends on the immune response of each person with a crucial impact on the appearance of clinical signs. Therefore, it is important to identify endogenous molecules with a fundamental role in severe pulmonary inflammation associated with SARS-CoV-2 infection. The impact of high mobility group proteins (HMGBs) in the pathogenesis of coronavirus disease 2019 (COVID-19) was recently proposed. There is also recent evidence that HMGBs, particularly HMGB1–2, play important roles in the replication of viral genomes. Moreover, HMGB1–4 proteins appear to be associated with inflammatory processes in the pathogenesis of many other viral diseases and disorders, including lung disease, ischemia-reperfusion-injury, sepsis, coagulopathy, trauma, neurological disorders, and cancer. This article presents the possible roles of HMGB1 in SARS-CoV-2 replication and its involvement in the pathogenesis of clinical severe pulmonary manifestations;these data can be useful in further virologic studies and the finding of new potential therapeutic targets in COVID-19.
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COVID-19 pandemic is a challenge in the current era. The spread of this viral infection began in Wuhan City in China, and Iran was also one of the countries struggling with it. Considering the nature of this virus and the current pandemic, it is essential that the healthcare system authorities issue a clear and firm law on treating people infected with COVID-19 to prevent the consequences affecting the professional life of physicians and healthcare staff. The current study aimed at evaluating the legal consequences of COVID-19 cases in emergency department (ED). This case series reported 10 patients that filed complaints against medical staff for problems that occurred on arrival, during the hospital stay or discharge in Shohada-ye-Tajrish and Shahid Modarres educational Hospitals, Tehran, Iran. Consultation with forensic medicine department was requested for all patients and the final decision for each case was reported under the title legal considerations.
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Background: The purpose of the current systematic review is to evaluate the efficacy of antiviral therapies in treatment of COVID-19. In addition, clinical trials on the efficacy of antiviral therapies in the management of Severe Acute Respiratory Syndrome coronavirus (SARS-Cov) or Middle East Respiratory Syndrome coronavirus (MERS-CoV) have also been reviewed, in order to identify potential treatment options for COVID-19. Method: An extensive search was performed in Medline, Embase, Scopus, Web of Science and CENTRAL databases until the end of March 15, 2020. Two independent researchers performed the screening, and finally the related studies were included.
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Introduction: Following the widespread pandemic of the novel coronavirus diseases (COVID-19), this study has reported demographic and laboratory findings and clinical outcomes of patients with COVID-19 admitted to a tertiary educational hospital in 99 days in Iran. Objective: We aimed to investigate in-hospital death risk factors including underlying diseases and describe the signs, symptoms, and demographic features of COVID-19 patients. Methods: All confirmed COVID-19 cases admitted from 22 February to 30 May 2020 were extracted from hospital records. A follow-up telephone survey was conducted 30 days after discharge to acquire additional data such as survival status. Distribution of demographic and clinical characteristics was presented based on survival status during hospitalization. All analyses were performed using STATA version 14 with a level of significance below 5%. Results: Among 1083 recorded patients, the rate of survival and death was 89.2% (n=966) and 10.8% (n=117), respectively. 62% of the cases (n=671) were male. The mean recovery time was 1.90 (3.4) days in survived cases, which was significantly lower than that in deceased cases 4.5 (5.2) days, p<0.001). A significantly higher rate of death was observed among patients above the age of 60 years (24.8%, p<0.001), cases with hypertension (25.4%, P<0.001) and cases without cough ( 17 %, p=0.002) but with shortness of breath (16.5%, p=0.001). Conclusions: Our study emphasized the significant effect of different underlying conditions as mortality factors among COVID-19 patients, namely older age spectrum, hypertension, and ischemic heart disease. By acknowledging the epidemiologic pattern and mortality factors, we have more tools to prioritize and make better judgments, and more lives can be saved.
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Introduction: Given the importance of evidence-based decision-making, this study aimed to evaluate epidemiological and clinical characteristics as well as associate factors of mortality among admitted COVID-19 cases. Methods: This multicenter, cross-sectional study was conducted on confirmed and suspected COVID-19 cases who were hospitalized in 19 public hospitals affiliated to Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran, between February 19 and May 12, 2020. Epidemiological and clinical characteristics of the infected cases were compared between the deceased and survivors after discharge. Case fatality rates (CFRs) were calculated across all study variables. Single and multiple logistic regressions were used to explore the risk factors associated with COIVD-19 mortality. Results: Out of the 16035 cases that referred to the hospitals affiliated to SBMU, 16016 patients (99.93% of Confirmed and 99.83% of suspected cases) were hospitalized. 1612 patients died with median hospitalization days of 5 (interquartile range (IQR): 2-9) and 3 (1-7) for confirmed and suspected COVID-19 cases, respectively. The highest death rate was observed among ages>65 (63.4% of confirmed cases, 62.3% of suspected cases) and intensive care unit (ICU)/critical care unit (CCU) patients (62.7% of confirmed cases, 52.2% of suspected cases). Total case fatality rate (CFR) was 10.05% (13.52% and 6.37% among confirmed and suspected cases, respectively). The highest total CFR was observed in patients with age>65 years (25.32%), underlying comorbidities (25.55%), and ICU/CCU patients (41.7%). The highest CFR was reported for patients who had diabetes and cardiovascular diseases (38.46%) as underlying non-communicable diseases (NCDs), and patients with cancer (35.79%). Conclusion: This study showed a high CFR among suspected and confirmed COVID-19 cases, and highlighted the main associated risk factors including age, sex, underlying NCDs, and ICU/CCU admission affecting survival of COVID-19 patients