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Background: The COVID-19 pandemic has proven to be a major threat to public health in the present century. In this situation, adherence to preventive behaviors seriously impacts the prevention of viral diseases. The present study aims to investigate adherence to public health preventive instructions in patients infected with COVID-19 before contracting the disease. Methods: This cross-sectional study was carried out from November 2020 to March 2021 in Fars province. 3242 patients infected with COVID-19 were selected via multistage sampling. Data were collected using a demographic information form and a researcher-made questionnaire. The collected data were analyzed by Stata v. 14 using the chi-square test. P<0.05 was considered statistically significant. Results: The average age of participants was 38.45±13.07 years. 48.80% had a high rate, 47.90% had a moderate rate, and only 3.30% had a low compliance rate with COVID-19 preventive instructions. The patients' main reason for not following preventive behaviors was having to be present in busy places (41.1%). There was a significant correlation between the participants' age, gender, place of residence, occupation, education, history of underlying diseases (P≤0.001), marital status (P=0.041), and use of masks with a rate of adherence to preventive behaviors(P≤0.001). In the random forest, the job represents 36.75% compliance with COVID-19 preventive guidelines. Conclusion: Therefore, by raising public awareness, healthcare policymakers and administrators can enhance the public's observance of the COVID-19 prevention instructions and consequently control the spread of the infection and improve public health during the current crisis caused by the pandemic. © 2022 by the Author(s).
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Purpose: Coronavirus disease-2019 (COVID-19) is becoming a crucial health problem worldwide. Continued and high-speed mutations of this virus result in the appearance of new manifestations, making the control of this disease difficult. It has been shown that well-nourished patients have strong immune systems who mostly have short-term hospitalization compared to others. The purpose of this study is to review the major nutrients involved in the immune system reinforcement and to explain nutritional aspects during the recovery of COVID-19. Design/methodology/approach: In this review paper, the mechanistic role of nutrients in boosting the immune system and the nutritional aspects during the recovery of COVID-19 patients were discussed. Papers indexed in scientific databases were searched using antioxidants, COVID-19, inflammation, immune system, macronutrient, micronutrient and probiotic as keywords from 2000 to 2022. Findings: Because of the adverse effects of drugs like thrombosis, pulmonary embolism and hypercholesterolemia, a balanced diet with enough concentrations of energy and macronutrients could increase the patient's durability. The inflammatory cytokines in a vicious cycle delay patients’ rehabilitation. The main mechanistic roles of micronutrients are attributed to the downregulation of virus replication and are involved in energy homeostasis. Dysbiosis is defined as another disturbance among COVID-19 patients, and supplementation with beneficial strains of probiotics helps to exert anti-inflammatory effects in this regard. Being on a well-planned diet with anti-inflammatory properties could reverse cytokine storms as the major feature of COVID-19. Future studies are needed to determine the safe and effective dose of dietary factors to control the COVID-19 patients. Originality/value: Being on a well-planned diet with anti-inflammatory properties could reverse cytokine storms as the major feature of COVID-19. Future studies are needed to determine the safe and effective dose of dietary factors to control the COVID-19 patients. © 2022, Emerald Publishing Limited.
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High incidence of thromboembolic diseases in patients with coronavirus disease 2019 (COVID-19) have been reported that can affect several organs ranging from cutaneous thrombosis to pulmonary embolism, stroke, coronary thrombosis or kidney infarction. There are two proposed mechanisms for these phenomena, disseminated intravascular coagulation (DIC) and endotheliopathy. We report a case of 11-year-old girl presented to the emergency department with generalized tonic colonic seizure with upward gaze which was repeated in emergency room. Respiratory distress and loss of consciousness happened which led to her intubation. Due to increased serum creatinine levels and impaired consciousness which was associated with thrombocytopenia and hemolysis, she underwent plasmapheresis three times by the diagnosis of hemolytic uremic syndrome. Additionally, antihypertensive therapy was conducted. The patient's condition improved and was discharged with good circumstances. Two weeks later the patient returned with thromboembolism that happened in the distal part of her left hand which underwent fasciotomy and thrombectomy.
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The severity of COVID-19 disease and its mortality may be due to a localized vascular problem owing to the activation of bradykinin B1 receptors on endothelial cells in the lungs that occur following inflammation. Bromelain acts as an anti-inflammatory factor and can lower the level of bradykinin in the serum and tissues. Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari Hospital in Tehran were included in the study after providing full explanations and obtaining written consent. The 40 patients with mild to moderate symptoms were randomly divided into the control group (No: 20) and sample (No: 20). In the sample group, a dose of 200 mg bromelain was given to patients every 8 hours. In the control group, placebo capsules were administered exactly at the above intervals. Clinical and paraclinical factors (including SaO2, RR body temperature, MAP, HR, CRP, ESR, AST, ALT, Bil, BUN, Cr, WBC, Lymph, LDH, Plt were evaluated on a regular basis for up to five days. The results were evaluated using t-test and SPSS21 software. After treatment, the sample (Bromelain) group indicated significant improvement in SaO2, RR, HR, AST, ALT, BUN, ESR, LDH, and WBC and Lymphocyte count (P<0.05). Other factors did not have a significant difference with the control group. Bromelain causes improvement in some clinical symptoms such as respiratory parameters and para clinical items of mild to moderate hospitalized COVID-19 patients, so it can be a promising treatment. Furthered evaluation of larger groups is recommended.
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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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Introduction: Direct and indirect sequels of COVID-19 in the cardiovascular system are unclear. The present study aims to investigate the echocardiography findings in COVID-19 patients and possible correlations between the findings and the disease outcome. Methods: In this cross-sectional study, baseline characteristics and echocardiographic findings of hospitalized COVID-19 cases, and their correlationwith mortalitywere evaluated.Furthermore, computed tomography (CT) angiography was performed to assess possible pulmonary embolism.In-hospital mortality was considered as the main outcome of the present study. Results: 680 confirmed COVID-19 cases with the mean age of 55.15 ± 10.92 (range: 28 – 79) years were studied (63.09% male). Analysis showed that history of ischemic heart disease (RR=1.14;95% CI: 1.08-1.19), history of hypertension (RR=1.04;95% CI:1.00-1.08), presence of embolism inmain pulmonary artery (RR=1.53;95% CI: 1.35-1.74), CT involvement more than 70%(RR=1.08;95%CI: 1.1.01-1.16), left ventricular ejection fraction < 30 (RR=1.19;95%CI: 1.07-1.32), pleuraleffusion (RR=1.08;95% CI: 1.00-1.16), pulmonary artery systolic blood pressure 35 to 50 mmHg (RR=1.11;95% CI: 1.03-1.18), right ventricular dysfunction (RR=1.54;95% CI: 1.40-1.08), and collapsed inferior vena-cava (RR=1.05;95% CI: 1.01-1.08) were independent prognostic factors of in-hospital mortality. Conclusion: Our study showed that cardiac involvement is a prevalent complication in COVID-19 patients. Echocardiography findings have independent prognostic value for prediction of in-hospital mortality. Since echocardiography is an easy and accessible method, echocardiographymonitoring of COVID-19 patients can be used as a screening tool for identification of high-risk patients
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Introduction: Being infected with COVID-19 is associated with direct and indirect effects on the cardiopulmonary system and electrocardiography can aid in management of patients through rapid and early identification of these adversities. Objective: The present study was designed aiming to evaluate electrocardiographic changes and their correlation with the outcome of COVID-19 patients. Methods: This Prospective cohort study was carried out on COVID-19 cases admitted to the emergency department of an educational hospital, during late February and March 2020. Electrocardiographic characteristics of patients and their association with in-hospital mortality were investigated. Results: One hundred and nineteen cases with the mean age of 60.52±13.45 (range: 29-89) years were studied (65.5% male). Dysrhythmia was detected in 22 (18.4%) cases. T-wave inversion (28.6%), pulmonale P-wave (19.3%), left axis deviation (19.3%), and ST-segment depression (16.8%) were among the most frequently detected electrocardiographic abnormalities, respectively. Twelve (10.1%) cases died. There was a significant correlation between in-hospital mortality and history of diabetes mellitus (p=0.007), quick SOFA score > 2 (p<0.0001), premature ventricular contraction (PVC) (p=0.003), left axis deviation (LAD) (p=0.039), pulmonale P-wave (p<0.001), biphasic P-wave (p<0.001), inverted T-wave (p=0.002), ST-depression (p=0.027), and atrioventricular (AV) node block (p=0.002). Multivariate cox regression showed that history of diabetes mellitus, and presence of PVC and pulmonale P-wave were independent prognostic factors of mortality. Conclusions: Based on the findings of the present study, 18.4% of COVID-19 patients had presented with some kind of dysrhythmia and in addition to history of diabetes, presence of PVC and pulmonale P-wave were among the independent prognostic factors of mortality in COVID-19 patients. © 2021 Tehran University of Medical Sciences.
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Introduction: Direct and indirect sequels of COVID-19 in the cardiovascular system are unclear. The present study aims to investigate the echocardiography findings in COVID-19 patients and possible correlations between the findings and the disease outcome. Methods: In this cross-sectional study, baseline characteristics and echocardiographic findings of hospitalized COVID-19 cases, and their correlation with mortality were evaluated. Furthermore, computed tomography (CT) angiography was performed to assess possible pulmonary embolism. In-hospital mortality was considered as the main outcome of the present study. Results: 680 confirmed COVID-19 cases with the mean age of 55.15 +/- 10.92 (range: 28 - 79) years were studied (63.09% male). Analysis showed that history of ischemic heart disease (RR=1.14;95% CI: 1.08-1.19), history of hypertension (RR=1.04;95% CI: 1.00-1.08), presence of embolism in main pulmonary artery (RR=1.53;95% CI: 1.35-1.74), CT involvement more than 70% (RR=1.08;95% CI: 1.1.01-1.16), left ventricular ejection fraction < 30 (RR=1.19;95% CI: 1.07-1.32), pleural effusion (RR=1.08;95% CI: 1.00-1.16), pulmonary artery systolic blood pressure 35 to 50 mmHg (RR=1.11;95% CI: 1.03-1.18), right ventricular dysfunction (RR=1.54;95% CI: 1.40-1.08), and collapsed inferior vena-cava (RR=1.05;95% CI: 1.01-1.08) were independent prognostic factors of in-hospital mortality. Conclusion: Our study showed that cardiac involvement is a prevalent complication in COVID-19 patients. Echocardiography findings have independent prognostic value for prediction of in-hospital mortality. Since echocardiography is an easy and accessible method, echocardiography monitoring of COVID-19 patients can be used as a screening tool for identification of high-risk patients.
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Introduction: Direct and indirect sequels of COVID-19 in the cardiovascular system are unclear. The present study aims to investigate the echocardiography findings in COVID-19 patients and possible correlations between the findings and the disease outcome. Methods: In this cross-sectional study, baseline characteristics and echocardiographic findings of hospitalized COVID-19 cases, and their correlation with mortality were evaluated. Furthermore, computed tomography (CT) angiography was performed to assess possible pulmonary embolism. In-hospital mortality was considered as the main outcome of the present study. Results: 680 confirmed COVID-19 cases with the mean age of 55.15 +/- 10.92 (range: 28 - 79) years were studied (63.09% male). Analysis showed that history of ischemic heart disease (RR=1.14;95% CI: 1.08-1.19), history of hypertension (RR=1.04;95% CI: 1.00-1.08), presence of embolism in main pulmonary artery (RR=1.53;95% CI: 1.35-1.74), CT involvement more than 70%(RR=1.08;95% CI: 1.1.01-1.16), left ventricular ejection fraction < 30 (RR=1.19;95% CI: 1.07-1.32), pleural effusion (RR=1.08;95% CI: 1.00-1.16), pulmonary artery systolic blood pressure 35 to 50 mmHg (RR=1.11;95% CI: 1.03-1.18), right ventricular dysfunction (RR=1.54;95% CI: 1.40-1.08), and collapsed inferior vena-cava (RR=1.05;95% CI: 1.01-1.08) were independent prognostic factors of in-hospital mortality. Conclusion: Our study showed that cardiac involvement is a prevalent complication in COVID-19 patients. Echocardiography findings have independent prognostic value for prediction of in-hospital mortality. Since echocardiography is an easy and accessible method, echocardiography monitoring of COVID-19 patients can be used as a screening tool for identification of high-risk patients.
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Although the findings of some studies have been indicative of the direct relationship between the severity of clinical findings and imaging, reports have been published regarding inconsistency of clinical findings with imaging and laboratory evidence. Physicians treating these patients frequently report cases in which patients, sometimes in the recovery phase and despite improvements in imaging indices, suddenly deteriorate and in some instances suddenly expire. This letter aimed to draw attention to the role of pulmonary thromboembolism as a potential and possible cause of clinical deterioration in covid-19 patients.
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COVID-19 is a novel infectious disease, which has challenged people all around the world. As of today, healthcare practitioners and researchers have made great effort to understand the characteristics and clinical presentations of the disease;however, the existing literature is still incomplete in this regard. A growing body of evidence indicates that coagulopathies and thromboembolic events are of utmost importance in COVID-19 patients and are related to poor prognosis. Here, we report three ICU admitted cases of COVID-19, in which massive pulmonary thromboembolism (PTE) occurred a few days after disease onset. Unfortunately, one of the patients did not survive and two were treated;one with thrombectomy and other with antithrombotic agents. It seems that severe cases of COVID-19 are at risk for developing PTE and in-charge physicians should be prepared and plan for anticoagulant prophylaxis using low-molecular-weight heparin (LMWH).
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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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The coronavirus disease 2019 (COVID-19) was first detected in December 2019 in Wuhan, China . So far, 136 reports from the WHO were reported. In the latest report, 6416828 patients in almost all countries have been infected with the COVID-19. The present study discusses the different aspects of COVID such as emergence, signs and symptoms, comparisons with SARS and MERS, concerns, governments' actions in controlling the virus and a descriptive analysis of the spread and death. The emergence of the coronavirus family in the last two decades has created a public health issue around the world. It has also caused serious damages to infrastructure, economy, culture and communities of countries. Thus, affected governments have taken steps to reduce these concerns such as quarantine, education, traffic control, closure of recreational centers, reduction of working hours etc. Despite strict measures to contain the COVID-19, this virus is still expanding and the question of "what actions should be taken with what political package?" is being asked. To answer this question, it is important to understand the process of disease occurrence and modeling different interventions on changing the natural course of the disease is very important.