Persistent/Late-Onset Complications of COVID-19 in General Population: A Cross-Sectional Study in Tehran, Iran.

Background: After recovery from acute phase of the COVID-19, some patients suffer from persistent/late-onset complications. The main objective of this study was to investigate the prevalence of such complications in a large scale of COVID-19 patients in Tehran, Iran. Methods: In this cross-sectional study, those patients who called Tehran emergency medical services center and were visited by the emergency medical technicians from 20 March 2020 until 21 September 2020 and diagnosed as a confirmed COVID-19 case were enrolled. The minimum required sample size was estimated 385 cases, and they were selected randomly. The patients were interviewed by phone at least 4 weeks since initiation of their symptoms. Using a pre-prepared checklist, made by an expert panel who were involved in management of COVID-19 patients, data were collected on the types and duration of the complications, clinical information, and factors which could interfere with developing the complications. All analyses were performed using STATA 16 software. The association of the prevalence of each complication with independent factor was assessed using Chi-square test (or Fisher's exact test) for categorical variable, and the mean difference of numerical variables in the two groups (with and without complication) was assessed using independent t-test. Statistical significance was accepted at P value<0.05. Results: Four-hundred forty-seven patients participated in the study. Among our total population, 345 (77.2%) patients experienced at least one of the persistent/late-onset complications. Cardiopulmonary and then skin-related symptom categories were reported in 179 (40.0%) and 173 (38.7%) patients, respectively, and were the most prevalent persistent/late-onset complications. The associations of long term persistent/late-onset complications with older ages (P=0.04), female (P<0.001), psychological stress (P=0.01), and inadequate rest after illness (P<0.001) were significant. Conclusion: The findings of this study indicate that a significant number of patients will experience persistent/late-onset complications, both physically and mentally, after recovering from acute phase of COVID-19. Thus, physicians should have adequate resources and support to care for the patients to help them cope with the condition.

The Possible Factors Correlated with The Higher Risk of Getting Infected by COVID-19 in Emergency Medical Technicians; A Case-Control Study.

OBJECTIVE: To assess the possible factors associated with increasing risk of COVID-19 among EMTs. METHODS: This study was a case-control study conducted in Tehran, Iran. Case group was consisted of confirmed COVID-19 EMTs based on the results of reverse transcriptase polymerase chain reaction and/or lung computed tomography scan. Healthy EMTs were randomly selected as control group. Patients were asked to fill out a checklist including demographic data, data related to the work situation (such as number of missions and type of mask and cloth) and PPE precautions. RESULTS: Sixty-eight patients and 148 healthy persons took part in this study as case and control group, respectively. Having two EMTs involved directly in taking care of patients (p<0.001) and working with a confirmed case teammate (p<0.001), considering the precautions such as seal check after wearing the mask (p=0.015), covering the hair with a medical hat (p<0.001), not using personal items despite protective clothing (p<0.001), and avoiding contact with the outer surface of clothing while removing (p<0.001) had significant difference in two groups. CONCLUSION: We found that the type and method of use of PPE were correlated with the increasing risk of COVID-19 in EMTs. Also, we found that when two EMTs were involved directly in taking care of the patients, and those who worked with a confirmed case teammate, more frequently affected.

The Geographical Distribution of Probable COVID-19 Patients Transferred by Tehran Emergency Medical Services; a Cross Sectional Study.

INTRODUCTION: Mapping of COVID-19 infection in the city can help us know more about how the disease is distributed and spread. This study was conducted to investigate the geographical distribution of probable COVID-19 patients who were transferred to destination hospitals by emergency medical services (EMS) in the first wave of the epidemic, in Tehran, Iran. METHODS: This cross-sectional study was performed based on recorded missions during the first 3-month period of the pandemic in Tehran, Iran. All probable cases of COVID-19 who were transferred to the hospitals following contact with Tehran EMS during the study period were enrolled. Arc-GIS software was utilized to draw the distribution map of the contact places of the cases. RESULTS: In this study, the data of 4018 patients were analyzed (60.9% male). The mean age of the patients was 54.1 ± 20.7 years; and the mean age of the patients had increased with time during the studied 3 months (p = 0.003). The average incidence rate of this disease in Tehran during the study period was 4.6 per 10,000 population. Generally, the lowest and highest raw frequencies of Tehran COVID-19 contamination were seen in municipal districts 21 and 4, respectively. The raw frequency of cases during the 3-month study period also showed that the highest number of cases in Tehran occurred in municipal districts 5 and 4, respectively. CONCLUSION: In the present study, using geographic information systems (GIS), geographical distribution map of COVID-19 in Tehran, Iran, during the first 3 months of the pandemic was drawn.

The effect of prehospital telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction patients undergoing primary percutaneous coronary intervention: A cross-sectional study.

OBJECTIVES: The sooner the primary percutaneous coronary intervention (PPCI) is performed, the better prognosis is expected in patients with acute myocardial infarction. The objective is to evaluate the effect of prehospital triage based on electrocardiogram (ECG) and telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction (STEMI) patients undergoing PPCI. METHODS: This cross-sectional study was conducted based on the data extracted from the hospital information system (HIS) of one general hospital, which had the capability of performing PPCI 24 h a day, 7 days a week. All patients with STEMI who undergone PPCI during 1 year, transferred by emergency medical service (EMS) and their data were registered in the HIS were eligible. Besides the baseline characteristics, first medical contact (FMC)-to-balloon time was recorded. Morbidity based on predischarge left ventricular ejection fraction (LVEF) and mortality based on Global Registry of Acute Cardiac Events (GRACE) score were also recorded. Patients who were referred to the hospital by EMS with prehospital ECG and telecardiology were compared with those without prehospital ECG. RESULTS: Totally, 298 patients with STEMI were enrolled, of whom 183 patients (61.4%) had prehospital ECG (telecardiology), and 115 patients (38.6%) had not. The means of predischarge LVEF of the patients in the first and the second groups were 40.7 ± 10.4 and 40.6 ± 11.2, respectively (P = 0.946). The mean of the probability of 6-month mortality based on GRACE score in the first group was significantly less than that of the second group (P = 0.004). Analyses of multivariable ordinal logistic regression showed that 6-month mortality severity risk in the second group was 1.5 times more than the first group (95% confidence interval 0.8-2.6), although this difference was not statistically significant (P = 0.199). CONCLUSIONS: It is likely that prehospital telecardiology, with shortening FMC to balloon time result in reducing probability 6-month mortality in STEMI patients who undergone PPCI. However, the process of telecardiology had no effect on predischarge LVEF in the current study.

Iranian Emergency Medical Service Response in Disaster; Report of three Earthquakes.

INTRODUCTION: The earthquake is one of the most natural catastrophic crises that can cause a lot of casualties. Considering an earthquake-prone country, Iran is ranked as one of the world's most dangerous countries. OBJECTIVE: In this article, we describe the actions taken by emergency medical service (EMS) after the earthquake in Kermanshah, Varzaghan, and Bam and compared the strengths and weaknesses of the emergency response program and the limitations and challenges of this system in dealing with these major crises. METHOD: This study is a cross-sectional study that compares some of the information and findings related to three earthquakes that occurred in Iran, including Bam, Varzaghan and Sarpol-e-Zahab earthquakes. The data reported in the present article is descriptive and is based on various independent sources such as National Emergency Operation Center, Local Emergency Operations Center (EOC), the EMS of the country, the World Health Organization, the United Nations, the statistics website, the Forensic Data website, the International Institute of Seismology and Earthquake Engineering, conferences and personal interviews. To ensure the credibility of the information, the authors reported data that had been verified by two or more sources. RESULTS: The characteristics of the geographic area of the 3 earthquakes has been described. Post-earthquake response activities were described in details in subheadings including rapid warning and response, surge capacity plan, rapid response teams, emergency medical teams, increasing the capacity of health facilities, increasing transfer capacity, and handling, transportation and distribution of injuries. CONCLUSION: In the recent earthquake, had been occurred in Sarpol-e-Zahab, the health response of the country was largely satisfactory. The existence of structures such as EOC at various levels, the unified incident command system, emergency operations plan, and Medical Care Monitoring Center are among the most important reasons for satisfactory performance.

Radioprotective effects of lentil sprouts against X-ray radiation.

The present study investigated the radioprotective efficacy of lentil (Lens culinaris) sprouts against X-ray radiation-induced cellular damage. Lentil seeds were dark germinated at low temperature and the sprout extract was prepared in PBS. Free radical scavenging of extract was evaluated using 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay and then the radioprotective potency of extract (0 to 1000 µg/mL) on the lymphocyte cells was determined by lactate dehydrogenases assay. Moreover, micronuclei assay was assessed using the cytokinesis-block technique. The irradiations were performed using 6 MV X-ray beam. The value of IC50 for DPPH assay was 250 µg/mL. The median lethal dose for radiation was determinate at 5.37 Gy. Pretreatment with lentil sprout extract at 1000 µg/mL reduced cytotoxicity at 6 Gy total concentration from 70% to 50%. The results of micronuclei assay indicated that cells were resistant to radiation at concentrations of 500-1000 µg/mL of exogenous lentil sprout extract. The value of median effective concentration for micronuclei assay was 500 µg/mL. The results indicated that lentil sprout extract showed actually somewhat radioprotective effect on lymphocyte cell. In addition, the obtained results suggest that extract of total lentil sprout have more antioxidant activity than radicle part.