Pilot analysis of intravenous lipid infusion role in COVID-19 mortality.

INTRODUCTION: How to reduce the fatality of coronavirus disease (COVID-19) is still challenging. A proper nutritional support has been always a matter of attention in critically ill patients. MATERIAL AND METHODS: We assessed COVID-19 patients who had received intralipid infusion due to medical indications and compared them with those who did not receive it regarding fatality rate and prognosis. As a part of a data mining project using data of observational cohort of COVID-19 patients hospitalized in the educational centers of Iran University of Medical Sciences, Tehran, Iran, an inferential case series was performed. A total of 19 patients with SARS-CoV-2 infection were selected from the cohort. Briefly, 13 patients survived and 6 patients died, and 12 patients were admitted in intensive care unit (ICU). All dead cases were ICU admitted. The association of intralipid infusion and survival rate was examined using Fisher exact test. No association was observed between intralipid infusion and survival. CONCLUSIONS: No significant protecting effect was observed for patients who received intralipid for medical indications. Since intralipid was administered according to medical indications, surviving of all the non-ICU admitted patients despite having underlying diseases was remarkable. Despite the fact, due to several bias factors that could not be controlled in such a retrospective study, the results might be accidental. We suggest to assess such an effect retrospectively in other centers as well.

A near real-time electronic health record-based COVID-19 surveillance system: An experience from a developing country.

CONTEXT: Access to real-time data that provide accurate and timely information about the status and extent of disease spread could assist management of the COVID-19 pandemic and inform decision-making. AIM: To demonstrate our experience with regard to implementation of technical and architectural infrastructure for a near real-time electronic health record-based surveillance system for COVID-19 in Iran. METHOD: This COVID-19 surveillance system was developed from hospital information and electronic health record (EHR) systems available in the study hospitals in conjunction with a set of open-source solutions; and designed to integrate data from multiple resources to provide near real-time access to COVID-19 patients' data, as well as a pool of health data for analytical and decision-making purposes. OUTCOMES: Using this surveillance system, we were able to monitor confirmed and suspected cases of COVID-19 in our population and to automatically notify stakeholders. Based on aggregated data collected, this surveillance system was able to facilitate many activities, such as resource allocation for hospitals, including managing bed allocations, providing and distributing equipment and funding, and setting up isolation centres. CONCLUSION: Electronic health record systems and an integrated data analytics infrastructure are effective tools to enable policymakers to make better decisions, and for epidemiologists to conduct improved analyses regarding COVID-19. IMPLICATIONS: Improved quality of clinical coding for better case finding, improved quality of health information in data sources, data-sharing agreements, and increased EHR coverage in the population can empower EHR-based COVID-19 surveillance systems.

An Easy-to-Use Platform for Reporting COVID-19 Patients by Private Offices and Clinics Without IT Support: A Pilot Study.

BACKGROUND: It is feasible to collect data rapidly and online using IT solutions. OBJECTIVES: To present a data collection platform for COVID-19 suspected patients in private offices and clinics without a standard software. METHODS: The proposed system for collecting and sharing data of patients with respiratory symptoms was designed to be simple to use, without the need for special technology, and with proper security to authenticate reporters. RESULTS: Two methods were developed to collect data from private physicians and offices. Finally, the data collected by both approaches is integrated and provided to primary healthcare staff to arrange appropriate healthcare measures. CONCLUSION: Our platform can provide an easy-to-use case reporting system for private physicians.

Effects of Immune System-Related Medications on COVID-19 Outcome in a Cohort of Iranian Patients: Preliminary Report of a Data Mining Study.

BACKGROUND: Regulation of the immune system is critical for fighting against viral infections. Both suppression and hyperactivity of the immune system result in failure of treatment. The present study was designed to show the effects of immune system-related medications on mortality and length of stay (LOS) in a cohort of Iranian patients with coronavirus disease 2019 (COVID-19). METHODS: A data mining study was performed on 6417 cases of COVID-19 covered by 17 educational hospitals of Iran University of Medical Sciences, Tehran. Association of a researcher-designed drug list with death and LOS was studied. For death outcome, logistic regression was used reporting odds ratio (OR) with 95% confidence interval (CI). For LOS, right censored Poisson regression was used reporting incidence rate ratio (IRR) with 95% CI. RESULTS: Among the corticosteroids, prednisolone was a risk factor on death (OR = 1.41, 95%CI = 1.03 - 1.94). This association was increased after adjustment of age interactions (OR = 3.45, 95%CI = 1.01 - 11.81) and was removed after adjustment of ICU admission interactions (OR = 2.64, 95%CI = 0.70 - 9.92). Hydroxychloroquine showed a protecting effect on death (OR = 0.735, 95%CI = 0.627 - 0.862); however, this association was removed after adjustment of age interactions (OR = 0.76, 95%CI = 0.41 - 1.40). Among the antivirals, oseltamivir showed a protecting effect on death (OR = 0.628, 95%CI = 0.451 - 0.873); however, this association was removed after adjustment of age interactions (OR = 0.45, 95%CI = 0.11 - 1.82). For reduction of LOS, the only significant association was for hydroxychloroquine (IRR = 0.85, 95%CI = 0.79 - 0.92). CONCLUSION: The results of such data mining studies can be used in clinics until completing the evidence. Hydroxychloroquine may reduce mortality in some specific groups; however, its association may be confounded by some latent variables and unknown interactions. Administration of corticosteroids should be based on the conditions of each case.

The Iranian Integrated Care Electronic Health Record.

E-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using E-health solutions is one of the challenging issues. One of these significant challenges is how one integrates heterogeneous healthcare information of the different point of care systems. This paper introduces the Iranian integrated care electronic health record using the information gathered from several point-of-care systems in healthcare enterprises in Iran. This service-oriented architecture has a remarkable characteristic - its accessibility to medical knowledge and medical concepts through archetypes and ontology, respectively. The Ministry of Health and Medical Education of the Islamic Republic of Iran has designed and implemented this national architecture.

DITAS: An Integrated Gateway to E-health Communications.

Today, the demand for health-oriented systems to facilitate and improve treatment processes is growing. For different information systems with different structures and technologies to be able to communicate with each other, a single gateway is required. The gateway acts as an interface between information systems and unifies protocols, rules, and standards related to communication processes. Health-related systems need a unique regulator that explains data models, coding, and data exchange structures. Moreover, the gateway has control over information systems and the data transmitted between them. In this paper, we explain an integrated gateway of health information exchange named DITAS which is a bridging point between health-related systems.

Advantages of a Web-Based Real-Time Bed-Management System for Hospital Admission Monitoring in Iran.

Lack of up-to-date information of hospitals beds, specifically in emergencies, is a significant problem in many large countries; The Ministry of Health and Medical Education of Iran (MOHME) designed and implemented a dynamic system that reports the status of beds in 2012. This system created great opportunities for national bed management, including real-time hospital admission monitoring, especially for emergency departments, ICUs and CCUs. Therefore, an additional online system was planned to be implemented for monitoring hospital admissions, including a national alert system. Prior to the design of this system, a study was done using literature study and expert opinion to investigate the advantages and features that this monitoring system was required to have. We used the MoSCoW method to prioritize the requirements of the system. This system was designed to have the following advantages, among other things: the hospitals as well as government should be able to track the patients, manage patient distribution in healthcare centers, and make policy for supplying extra beds. It should also be possible for the hospitals executive board, as well as the government, to monitor the performance of the hospitals regarding patient admissions (i.e., the rate of rejection of patients with severe conditions).

The impact of ambient temperature on acute myocardial infarction admissions in Tehran, Iran.

While the effect of temperature on risk of cardiovascular events is well documented, few studies report evidence from the Middle East. In this study, we investigate the short-term effect of ambient temperature on admissions for acute myocardial infarction (AMI) in Tehran, Iran. We used a case-crossover design combined with a distributed lag non-linear model to examine nonlinear and delayed associations between ambient temperature and AMI admissions from 2013 to 2016. We also examined hot and cold effects on AMI admission by gender and age categories (≤ 65 years old and > 65 years old). Both hot and cold temperatures increased the risk of AMI admissions. Effects of high temperature appeared immediately on the current day and lasted for 3 days, whereas cold effects became apparent after 2 days and persisted for about 8 days. The early acute increase in risk associated with high temperature was followed by a deficit, thus suggesting evidence of a harvesting effect. In additions, males and those aged ≤ 65 years old were more vulnerable to high temperatures.

Association between Air Temperature and Acute Myocardial Infarction Hospitalizations in Tehran, Iran: A Time-Stratified Case-Crossover.

BACKGROUND: Although the effect of temperature on the incidence of acute myocardial infarction (AMI) has been extensively documented, no study has previously investigated the association between temperature and AMI in the Middle Eastern countries. OBJECTIVE: To examine the association between daily mean temperature and AMI admission rates in Tehran, Iran. METHODS: Data on daily number of admissions of patients with AMI to Tehran hospitals between March 21, 2013 and March 19, 2016, were retrieved from the Iranian Myocardial Infarction Registry (IMIR). Over the same period, data on daily mean temperature and relative humidity were measured at Mehrabad International Airport weather station of the Islamic Republic of Iran Meteorological Organization. Time-stratified case-crossover design was employed to investigate the short-term association between the daily mean temperature and the number of daily admissions of patients with AMI, after adjusting for public holidays, relative humidity, and air pollution. RESULTS: An interquartile range (IQR) increase in daily mean temperature was associated with 15.1% (95% CI 1.3 to 30.8%) and 13% (95% CI 1.9% to 25.4%) increase in the risk of AMI hospitalizations during the entire year, and in the warm months of the year, respectively. There were no significant associations between IQR increase in the two-day cumulative average up to the six-day cumulative average of the daily mean temperature and AMI during the entire year, and warm or cold months of the year. CONCLUSION: An increase in temperature would increase the rate of AMI hospitalization.

Towards National eHealth Implementation--a comparative study on WHO/ITU National eHealth Strategy Toolkit in Iran.

Experiences has shown that utilization of ICT in health sector requires national commitment and planned efforts to make the best use of existing capacity. Establishing the main directions as well as planning the detailed steps needed are key to achieving longer-term goals such as health sector efficiency, reform or more fundamental transformation. Collaboration between the health and ICT sectors, both public and private, is central to this effort. As the major United Nations agencies for health and telecommunications respectively, the World Health Organization (WHO) and the International Telecommunication Union (ITU) have recognized the importance of collaboration for eHealth in their global resolutions, which encourage countries to develop national eHealth strategies; the National eHealth Strategy Toolkit is the proof of these recommendations. In this study a mapping of eHealth components in WHO/ITU National eHealth Strategy Toolkit and our national eHealth vision is presented.