Preexisting depression and COVID-19: a cohort study on the risk of susceptibility and hospitalization.

BACKGROUND: Depression can have negative effects on a person's physical health. However, the available evidence on the risk of susceptibility to COVID-19 and its adverse outcomes in people with mental disorders, including depression, is limited and inconsistent. Therefore, we investigated the relationship between major depressive disorder (MDD) and the risk of susceptibility to COVID-19 infection and hospitalization. The data used in the study were obtained from the Employees' Health Cohort Study of Iran (EHCSIR). METHODS: We conducted a cohort study that included 3355 participants who had complete data on major depressive disorder at baseline assessment and two annual telephone follow-ups between January 2020 and March 2022. Trained psychologists used the Persian version of the Composite International Diagnostic Interview (CIDI-2.1) to identify major depressive disorders during the baseline assessment. We applied log binomial regression models to adjust for sociodemographic factors and background health conditions. RESULTS: We found that 11.4% of participants had lifetime MDD and 7.3% had MDD in the past 12 months. During the pandemic, 26.1% of participants were infected with COVID-19, and 14.4% of those who were infected were hospitalized. The risk of susceptibility to COVID-19 infection was significantly higher among participants with lifetime MDD than among those without MDD (adjusted risk ratio (ARR) = 1.24, 95% CI: 1.06-1.47). However, lifetime MDD or 12-month MDD was not independently associated with hospitalization among COVID-19 cases. CONCLUSIONS: Preexisting major depressive disorder may increase the risk of susceptibility to COVID-19.

Association of Emotional Response Indicators with the Risk of Recurrence and Hospitalization in Coronavirus Patients.

Anxiety, stress, and fear can adversely affect the mental and physical health of people. The present study aimed to examine the association of these emotional response indicators with outcomes (recurrence, hospitalization, and mortality) in coronavirus 2019 (COVID-19) patients. A prospective cohort study was conducted between February 2020 and July 2021 in three hospitals in Tehran, Iran. The included patients (n=350) completed three questionnaires on COVID-19-related anxiety, stress, and fear. Patients with at least one emotional response indicator were assigned to the exposed group (n=157) and those without to the unexposed group (n=193). After one month of follow-up, the medical condition of all participants was determined through phone calls. Data were analyzed with logistic and multivariate regression models using STATA 9 software. The number of patients with COVID-19 recurrence in the exposed and unexposed groups was 71 (45%) and 16 (8%), respectively, and for hospitalization 79 (50%) and 16 (8%), respectively. The relative risk of recurrence and hospitalization due to COVID-19 in the exposed group was 5.62 and 6.25 higher than in the unexposed group, respectively (P<0.001 for both). The results of regression analysis showed that underlying diseases were not significantly associated with recurrence and hospitalization. The total number of deaths was six, all of which were in the exposed group. Given the greater risk of recurrence and hospitalization in COVID-19 patients with anxiety, stress, or fear, there is a need to devise and implement appropriate strategies to prevent and manage mental disorders.

Anxiety, Knowledge and Lived Experiences of Families with COVID-19 Patients: A Mixed-Method Multi-Center Study in Iran.

Background: During community-wide outbreaks, patients and their families may suffer from anxiety after making behavioral changes. This study aimed to investigate the anxiety, knowledge, and lived experiences of families with COVID-19 patients admitted to medical centers. Methods: The present multi-center study was conducted by a mixed method using convenient sampling in hospitalized COVID-19 patients in Firoozgar and Rajaie Hospitals between May and July 2020. Anxiety was measured using a short form of the State-Trait Anxiety Inventory. The participants' level of knowledge was assessed by an online questionnaire. The lived experiences of the families were explained through semi-structured interviews. Data were analyzed by Chi square, ANOVA, independent-samples t test, Kruskal Wallis, and Mann-Whitney tests in SPSS 16. P values≤0.05 were considered statistically significant. Results: The mean age of the 324 family members, who participated in the study was 45.1±13.3 years. The mean anxiety score of the subjects was 13.5±4.1, and 63.6% of the participants had moderate to severe anxiety. The subjects' mean score for knowledge on COVID-19 was 7.15±1.32. The highest mean percentage of data received by the subjects on COVID-19 (42.7%) was obtained through radio and television broadcasting. A total of 251 important phrases were obtained from interview analysis and code extraction, out of which five main themes and 17 sub-themes were extracted. Conclusion: Our findings showed that anxiety was relatively high in families with COVID patients during the pandemic, and it was associated with age, sex, income, and familial relationships. The level of knowledge on the COVID-19 disease in families was moderate. Therefore, relevant interventions and raising people's awareness are recommended.

Aftercare and Suicide Reattempt Prevention in Tehran, Iran.

Background: A previous suicide attempt is one of the strongest risk factors for subsequent suicide. Effective care following a suicide attempt may reduce the risk of suicide reattempts. Aims: We aimed to investigate the effect of a brief educational intervention and contact program on suicide reattempts. Method: This study was performed as a randomized clinical trial (RCT) recruiting 305 individuals who had attempted suicide (brief intervention and contact = 153 individuals, BIC; treatment as usual = 152 individuals, TAU) who were referred to Baharlu Hospital in Tehran. The SUPRE-MISS questionnaire and a discharge follow-up questionnaire were used for data collection. Cox proportional hazard models and log-rank tests were used to assess the association of the variable with the event (reattempt). Kaplan-Meier curves were used to depict the time to the event of reattempt. Results: In the BIC group, 11% of the individuals had attempted suicide once, and 25% of the TAU group had attempted suicide once (12.4%), twice (9.3%), and three times (3.8%), respectively. The results of Kaplan-Meier analysis indicated the mean time of reattempt in the BIC (0.76) and TAU groups (0.25) as the fourth and second months of follow-up, respectively (log rank, χ2 = 12.48, p < .001). The hazard ratio for the TAU group was 2.57 (95% CI [1.4, 5.9]). Limitations: Loss to follow-up due to stigma is one of the serious problems of follow-up services. Conclusion: Implementing a brief educational intervention and contact program on suicide reattempts is feasible and effective in reducing the rate of reattempt; however, it should be accommodated within the mental health services of the county.

Serum level of Vitamin D is associated with COVID-19 mortality rate in hospitalized patients.

BACKGROUND: Due to widespread of coronavirus disease 2019 (COVID-19) infection, identification of its risk factors and clinical characteristics are important. The aim of the present study was to assess Vitamin D levels in individuals with severe acute respiratory syndrome coronavirus-19 infection and to report on its potential as a predictive marker. MATERIALS AND METHODS: All patients, diagnosed with COVID-19 infection from February 16 to March 21, 2020, and referred to Firoozgar Hospital, Tehran, Iran, were enrolled in this study. Vitamin D analysis was undertaken on patient serum samples using a commercial kit (Pars Azmoon Co., Tehran, Iran). SPSS v. 22 was used for statistical analysis. RESULTS: Vitamin D serum concentration was analyzed in a total of 317 patients whose mean age ± standard deviation was 62.05 ± 15 years and with 62.5% being male. A significant association of Vitamin D level and death was observed. Higher levels of serum Vitamin D had protection against death (odds ratio = 0.955 [95% confidence interval = 0.923-0.988], P = 0.008). CONCLUSION: As a preliminary study in the Iranian population who suffered COVID-19 disease, we identified that Vitamin D deficiency was associated with a higher death rate and intensive care unit admission.

Effectiveness of self-help mobile telephone applications (apps) for suicide prevention: A systematic review.

Background: According to the expansion of suicide prevention applications in recent years, the aim of this study was to review randomized controlled trials (RCTs) and pretest-posttest studies that evaluated the effectiveness of suicide prevention applications. Methods: In this systematic review, we searched online databases including Pubmed, SCOPUS, Web of Science, Chocrane Database, and Google Scholar to find randomized controlled trials and pretest-posttest studies published up to Jul 18, 2019. Randomized controlled trials and pretest-posttest of efficacy self-guided telephone applications that reported any primary and secondary outcome of suicidal thoughts and behaviors were included in the review. We evaluated the articles using the CONSORT 2010 checklist. Results: After screening articles, 7 studies were included in this review. Four studies focused on the effectiveness of applications on suicide thoughts and attempt, 2 on effectiveness of applications on self-injury, 4 on depression and anxiety, 1 on impulsivity, and 2 on adaptive strategies. Overall, mobile phone applications were associated with reductions in suicidal ideation scores at post intervention, and enhancement of adaptive skills; however, no evidence of reduction was reported in impulsivity after use of applications. Conclusion: Despite the differences in studies, this review showed that the use of mobile applications had an overall positive effect on reducing the risk of suicide and improving performance and health of patients.

Resistance-associated substitutions (RASs) to HCV direct-acting antivirals (DAAs) at baseline of treatment in thalassemia patients: a referral center study.

Patients with thalassemia major are at high risk of hepatitis C through blood transfusion from donors infected by hepatitis C virus (HCV). The use of direct-acting antiviral (DAA) therapy against such HCV infections has increased in different populations. However, resistant viral variants can affect treatment outcomes, and therefore improved surveillance strategies are needed. Accordingly, we aimed to evaluate resistance-associated substitutions (RASs) to HCV DAAs at the baseline of treatment in thalassemia patients in a referral center. Out of 89 thalassemia patients who suffered from HCV infection and were referred to our center between 2016 and 2017, 43 underwent further analysis of the HCV nonstructural proteins NS5A and NS5B using polymerase chain reaction (PCR) sequencing methods. Unique primers were designed using bioinformatics software for separate detection of HCV subtypes 1a, 3a, and 1b. Detection of RASs was performed based on previously published literature. Statistical analysis was carried out using SPSS version 19. The participants, 60.4% (26/43) of whom were male, had a mean age ± standard deviation (SD) of 33.0 ± 5.0 years. HCV subtype 1a was found in 27 cases, 3a in 13, and 1b in three. In HCV subtype 1a there were 163 mutations in NS5A and 212 mutations in NS5B. The frequency of RASs was 20.9% (8 RASs in 9 patients), including M28V and H58P in subtype 1a, L28M, R30Q, C316N, and C316S in subtype 1b, and S24F in subtype 3a. Statistically, the subtype 1b and a higher mutation rate in NS5A were associated with RASs (p-value < 0.05). The emergence of natural RASs to HCV DAAs serves as a warning of the risk of drug resistance in response to the broad usage of antivirals. However, relapses in these DAA-treated HCV-infected thalassemia patients are rarely reported. Our findings indicate that the prevalence of RASs prevalence at baseline was 20.9% in these patients, and this calls for extrapolation to a larger population study, as highlighted in other studies, with larger sample sizes, high-throughput methods, and follow-up in order to fully evaluate treatment outcomes in RASs-detected individuals. Optimized therapeutic strategies, particularly in complex, difficult-to-cure patients, can effectively prevent DAA treatment failure as a result of selection for RASs.

SARS-CoV-2 Molecular and Phylogenetic analysis in COVID-19 patients: A preliminary report from Iran.

BACKGROUND: The aim of the current study was to investigate and track the SARS-CoV-2 in Iranian Coronavirus Disease 2019 (COVID-19) patients using molecular and phylogenetic methods. METHODS: We enrolled seven confirmed cases of COVID-19 patients for the phylogenetic assessment of the SARS-CoV-2 in Iran. The nsp-2, nsp-12, and S genes were amplified using one-step RT-PCR and sequenced using Sanger sequencing method. Popular bioinformatics software were used for sequences alignment and analysis as well as phylogenetic construction. RESULTS: The mean age of the patients in the present study was 60.42 ± 9.94 years and 57.1% (4/7) were male. The results indicated high similarity between Iranian and Chinese strains. We could not find any particular polymorphisms in the assessed regions of the three genes. Phylogenetic trees by neighbor-joining and maximum likelihood method of nsp-2, nsp-12, and S genes showed that there are not any differences between Iranian isolates and those of other countries. CONCLUSION: As a preliminary phylogenetic study in Iranian SARS-CoV-2 isolates, we found that these isolates are closely related to the Chinese and reference sequences. Also, no sensible differences were observed between Iranian isolates and those of other countries. Further investigations are recommended using more comprehensive methods and larger sample sizes.

Intravenous Immunoglobin Utilization Study in a Teaching Hospital.

BACKGROUND: Intravenous immunoglobulin (IVIG) is an immunomodulating agent that has several actions. The aim of this study was to investigate the indications of IVIG according to available evidence and the cost in our center. METHODS: This retrospective study was conducted between September 2017 and June 2018 at a teaching hospital affiliated with Iran University of Medical Sciences, Tehran, Iran. Patients' demographic data and disease, indication for IVIG use, its dosage and treatment regimen and previous and concurrent treatments were assessed. The collected data were compared with the present criteria for the pattern of IVIG usage. The last version of Lexicomp® was used as the reference for indications of the administrated drug and its dosage. RESULTS: A total of 119 patients received IVIG during the study period. The wards with the most frequent IVIG prescription were the neurology (46.2%) and neonatal intensive care unit (21%). The most common reasons of IVIG therapy were various inflammatory neurological disorders. IVIG was used in 22, 43 and 54 cases according to on-label, off- label and other indications, respectively. The total price was higher for off-label indications for IVIG ($254343.75) than on-label indications ($152625). As well, $107250 was exhausted for cases in which there was not sufficient evidence. CONCLUSION: One important aspects of this study was the use of IVIG in cases other than on-label indications. Although a number of studies support IVIG therapy in some diseases, further trials are needed to establish efficacy and safety in these fields.

New visiting policy: A step toward nursing ethics.

BACKGROUND:: Patients' rights arise from their expectations of the healthcare system, which are rooted in their needs. Visitation is seen as a necessary need for patients and families in intensive care units. OBJECTIVES:: The authors attempted to design, implement, and evaluate a new visiting policy in the intensive care units. RESEARCH DESIGN:: This study was an action research, including two qualitative and quantitative approaches. PARTICIPANTS AND RESEARCH CONTEXT:: The viewpoints of 51 participants (patients, families, doctors, nurses, and guards) on how to change the limited visiting policy were explained through semi-structured interviews and focus groups. The new visiting policy (contractual visitation) was designed, implemented, and evaluated with the involvement of participants. ETHICAL CONSIDERATIONS:: The hospital ethics committee approval was gained and the informed consent was obtained from all the participants. FINDINGS:: The content of interviews was analyzed and classified into four categories: advantages and disadvantages of visiting policies, and barriers and facilitators of changing the limited visiting policy. After implementation of the new policy (contractual visitation), a significant difference observed in satisfaction status before and after the changes (p value < 0.001). DISCUSSION:: Nowadays, many countries' clinical guidelines recommend flexible visiting policy, which is consistent with the results of this study. CONCLUSION:: Changing the limited visiting policy was a necessary need for patients and families that established with the involvement of them and staff.

Albumin Utilization Evaluation in a Major Teaching Hospital in Iran: Recommendations for Guideline Development.

OBJECTIVE: Human albumin solution is an expensive colloidal preparation which is commonly used in clinical practice. Due to high cost of albumin, increased rate of the inappropriate use worldwide, and many other reasons, it is imperative to establish a practical protocol to use albumin products and limit its usage. The aim of this study was to identify albumin utilization patterns in a teaching hospital and to demonstrate the importance of the need to reconsider prescribing strategies for albumin administration. METHODS: This retrospective cross-sectional study was performed between August 2016 and December 2016 at Firoozgar Hospital affiliated to Iran University of Medical Sciences, Tehran, Iran. All albumin prescriptions for adult patients during the study period were enrolled for appropriateness evaluation according to the latest evidence-based studies and guidelines. FINDINGS: Among 320 albumin prescriptions, 168 (52.5%) were inappropriate according to the current evidence. The most common irrational causes for the albumin usage were hypoalbuminemia (23.4%), nutritional support (13.7%), neuroprotection in subarachnoid hemorrhage (3%), pretreatment for cancer surgery (2.8%), edema (1.6%), hepatic failure (1.6%), and paracentesis (3%). The total amount of albumin used for 320 patients was 52,050 g, from which 28,470 g was inappropriate resulting in $97,398 wastage. CONCLUSION: These findings, along with aforementioned guidelines, support the requirement for physicians' educational programs and proper strategies for appropriate prescriptions and could also be important in modifying the available guidelines concerning expensive drugs such as albumin.

Patients' and Families' Satisfaction With Visiting Policies in Cardiac Intensive Care Units.

BACKGROUND: Families play a vital role in the recovery of patients admitted to intensive care units. They can help patients to adapt themselves to the crisis and feel more satisfied. OBJECTIVE: In this study, we examined the patients' and families' satisfaction with the current visiting policies in cardiac intensive care units in the largest Cardiovascular Medical and Research Center of Iran. METHOD: This research used a cross-sectional descriptive design. To do so, 303 patients admitted to those cardiac intensive care units and their families responded to a 2-part questionnaire between September 2014 and March 2015. RESULTS: The results showed that 55.1% of the participants were dissatisfied with the limited visiting policies of the cardiac intensive care units, whereas the satisfaction rate was 14.2%. The remaining participants (30.7%) were slightly satisfied with the visiting policies in cardiac intensive care units. CONCLUSIONS: Patient-centered care is an expectation among patients and their families in the cardiac intensive care units. It seems that a change in visiting policies is necessary.

Suicide Prevention and Follow-Up Services: A Narrative Review.

Previous suicide attempt is the most important predictor of death by suicide. Thus preventive interventions after attempting to suicide is essential to prevent reattempts. This paper attempts to determine whether phone preventive interventions or other vehicles (postal cards, email and case management) are effective in reattempt prevention and health promotion after discharge by providing an overview of studies on suicide reattempts. The research investigated in this review conducted from 1995 to 2014. A total of 26 cases related to the aim of this research were derived from 36 English articles with the aforementioned keywords Research shows that providing comprehensive aids, social support, and follow-up after discharge can significantly prevent suicide reattempts. Several studies showed that follow-up support (phone calls, crisis cards, mails, postal cards.) after discharge can significantly decrease the risk of suicide. More randomized controlled trials (RCT) are required to determine what factors of follow-up are more effective than other methods.

Alcohol Abuse and Suicide Attempt in Iran: A Case-Crossover Study.

Alcohol use and its disorders are associated with increased risk of suicidal behaviors Research has shown that 6-8% of those who use alcohol have a history of suicide attempt. Given the prohibition of alcohol use legally, the increased alcohol consumption, and the lack of strong evidence in favor of its use associated with suicide in Iran, this study was conducted to determine the link between suicide attempt and alcohol abuse. The case-crossover method was used in this research. Out of 305 referrals to the emergency room due to a suicide attempt, 100 reported drinking alcohol up to six hours before their attempt. Paired Matching and Usual Frequency were employed to analyze the data with STATA 12.0. The probability of attempting suicide up to six hours after drinking alcohol appeared increased by 27 times (95% CI: 8.1-60.4). Separate analysis for each of these hours from the first to the sixth hour after alcohol use was also performed. Fifty percent of attempted suicides happened one hour after alcohol use. Relative risk for the first and second hour was 10% and 5% respectively. Alcohol use is a strong proximal risk factor for attempted suicide among Iranian subjects. Prevention of alcohol use should be considered in setting up of the national Suicide attempt prevention program.

A Review of Visiting Policies in Intensive Care Units.

Admission to intensive care units is potentially stressful and usually goes together with disruption in physiological and emotional function of the patient. The role of the families in improving ill patients' conditions is important. So this study investigates the strategies, potential challenges and also the different dimensions of visiting hours' policies with a narrative review. The search was carried out in scientific information databases using keywords "visiting policy", "visiting hours" and "intensive care unit" with no time limitation on accessing the published studies in English or Farsi. Of a total of 42 articles, 22 conformed to our study objectives from 1997 to 2013. The trajectory of current research shows that visiting in intensive care units has, since their inception in the 1960s, always considered the nurses' perspectives, patients' preferences and physiological responses, and the outlook for families. However, little research has been carried out and most of that originates from the United States, Europe and since 2010, a few from Iran. It seems that the need to use the research findings and emerging theories and practices is necessary to discover and challenge the beliefs and views of nurses about family-oriented care and visiting in intensive care units.

Can plasma fibrinogen levels predict bleeding after coronary artery bypass grafting?

BACKGROUND: Fibrinogen is the main biomarker for bleeding. To prevent excessive postoperative bleeding, it would be useful to identify high-risk patients before coronary artery bypass grafting (CABG). OBJECTIVES: In order to predicating bleeding after CABG, we sought to determine whether preoperative fibrinogen concentration was associated with the amount of bleeding following CABG. PATIENTS AND METHODS: A total of 144 patients (mean age = 61.50 ± 9.42 years; 65.7% men), undergoing elective and isolated CABG, were included in this case-series study. The same anesthesia technique and medicines were selected for all the patients. In the ICU, the patients were assessed in terms of bleeding at 12 and 24 hours post-operation, amount of contingent blood products received, and relevant tests. Statistical tests were subsequently conducted to analyze the correlation between preoperative fibrinogen concentration and the amount of post-CABG bleeding. RESULTS: The mean ± standard deviation of bleeding at 12 and 24 hours post-operation was 285.37 ± 280.27 and 499.31 ± 355.57 mL, respectively. The results showed that postoperative bleeding was associated with different factors whereas pre-anesthesia fibrinogen was not correlated with bleeding at 12 (P = 0.856) and 24 hours (P = 0.936) post-operation. There were correlations between the extra-corporal circulation time and bleeding at 12 hours post-operation (ρ = 0.231, P = 0.007) and bleeding at 24 hours post-operation (ρ = 0.218, P = 0.013). CONCLUSIONS: Preoperative assessment of plasma fibrinogen levels failed to predict post-CABG bleeding.

Nutritional status and coronary artery disease: a cross sectional study.

BACKGROUND: Nutrition is among the most important factors influencing coronary artery disease. OBJECTIVES: Here we aimed to study the nutritional status of patients with and without coronary artery disease (CAD). PATIENTS AND METHODS: We performed a cross-sectional study on 600 patients referred to a cardiology clinic with the signs of ACS. The patients were then classified in to two groups (CAD group and the normal group) based on angiographic findings. The amount of nutritional profile was questioned from all participants. RESULTS: Men were more often diagnosed with CAD compared to women (198/362 vs. 102/238; P < 0.01). Patients with coronary artery disease were mostly older, smoker, coffee and black tea drinker had a higher BMI and more frequently diagnosed with hypertension, hyperlipidemia and diabetes. On the other hand, green tea consumption was seen more in women (92/238 vs. 115/362; P < 0.05) and those with regular physical activity (119/299 vs. 88/301; P < 0.01). Backward regression modeling was employed to study the predictors of CAD. Type of tea and meat remained as one the most important nutritional factors predicting CAD. CONCLUSIONS: White mean and type of tea were the most important predictors of CAD. Dietary prevention strategies from childhood could prevent early CAD.

The effectiveness of discharge planning on the knowledge, clinical symptoms and hospitalisation frequency of persons with schizophrenia: a longitudinal study in two hospitals in Tehran, Iran.

AIMS AND OBJECTIVES: To investigate the effectiveness of discharge planning on the knowledge, clinical symptoms and frequency of hospitalisation of persons with schizophrenia. BACKGROUND: Discharge planning is associated with decreases in the duration of hospitalisation, readmission to hospitals and decreases in medical costs. Yet, there is little known about the effectiveness of discharge planning among persons with schizophrenia in Iran. DESIGN: Longitudinal clinical trial. METHODS: In this longitudinal clinical trial, 46 persons with schizophrenia admitted to psychiatric hospitals were selected and classified into either intervention or control groups. For the intervention group, the discharge planning was designed using the nursing process model. The intervention was implemented across six sessions in the hospital and six sessions in patient's home (up to three months after discharge). Friedman test, independent t-tests, chi-squared test, Mann-Whitney U-test and Mc-Nemar's test were used to analyse demographic characteristics, knowledge scores, clinical symptoms and the frequency of hospitalisation. RESULTS: The intervention group demonstrated improved clinical symptoms between the time of discharge and three months after discharge and had higher knowledge levels compared with the control group. In addition, the frequency of patients' hospitalisation preintervention and three months postintervention was statistically significantly lower in the intervention group, while no such differences were found among the control group during this same time period. CONCLUSION: This study suggests that there are a number of advantages to discharge planning including an increase in the knowledge of patients, a decline in clinical symptoms and a reduction in the frequency of admission to hospitals. RELEVANCE TO CLINICAL PRACTICE: Due to high frequency of relapse, rehospitalisation and high remedial costs of persons with schizophrenia, it is important to consider discharge planning as a therapeutic approach for patients.