Mohammad Haji Aghajani; Roxana Sadeghi; Reza Miri; Mohammad Parsa Mahjoob; Fatemeh Omidi; Fatemeh Nasiri-Afrapoli; Asma Pourhosseingoli; Niloufar Taherpour; Amirmohammad Toloui; Mohammad Sistanizad
Volume 10, Issue 1 , January 2022, , Pages 9-15
Abstract
Objective: To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their inhospital mortality as a cardiac biomarker. Methods: The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat ...
Read More
Objective: To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their inhospital mortality as a cardiac biomarker. Methods: The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat one positive polymerase chain reaction (PCR) test in Tehran, Iran from February 2020 to early June 2020. The on admission troponin I level divided into two groups of ≤0.03ng/mL (normal) and >0.03ng/mL (abnormal). The adjusted COX-regression model was used to determine the relationship between the studied variables and patient’s in-hospital mortality. Results: In this study, the median age of subjects was 65 years (54.8% men) and 29.53% of them had abnormal troponin I levels. Besides, the in-hospital mortality rate among patients with abnormal troponin I levels was found to be 51.56%; whereas, patients with normal levels exhibited 18.82% mortality. Also, the multivariable analysis indicated that the risk of death among hospitalized COVID-19 patients displaying abnormal troponin I levels was 67% higher than those with normal troponin I levels (Hazard ratio=1.67, 95% confidence interval=1.08-2.56, p=0.019). Conclusion: It seems that troponin I is one of the important factors related to in-hospital mortality of COVID-19 patients. Next, due to the high prevalence of cardiac complications in these patients, it is highly suggested to monitor and control cardiac biomarkers along with other clinical factors upon the patient’s arrival at the hospital.
Navid Kalani; Naser Hatami; Sajed Ali; Neema John Mehramiz; Fatemeh Rahmanian; Esmaeel Raeyat doost; Marzieh Haghbeen; Samaneh Abiri; Mahdi Foroughian; Mohsen Ebrahimi
Volume 10, Issue 1 , January 2022, , Pages 21-26
Abstract
Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, ...
Read More
Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, respiratory distress, PO2 at arrival, admission length and inhospital death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients. Results: There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant and lower than SRW group (p <0.05). Despite the SRW patients, respiratory distress was associated with lower survival in EMS group (p <0.05). Days passing the symptom’s beginning was significantly different between EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in patients higher than 75 years old in both groups (p <0.05). Higher PO2 at arrival was associated with lower mortality rate of Hazard Ratio of 0.959 (p <0.001) and 0.903 (p <0.001) in EMS and SRW groups, respectively. The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group. Conclusion: It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Mahmoudreza Peyravi; Milad Ahmadi Marzaleh
Volume 9, Issue 4 , October 2021, , Pages 204-205
Abstract
The new corona disease (COVID-19) is very contagious and features a high risk of vast outbreak and infection. The World Health Organization (WHO) declared a global public health emergency condition on 30 January 2020 and a universal epidemic afterwards by given its rapid epidemic worldwide (1). Iran ...
Read More
The new corona disease (COVID-19) is very contagious and features a high risk of vast outbreak and infection. The World Health Organization (WHO) declared a global public health emergency condition on 30 January 2020 and a universal epidemic afterwards by given its rapid epidemic worldwide (1). Iran was amongst the first countries influenced by COVID-19. Iran’s health system was shocked by the fast and vast outbreak of the virus which made it impossible to take appropriate measures on the first days of COVID-19 outbreak for its management. However, Iran made maximal efforts returning to normal conditions. On the other hand, United States (US) sanctions contributed to the worsening of the conditions. The sanctions that mark the US’s economic and political war against Iran, date back to long time ago. These sanctions had indirect, adverse effects on the relief and rescue measures during the 2019 flood in Iran, as well (2). Sanctions are the perfect violation of humanitarian programs and are in conflict with the United Nations (UN) charter and the international human right declaration. Nonetheless, not only COVID-19 had no effects on the US’s perspectives and policies, but the sanctions have also been increased by the US in this period. In fact, the sanctions are the genuine manifestation of the US’s application of terrorism. These sanctions exert subtle physical, psychological, and mental effects on the people based on contribution to further spread of COVID-19.
Sophia Aguirre; Kristen M. Jogerst; Zachary Ginsberg; Sandeep Voleti; Puneet Bhullar; Joshua Spegman; Taylor Viggiano; Jessica Monas; Douglas Rappaport
Volume 9, Issue 3 , July 2021, , Pages 125-132
Abstract
Objective: To investigate in how the current COVID-19 pandemic affects patient’s perceptions of emergency physician empathy and communication. Methods: Patients cared for by Emergency Department physicians with the lowest satisfaction scores were surveyed within one week of discharge via phone. ...
Read More
Objective: To investigate in how the current COVID-19 pandemic affects patient’s perceptions of emergency physician empathy and communication. Methods: Patients cared for by Emergency Department physicians with the lowest satisfaction scores were surveyed within one week of discharge via phone. Using questions from the Consultation and Relational Empathy (CARE) survey, patients rated their satisfaction with their Emergency provider’s empathy and communication on a scale of 1 to 5 and provided feedback on how the patient-provider interaction could be improved. Demographic data and patient responses to CARE survey questions were compared between preCOVID-19 and during COVID-19 time. Patient’s open-ended responses were analyzed for themes related to the impact of COVID-19 on the patient-provider relationship. Results: Patient median quantitative scores were 5 (4-5) across all five questions of pre-COVID-19 and 5 (4-5) during COVID-19 for all questions except two (showing care and compassion), median 5(5-5). Female patients rated provider empathy and communication lower than mens. There was no differences across age strata. A shift in provider focuses to COVID-19 only care (N=3), and an understanding of the stress on healthcare processes (N=13) from open-ended responses themes emerged of patients who want to minimize interactions within the emergency department (N=3). Conclusion: The external factor of the current pandemic did not negatively impact patient’s satisfaction scores. Many patients express leniency and gratitude for emergency providers during this challenging time. Their responses seem to mirror current societal views of frontline healthcare workers.
Shahla Chaichian; Abolfazl Mehdizadehkashi; Shahla Mirgaloybayat; Neda Hashemi; Farahnaz Farzaneh; Roya Derakhshan; Samaneh Rokhgireh
Volume 9, Issue 3 , July 2021, , Pages 145-150
Abstract
Objective: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. Methods: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 ...
Read More
Objective: To evaluate the maternal and fetal outcomes of COVID-19 up to three months after the delivery in pregnant women. Methods: This case series study was conducted on all pregnant women with COVID-19 hospitalized in Hazrat -E- Rasoul Akram Hospital, Tehran, Iran from March 8, 2020 to December 28, 2020. Data were included maternal age and gestational age (GA) which presenting signs and symptoms were collected at hospital admission. To confirm COVID-19 diagnosis, high-resolution computed tomography (HRCT) or reverse transcription-polymerase chain reaction (RT-PCR) tests were conducted. Both the mothers and the newborns were followed up to three months after delivery. Results: Fourteen pregnant women with the median age of 31.5 were enrolled. HRCT was done in twelve mothers (85.7%), and eleven mothers (78.6%) were evaluated via RT-PCR; four of them (36.36%) were positive. Two mothers (14.28%) were admitted to ICU. The cesarean section (C/S) was done following fetal distress in only three mothers due to their concerns of vertical transmission. Two mothers were admitted to the intensive care unit (ICU), and one of them died of pneumomediastinum. Fortunately, no neonatal death was reported three months after the delivery. Conclusion: COVID-19 affects mothers more in the last trimester of the pregnancy. Although no fetal death was reported in the recent study, physicians should closely monitor pregnant women to reduce the adverse event.
Gaurav Kaushik; Ankita Sharma; Dinesh Bagaria; Subodh Kumar; Sushma Sagar; Amit Gupta
Volume 9, Issue 2 , April 2021, , Pages 60-66
Abstract
Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data ...
Read More
Objective: To describe the restructuring if in-hospital systems of care at a Level -1 trauma center in India and to analyze volume and patterns of injury for future preparedness as well as to institute preventive measures for specific injuries during health emergencies like COVID-19.Methods: The data were extracted from a prospectively managed trauma registry at level-1 trauma center in India. We compared data of lockdown period with data of the same number of days from the pre-lockdown period. Patients were grouped according to age, gender, cause of injury, place of injury, injury severity, and injury outcome for comparative analysis between two periods.Results: Total emergency department (ED) footfall due to trauma decreased significantly by 73% during lockdown period. Injuries resulting due to blunt forces, increased significantly. There was a significant decrease in the percentage of patients having major injury. The road traffic injuries (RTIs) cases were less, but number of falls reported increased significantly during lockdown. Significantly less number of patients presented without receiving primary care. Majority of the patients were transported using private cars, police vehicle, and two wheelers during lockdown, however, as expected significantly less number of patients were transported by three wheelers. The comparative analysis between quantitative data points shows significant difference in median ISS and length of stay during lockdown. Conclusion: This study highlighted that the preparedness during health emergencies should not focus solely on the response to treatment of infectious disease but also on ensuring access and provision of reasonable quality of care for non-infectious illnesses, especially acute conditions like trauma.
Mostafa Sadeghi; Peyman Saberian; Parisa Hasani-Sharamin; Fatemeh Dadashi; Sepideh Babaniamansour; Ehsan Aliniagerdroudbari
Volume 9, Issue 2 , April 2021, , Pages 67-72
Abstract
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 ...
Read More
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.
Fatemeh Rahmanian; Naser Hatami; Marzieh Haghbeen; Rahim Raofi; Alireza Abbasi; Heshmatollah Shakeri; Poyan Keshavarz; Elham Rafiee; Mahdi Chegin; Esmaeel Rayad doost; Samaneh Abiri; Navid Kalani; Mahdi Foroughian; Mohsen Ebrahimi
Volume 9, Issue 2 , April 2021, , Pages 80-85
Abstract
Objective: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising mortality rate in Jahrom city. Methods: ...
Read More
Objective: To evaluate the clinical and epidemiological features of deceased patients and comparing the discrepancies between male and female patients based on high prevalence of coronavirus disease 2019 (COVID-19), its irreversible effects and the rising mortality rate in Jahrom city. Methods: This is a descriptive-analytical retrospective study that was conducted from the beginning of March 2020 to the end of November 2020. The study population were included all patients with COVID-19 who admitted to Peymaniyeh Hospital in Jahrom and died of COVID-19. Clinical and demographic data were collected from medical records and analyzed by SPSS software. Results: In this study, 61 patients (57.54%) were men and 45 patients (42.36%) were women. The mean age was 68.7±18.33 in men and 68.82±14.24 in women. The mean hospitalization length was 9.69±7.75 days in men and 9.69±7.75 days in women patients. There was no statistically significant difference between men and women patients (p>0.05). The results showed that 17 (27.87%) men and 28 (45.9%) of women patients had hypertension and the prevalence of this disease was significantly higher in women than men (p=0.01). In this study, 7 (11.48%) men and 13 (21.31%) women had hyperlipidemia. The frequency of hyperlipidemia in women caseswas significantly higher than in men patients (p=0.024). Men cases’ diastolic blood pressure (mean=77.53) was significantly higher than women’s diastolic blood pressure at the same time with a mean of 71.42 (p <0.05). Conclusion: The findings of the study represented the mortality rate in men which is higher than women patients. The prevalence of underlying diseases such as hypertension and hyperlipidemia were higher in women than men. Despite higher mortality among women, symptoms such as fever and dyspnea were less common in women than men.
Rizwan Khan; Arvind Kumar; Mukesh Kumar; Javed Jameel
Volume 9, Issue 1 , January 2021, , Pages 46-47
Abstract
The current COVID-19 situation has been taking a high toll on the healthcare workers who are at constant risk of exposure to the contagion, especially those who are involved in treating the COVID-19 infected patients. The risk of exposure is further high during the surgical procedures, considering the ...
Read More
The current COVID-19 situation has been taking a high toll on the healthcare workers who are at constant risk of exposure to the contagion, especially those who are involved in treating the COVID-19 infected patients. The risk of exposure is further high during the surgical procedures, considering the aerosol generation and prolonged contact with the patients. Performing orthopedic surgeries in PPEs (personal-protective-equipment) is not an easy task. Besides the cumbersome body coverage of PPE gown and hood, and the N95 masks which result in early fatigue and exhaustion, a constantly frustrating issue is the fogging of eyewear which limits surgeon’s vision and ability to perform fine tasks [1].
Fariborz Ghaffarpasand; Mohammad Reza Saki; Nazanin Dadashpour; Zahra Ghahramani; Shahram Paydar
Volume 8, Issue 3 , July 2020, , Pages 133-134
Abstract
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) was first reported in Wuhan, China in December 2019 [1, 2] and was rapidly spread all over the world, being announced as a pandemic on March 11th, 2020 by the World Health Organization ...
Read More
The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) was first reported in Wuhan, China in December 2019 [1, 2] and was rapidly spread all over the world, being announced as a pandemic on March 11th, 2020 by the World Health Organization (WHO) [3]. Approaching the mid of August, approximately 20 million people are infected worldwide and 720,000 have died due to the infection and its complications [4]. The virus causes respiratory infection and involves both the upper and lower respiratory tract as well as the gastrointestinal tract, hepatic, neurologic and renal systems [5].
Hossein Akbarialiabad; Hossein Aabdolrahimzadeh fard; Hamid Reza Abbasi; Shahram Bolandparvaz; Shahin Mohseni; Vahid Mehrnoush; Mina Salehi; Sima Roushenas; Shahram Paydar
Volume 8, Issue 3 , July 2020, , Pages 199-201
Abstract
During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide ...
Read More
During the past few months, the novel coronavirus 2019 (COVID-19) pandemic has significantly affected medical service provision. In Iran, it has caused around 197,000 inflictions and 9200 deaths up to June 18, 2020. While many departments turned to telehealth in this era, the trauma service should provide non-stop in presence service to the trauma victims. Our trauma center is the largest in the southwest of Iran, with the mean annual admission of 18,500 polytrauma patients. In this center, we designed a safety protocol to mitigate the spread of disease and also have a more robust case finding system, especially among asymptomatic carriers who attend hospitals based on their trauma. In brief, all unstable patients were considered SARS-COV-2 positive and were directed toward the Specialized COVID-19 related ICU. For all stable patients, history, physical examination, CXR, and lab test (Complete Blood Count, Erythrocyte Sedimentation Rate, C-Reactive Protein) were ordered before entering the wards. If there was any suspicion of COVID-19, the stable patient was admitted to the COVID-19 specialized ward. Among all 1805 patients admitted during a ten weeks interval (from January 30, 2020, to April 14, 2020), 84 had a red flag and toward to COVID-19 related wards. Of those, 67 had positive PCR or evidence in CT in favor of the COOVID-19. Moreover, during regular workups, we found that 19 completely asymptomatic trauma victims had typical Chest CT scan findings of COVID-19.
