Imam Khomeini Hospital Complex Research Articles

Long-term survival after hepatic resection for colorectal liver metastases: a single-center study in Iran

BackgroundSurgical resection of colorectal cancer liver metastasis (CRLM) has been associated with improved survival in these patients. The purpose of this study was to investigate the usefulness of liver metastasectomy, also finding independent factors related to survival after liver metastasectomy.MethodsIn a retrospective study, all patients with CRLM who underwent resection of liver metastases between 2012 and 2022 at Imam Khomeini Hospital Complex in Tehran, Iran, were enrolled. All patients were actively followed based on clinicopathologic and operative data.ResultsA total of 248 patients with a median follow-up time of 46 months (Range, 12 to 122) were studied. Eighty-six patients (35.0%) underwent major hepatectomy, whereas 160 (65.0%) underwent minor hepatectomy. The median overall survival was 43 months (Range, 0 to 122 months), with estimated 1-, 3- and 5-year overall survival rates of 91%, 56%, and 42%, respectively. Multivariate analysis demonstrated that a metastasis size > 6 cm, major hepatectomy, rectum as the primary tumor site, and involved margin (< 1 mm) were independent factors associated with decreased overall survival (OS).ConclusionSurgical resection is an effective treatment for patients with CRLM that is associated with relatively favorable survival. A negative margin of 1 mm seems to be sufficient for oncological resection.

A placebo-controlled, crossover trial to investigate the efficacy of tiotropium bromide or placebo added to usual care in stable symptomatic post-hematopoietic stem cell transplantation (HSCT) bronchiolitis obliterans syndrome (BOS).

Despite the fundamental progress in hematopoietic stem cell transplant, this treatment is also associated with complications. Graft-versus-host disease is a possible complication of HSCT. Bronchiolitis obliterans syndrome (BOS) is the pulmonary form of this syndrome. Due to the high morbidity and mortality rate of BOS, various studies have been conducted in the field of drug therapy for this syndrome, although no standard treatment has yet been proposed. According to the hypotheses about the similarities between BOS and chronic obstructive pulmonary disease, the idea of using tiotropium bromide as a bronchodilator has been proposed. A randomized, double-blind, placebo-controlled, and crossover clinical trial is being conducted to evaluate the efficacy of tiotropium in patients with BOS. A total of 20 patients with BOS were randomly assigned (1:1) to receive a once-daily inhaled capsule of either tiotropium bromide (KP-Tiova Rotacaps 18 mcg, Cipla, India) or placebo for 1 month. Patients will receive tiotropium bromide or placebo Revolizer added to usual standard care. Measurements will include spirometry and a 6-min walking test. This study was approved by the Research Ethics Committees of Imam Khomeini Hospital Complex, Tehran University of Medical Science. Recruitment started in September 2022, with 20 patients randomized. The treatment follow-up of participants with tiotropium is currently ongoing and is due to finish in April 2024. The authors will disseminate the findings in peer-reviewed publications, conferences, and seminar presentations. Iranian Registry of Clinical Trial (IRCT) IRCT20200415047080N3. Registered on 2022-07-12, 1401/04/21.

Influential factors for final neurorehabilitation outcome scores in patients with spinal cord injury: A longitudinal cohort study

Study designLongitudinal prospective cohort study. ObjectivesTo assess the coefficient of efficacy and the influence of various demographic and neurological factors on changes in Spinal Cord Independence Measure III (SCIM-III) scores over time in traumatic spinal cord injury (TSCI) patients. SettingPatient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center in Imam Khomeini Hospital Complex, Tehran, Iran. MethodsThe study was performed over an 8-year period in our outpatient rehabilitation setting. Changes in SCIM-III scores were assessed in 559 TSCI patients (of 1460 enrolled patients) who fit the inclusion criteria. All included patients participated in our outpatient rehabilitation program, which consisted of a multidisciplinary education program combined with occupational therapy, physical therapy, and home nursing as a rehabilitation package for a 6-month period. Patients then received follow-up assessments every 6 months. ResultsPredictors of the SCIM-III score as a rehabilitation outcome tool, and of its change over time, included age (younger patients had better outcomes, p = 0.067), marital status (married patients had better outcomes, p = 0.031), education level (patients with university education had better outcomes, p = 0.003), occupation status (employed patients had better outcomes, p = 0.009), and neurological level of injury (patients with injuries at lower levels had better outcomes, p < 0.001). However, sex and injury severity as per the American Spinal Injury Association Impairment Scale (AIS) had no significant effects on functional outcomes (i.e., SCIM-III score changes over time). ConclusionAge, marital status, education level, employment, and neurological level all affected the final SCIM-III scores of SCI patients. By contrast, sex and AIS grade were not significant predictors of SCIM-III outcomes. Further studies that include additional factors may be useful for future SCIM-III models.

Clinical Characteristics of Patients with Hematologic Malignancies and Invasive Aspergillosis: A Cross-sectional Clinical Report from Iran

Background: The incidence of invasive aspergillosis (IA) has significantly increased in recent decades. In patients with hematologic malignancies (HM), IA is associated with higher mortality rates. Objectives: This study aimed to assess the clinical features of IA in patients with HM. Methods: In this retrospective study, we used the hospital information system (HIS) database to extract clinical and paraclinical characteristics of patients with various HMs who received a diagnosis of probable or proven IA during their hospitalization at Imam Khomeini Hospital Complex in Tehran, Iran, between March 2018 and March 2022. Results: After evaluating 350 patients with HM, 51 patients with IA (14.6%) were identified, of whom 40 cases (78.4%) were probable and 11 (21.6%) were proven. Among these, 34 individuals (66.7%) were male. The most common symptoms were fever (n = 23, 62.7%), cough (n = 20, 39.2%), and fever that did not respond to antibiotic therapy (n = 16, 31.4%). The most prevalent malignancies were AML (n = 28, 54.9%), ALL (n = 16, 31.4%), and lymphoma (n = 7, 13.7%). Out of the 51 patients with HM and IA, 48 (94.1%) had abnormal findings on chest CT scans, with the majority (n = 31, 72.1%) showing a nodule with a halo sign. Aspergillus flavus (n = 19/24, 79.2%) was the most commonly isolated species. Initially, patients received liposomal amphotericin B or caspofungin as empiric antifungal therapy, which was then switched to voriconazole once the diagnosis of IA was probable or proven. Eight patients (15.6%) died. Conclusions: Patients with HM presenting with fever and cough should undergo close monitoring for IA. A higher incidence of IA is observed in AML patients, and voriconazole could be considered as antifungal prophylaxis in HM patients. A. flavus is likely the most frequent cause of IA in Iranian patients with HM.

Relationship between body mass index and disease severity in COVID-19 patients admitted from April to September 2020 at Imam Khomeini Hospital Complex, Tehran, Iran

Relationship between body mass index and disease severity in COVID-19 patients admitted from April to September 2020 at Imam Khomeini Hospital Complex, Tehran, Iran

Liver Transplant in Patients With Autoimmune Hepatitis: A Large Single-Center Study.

Autoimmune hepatitis is a rare indication for liver transplant in Western countries. Our goal was to identify characteristics and long-term outcomes of patients who underwent liver transplant for autoimmune hepatitis-related end-stage liver disease at our center. Adult patients who underwent primary liver transplant from January 2007 to March 2022 at Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran, were enrolled in our study. Among 1107 patients enrolled in our study, mean age was 45.94 ± 12.43 years (range, 16-73 years) and 423 (38.2%) female patients were included. Autoimmune hepatitis was the underlying cause of cirrhosis in 177 patients (experimental group); the other 930 patients did not have autoimmune hepatitis (control group). All patients were followed for a median of 60 ± 40.3 months (range, 3-187 months) after transplant. In the experimental group, patient survival rates at 1 month, 1 year, and 3 years were 87%, 81%, and 78%, which were not significantly different between the 2 groups (P = .445). Recurrence of autoimmune hepatitis was detected in 8 patients (4.5%) in the experimental group. Acute allograft rejection was more significantly detected in the patients with recurrence of autoimmune hepatitis than in patients without recurrence of autoimmune hepatitis. Liver transplant in patients with autoimmune hepatitis is safe and is associated with good outcomes.

Prevalence of Sputnik V COVID-19 Vaccine Side Effects Among Healthcare Workers in a Tertiary Care, Academic Center in Tehran City, Iran

Background and Purpose: COVID-19 vaccine side effects predominantly affect public confidence in vaccination. Therefore, this study evaluated the rate and severity of adverse reactions associated with the COVID-19 Sputnik V vaccine among tertiary healthcare providers in an academic medical center. Materials and Methods: This retrospective observational study was carried out from March 2021 to August 2021 among Imam Khomeini Hospital Complex healthcare workers, a tertiary referral healthcare center affiliated with Tehran University of Medical Sciences. Participants provided demographic and clinical information through a validated questionnaire after being interviewed. The frequency, severity, and outcome of all reactions after vaccination were recorded. The study utilized SPSS software, version 24.0 to conduct descriptive statistics on baseline variables and inferential statistics to examine associations between vaccine side effects and gender, medical history, and COVID-19 history of the participants. Additionally, ordinal regression analysis was employed to identify factors predicting the severity of adverse effects after the first and second doses of the Sputnik V vaccine. Results: A total of 372 participants (54.3% female) with a mean age of 36.5±9.18 years were recruited. The rate of at least one side effect was 77.15% and 57.8% after the first and second doses, respectively. The most common side effects among participants were myalgia (48.4% after the first and 28.2% after the second dose), injection site pain (26.3% after the first and 12.6% after the second dose), and fever (19.6% after the first and 12.9% after the second dose). The higher rate of fever and myalgia after the first dose was observed among subjects with a history of COVID-19. Conclusion: Among healthcare workers, the side effects following the first and second doses of the Sputnik V vaccine were primarily mild, with no cases requiring hospitalization. Further research is required to assess potential side effects in larger and diverse populations with varying demographic and social characteristics.

The Dilemma of Underutilized Health Insurance: A Matched Case-Control Study Investigating Reasons in Iran's Free Universal Health Insurance.

In May 2014, the Iranian government announced it would cover all uninsured Iranians. Despite free-of-charge insurance, the studies found that the coverage still needed to be completed (93%). This study aimed to understand why certain population groups remain without insurance despite the accessibility of free-of-charge coverage. This issue is not unique to Iran; it is prevalent in many other countries where, despite free coverage, not all individuals avail themselves of it, thereby exposing themselves to risks. In a matched case-control study, 89 non-insured patients were compared with 178 hospital-based controls with health insurance (2:1). The samples were recruited at one of the leading public hospitals in the country (Imam Khomeini Hospital Complex in Tehran) in 2019. Two insured controls were selected and matched for age (± five years) and sex for each person without insurance. A conditional logistic regression was performed to assess the magnitude of effects and the goodness of fit test used to examine the model. Unemployment (Odds Ratio (OR)=8.33, 95% Confidence interval (CI): 1.05-50.0), being single (OR=3.69, CI: 1.18-11.55), low economic status (OR=1.85, CI: 1.02-3.33) and attitude towards performance of health insurance (OR=0.86, CI: 0.75-0.99) were affected not having health insurance. Approaches that cover the entire population may struggle to ensure no one is left without needed services. There is a need for greater focus on vulnerable groups to achieve universal health coverage conscientiously. Moreover, improved services and education can positively shape public perceptions of insurance efficacy, affecting their enrollment choices.

Assessment of manometric results following posterior pericervical repair or level I to III surgical procedures.

Constipation and obstructive bowel disorders are the most common symptoms of prolapse and posterior defects. Prolapse and obstructive defecation disorders are treated using various surgical techniques to repair posterior defects. This study aimed to evaluate the manometry results of patients before and after reconstructive surgery of the posterior compartment. This retrospective cohort study included 40 women with defecation disorders referred to the Imam Khomeini Hospital Complex, an academic center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from 2020 to 2021. Data were collected through medical records and a checklist developed by the researcher before and after surgery. All analyses were performed using SPSS software (version 26), with significance at p<0.05. Forty women with a mean age of 49.47±9.66 years participated in this study. The manometry results showed significant differences in patients before and after surgery in parameters such as maximum resting pressure, push test, constipation, straining during defecation, finger support necessity, sensation of incomplete defecation, dyspareunia, and husband's sexual satisfaction (p<0.001). In addition, all patients had a grade 2 or higher posterior compartment prolapse, which improved in all cases after surgery (p<0.0001). Patients' symptoms significantly improved during the 12-month follow-up after DeLancey level 3 to 1 surgery. This type of surgery proved to be an effective surgical intervention without significant complications in the short-term follow-up.

Prevalence of Postoperative Nausea and Vomiting in Orthopedic Patients in Imam Khomeini Hospital Complex during 2018-2019: A Cross-Sectional Study

Background: Postoperative nausea and vomiting (PONV) is one of the most common postoperative complaints of the patients that affects the surgical outcome, quality of life, length of hospital stay, and costs. The prevalence of nausea and vomiting is estimated at 52% and 25% within the first 24 hours after surgery. Many risk factors have been identified for PONV, including female gender, being a non-smoker, young age, general anesthesia, use of volatile anesthetics and Nitrous Oxide, and duration of anesthesia. Following receiving reports indicating an unusually high prevalence of PONV in the male orthopedic ward of Imam Khomeini Hospital Complex despite applying regional techniques, the present study was conducted to investigate its prevalence and possible reasons.&#x0D; Methods: After obtaining informed consent, 300 patients admitted to male and female orthopedic wards of Imam Khomeini Hospital complex that had undergone surgery within the past 48 hours were interviewed in person and their medical records were reviewed.&#x0D; Results: Of 300 patients, 61 (20.3%) had nausea and 39 (13%) had vomiting. Three patients (1%) experienced recurrence of PONV after treatment. The risk factors associated with PONV were female gender, history of motion sickness, general anesthesia with sodium thiopental, atracurium, IV lidocaine, isoflurane, neostigmine, and postoperative administration of ciprofloxacin.&#x0D; Conclusion: The prevalence of PONV was lower than other studies, which was in contrast to reports received from the ward, indicating a reduction in PONV following the use of regional techniques.

Early Versus Late Tracheostomy in Mechanically Ventilated COVID-19 Patients: A Comparative Study

The decision to perform tracheostomy during the COVID-19 pandemic has been based mainly on practical and empirical standards. Also, the amount of scientific evidence to determine the exact timing of tracheostomy in patients with severe COVID-19 on mechanical ventilation is not significant. We conducted a retrospective cohort study on mechanically ventilated COVID-19 patients from April 25, 2021 to January 25, 2022 in intensive care units of Imam Khomeini Hospital Complex, Tehran, Iran. The 30-day survival of patients was calculated and compared between patients under tracheostomy and those without tracheostomy. A number of 135 COVID-19 cases (75 patients in the intubated group and 60 patients in the tracheostomy group) were included in this study. The mean age of the population was 53.6±12.4. The overall mortality rate was 101 (74.8%). The 30-day mortality rate was significantly higher in the intubated group (90.6%) than in the tracheostomy group (55%) (P&lt; 0.001). The mortality rate was 60% in the early (≤ 7 days) tracheostomy group and 50% in the late (&gt;7 days) group. This difference was not statistically significant (P&gt; 0.05). Tracheostomy is a preferred method in airway management of severe COVID-19 patients under mechanical ventilation; however, early tracheostomy during the first week of intubation may not be superior to late tracheostomy in decreasing the mortality rate.

Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality.

Infections, including invasive fungal infections (IFIs), are among the leading causes of mortality in liver transplant recipients during the first year post-transplantation. To investigate the epidemiology, clinical manifestations, risk factors, treatment outcomes, and mortality rate of post-liver transplantation invasive aspergillosis (IA). In this case-control study, 22 patients with IA were identified by reviewing the archived and electronic medical records of 850 patients who received liver transplants at the Imam Khomeini Hospital complex in Tehran, Iran, between 2014 and 2019. The control group comprised 38 patients without IA infection matched for age and sex. The information obtained included the baseline characteristics of liver transplant patients, operative reports, post-transplantation characteristics of both groups and information about the fungal infection of the patient group. The prevalence rate of IA among liver transplant recipients at Imam Khomeini Hospital was 2.7%. The risk factors of IA among studied patients included high serum creatinine levels before and post-transplant, renal replacement therapy, antithymocyte globulin induction therapy, post-transplant bile leakage, post-transplant hepatic artery thrombosis, repeated surgery within 30 d after the transplant, bacterial pneumonia before the aspergillosis diagnosis, receiving systemic antibiotics before the aspergillus infection, cytomegalovirus infection, and duration of post-transplant hospitalization in the intensive care unit. The most prevalent form of infection was invasive pulmonary aspergillosis, and the most common chest computed tomography scan findings were nodules, pleural effusion, and the halo sign. In the case group, prophylactic antifungal therapy was administered more frequently than in the control group. The antifungal therapy response rate at 12 wk was 63.7%. The 3- and 12- mo mortality rates of the patients with IA were 36.4% and 45.4%, respectively (compared with the mortality rate of the control group in 12 mo, which was zero). In this study, the prevalence of IA among liver transplant recipients was relatively low. However, it was one of the leading causes of mortality following liver transplantation. Targeted antifungal therapy may be a factor in the low incidence of infections at our facility. Identifying the risk factors of IFIs, maintaining an elevated level of clinical suspicion, and initiating early antifungal treatment may significantly improve the prognosis and reduce the mortality rate of liver transplant recipients.

The Blood Sugar Trends in Patients with Diabetic Foot Ulcers: A Comparative Study before and after Amputation Surgery

Background: The diabetic foot is a chronic complication of diabetes. There is a strong relationship between glucose levels, the severity of diabetic foot ulcers (DFUs), and the need for amputation. This study aimed to evaluate the blood sugar (BS) trends before and after surgery in patients with DFU who had been amputated.&#x0D; Methods: The adult patients who had undergone DFU-related amputation surgery between 2017 and 2020 in Imam Khomeini Hospital Complex, Tehran, Iran, were evaluated. The cases whose BS levels were charted at least three days before and after amputation were recruited. The main data, including hypoglycemia (defined as a blood glucose level &lt; 70 mg/dl) and mean BS and fasting BS (FBS) levels, were recorded. The data were then analyzed and compared before and after amputation.&#x0D; Results: Of 267 patients reviewed for inclusion criteria, 55 patients were included in the study. Twenty-eight patients (50.9%) were men, and the mean age was 60 years. The mean FBS before and after amputation was 229.5 and 181.3 mg/dl, respectively, and the mean BS before and after amputation was 227.3 and 197.8 mg/dl, respectively. The differences were significant (P &lt; 0.001). Twelve patients (21.8%) before and 21 patients (36.4%) after amputation suffered from hypoglycemia (P = 0.057).&#x0D; Conclusion: DFU-related amputation is associated with a significant decrease in blood glucose levels and inflammatory indexes. However, it can increase the risk of hypoglycemia during the first three days after the surgery.

Posteromedial Translation for Correction of Severe Hypokyphosis in Adolescent Idiopathic Scoliosis: Outcome Analysis with 2-year Follow-ups

Background: The deformity in the coronal plane is over-emphasized in the surgical management of adolescent idiopathic scoliosis (AIS), whereas the importance of the patient’s sagittal profile is generally neglected. Gold standard treatment in AIS consists of posterior instrumentation, deformity correction - through a reduction maneuver - and arthrodesis. The main focus in most reduction techniques is placed on the correction of deformity in the coronal and/or axial plane, worsening the patient’s sagittal profile. Objectives: This outcome analysis study aimed to investigate the surgical treatment of AIS patients with severe thoracic hypokyphosis (&lt; 10) by adopting the posteromedial translation technique (PMT). Methods: In this retrospective study, the data and records of the patients with minimum 2-year follow-ups were analyzed. Correction of the deformity was radiologically assessed based on Cobb’s angle, thoracic kyphosis, and apex translation. The Scoliosis Research Society 22-item questionnaire (SRS-22r) was used for clinical evaluation before and after the surgery. Results: A total of 11 AIS patients (8 females and 3 males) with hypokyphosis underwent operations by the PMT at Imam Khomeini Hospital Complex between 2000 and 2020. According to the results, 78% correction in the coronal plane and an average correction of 56° (P &lt; 0.001) were obtained. As for the sagittal plane, 18.8° correction was recorded (75%) (P &lt; 0.001). Scoliosis Research Society 22-item questionnaire subscale analysis showed a significant improvement in patients' self-image (P = 0.035) and satisfaction (P = 0.043). Conclusions: The management of hypokyphosis in AIS was challenging. The PMT facilitated the tri-planar deformity correction, including a restoration of the thoracic kyphosis in all patients. A significant improvement was observed in both the coronal and sagittal profiles of the patients.

Factors affecting the incidence of surgical site infections after geriatric hip fracture surgery: a retrospective study during 2017-2020.

Geriatric hip fracture are a common and disruptive public health problem worldwide. Surgical Site Infection (SSI) can be a devastating complication of this injury. By identifying these factors, the adverse outcomes of elderly hip fractures can be prevented. The objective of this study was to identify factors affecting the incidence of surgical site infection after geriatric hip fracture surgery. In this retrospective study, 440 patients (60 years or older) underwent hip surgery at Imam Khomeini Hospital Complex were selected based on census between April 2017 and March 2020. Demographics information, and additional comorbidities and operation-related variables were extracted and analyzed. Data analyses were performed by descriptive statistics and inferential statistics. SPSS-19 software was used in this study and P values less than 0.05 were considered significant. The results of univariate analyzes showed that the type of surgery (p=0.005), readmission (p=0.0001) and level of self-care (p=0.001) were significantly associated with Surgical Site Infection (SSI). The results of regression analysis showed that history of readmission and self-care at all levels on SSI. The findings showed that the history of readmission and self-care at all levels is effective on SSI in the elderly with hip fractures. Therefore, it can be concluded that by identifying the factors affecting the SSI with hip fractures, fewer acute complications, reduced death and shorter length of hospital stay.

A Study of Platelet-Derived Growth Factor A and Its Ligand among Patients with Glioblastoma and Astrocytoma in Imam Khomeini Hospital Complex, Tehran

A Study of Platelet-Derived Growth Factor A and Its Ligand among Patients with Glioblastoma and Astrocytoma in Imam Khomeini Hospital Complex, Tehran

Laboratory Findings and Outcomes of Critically Ill COVID-19 Patients

Background: COVID-19 patients have various laboratory findings associated with severe conditions and higher mortality rates. We conducted this study to evaluate the laboratory changes and their effect on the mortality of critically ill patients with COVID 19.&#x0D; Methods: This cohort study evaluated the laboratory changes in 192 patients admitted to intensive care units of Imam Khomeini hospital complex, Tehran, Iran. The patients with manifestations of severe COVID-19 of both sexes and older than 16 years were enrolled in the study. The primary outcome was the laboratory changes, and the secondary outcome was the death or survival of the patients. The laboratory data were recorded on the admission day, followed daily by the changes and the neutrophil-lymphocyte ratio (NLR). The laboratory changes of two groups of survived or non-survived patients were compared by chi-square for categorical variables. An independent sample t-test was applied to study the differences between the two groups' continuous variables. Values are shown as mean±SD.&#x0D; Results: Of all the 192 patients, 123 (64.06%) were male, and 69 (35.93%) were female. The survived group was 86 (44.79%), and the non-survived group was 106 (55.20%). Age (62.31±13.77), sex, and BMI (27.34±4.63) were not significantly different in the two groups (P value= .248, .368, and .444, respectively). NLR, lactate dehydrogenase/lymphocyte (LDH/LYM) ratio were significantly different in the two groups (P value= .000, .004, respectively).&#x0D; Conclusion: COVID-19 patients have a variety of laboratory findings. NLR and LDH/LYM ratios have a prognostic value in severe COVID-19 patients.

Characteristics and outcomes of COVID-19 patients during the BA.5 omicron wave in Tehran, Iran: a prospective observational study

BackgroundOmicron (B.1.1.529) is the fifth variant of concern of SARS-CoV-2, which has several subvariants. Clinical features of BA.1 and BA.2 infections have been described in the literature, but we have limited information about the clinical profile of BA.5, which caused the seventh wave in Iran.MethodsA prospective observational study was conducted on the BA.5 confirmed patients referred to Imam Khomeini Hospital Complex, Tehran, Iran, from 11th to 31st August 2022. The patients were divided into the two groups of outpatients and hospitalized patients, and their clinical, radiological, and laboratory data and outcomes were recorded and analyzed.ResultsWe included 193 patients with confirmed BA.5 infection, of whom 48 patients (24·8%) were hospitalized. The mean age of the patients was 45·3 ± 16·5 years, and 113 patients (58·5%) were female. The mean number of days patients had symptoms was 6·8 ± 2·4 days. The most common symptoms were weakness (69·9%), sore throat (67·4%), myalgia (66·3%), hoarseness (63·7%), headache (55·4%), fatigue (54·9%), and dry cough (50·3%). Fever and dyspnea were significantly more observed in the hospitalized patients (p < 0·0001). The COVID-19 vaccination rate was significantly lower in hospitalized patients than in outpatients (35/48–72·9% vs. 140/145 − 96·6%, p < 0·0001). The most common underlying diseases were hypertension (16·1%), diabetes mellitus (9·8%), and cardiovascular diseases (9·8%), all of which were significantly more common in hospitalized patients. Lung opacities were observed in 81·2% of hospitalized patients. By the end of our study, 1·5% of patients died despite receiving critical care services.ConclusionsOur findings suggested that BA.5 symptoms are more non-respiratory and usually improve within 7 days. Although the proportion of hospitalized patients is still significant, very few patients require intensive care. COVID-19 vaccination is effective in reducing the hospitalization rate.Trial registrationNot applicable. This study is not a clinical trial.

The feasibility and acceptability of an early tele-palliative care intervention to improve quality of life in heart failure patients in Iran: A protocol for a randomized controlled trial

BackgroundHeart failure (HF) has become a global health problem that has affected the quality of life of millions of people. One approach to improving patients’ quality of life (QoL) with chronic diseases such as HF is palliative care. In Iran, the bulk of palliative care research is directed to patients with cancer, with the primary focus on the physical aspect rather than the psychosocial and spiritual aspects of palliative care. To address this gap, this study aims to determine the feasibility and acceptability of this early tele-palliative care intervention to improve quality of life in heart failure patients in Iran. MethodsThe early tele-palliative care versus usual care study is designed as a single-centre, randomised, feasibility trial of 50 patients with heart failure aged 18 to 65 and clinician-determined New York Heart Association class II/III or American College of Cardiology stage B/C HF, recruited in Imam Khomeini Hospital Complex, Tehran, Iran. This intervention contains 6 weekly educational webinars and concurrent WhatsApp® group activities. Program feasibility and acceptability will be assessed by measuring the recruitment, attrition, and questionnaire completion rates; satisfaction and attitudes about the intervention will be measured via a telephone-based interviews. Secondary outcomes of Qol, mood status and number of emergency department visits will be measured with validated instruments. Participants in both groups will be followed up for 6 weeks, and the measures will be re-administered. Appropriate statistical tests will be used to analyse the data. ConclusionThis is the first early tele-palliative care intervention designed for heart failure patients in Iran. The intervention has been developed by a multidisciplinary team of academic and clinical professionals with patient stakeholder input to create a rigorous and culturally responsive approach for palliative care delivery for heart failure patients in Iran. Trial registrationIRCT registration number - IRCT20100725004443N29.

Organizational Ethics Indicators in Iranian Hospital: An Importance-Performance Analysis.

Organizational ethics focuses on the importance of how organizations behave when faced with specific situations and decisions. This study aims to identify and prioritize organizational ethics indicators in Imam Khomeini Hospital Complex (IKHC) in Iran. This was a mixed-method research project. To recognize hospital ethics indicators, 18 semistructured interviews were conducted and 38 indicators were identified through thematic analysis. In the next stage, a quantitative approach was adopted to use the importance-performance matrix for data analysis. This part was a descriptive survey with a statistical population consisting of nurses, medical, clinical, and administrative staff. The questionnaire was distributed using the random sampling method, and a total of 349 samples were collected. Based on the interviews and open coding, 73 themes were identified for organizational ethics indicators and classified into two main groups: "ethics drivers in hospital" and "personal ethics." After measuring content validity, 35 indicators of organizational ethics in IKHC were examined in terms of importance and performance. The results showed that nine indicators had high importance and poor performance, 11 had high importance and performance, nine had low importance and performance, and finally six indicators had low importance and high performance, and according to these findings, practical suggestions were put forward. Based on the identified indices and by applying importance-performance analysis, it is recommended to continually assess the status of ethics in hospitals and offer strategies for improving organizational ethics.