Imam Khomeini Hospital Research Articles

Investigating the Relationship Between the Levels of Hematological and Biochemical Parameters of COVID-19 Patients with the Length of Hospitalization

Background: Identifying and treating patients with COVID-19 requires the use of quick and precise laboratory diagnostic techniques that assess the patient's health and identify the illness. Aim: This study was conducted to determine the relationship between hematological and biochemical parameters and length of hospitalization in patients with COVID-19. Methods: This is a cross-sectional study of a descriptive-analytical type, which was conducted by census method on 360 medical records of patients with COVID-19 in Imam Khomeini Hospital in Jiroft in 2022. Data were analyzed using descriptive and inferential statistics tests. Results: The average number of days of hospitalization in the present study was 4 days. The rate of COVID-19 was higher in men than in women. The most common underlying diseases in the patients were heart, pulmonary, and diabetes. Among the biochemical parameters, only lactate dehydrogenase (LDH), blood urea nitrogen (BUN), aspartate aminotransferase (AST), alanine transaminase (ALT), platelet (PLT), and erythrocyte sedimentation rate (ESR) parameters had a statistically significant relationship with the total length of hospitalization (P-value<0.001). LDH, AST, ALT, creatinine (Cr), creatine phosphokinase (CPK), blood sugar (BS), total bilirubin, and direct bilirubin parameters were higher than normal in hospitalized patients. Conclusion: The results showed that there is a relationship between LDH, BUN, AST, ALT, PLT, and ESR parameters and the length of hospitalization of patients. The levels of LDH, AST, ALT, Cr, CPK, BS, total bilirubin, and direct bilirubin parameters in patients were higher than normal.

Psychometric properties of Farsi version of Demoralization Scale-II (DS-II) in Iranian cancer patients.

Demoralization, a prevalent form of psychological distress, significantly impacts patient care, particularly in terminally ill individuals, notably those diagnosed with cancer. This study aimed to assess psychometric properties of Farsi version of Demoralization Scale-II (DS-II) in Iranian cancer patients. This study was descriptive-analytical cross-sectional research. The statistical population was cancer patients who sought treatment at Imam Khomeini Hospital in Tehran throughout the 2021-2022. In the initial phase of the study, a preliminary sample comprising 200 patients was carefully selected through convenience sampling. After applying these criteria, 160 patients satisfactorily completed the questionnaires, forming the final study sample. They completed series of questionnaires that included sociodemographic information, DS-II, Scale of Happiness of the Memorial University of Newfoundland, and Beck Depression Inventory (BDI-II). The evaluation included exploratory factor analysis, confirmatory factor analysis (CFA), assessments of convergent validity, and internal consistency reliability. The CFA revealed a 2-factor model consistent with the original structure. The specific fit indices, including the Comparative Fit Index, Root Mean Square Error of Approximation, and Goodness-of-Fit Index, were 0.99, 0.051, and 0.86, respectively. Significant correlation coefficients (p < 0.05) were found between the DS-II and the Beck Depression and MUNSH Happiness scales. The internal consistency of the DS-II, as measured by Cronbach's alpha, yielded values of 0.91 for the meaning and purpose factor, 0.89 for the coping ability factor, and 0.92 for the total score. The Farsi version of DS-II has demonstrated reliability and validity in evaluating demoralization among cancer patients in Iran. This tool can offer valuable insights into the psychological problems of terminally ill patients. Further research opportunities may include conducting longitudinal studies to track demoralization over time and exploring the impact of demoralization on the overall well-being and care of terminally ill patients in Iranian society.

One Public Health Crisis into Many Others: The Impact of COVID-19 on Upstaging of Gastric Cancer

Background: This study aimed to investigate how COVID-19 affects patients with Gastric Cancer (GC) and what should be expected to happen in post-CVOID-19 era. Methods: A retrospective study of GC patients referring to Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences in two parallel time periods of February 25th to December 25th of 2020 and the same period in 2019 was conducted. Results: Twenty-six patients during COVID-19 pandemic and 54 patients during pre-COVID-19 time were recruited. Mean age, gender, tumor location and T status distribution did not show statistically significant difference between study groups (all p-values &gt;0.05). Regarding N status, distributions of N0, N1, N2 and N3 in pre-COVID group were as follows: 2(3%), 21(39%), 25(48%) and 6(10%). In COVID-19 period, group N0 was not reported and N1, N2 and N3 were 7(27%), 7(27%) and 13(46%), respectively (p-value &lt;0.05). Among pre-COVID patients, 6(11%) patients had gross metastasis in Staging Laparoscopy (SL) and 10(18.5%) patients had positive malignant cytology. In COVID-19 group positive SL and positive cytology were found in 9(35%) and 11(42%) patients, respectively (all p-values &lt;0.05). Conclusion: Health care systems should adopt reasonable approaches to cancer management, otherwise we might face the upcoming pandemic of locally advanced and metastatic cancers.

Placental Histopathological Changes and the Level of Anti-Spike Antibody After Covid-19 Vaccination During Pregnancy: A Case Series

Background: COVID-19 infection during pregnancy could be associated with placental histopathological changes such as vascular diseases and malperfusion. There are studies showing that mRNA vaccines are not associated with significant placental pathological changes. Our objective was to evaluate the placental histopathology in pregnant women who received Sinopharm, an inactivated virus vaccine, during pregnancy. Case Presentation: The study included placental samples collected from mothers who gave birth of living singletons through elective cesarean sections performed between March 2022 and May 2022 at Imam Khomeini Hospital Complex. The study included women who had no history of positive reverse transcription polymerase chain reaction (RT-PCR) testing for COVID-19 during pregnancy, and had received at least one dose of COVID-19 vaccine during their pregnancy. Humoral levels of anti-SARS-CoV-2 spike IgG were measured in both the mothers and neonates. Results: The study included 20 mother-neonate pairs. The mean maternal age was 34±3.6 years, and all mothers received Sinopharm vaccine as their first and second doses. The last vaccine dose was administered during pregnancy, with 3 mothers receiving it in the first trimester, 9 in the second trimester, and 8 in the third trimester. The histopathological findings in the placental samples included decidual vasculopathy, subchorionic thrombosis, and chronic histiocytic intervillositis. All mothers and neonates, except one pair, were positive for anti-spike antibody. Conclusion: Multiple abnormal histopathological findings were reported in placenta of vaccinated mothers. However, similar to previous studies, these placental findings are considered mild lesions and have been observed in both vaccinated and unvaccinated mothers.

Assessing the state of cognitive performance of employees and determining the range of thermal comfort of different genders in Ilam hospitals

Introduction: Thermal comfort is essential for a productive work environment and affects the well-being and performance of employees, so maintaining optimal levels of satisfaction, productivity, and efficiency, especially in indoor spaces, is essential. Therefore, the present study's aim is to evaluate the state of cognitive performance. Employees and determination of the thermal comfort range of different genders of employees in the hospitals of Ilam city were done. Methods and Materials: This research was conducted by survey and field method to identify the state of thermal comfort and cognitive performance of people in the real conditions of therapeutic spaces. For this purpose, the responses of 400 employees of five hospitals in Ilam City were recorded by simple sampling from the beginning of August to November 1402. The reliability status of the questionnaires was confirmed using Cronbach's alpha, and the thermal comfort status of the people was determined through the regression model. Linearity and correlation analysis between measured variables were analyzed through SPSS27 software. Results: The analysis of the linear regression model showed that the range of thermal comfort between men and women differs by 1.79 degrees Celsius, and this difference is a tendency for warmer temperatures in men and a tendency for colder temperatures in women, the average scores obtained at Zagros Hospital In the visual-spatial/executive component (7.00), attention (4.34), memory (3.08) has the best performance, Imam Khomeini Hospital (RA) has the best performance in the verbal component (2.95), Hazrat Qaim Hospital (A) In the abstraction component (2.02), it has the best performance and awareness of time and place in all hospitals equal to 6.00. Conclusion: The level of coverage and activity rate among women significantly affects the feeling of thermal comfort, cognitive performance, and productivity of employees at work. The results of this research show the need to revise the current standards of workplace clothing, attendance time, and employee activity rate. Moreover, changes in cognitive performance among hospital staff highlight the need to consider targeted cognitive enhancement strategies to increase staff efficiency.

Gallstones increase the risk of nonalcoholic fatty liver: A case-control study.

Nonalcoholic fatty liver disease (NAFLD) and gallstones are generally seen together, and many of the risk factors for fatty liver and gallstones are common and similar. Therefore, this study aims to investigate the relationship between NAFLD and gallstones. This case-control study was conducted in patients referred to Imam Khomeini and Golestan hospitals of Ahvaz University of Medical Sciences in 2023, whose ultrasound showed fatty liver. Patients who were diagnosed with NAFLD by ultrasound were considered as the case group, and patients who did not have diagnostic findings of fatty liver in ultrasound were considered as the control group. Finally, the information recorded in the checklists was statistically analyzed using SPSS version 26 (SPSS Inc.). Three hundred patients were included in our study, 150 as cases and 150 as controls. There was no significant difference between the groups in terms of gender and age (gender P-value: 0.817/age P-value: 0.102). A statistically significant relationship was found between obesity, diabetes mellitus (DM), the presence of gallstones, and NAFLD (weight p-value < 0.001/DM p-value < 0.001/gallstones P-value: 0.03). In addition, based on binary logistic regression analysis, the presence of gallstones increases the odds of NAFLD by 2.33 times (P-value: 0.035). Furthermore, having DM and increasing each BMI unit increases the odds of NAFLD by 16 times and 30%, respectively (BMI p-value < 0.001/DM p-value < 0.001). Based on the results of our study, gallstones are an important risk factor for NAFLD. The possible mechanisms are the existence of common risk factors between gallstones and NAFLD and the reduction of motility and flow of bile in the bile ducts with the presence of gallstones.

Revisiting the Normal Ranges of Aortic Valve Area in 2D Echocardiography and Its Association With Age, Sex, and Anthropometric Characteristics.

Defining normative aortic echocardiographic values in each geographical district is crucial as aortic valve area (AVA) may vary across races, genders, and ages. Notably, variations in normal values can have implications for clinical decision-making, and available data on the Middle East population is also scarce. We sought to establish normal ranges for aortic valve echocardiographic parameters in the Iranian population and assess the effect of age, gender, weight, height, BMI, BSA, and blood pressure on them. Our data were provided from the web-based echocardiographic data registry of Imam Khomeini Hospital Complex (IKHC). A total of 3251 healthy subjects older than 18 years old without any valvular stenosis were included in our study. AVA's normal range was estimated at 1.92-4.52 and 1.67-3.80 cm2 in men and women, respectively. The annulus, AVA, AV VTI, and LVOT VTI were significantly larger in males, and this association remained significant after indexing AVA for weight, height, BMI, and BSA. Also, smaller AVA was associated with lower height, weight, BMI, and BSA in both men and women. Obese and hypertensive subjects had significantly larger AVA and annulus diameters. Our study provided region-specific normal reference values for AV echocardiographic parameters and compared them across genders, ages, BMI, and blood pressure groups in the Iranian population.

Clinical features and survival rate of patients with ovarian granulosa cell tumor in Iran; a 10-year retrospective study

IntroductionOvarian granulosa cell tumor (OGCT) is a rare female pathology with few available demographic data. Besides, there are no comprehensive clinical characteristics regarding the OGCT in Iran. Thus, this study aimed to assess the clinical features and survival rate of OGCT patients in Iran to expand the scope of knowledge in this field.Materials and methodsIn this 10-year retrospective study (2013–2023), the cases were gathered from the oncologic clinic of women (Imam Khomeini Hospital, Tehran, Iran). The patients with definite OGCT diagnosis were selected based on the inclusion and exclusion criteria including medical history, interfering backgrounds, demographic data, histopathological assessment, clinical and para-clinical features, survival rates, and all previous medical reports for definite diagnosis of OGCT along with approved pathology samples.ResultsThe median age and BMI values of Iranian patients were 45 (19 ~ 83) years and 28.04 (19.4 ~ 48.0), respectively. The most common symptom was abdominal pain (56%) and 69.2% of cases were menopause. In 81.3% of cases, ovarian tumors were detected and metastasis was rare. Most patients (40.6%) underwent total abdominal hysterectomy and OGCT relapsing cases were seen in 13.2% of patients. The median of overall survival (OS) value using the Kaplan-Meier estimate was 52 months (95%CI:37.47–66.53), and the median of disease-free survival (DFS) was 45 months (95%CI: 28.88–61.12). There was a significant (p < 0.05) relation between chemotherapy and left oophorectomy with OS. A significant (p < 0.05) correlation was also detected among the OGCT stage and left oophorectomy with DFS.ConclusionOS and DFS values showed that the OGCT in Iranian patients can be treated in most cases using two main procedures of chemotherapy and oophorectomy. Parallel application of both procedures and associated outcomes are suggested for future studies.

Marginal bone resection and immediate internal fixation in multidrug resistant chronic septic nonunions of lower limb long bones: a case series.

This study aimed to evaluate the efficacy of a combined treatment approach integrating extensive debridement, immediate internal fixation, and the Masquelet technique for the management of infected nonunion of long bones in the lower limbs caused by multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria. This retrospective case series was conducted at the Imam Khomeini Hospital Complex, Tehran, Iran, a tertiary-level academic referral centre. The study documented consecutive cases of patients presenting with infected nonunion of the tibia or femur, with a positive culture for MDR or XDR bacteria, treated between January 2019 and December 2022. Inclusion criteria were adults with a confirmed diagnosis of infected nonunion due to MDR or XDR bacteria, with exclusion criteria including patients with unrelated infections or allergies to the components of the treatment regimen. The primary outcomes measured were infection resolution and bone healing. The study cohort comprised 16 patients, predominantly male (87.5%) with an average age of 38.5 years. Methicillin-resistant Staphylococcus aureus (MRSA) was identified as the causative agent in 31.25% of the infections. Patients were followed for a period ranging from 12 to 26 months. The treatment protocol was uniformly applied across all cases. Successful bone union was observed in the majority of patients within 140 to 240 days following grafting. However, there were two instances where amputation was necessitated due to the failure to eradicate the infection. Complications arose in three cases during the follow-up period: two required re-debridement due to a recurrence of the infection, and one was subjected to bone transport owing to persistent nonunion. Notably, all cases that either failed or encountered complications were smokers. In this integrated approach, high rates of infection resolution and bone healing were achieved, suggesting this method as a viable option for these complex cases.

Efficacy of Intraarticular Vancomycin in Preventing Infection in Patients Undergoing Hip Hemiarthroplasty

Background: Hip fractures are among the top ten causes of disability in adults worldwide. Patients with hip fracture are at significant risk of mortality and morbidity and reduced quality of life. This study was conducted with the aim of investigating the effect of intra-articular vancomycin in preventing infection in patients undergoing hip hemiarthroplasty. Materials and Methods: This double-blind controlled clinical trial study was conducted on 48 patients with femoral neck fracture candidates for hip hemiarthroplasty hemiarthroplasty in Orthopedic clinic of Golestan and Imam Khomeini Hospital, Ahvaz, Iran between June and November 2023. Eligible patients were divided into two equal groups. The intervention group received 1gram vancomycin intra-articularly during the operation before closure of fascia, and the control group did not receive vancomycin. The patients were followed up for 6 months after the operation, and the rate of superficial infection, periprosthetic joint infection (PJI) and wound complications were compared in two groups. The obtained data were statistically analyzed with IBM SPSS Statistics 21.0 for Windows. Results: The vancomycin group and the control group had no significant difference in the incidence of overall infection. The PJI in vancomycin and control groups were 4.16% and 8.33%, respectively. This difference was not statistically considerable (P=0.55). The results showed the incidence of superficial estimated 8.33% in vancomycin group and 4.16% in control group with no considerable difference in infection (P=0.52). Moreover, there was no meaningful difference in side effects between the two groups (P=0.63). There was no significant difference in wound complications between the two groups (P=0.3). . Conclusion: Intra-articular injection of 1gram of vancomycin suspension did not reduce the overall, superficial and deep infection after surgery. It is suggested that more clinical trial studies with higher sample size be conducted.

Comparison of treatment results of femoral shaft fracture with two methods of intramedullary nail (IMN) and plate

BackgroundFracture of the femur is one of the most common fractures that, if not stabilized and treated properly, may lead to severe disability, impairment of the individual’s efficiency, and numerous complications. This study aimed to evaluate the treatment results of femoral shaft fracture with two methods intramedullary nail (IMN) and Plate.Materials and methodsIn this cross-sectional study, 60 patients with femoral bone fractures were admitted to Imam Khomeini Hospital in Jiroft in 2020 and were treated for at least one year after discharge. They were divided into two treatment groups - Plate fracture fixation (n = 30) and IMN fracture fixation (n = 30). Data were collected using a researcher-made checklist including patient demographics and treatment outcomes. The collected data were analyzed using SPSS-v 26 statistical software and descriptive and inferential statistical tests at a significance level of p < 0.05.ResultsPatients in the Plate treatment group were generally older (50–60 years) compared to the IMN treatment group (30–40 years), and there were more men than women in both groups. Only 10% of patients in each group developed superficial infections after surgery. There were more cases of deep infections in the Plate group, but it was not statistically significant. The IMN group had fewer cases of malignancy and claudication compared to the Plate group. Patients in the IMN group also returned to functional activities faster than those in the Plate group, which was a statistically significant difference.ConclusionConsidering that deep infection, non-union, malunion, claudication, and ability to return to functional activities in the group using nails treated was less than the group treated with plates, the treatment method of femoral fracture using IMN is the preferred treatment method.

A Case-control Study on the Correlation between Serum Bilirubin Levels and Various Types of Appendicitis

Background Acute appendicitis is one of the most common types of surgical emergencies. Among laboratory factors, hyperbilirubinemia has recently been identified as a strong predictor of preoperative perforation and gangrene. Aim This study aimed to investigate the correlation between serum bilirubin levels and types of appendicitis. Methods This case-control study was conducted in 2022 using the convenience sampling method on 100 patients who were referred to the emergency department of Imam Khomeini Hospital in Jiroft with abdominal pain. These patients were diagnosed with appendicitis based on the initial clinical examinations. The white blood cells and total bilirubin levels were measured for all the patients. Intraoperative macroscopic findings were recorded by the surgeon, and the pathological results of the specimen were reported. Data was analyzed using SPSS 24, including descriptive and inferential statistics at the significance level of P&lt;0.05. Results Among 100 patients aged between 28.5±14.8, 48% were men, and the rest were women. There was a significant difference between the mean of bilirubin levels in patients with complicated and uncomplicated appendicitis (P &lt;0.01). The results of logistic regression analysis showed that the period of onset of symptoms to hospitalization, leukocytosis level, and preoperative total bilirubin level were significant variables for diagnosing complicated appendicitis (P&lt;0.05). Conclusion In this study, we found that patients with complicated appendicitis had higher total bilirubin levels than patients with uncomplicated appendicitis. Therefore, patients with hyperbilirubinemia and clinical symptoms of appendicitis should be considered as more probable cases of perforation than those with normal bilirubin levels.

Trend, Level, and Predictors of Glycemic Control among Iranians with Type 2 Diabetes: A 12-Year Retrospective Cohort Study

Abstract Objective We aimed to determine the trend, level, and predictors of glycemic control among adult type 2 diabetes on regular follow-up. Material and Method A 12-year unmatched retrospective cohort study was conducted at Imam Khomeini Hospital, Tehran, Iran. Statistical Analysis Descriptive statistics was computed for most variables, such as sociodemographic factors, medication-related factors, and disease-related factors. Multivariate logistic regression analysis was conducted to identify the functional independent predictors of good glycemic control among type 2 diabetes. Results A total of 297 patients with regular follow-up were included in this study. Patients' mean body mass index was 28.51 ± 4.61 kg/m2. The mean glycated hemoglobin (HbA1c %) was 7.4 ± 1.25%. One hundred thirteen (30%) patients achieved the glycemic control target (i.e., HbA1c &lt; 7.0%). The mean systolic blood pressure level was 132.88 ± 16.23 mm Hg. The mean diastolic blood pressure level was 76.58 ± 9.2 mm Hg. The mean level of low-density lipoprotein (LDL)-cholesterol was 79.23 ± 28.69 mg/dL. The highest trend of glycemic control was recorded in 2014 to 2015 (49.5%). Age less than 50 years, taking oral antidiabetic monotherapy, having blood pressure (BP) less than 140/90 mm Hg, and having LDL-cholesterol level &lt; 70 mg/dL were independently associated with good glycemic control. Conclusion Glycemic control levels among type 2 diabetes on regular follow-up were low. Young age was negatively associated with good glycemic control. Taking oral antidiabetic monotherapy, achieving BP, and meeting LDL-cholesterol targets were positively associated with good glycemic control. Therefore, addressing these factors can improve glycemic control and reduce associated complications.

Comparison of spring ankle braces versus splints and casts in treating ankle sprains in patients diagnosed with ankle sprains

BackgroundVarious treatment approaches for individuals with ankle sprains can reduce treatment costs and enhance recovery. This study aimed to compare the efficacy of spring ankle braces with splints and casts in treating ankle sprains.Materials and methodsThis cross-sectional study involved 60 patients diagnosed with ankle sprains at the orthopedic clinic of Imam Khomeini Hospital in Jiroft in 2022. Following diagnosis confirmation through additional examinations and imaging, patients with ankle sprains not requiring surgery were selected and placed in two groups: one treated with spring ankle braces and the other with splints or casts. Both groups underwent a 4-week treatment regimen, comprising 30 individuals each. Data were collected and analyzed using SPSS version 26.ResultsThe average age of patients was 32.5 ± 13.4 years. Of the ankle sprain patients, 56.7% were male. Patients reported the highest satisfaction levels with the plaster cast treatment method. A statistically significant relationship was found between patient satisfaction and the treatment methods of spring ankle braces and plaster casting (P < 0.05). Patients treated with plaster casts reported the lowest pain levels, with a significant relationship between pain levels and the two treatment methods (P < 0.05). Range of motion results were similar for both treatment methods, while the cast treatment showed the highest incidence of skin complications. A significant relationship was observed between spring ankle braces and plaster casts regarding skin complications (P < 0.05).ConclusionTreating ankle sprains with plaster casts leads to higher satisfaction and lower pain levels compared to using spring ankle braces.

Relapse of COVID-19-associated mucormycosis in patients receiving posaconazole as maintenance treatment.

Coronavirus disease 2019 (COVID-19) has been associated with secondary fungal infections such as mucormycosis. We investigated the relapse rate of mucormycosis and its risk factors. A prospective study was conducted on COVID-19-associated mucormycosis (CAM) patients discharged from Imam Khomeini Hospital Complex, Tehran, Iran, from July 2021 to February 2022. Patients who received posaconazole as a step-down therapy were included and examined monthly for six months. A relapsing mucormycosis case was defined as a patient with new clinical or radiological symptoms, confirmed by observing aseptate hyphae in the histopathological examination or tissue culture. The characteristics of patients with and without relapse were analyzed and compared. Seventy-seven patients completed the six-month follow-up after discharge. Most patients were male (n = 46, 59.8%), with a mean age of 53.1 years (median 19-84). The most common underlying diseases were diabetes (52/77, 67.5%), hypertension (33/77, 42.8%), and cancer/chemotherapy (25/77, 32.4%). Seven patients (7/77, 9%) were reported as relapsing cases. There was no difference in demographic features and underlying diseases between the groups. A significant difference was seen in the mean duration of posaconazole consumption between patients with and without relapse (24 ± 4.4 days vs. 49.4 ± 4.3 days, respectively, p = 0.015). The primary orbital involvement was also significantly associated with relapse (p = 0.04). Our findings showed a significant relapse of CAM (9%). A longer duration of posaconazole consumption and completion of treatment for initial orbital involvement in CAM patients are recommended for better patient management and prevention of relapse.

The relationship of COVID-19 severity with laboratory findings and neutrophil-to-lymphocyte ratio in patients admitted to a large teaching hospital in Iran: A cross-sectional study.

COVID-19 patients might be admitted to the hospital based on their clinical manifestations or to the intensive care unit (ICU) due to the severity of their symptoms or critical situation. Our main objective was to investigate clinical and demographic factors influencing COVID-19 patients' admission to the ICU and length of stay (LOS) using extracted data from the hospital information systems in Iran. The data of hospitalized patients with confirmed COVID-19 were retrieved from the health information system of Imam Khomeini Hospital Complex, Tehran, Iran between March 2020 and February 2022. The primary outcome was the ICU admission, and the secondary outcome was the LOS. The correlation analysis between laboratory findings and demographic data with ICU admission and LOS was done using SPSS 21.0, and p < 0.05 was considered significant. Of all the 4156 patients, 2391 (57.5%) were male and the mean age was 58.69 ± 8.19 years. Of these, 9.5% of patients were admitted to ICU at any time point during their hospital stay. Age and laboratory variables such as neutrophil-to-lymphocyte ratio (NLR), ALT (U/L), albumin (g/dL), plasma glucose (mg/dL), ferritin levels (ng/mL), and phosphorous levels (mg/dL) shown the significant relationship with ICU admission. Also, being a smoker and having hypoxemia had a significant relationship with longer stays in the hospital. In this study, we validated a cut-off value of 4.819 for NLR, calculated at hospitalization, as a useful predictor of disease progression and occurrence of serious clinical outcomes, such as ICU admission. The study examined various clinical factors associated with ICU admission in COVID-19 patients. The findings suggest that certain factors can increase the risk of ICU admission and influence the length of hospital stay which should be focused in future studies.

Comparison of Helicobacter pylori in hospitalized COVID-19 patients with and without gastrointestinal symptoms.

Helicobacter pylori plays an important role in causing digestive diseases. The purpose of this study is to investigate Helicobacter pylori in COVID-19 patients with and without gastrointestinal symptoms. In this case-control study, all patients with COVID-19 admitted to Imam Khomeini Hospital in Jiroft city in 2021 were convenience sampled and divided into two homogeneous groups. Ninety-five patients with COVID-19, who presented with gastrointestinal symptoms, were included in the case group, while 95 patients with COVID-19 without gastrointestinal symptoms were included in the control group. Noninvasive diagnostic methods, including serology and stool antigen tests, were used to identify Helicobacter pylori in the studied patients. Fifty-three people (55.8%) from the case group had Helicobacter pylori, and 48 (50.5%) from the control group had Helicobacter pylori. Among the 53 people from the case group, 27 (50.9%) were men and 26 (49.1%) were women. Nineteen people (35.8%) were taking pantoprazole, 10 people (18.8%) were taking nonsteroidal anti-inflammatory drugs, 20 people (37.7%) were taking narcotics, and 7 people (13.2%) had peptic ulcer. Seven people (13.2%) had an H2 blocker, and 21 people had an underlying disease. A significant relationship between infection with Helicobacter pylori and the use of pantoprazole, nonsteroidal anti-inflammatory drugs, narcotics, peptic ulcer, underlying disease, and H2 blocker in COVID-19 patients with gastrointestinal symptoms and without gastrointestinal symptoms was present (P-value < 0.05). The prevalence of Helicobacter pylori infection in patients with COVID-19, who have gastrointestinal symptoms, is high and should be considered as a treatment criterion for people infected with COVID-19.

Willingness to pay for cataract surgery and its associated factors in selected medical centers in Urmia, Iran

IntroductionCataracts represent a significant public health issue and are the most prevalent vision disorder following refractive errors. They can restrict the economic, social, and psychological activities of those affected, thereby diminishing their quality of life. This study was undertaken to examine the willingness to pay for cataract surgery and the factors influencing this decision in selected medical centers in Urmia. The two-stage Heckman model was utilized to aid decision-making in financing this service.MethodsThis research was a descriptive-analytical study evaluating the economic aspects of health interventions, conducted from the patient’s perspective. In this cross-sectional study, a sample size of 217 patients with cataract issues was selected using Michel Carson’s table. These patients were from Imam Khomeini Hospital and Aftab Urmia Surgery Center in 2023. Data was collected using a conditional valuation approach to determine the maximum amount patients were willing to pay, as gathered through a questionnaire. The factors influencing the willingness to pay for cataract surgery were estimated using the two-stage Heckman regression model. The final effect value of each variable was calculated using Stata version 14 software.ResultsIn this study, 81.11% of participants (176 individuals) expressed a willingness to pay for cataract surgery, with the average amount they were willing to pay being $206.3. However, out of the 217 respondents, 41 rejected the proposed amounts and were not willing to pay anything. The results of the Hemken model indicated that the income of patients and the size of their households significantly influenced their willingness to pay for cataract surgery. However, other variables investigated did not have a significant impact.ConclusionThe study results revealed a significant influence of both income and household size on the likelihood of willingness to pay, as well as the extent of willingness to pay for cataract surgery. Consequently, it is crucial to formulate policies and provisions that guarantee access to cataract services, particularly for individuals from large households with low income and high costs.

This is a successful removal of more than 450 pieces of metal objects from a patient’s stomach: a case report

BackgroundIngestion of foreign bodies may be seen unconsciously or intentionally in patients with mental health problems. Most cases pass through the esophagus slowly; however, in some cases, the tumor may be located in narrower areas of the digestive tract that require endoscopic or surgical intervention. This study describes a rare case of successful removal of more than 450 pieces of metal objects from the stomach of a 36-year-old man via ingestion of foreign bodies at Imam Khomeini Hospital in Ahvaz.Case presentationA 36-year-old male patient (Aryan race) presented with complaints of chronic abdominal pain, frequent vomiting, and intolerance to liquids and food. The patient’s companions mentioned a history of gradual ingestion of small metal objects 3 months prior. The patient was conscious and had stable vital signs. In the patient’s X-ray and endoscopy, multiple metal objects inside the patient’s stomach were observed, causing gastric outlet obstruction. The patient underwent gastrostomy surgery, and 452 screws, nuts, keys, stones, and other metal parts weighing 2900 g were removed from the stomach. Five days after the operation, the patient was transferred to the psychiatric service in good general condition and was diagnosed with psychosis, and her condition returned to normal at follow-up.ConclusionSuccessful removal of this foreign body is rare. In chronic abdominal pain, especially in the context of psychiatric disorders, attention should be given to the ingestion of foreign bodies. In swallowing large amounts of sharp and metallic foreign objects, surgical intervention is necessary, especially in cases of obstruction, and saves the patient’s life.

Opium and Tobacco Use, and Outcome in COVID-19 Infected Patients: A Cross-Sectional Study

Background: Individuals with compromised immune systems are more susceptible to novel coronavirus (COVID-19), and data are limited on the relationship between opium and tobacco use and COVID-19 mortality. Objectives: This study aimed to determine the effect of opium and tobacco use, as well as the effect of different consumption intensities of these substances, on the outcomes of patients with COVID-19. Patients and Methods: In this cross-sectional study, 900 patients with a clinical diagnosis of COVID-19 who were referred to Imam Khomeini Hospital in Sari, Iran, were reviewed. Data collection was conducted through the patient information registry system and telephone contact with patients or their companions. Statistical analysis was performed using SPSS 25 software. Chi-Square, Fisher's exact, and Mann-Whitney tests were used for comparisons between groups. A P-value of 0.05 or lower was considered statistically significant. Results: Death and systolic blood pressure were significantly higher (P = 0.023 and P = 0.01, respectively), and erythrocyte sedimentation rate was significantly lower in tobacco smokers (P = 0.046). Additionally, cardiovascular disease, pulmonary disease, and multiple co-morbidities were significantly higher in opioid users (P &lt; 0.001, P = 0.004, and P = 0.014, respectively), and fatigue was significantly lower in the group that did not use opioids (P = 0.009). No statistically significant relationship was found in any of the subgroups of opioid and tobacco users in terms of death or discharge (P &gt; 0.05). Conclusions: In a global context where COVID-19 mutations are prevalent, any amount of tobacco and opium use should be considered a risk factor.