Patients In Iran Research Articles

Oral neglect as a marker of broader neglect: a cross-sectional investigation of orodental consultation letter of leukemic admitted patients in Iran

BackgroundLeukemia is the main malignant hematologic disease of children with different oral manifestations and clinical features. Attention to the oral manifestations is essential for better management. This study assessed the oral and dental consultations conducted in the admitted leukemic patients of an Iranian teaching hospital.MethodsIn this descriptive cross-sectional study, medical records of patients admitted in Yazd Shahid Sadoughi Hospital were evaluated. Records of 300 patients with leukemia were randomly selected. Data including demographic information on age, sex, type of oral problems, prescribed instructions and leukemia type were extracted from archived records and registered on the checklist. Finally, Data were analyzed by SPSS17 using Chi-square test.ResultsThe results showed the average age ± SD of patients were 24.36 ± 23.91 with a range of 4 days to 86 years. Among 300 files, 167 belonged to males (55.7%) and 133 pertained to females (44.3%). The most prevalent type of underlying disease was ALL (Acute lymphocytic leukemia) with the frequency of 180 persons (60%). Only 12 (4%) of patients were referred to a specialist due to oral problems. Of all cases of consultation requests, 75% received consultation because of dental problems and 25% for mucosal problems. There was a statistically significant difference between age and consultation request (P = 0.002).ConclusionsAccording to the results of this study, orodental consultation request rate for admitted leukemic patients was low. Pediatric hematologist and oncologists to some extent had more interest to consult due to oral and dental problems rather than others.

Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study

BackgroundPsychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients.ObjectiveThis study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran.MethodsA website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention.ResultsWe invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics.ConclusionsThis web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level.

Nurses' experience of patient care using extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is an advanced form of temporary life support, to aid respiratory and/or cardiac function, which diverts venous blood through an extracorporeal circuit and returns it to the body after gas exchange through a semipermeable membrane. It may be used for oxygenation, carbon dioxide removal, and hemodynamic support. ECMO has been available to patients in Iran for only about 4 years. Because nurses do not widely use ECMO in Intensive Care Units (ICUs), for many it is still a unique experience and more needs to be understood about that experience in order to support nurses in that role. This study aimed to explore Iranian nurses' experience of caring for patients receiving ECMO. This interpretive phenomenological study was conducted in Iran in 2019. Semi-structured interviews were conducted in Farsi to collect data from 18 nurses who had cared for patients receiving ECMO. The interviews continued until data saturation, and thematic analysis of the interview transcripts was undertaken. Following thematic analysis, three main themes of "running on a suspension bridge," "sense of duality," and "bewilderment in the mirage of hope," and with seven sub-themes, emerged. Based on the results of this study, it is proposed that caring for patients receiving ECMO is a source of emotional turmoil for nurses. Nurses are constantly thinking about whether their patients receiving ECMO are recovering or dying, and the nature of this care may lead to stress and burnout. Therefore, it is recommended that these nurses receive counselling and psychological support. Nurses are able to provide comprehensive and holistic patient care when they enjoy good physical and mental health themselves. To prevent distress in nurses and to provide safe care for the patient receiving ECMO, provision of psychological support for these nurses is recommended.

High prevalence of hepatitis E among regular hemodialysis patients in South of Iran.

Hepatitis E virus (HEV) is one of the prevalent nosocomially transmitted agents among patients on maintenance hemodialysis due to parenteral transmission of HEV and immunocompromised condition of chronic hemodialysis patients. Therefore, this study aimed to investigate prevalence, risk factors, and genotypic pattern of HEV infection among hemodialysis patients in South of Iran. All patients on maintenance hemodialysis attending the hemodialysis centers of Bushehr, Borazjan, and Genaveh cities for regular hemodialysis were enrolled in this study. Serum samples were tested for the presence of anti-HEV antibodies using ELISA kit. The serum samples were further tested for detection of HEV RNA using nested RT-PCR. Of 226 hemodialysis patients, 155 patients (68.6%, 95% CI: 62.3%-74.3%) were positive for anti-HEV IgG antibody, of which 33 patients (14.6%, 95% CI: 10.6%-19.8%) had anti-HEV IgM antibody. The prevalence of anti-HEV IgG and anti-IgM antibodies in non-hemodialysis controls were 65.1% and 9.6%, respectively. Although the hemodialysis patients had higher prevalence of HEV than the controls, the difference was not significant. All samples were negative for HEV RNA. HEV seroprevalence among hemodialysis patients was not significantly associated with place of residency, ethnicity, level of education, gender distribution, hemodialysis duration, and levels of liver enzymes. HEV seropositive patients had significantly higher mean age compared to seronegative patients. This study reports the highest seroprevalence of HEV among hemodialysis patients in Iran. Inapparent HEV infection in the dialysis setting calls for regular screening of hemodialysis patients regardless of the hemodialysis duration, clinical symptoms, and liver function parameters.

Prevalence of Strongyloides stercoralis in the immunocompetent and immunocompromised individuals in Iran: a systematic review and meta-analysis.

Strongyloidiasis is a neglected tropical disease mostly distributed in tropical and subtropical regions. The current study evaluated the prevalence of Strongyloides stercoralis in immunocompetent and immunodeficient patients in Iran. The available online literature published from June 1994 to October 2020 was obtained from multiple English databases (PubMed, Science Direct, Scopus, Web of Science and Google Scholar) and four Persian databases (Magiran, Iran Medex, Iran Doc and SID). All statistical analyses were performed using R software (version 3.6) meta-package and p-values <0.05 were considered significant. From 1051 articles, 74 studies (248656 individuals) met the inclusion criteria. The pooled prevalence of S. stercoralis was 2% (95% confidence interval [CI] 1 to 3) and 4% (95% CI 1 to 8) in immunocompetent and immunodeficient patients, respectively. In immunodeficient cases, the pooled prevalence of studies utilizing serology, culture and microscopic methods was 10% (95% CI 2 to 23), 1% (95% CI 0 to 6) and 1% (95% CI 0 to 1), respectively. In immunocompetent cases, the pooled prevalence of studies utilizing microscopic, culture and molecular methods was 2% (95% CI 1 to 3), 2% (95% CI 1 to 4) and 2% (95% CI 0 to 6), respectively. We propose an appropriate screening and control program along with comprehensive research regarding the frequency of strongyloidiasis in the country.

Prevalence of occult hepatitis C virus infection in beta-thalassemia major patients in Ahvaz, Iran.

Occult hepatitis C virus infection (OCI) is defined by the presence of HCV RNA in peripheral blood mononuclear cells (PBMCs) and liver tissue cells despite the absence of HCV RNA in plasma. Currently, OCI is classified into two types: seropositive OCI (anti-HCV positive and serum HCV RNA negative) and seronegative OCI (anti-HCV and serum HCV RNA negative). Beta-thalassemia is described as a blood disorder that decreases the synthesis of hemoglobin. Repeated blood transfusion is the standard treatment for patients with beta-thalassemia major (BTM), and this increases the risk of exposure to infectious agents. The aim of this study was to investigate the prevalence of OCI among BTM patients. Plasma and PBMCs were collected from 90 BTM patients who were referred to Shafa Hospital in the city of Ahvaz and were screened for HCV antibody using a commercial ELISA kit as the first step. Next, nested RT-PCR was performed on extracts of plasma and PBMCs. HCV RNA from positive PBMCs was sequenced, the sequences were aligned, and a phylogenetic tree was constructed to determine their relationship to reference sequences retrieved from the GenBank database. Seventy-nine out of 90 patients (87.8%) were negative for HCV Ab (seronegative), while 11 patients (12.2%) were seropositive. HCV RNA was found in PBMCs of four patients (66.7%) who were negative for HCV Ab (seronegative) and two patients (33.3%) who were positive for HCV Ab (seropositive). HCV RNA was not detected in plasma samples from these six patients. Six out of 90 BTM patients (6.7%) had OCI. HCV genotyping revealed that all six patients were infected with HCV subtype 3a. We found a high frequency of OCI in BTM patients, which warrants more attention, considering the importance of this infection. Further studies are needed to determine the actual prevalence of OCI in BTM patients in Iran.

PCSK9 Gene Polymorphisms Associated With the Risk of Myocardial Infarction in Iranian Patients

Introduction: Proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulatory protein in lipid metabolism and a candidate gene in the etiology of cardiovascular diseases. The present study aimed to evaluate the prevalence and significance of PCSK9 rs505151 and rs11591147 variants with myocardial infarction (MI) risk in the Iranian population. Patients and Methods: The frequency of the PCSK9 rs505151 and rs11591147 variants were compared between 600 cases of MI and 600 healthy age- and sex-matched individuals. Tetra-primer amplification refractory mutation system-polymerase chain reaction (T-ARMS PCR) was used for rs505151, and amplification refractory mutation system-polymerase chain (ARMS-PCR) was utilized to detect the rs11591147 polymorphism. Finally, SPSS and SHEsis software were applied for data analysis. Results: Carriers of the GG genotype of rs505151 polymorphism (OR: 1.57, 95% CI: 1.05–2.35, P = 0.02; age-adjusted; OR: 1.54, 95% CI: 1.03–2.32, P = 0.03) and at least one G-allele including GG+AG vs. AA (OR: 1.54, 95% CI: 1.04–2.28, P = 0.03; age-adjusted; OR: 1.51, 95% CI: 1.01–2.24, P = 0.04) have an increased risk of MI. No association between PCSK9 rs505151 alleles and MI risk was observed. The ratio of individuals with the rs11591147GT variant was higher in healthy individuals vs. patients with MI (48.6% vs. 41.7%), indicating a reduced risk of developing MI (OR: 0.75; 95% CI: 0.59–0.95; P = 0.01; age-adjusted; OR: 0.74; 95% CI: 0.58–0.95; P = 0.01). The carriers of at least one T allele (TT+GT vs. GG) (OR: 0.78; 95% CI: 0.62–0.98; P = 0.03; age-adjusted; OR: 0.78; 95% CI: 0.62–0.98; P = 0.03) showed a significant reduction in MI risk. The allelic frequencies at this polymorphic site did not differ between MI patients and healthy counterparts. No association was found between the haplotypes constructed from the alleles of these two polymorphisms. Conclusion: Our study provides the first evidence that PCSK9 gene polymorphisms may serve as independent prognostic markers for MI patients in Iran.

Cladribine tablets are a cost-effective strategy in high-disease activity relapsing multiple sclerosis patients in Iran

Background: Cladribine tablets are the foremost oral immune-reconstitution therapy for high disease activity relapsing multiple sclerosis (HDA-RMS). We aimed to assess the cost-effectiveness of cladribine tablets compared to natalizumab in patients with HDA-RMS in Iran. Methods: A 5-year cohort-based Markov model was developed with 11 expanded disability status score (EDSS) health states, including patients with HDA-RMS as on and off-treatment. All costs were identified from the literature and expert opinion and were measured in Iranian Rial rates, changed to the 2020 USD rate and were discounted by 7.2%. Quality adjusted life years (QALY), discounted by 3.5%, and life years gained (LYG) were adopted to measure efficacy. The final results were presented as incremental cost-effectiveness ratio that was compared to a national willingness to pay (WTP) threshold of 1 to 3 gross domestic product (GDP) per capita. Deterministic and probabilistic sensitivity analyses (D/PSA) were employed to evaluate uncertainty. Results: Cladribine tablets dominated natalizumab and yielded 6,607 USD cost-saving and 0.003 additional QALYs per patient. LYG was comparable. The main cost component was drug acquisition cost in both arms. DSA indicated the sensitivity of the results to the cost discount rates and also the patients’ body weight; while they were less sensitive to the main clinical variables. PSA indicated that cladribine tablets were cost-effective in Iran, with a probability of 57.5% and 58.6% at lower and higher limits of threshold, respectively. Conclusion: Cladribine tablets yielded higher QALYs and lower costs compared to natalizumab, in patients with HDA-RMS in Iran.

Pressure Injury Prevention Knowledge Among Family Caregivers of Patients Needing Home Care.

One of the complications that patients in need of home healthcare might experience is pressure injury. Given that a significant part of the care of these patients is performed by their family caregivers, they must have sufficient knowledge about prevention and treatment of pressure injuries. We investigated the knowledge related to pressure injuries among family caregivers of patients needing home care who were at risk of pressure injury. Family caregivers of patients in Iran who needed home care services and were at risk of developing pressure injuries based on the Braden scale were invited to participate. A special questionnaire designed by Arboledas and Pancorbo-Hidalgo was used to assess the caregivers' level of knowledge. This questionnaire consists of 23 items, and with total scores between 23 and 46. A higher score indicates a higher level of knowledge about pressure injuries. A total of 323 family caregivers participated, most of whom were female. The mean total score of caregivers' knowledge about pressure injuries was 34.5 ± 3.4 (ranging 23 to 42). Most of the participants (n = 290) stated they did not receive adequate education related to pressure injuries. Among the demographic variables, a significant relationship was observed between the level of caregivers' knowledge with the level of education, younger age, offspring, admission in intensive care units, and male sex (p < 0.005). Family caregivers did not have sufficient knowledge about pressure injuries. Most of them did not receive the necessary education during the time of their patient's hospitalization. This issue should be considered by healthcare providers, and the necessary interventions should be considered to improve the situation.

Explaining Caregivers' Perceptions of Palliative Care Unmet Needs in Iranian Alzheimer's Patients: A Qualitative Study.

Introduction: The needs of Alzheimer's patients are very complex and diverse and many of them are considered unmet needs. Understanding and responding to the unmet and complex needs of Alzheimer's patients can affect the quality of care. Therefore, the present study aimed to explain the perception of formal and informal caregivers of the unmet needs of Iranian Alzheimer's patients.Methods: The present qualitative study employed a Directed Content Analysis approach and was conducted in Iran in 2020. This research was done through in-depth and semi-structured interviews with 19 qualified caregivers enrolled (11 informal caregivers and 8 formal caregivers) with the mean age of 46.05 ± 10.98 years in a purposive sampling method. Interviews continued until data saturation. Data analysis was performed simultaneously with data collection. After recording and transcribing, the data were analyzed using the Elo and Kyngas method based on the National Consensus Project framework (NCP). Data management was done with MAXQDA software. In order to achieve the accuracy and validity of the study, the criteria presented by Lincoln and Guba Credibility, Dependability, Confirmability, and Transformability were considered and used.Results: The mean age of participants was 46.05 ± 10.98. Participants in this study acknowledged that Alzheimer's patients need comprehensive needs management with a holistic approach to increase quality of life. This theme based on the NCP framework consists of seven main categories including “Structure and processes of care,” “Physical aspects of care,” “Psychological and psychiatric aspects of care,” “Social aspects of care,” “Cultural aspects of care,” “Care of the patient nearing the end of life,” and “Ethical and legal aspects of care” with 16 subcategories.Conclusion: The findings of this study provide a deep understanding of the unmet needs of Alzheimer's patients in Iran. Identifying the unmet needs of patients can pave the way for the treatment team to provide effective solutions to meet the needs and empower caregivers to provide comprehensive care for patients.

Causes of Delay in Establishing Permanent Vascular Access in Hemodialysis Patients in Iran

Causes of Delay in Establishing Permanent Vascular Access in Hemodialysis Patients in Iran

Some Clinical Features and Supportive Therapies in Covid-19 Patients Died in Hajar Hospital, Tehran, Iran

Objective: Due to the spread of Coronavirus Disease 2019 (COVID-19) worldwide and the resulting mortality as well as the lack of definitive treatment for this disease, various non-invasive and invasive drugs and treatments have been used around the world for reducing the effects of this disease or accelerating the treatment process, but the positive and definite effect of none of these methods has been confirmed and they have been effective only in some cases. This study aims to investigate some clinical features and supportive therapies in deceased COVID-19 patients in Iran. Methods: This descriptive-analytical retrospective study was conducted on 100 Covid-19 patients died in Hajar Hospital in Tehran, Iran from February to September 2020. They were divided into two groups of with and without underlying diseases. After coordination and obtaining the necessary permission and informed consent, information was collected from the medical files of samples. Results: Mechanical ventilation, vasoconstrictor injection and blood products had been used as supportive therapies in deceased patients, where ventilation use (n=62, 62%) was significantly higher (P=0.01) compared to vasoconstrictor injection (n=28, 28%) and blood products (n=13, 13%). Most of deceased patients had an underlying diseases (79%). Hypertension, diabetes and heart problems were the most common underlying diseases. The disease severity, clinical manifestations, and mortality rate of deceased patients with cardiovascular diseases, diabetes and hypertension were significantly different compared to those with other underlying diseases (P= 0.01). The age and gender of deceased patients had no significant relationship with the use of any supportive therapies (P≥0.01), but had a significant relationship with the underlying diseases (P≤0.01). Conclusion: The treatment methods that are the definite needs of the patient and have more favorable effects on the recovery process have a high value in the treatment of COVID-19 patients. These patients need to use supportive therapies for purposeful and effective treatment. Mechanical ventilation is more important than injecting vasoconstrictors or using blood products.

Oral Health Literacy and COVID-19 Pandemic Anxiety and Concerns Among Iranian Orthodontic Patients.

This study aims to evaluate the impact of the COVID-19 pandemic on orthodontic appointments, and the concerns and anxiety levels of orthodontic patients in Iran. An anonymous 40-question questionnaire was sent online to the patients of private orthodontic clinics in 2 cities of Birjand, and Mashhad, capitals of Eastern provinces of Iran. Orthodontic patients of Mashhad dental school received the questionnaire as well. Descriptive statistics were reported, and the association between gender, oral health literacy (OHL), and adherence to orthodontic appointments and attendance, along with data on feeling, concern, and level of anxiety regarding quarantine/coronavirus pandemic were evaluated using the chi-square analysis. Three hundred twenty-four patients, with a mean age of 32.43 years, answered the questionnaire. Fifty-seven percent of participants said that they only left home for their daily requirements. Seventy-two percent of the participants reported feeling calm about the COVID-19 pandemic and its consequences. Most of the patients (74%) said that they would attend their orthodontic appointment in case of urgency, and 41% of patients declared that their greatest concern was the probability of a delay in completion of treatment. Forty-five percent of patients had adequate OHL. There was a significant association between OHL and willingness to attend orthodontic treatment, concerns regarding the impact of the pandemic on orthodontic treatment, and the frequency of daily teeth brushing. Women respected the quarantine more than men. Patients with higher OHL were more willing to attend their appointments, but only in case of an emergency, due to the outbreak of COVID-19. Women were more concerned and had better oral hygiene behaviors.

Developing an integrated model of community-based palliative care into the primary health care (PHC) for terminally ill cancer patients in Iran

BackgroundPatients with cancer commonly experience pain and suffering at the end of life days. Community-based palliative care can improve the quality of life of terminally-ill cancer patients and provide them with a merciful death. The purpose of this study was to develop an integrated model of community-based palliative care into PHC for terminally ill cancer patients.MethodThis study is a health system research (HSR) that was conducted in three phases from October 2016 to July 2020. In the first phase, dimensions of community-based palliative care were explored in patients with cancer using qualitative methods and conventional content analysis. In the second phase, a scoping review was carried out to complete the collected data from the qualitative phase of the study. Based on the collected data in the first and second phases of the study, a preliminary draft of community-based palliative care was developed for patients with cancer based on the framework of the World Health Organization. Finally, the developed model was validated using the Delphi technique in the third phase of the study.ResultsData analysis indicated that providing community-based care to patients with cancer is influenced by the context of care. According to the developed model, patients are identified as terminally ill, and then are referred to the local comprehensive health center in a reverse manner. After patients’ referral, they can receive appropriate healthcare until death by the home care team in relation to the comprehensive health center based on the framework of primary healthcare.ConclusionsThis model was developed based on the current Iranian healthcare structure and the needs of terminally ill cancer patients. According to the model, healthcare is provided in a reverse manner from the subspecialty centers to patients’ homes in order to provide easy access to palliative care. It is suggested to use this model as a pilot at the regional level.

Clinical characteristics, gastrointestinal manifestations and outcomes of COVID-19 patients in Iran; does the location matters?

BACKGROUNDCoronavirus disease 2019 (COVID-19) started in Asia, and Iran was one of its first epicenters. AIMTo study the gastrointestinal (GI) symptoms and comorbidities associated with this pandemic in four different regions of Iran.METHODSWe analyzed data from severe acute respiratory syndrome coronavirus 2 positive patients evaluated at four hospitals of Iran (n = 91), including South (Shiraz), Southeast (Dezful), Rasht (North), and Northwest (Mashhad) between April and September 2020. Demographics, comorbidities and clinical findings including GI symptoms were collected. Statistical descriptive analysis and correlation analyses of symptoms, comorbidities, and mortality were performed.RESULTSThe average age of COVID-19 patients was 51.1 years, and 56% were male. Mortality rate was 17%. Cough with 84.6%, shortness of breath with 71.4%, fever with 52.7%, and loss of appetite with 43.9% were the main symptoms. Overall cardiac disease was the most common comorbidity with an average of 28.5% followed by hypertension (28.5%) and diabetes (25.2%). The highest comorbidity in North (Rasht) was diabetes (30%) and in South (Dezful) hypertension (37%). Shiraz leads cardiac disease with 43.4%. The most reported GI symptoms included nausea, diarrhea, vomiting, and abdominal pain, with 42.8%, 31.8%, 26.8%, and 12% prevalence, respectively. In addition, albumin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were elevated in 26.3%.CONCLUSIONOur results show hypertension and diabetes as the most common comorbidities, but their distribution was different in COVID-19 patients in the four studied regions of Iran. Nausea, diarrhea, and elevated liver enzymes were the most common GI symptoms. There was also a high mortality rate that was associated with high infection rates in Iran at the beginning of the pandemic.

A Large Case Series on Surgical Outcomes in Congenital FXIII Deficiency Patients in Iran

BackgroundFXIII requires low plasma FXIII levels for normal hemostasis. The lack of accepted standardized surgical guidelines necessitates dependence on the treating physicians' and centers' experiences.AimOur aim is to evaluate surgical outcomes on a large group of congenital FXIII deficiency (FXIIID) patients.MethodsA case series study was conducted on congenital FXIIID patients in two major referral centers located in Iran from 2010 to 2016. All patients were on prophylaxis using plasma factor XIII concentrate (10 U kg−1, every 28 days) except three patients prior to surgery. One single dose of 10 U kg−1 and 30 U kg−1 plasma factor XIII concentrate before a minor procedure and circumcision were given, respectively. Two doses of plasma factor XIII concentrate, one 30 U kg−1 prior to the procedure and the second dose of 30 U kg−1 on post-operative day 3, were given for major surgery. The plasma factor XIII concentrate dose was 50 U kg−1 both before and after the procedure for neurosurgery.ResultsOne hundred sixty-two FXIIID patients underwent minor, major and obstetrical and gynecological surgeries. The median age of the patients was 14 years (ages ranged 15 days to 47 years). The male-to-female ratio was 89/73. Five post-operative complications, two bleeding and three thrombosis, were recorded for two patients who were undiagnosed prior to surgery.ConclusionOur study showed excellent hemostasis in FXIIID patients undergoing surgeries. Of these surgeries, we observed only 1.8% post-operative complications. Surgery can be performed safely in FXIIID patients, and the proposed treatment regimens lead to adequate hemostatic coverage with minimal risk for both minor and major surgeries. DisclosuresPeyvandi:Freeline, Kedrion, LFB, Octapharma: Consultancy; Ablynx, Roche: Membership on an entity's Board of Directors or advisory committees; Ablynx, Bayer, Grifols, Novo Nordisk, Sobi: Speakers Bureau.

Caregivers\u2019 perception of the caring challenges in coronavirus crisis (COVID-19): a qualitative study

BackgroundThe nurses act as the guardians of people’s health by preventing, controlling, and curing emerging diseases, including coronavirus, a highly infectious and contagious disease which has presented the caregivers in the Iranian healthcare system with many clinical challenges. In view of lack of research on the clinical challenges which arise during health crises, emerging diseases included, there is need for further investigation of those clinical challenges and dilemmas. The aim in present study was to describe the caregivers’ experiences of the caring challenges in patients with coronavirus (COVID-19).MethodsThe present study is a qualitative work with a phenomenological-descriptive design. Data were collected via semi-structured, in-depth, individual interviews. The collected data were analyzed according to Colaizzi’s method. The participants were 23 members of the medical staff responsible for coronavirus patients in Iran who met the inclusion criteria. The participants were selected via purposeful sampling which was continued to the point of data saturation.ResultsThe results yielded 3 main themes “psychological tension”, “inefficient management”, and “contextual factors” with 11 categories.ConclusionIn dealing with coronavirus patients and providing quality care to them, nurses face various clinical challenges which affect their performance. Administrators must, alongside giving instructions to people on how to prevent the coronavirus disease and taking effective safety measures, make sure that clinical centers are managed efficiently in order for nurses to fulfill their caring objectives satisfactorily.

Epidemiology of Hepatitis C Virus in Iranian Thalassemic, Hemodialysis and Hemophiliac Patients: A Meta-Analysis Study

Introduction: Hepatitis C is one of the most serious viral infections that cause chronic liver disease. Objectives: The current study was conducted to estimate the pooled prevalence and geographical distribution of Hepatitis C Virus (HCV) in thalassemic, hemodialysis, and hemophiliac patients in Iran. Evidence Acquisition: Articles were identified through international searching databases including PubMed, Scopus, Elsevier, Google Scholar, and Web of Science and Iranian scientific information database (SID), Health.barakatkns, IranDoc, Civilica and MagIran. We reviewed systematically all studies reporting the prevalence of HCV in thalassemic, hemodialysis, and hemophiliac patients. All studies conducted ELISA tests for the evaluation of HCV antibodies In this study meta-analysis method has been used to estimate the pooled prevalence. Results: 270 records were identified by the electronic search, of which 151 studies were identified as relevant papers that were meta-analyzed for the pooled HCV prevalence. Overall, prevalence of HCV were 18.27%(15.99%-20.55%), 11.60%(9.98%-13.22%) and 45.16%(36.72%-53.60%) in thalassemic, hemodialysis and hemophiliac patients. Conclusion: Concerning the high prevalence of HCV among hemophiliac patients, ongoing preventive actions for this group are recommended.

EVALUATION OF PHARMACOTHERAPY PROTOCOLS FOR COVID 19 PATIENTS IN BAQIYATALLAH HOSPITAL AND THEIR OUTCOMES

Purpose: The propagation of the new coronavirus, COVID 19, is still a major priority for many countries around the world. Because of the lack of effective certain antiviral therapy for COVID 19. Special medicinal protocols are needed in medical centers to reduce the mortality rate. Methods: Due to constant change of national pharmacotherapy protocols for COVID-19 patients, this study compares the outcomes of three specific pharmacotherapy regimens (Table 1) and the combination of all 3 regimens for management of 614 COVID-19 patients hospitalized in Baqiyatallah hospital in Tehran, this hospital became a referral centers for receiving COVID 19 patients in Iran. Results: The more reliable result of treatments belongs to regimen 3 which indicated 98.26% recovered patients and 1.15% mortality rate and the lowest period of hospitalization with 4.4±0.21 days’ duration. Conclusion: It seems that regimen 3 (with a special combination of antiviral and Azithromycin ant anti-inflammatory drugs) had the best result in improving patients with COVID 19 and this result has not conflict with the comorbidity status of patients.

Epidemiological, imaging, laboratory, and clinical characteristics and factors related to mortality in patients with COVID-19: a single-center study.

ObjectivesCoronavirus disease 2019 (COVID-19) is a novel pandemic. Considerable differences in disease severity and the mortality rate have been observed in different parts of the world. The present study investigated the characteristics and outcomes of patients hospitalized with COVID-19 in Iran.MethodsWe established a retrospective cohort to study hospitalized COVID-19 patients in Iran. Epidemiological, imaging, laboratory, and clinical characteristics and outcomes were recorded from medical documents. The chi-square test, t-test, and logistic regression models were used to analyze the data. A p<0.05 was considered to indicate statistical significance.ResultsIn total, 364 cases (207 males and 157 females) were analyzed. The most common symptoms were cough, fever, and dyspnea. Multifocal bilateral ground-glass opacities with peripheral distribution were the predominant imaging finding. The mean age of patients was 54.28±18.81 years. The mean age of patients who died was 71.50±14.60 years. The mortality rate was 17.6%. The total proportion of patients with a comorbidity was 47.5%, and 84.4% of patients who died had a comorbidity. Sex, history of diabetes mellitus, and dyslipidemia were not significantly associated with mortality (p>0.05). However, mortality showed significant relationships with body mass index; age; history of hypertension, chronic kidney disease (CKD), ischemic heart disease, cerebrovascular accident (CVA), pulmonary disease, and cancer; and abnormal high-resolution computed tomography (HRCT) findings (p<0.05 for all). Cancer had the highest odds ratio.ConclusionComorbidities (especially cancer, CKD, and CVA), severe obesity, old age, and abnormal HRCT findings affected the health outcomes of patients hospitalized with COVID-19.