Shahid Mohammadi Hospital Research Articles

Mortality Predictors in Patients With COVID-19 Referred to the Emergency Department in Bandar Abbas, Southern Iran: A Single-Center Experience

Background: Determining the predictors of mortality in COVID-19 is a way of identifying high-risk patients. Previous studies reported comorbidities and old age as the essential components of COVID-19 mortality. The present study aimed to determine the predictors of mortality in patients with COVID-19 referred to the emergency department. Materials and Methods: The present descriptive-analytical study was conducted retrospectively on patients with confirmed COVID-19 referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2019. Patient information, including age, gender, underlying disease, history of smoking, clinical symptoms, type of treatment, and laboratory findings, was extracted from the COVID registry. Results: In general, 2478 patients with COVID-19 were examined in this study. The average age of the patients was 52.57±16.41 years. Of them, 1371 people (55.3%) were men. The most common clinical symptom of the patients was shortness of breath (63.2%), and the most common underlying disease was hypertension (HTN) (24.3%). About 16.9% of the examined COVID-19 patients died. According to the results of multiple logistic regression analysis, with a 1-year increase in the age of the patients, the chance of death increased by 4.7% (P<0.001). In addition, dyspnea, HTN, ischemic heart disease, dyslipidemia, stroke, and malignancy increased the probability of death by 2.4, 1.6, 1.7, 3.6, 2.9, and 2.2 times, respectively (P<0.05). The most important predictor of mortality was C-reactive protein (CRP) 3+, which increased the probability of mortality in COVID-19 patients by almost 25 times (odds ratio [OR]=25.338, 95% CI=1.978–324.668, P=0.013). Moreover, with each unit increase in erythrocyte sedimentation rate (ESR), the chance of death in patients increased by 3.3% (P<0.001). On the other hand, among the clinical symptoms, anorexia (OR=0.711, 95% CI=0.506–0.999, P=0.050) and receiving macrolides (OR=0.212, 95% CI=0.091–0.492, P<0.001) had a protective role in mortality. Conclusion: Based on the results of this study, old age, dyspnea, HTN, ischemic heart disease, dyslipidemia, stroke, malignancy, CRP 3+, and high ESR were identified as predictors of mortality in COVID-19 patients. Of course, receiving macrolide and the presence of anorexia played a protective role in mortality in these patients.

Psychometrics properties of type 2 diabetes treatment adherence questionnaire (DTAQ): a study based on Pender’s health promotion model

BackgroundManagement of type 2 diabetes (T2D) as a chronic disease requires treatment adherence such as controlling the blood glucose level and adopting a healthy lifestyle. The present study aimed to develop and psychometrically evaluate a questionnaire based on the Pender’s Health Promotion Model (HPM) to measure treatment adherence and the associated factors among T2D patients.MethodsThe present study was conducted in qualitative and the quantitative phases between March 2022 and March 2023. The participants were T2D patients visiting Shahid Mohammadi hospital Diabetes Clinic in Bandar Abbas in the south of Iran. The first draft of items was extracted from the qualitative phase. The present study used interviews with T2D patients, item construction, validity and reliability evaluation of the instrument, and the relevant statistical analyses. It emphasized the significance of content, face, and construct validity, along with reliability testing using Cronbach’s alpha and test-retest method. Data were analyzed using SPSS software, V16 and AMOS, V23.ResultsA 97-item questionnaire was developed through the qualitative phase and, after content validity, it was reduced to 86 items. Five items were removed in face validation, and after the test-retest method, 79 items were retained. The confirmatory factors analysis confirmed a 65-item model with appropriate fitness of data. Cronbach’s alpha coefficient showed an acceptable reliability of the diabetes treatment adherence questionnaire (α = 0.92).ConclusionThe questionnaire developed based on the HPM model provides a standard and comprehensive measurement of the degree of adherence to treatment and the associated factors among Iranian T2D patients. This is especially valuable in the Iranian healthcare context, where effective management of chronic diseases such as diabetes is of a top priority. Questionnaires can help identify barriers and facilitators of treatment adherence to inform systematic and goal-oriented interventions. The proposed questionnaire had good psychometric properties, and can be used as a valid and practical instrument to measure the factors related to treatment adherence behaviors.

Is admission neutrophil-to-lymphocyte ratio an outcome predictor in critically ill multiple trauma patients? A retrospective single-centre cross-sectional study

Background Trauma is a global health concern with a high mortality rate. Research suggests a potential link between neutrophil-to-lymphocyte ratio (NLR) and mortality. This study aims to assess the prognostic value of NLR in intensive care unit (ICU)-admitted individuals with multiple trauma. Methods This study reviewed medical records of multiple trauma patients admitted to the ICU of Shahid Mohammadi Hospital in Bandar Abbas, Iran, from 2020 to 2021. Variables assessed included age, sex, blood pressure, Glasgow Coma Scale, Injury Severity Score, NLR, trauma details, surgical procedures, hospital and ICU length of stay, duration of mechanical ventilation, and mortality. Results In the study, 160 multiple trauma patients were analyzed, with an average age of 34.13 ± 14.74 years. Among them, 130 (81.3%) were male and 75 (46.9%) died. The mean NLR did not show a significant difference between survivors and non-survivors ( p = 0.853). The predictive ability of NLR for mortality, as measured by the area under the receiver operating characteristic curve, was 0.530 (95% confidence interval [CI] 0.440; 0.620, p = 0.517). Patients who died had higher rates of ICU admission, mechanical ventilation requirement, longer mechanical ventilation duration, and longer hospital and ICU stays (all p < 0.001). Multivariable logistic regression analysis found that a non-sinus rhythm in the admission ECG was associated with approximately eight times higher odds of mortality compared to a sinus rhythm (adjusted odds ratio = 7.961, 95% CI 1.724; 36.759, p = 0.008). No significant association was found between NLR and mortality in univariable binary logistic regression, even after adjusting for various factors (adjusted OR = 0.967, 95% CI 0.989; 1.042, p = 0.375). Conclusions Our findings indicate that admission NLR did not demonstrate efficacy as a prognostic indicator of mortality among patients with multiple trauma admitted to the ICU.

Micro- and Macrovascular Complications of Type 2 Diabetes in Southern Iran

Objectives: Type 2 diabetes mellitus (T2DM) is one of the most common diseases worldwide, imposing a great burden on the community by its complications. This study evaluates micro-and macrovascular complications of T2DM and the associated factors in the south of Iran. Methods: This cross-sectional study was conducted on T2DM patients referred to the Diabetes Clinic of Shahid Mohammadi Hospital in Bandar Abbas City, Iran, in 2018. Patients’ age, sex, marital status, smoking status, diabetes medications, cardiovascular disease, and duration of T2DM were recorded. Weight, height, and blood pressure were measured and body mass index was calculated for every participant. Also, all patients were evaluated regarding diabetes complications, including retinopathy, nephropathy, and neuropathy. Serum fasting plasma glucose (FPG), lipid profile, glycated hemoglobin, creatinine levels as well as urinary albumin were also measured in the patients. Results: Of the 263 T2DM patients included in the current study with a mean age of 55.32±13.09 years, 109 (41.4%) were male. The most common T2DM complications were chronic kidney disease (CKD) (49.8%) and nephropathy (36.5%), followed by neuropathy (30.8%), retinopathy (19%) and ischemic heart disease (8.7%). Elevated systolic blood pressure was significantly correlated with the presence of all complications. Patients with ischemic heart disease, CKD, neuropathy, and retinopathy were significantly older than subjects without such complications. Diabetes was significantly more prolonged in patients with ischemic heart disease and CKD. Elevated FPG was only correlated with CKD (P=0.019) and nephropathy (P=0.003), while increased glycated hemoglobin and decreased high-density lipoprotein were significantly associated with retinopathy (P=0.050 and P=0.001, respectively). Moreover, a significant relationship was observed between elevated urinary albumin with retinopathy and neuropathy. Discussion: Diabetic kidney disease was the most common complication of T2DM in the current study. Increased systolic blood pressure is the most important risk factor for the development of diabetic complications.

Clinicopathological Pattern of Endometrial Specimens in Women with Abnormal Uterine Bleeding and Ultrasonography Correlation.

Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation. Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis. During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age. Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps.

Investigating Ki67 and p16 Positivity Pattern in Human Papillomavirus 16 and 18 Versus Other High-risk Human Papillomaviruses

Objectives: The expression of Ki67 and p16 has been used for the diagnosis of human papillomavirus (HPV) 16 and 18; however, limited research has been conducted on the comparison with other high-risk HPVs (HR-HPVs) in this respect. Accordingly, this study compares the positivity pattern of Ki67 and p16 in HPV16/18 with other HR-HPVs. Methods: This descriptive study included women with positive screening test (Pap smear test) and positive HR-HPV referred to Shahid Mohammadi Hospital, Bandar Abbas, Iran, from 2018-2019 for colposcopy and cervical biopsy. Biopsy specimens were stained for Ki67 and p16. Data on age, education, and menopause status were also recorded. Results: Of the 80 women included in this study with a mean age of 33.16±8.55 years, 48.8% had positive HPV16/18, and 51.2% were positive for other HR-HPVs. The positivity pattern of Ki67 and the type of HR-HPV (HPV16/18 vs other HR-HPVs) were significantly correlated (P=0.006). Full-thickness positive Ki67 was only observed in HPV16/18 positive specimens. Positive Ki67 in the upper and middle thirds were also significantly more frequent with HPV16/18. The correlation between positive Ki67 and HR-HPVs remained significant in women aged >30 years, with university education, and of childbearing age. Discussion: The positivity pattern of Ki67 is significantly correlated with HPV16/18, and age, education, and menopause status are the influential factors. Meanwhile, the strongly positive p16 pattern was more frequent in HPV16/18 compared to other HR-HPVs; however, the relationship between the positivity pattern of p16 and the type of HR-HPV was not significant.

Propofol Versus Midazolam for Sedation in Patients With Cirrhosis Undergoing Upper Endoscopy: A Single-Blind Randomized Clinical Trial

Background: Patients with hepatic cirrhosis are frequently screened for the complications of portal vein hypertension using upper endoscopy. The current study aimed to compare the efficacy and safety of midazolam and propofol for sedation in patients with cirrhosis undergoing upper endoscopy. Methods: This single-blind randomized clinical trial included 60 cirrhotic patients aged 18-80 years referred to Shahid Mohammadi hospital, Bandar Abbas, Iran from May 22, 2019, to May 21, 2020, for upper endoscopy. The age, gender, weight, and height of the patients were recorded, and they were randomized into two groups. Patients in the midazolam group (n=30) received 0.05 mg/ kg midazolam for induction which continued with a 1 µg/kg/min dose, and those in the propofol group received 1 mg/kg propofol which continued with a 25-75 µg/kg/min dose. Blood pressure, oxygen saturation (SpO2 ), respiratory rate (RR), and heart rate (HR) were measured before induction, immediately, 1, and 5 minutes after induction, and in the recovery unit. Finally, the time to reach the target sedation (Ramsay sedation scale≥5), sedation duration, and recovery time were noted as well. Results: Patients in both groups were comparable regarding age, gender, weight, and height. There were no significant differences between groups regarding hemodynamic parameters at any given time point, except for RR 1 minute after induction, which was significantly higher in the propofol group (P=0.012). Changes in HR from baseline to recovery were significant in both groups. Moreover, changes in SpO2 from baseline to recovery were only significant in the midazolam group (P<0.001). The time to reach the target sedation and sedation duration were significantly lower in the propofol group (P<0.001 and P=0.003, respectively); however, there was no significant difference between groups with regard to the recovery time. Grade II encephalopathy (West Haven criteria) developed in one patient in the midazolam group. Conclusion: Based on the results of the current study, although propofol was superior to midazolam for upper endoscopy in cirrhotic patients with respect to the time to reach the target sedation and sedation duration, the two drugs were rather comparable in terms of hemodynamic stability. However, hepatic encephalopathy with midazolam remains a major concern.

Rapid Response to Gauze Strip Soaked in Triamcinolone, Neomycin, and Nystatin in Acute Otitis Externa

Background: Acute otitis externa (AOE) is a common condition with multiple available treatments. This study aimed to compare gauze strips soaked in triamcinolone, neomycin, and nystatin with conventional eardrops for the treatment of AOE. Methods: This experimental study included patients with AOE referred to the Otolaryngology Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, 2014-2015. Based on their signs and symptoms, patients were divided into two clinical groups of mild to moderate and moderate to severe AOE. Patients treated with polymyxin B, neomycin, and hydrocortisone (polymyxin NH), or ciprofloxacin plus betamethasone eardrops were regarded as controls (conventional eardrops), and those whose ear canal had been filled with a gauze strip soaked in triamcinolone, neomycin, and nystatin (triamcinolone NN) were regarded as cases. Results: A total of 76 ears were included in this study (36 and 40 cases with mild to moderate and moderate to severe AOE, respectively). After 24 hours, in both clinical groups with mild to moderate and moderate to severe AOE, response to treatment with triamcinolone NN-soaked gauze strips was significantly higher than conventional eardrops (94.4% vs. 11.1%, P<0.001 and 80% vs. 10%, P<0.001, respectively). Conclusion: Patients with mild to severe AOE appear to rapidly respond to gauze strips soaked in triamcinolone, neomycin, and nystatin.

Prevalence of Subdural and Epidural Hematoma in Head Trauma Patients: A Cross-sectional Study

Background: Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department. Materials and Methods: This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files. Results: The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028). Conclusion: The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.

Evaluating the Effect of Smoking on COVID-19 Severity in Patients Admitted to Shahid Mohammadi Hospital in Bandar Abbas During 2021-2022

Background: The coronavirus disease 2019 (COVID-19) is a newborn virus that has become an emergency since December 2019. A severe form of this disease is accompanied by intensive care unit (ICU) admission and death. The COVID-19 pandemic is still occurring in several countries; however, few facts are available about the disease. Risk factors and protective factors of this disease are still unknown. We know that smoking is a risk factor for several respiratory infections. However, considering some previous studies and nicotine’s anti-inflammatory mechanism, a smoking paradox in COVID-19 still persists as an obscure issue. Thus, we decided to evaluate the association between smoking and COVID-19 disease. Materials and Methods: In this study, sampling was performed simply and randomly from all admitted COVID-19 patients in 2020-2021. This is a retrograde case-control study, and 92 COVID-19 patients with a history of smoking were enrolled in the case group, and 92 COVID-19 patients without any smoking history were selected for the control group. Data were collected through a checklist. In this checklist, information such as the patient’s age, gender, and medical condition was recorded. In the end, collected data were analyzed by SPSS software version 26.0. Results: In this study, we used a logistic regression test to indicate that smoking had a significant relationship with subsequent plasmapheresis (P=0.001). We also found a significant relationship between cigarette smoking and plasmapheresis (P<0.001). Furthermore, old age and diabetes were related to ICU admission (P=0.001 and P<0.000, respectively), and male gender and hypertension were related to plasmapheresis (P=0.007 and P=0.001, respectively). Moreover, only old age was related to mortality caused by COVID-19 infection (P=0.025). Conclusion: Considering the issue of the smoking paradox in COVID-19, the association between smoking and COVID-19 disease was evaluated in this study. it was found that smoking is related to the need for plasmapheresis and was not related to ICU admission or death. Cigarette smoking had the same association. It should be noted that plasmapheresis had no significant relation with ICU admission and death. Moreover, hookah smoking had no relationship with plasmapheresis, ICU admission, and death. This study also evaluated other factors such as age, gender, and medical conditions such as hypertension, diabetes, and cardiovascular disease and their effect on COVID-19. We found that only old age was related to mortality caused by COVID-19.

Association of electrocardiographic abnormalities and COVID-19 clinical outcomes

BackgroundAlterations in the electrocardiogram (ECG) have been associated with coronavirus disease 2019 (COVID-19) severity. ECG irregularities have been linked to death from any cause. However, in previous studies, different abnormalities have been shown to be associated with COVID-19 mortality. We aimed to evaluate the association between ECG abnormalities and COVID-19 clinical outcomes. MethodsThis cross-sectional retrospectively evaluated patients with COVID-19 admitted to the emergency department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients' data were extracted from their medical records, including demographics, smoking, underlying diseases, treatment, laboratory test results, and in-hospital parameters. Their admission ECGs were assessed for abnormalities. ResultsOf the 239 COVID-19 patients with a mean age of 55.18 ± 16.85 years, 126 (52.7%) were male. Fifty-seven patients (23.8%) died. Intensive care unit (ICU) admission and mechanical ventilation requirement were higher in patients who died (P < 0.001). Furthermore, mechanical ventilation duration and hospital and ICU length of stay were significantly longer in patients who died (P < 0.001). Multivariable logistic regression analysis revealed that a non-sinus rhythm in the admission ECG was associated with approximately eight times higher odds of mortality than a sinus rhythm (adjusted odds ratio = 7.961, 95% confidence interval 1.724; 36.759, P = 0.008). ConclusionsAmong ECG findings, a non-sinus rhythm in the admission ECG appears to increase the odds of mortality in patients with COVID-19. Therefore, it is advised that COVID-19 patients be continuously monitored for ECG alterations, as this might provide crucial prognostic data.

The effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19: a structured summary of a study protocol for a randomized controlled trial

ObjectivesThis study aims to evaluate the effect of vitamin D and magnesium supplementation on clinical symptoms and serum inflammatory and oxidative stress markers in patients with COVID-19.Trial designThis study is a 4-arm randomized, double-blind, placebo-controlled clinical trial with a factorial design and the intervention period is 3 weeks.ParticipantsThis study is conducted on COVID-19 patients admitted to the Shahid Mohammadi hospital in Bandar Abbas, Iran, who are eligible for inclusion in the study. Patients are included only if they meet all of the following criteria: (1) aged from 18 to 65 years old; (2) confirmation of COVID-19 by RT-PCR test; (3) completing informed consent; (4) passing less than 48 h since the patient's hospitalization; (5) no skin or gastrointestinal allergies due to taking multivitamin supplements, vitamin D, and magnesium; and (6) having more than 30 breaths per minute and less than 93% oxygen saturation in room air and sea level. Patients are excluded if they have any of the following conditions: (1) pregnancy or lactation; (2) taking a daily multivitamin or take a vitamin D or magnesium supplement in the last month; (3) participating in other clinical trials; (4) renal failure or dialysis, severe liver disease or cirrhosis; (5) known diagnosis of hypercalcemia; (6) discharging from the hospital less than 24 h after the start of the intervention; (7) history of kidney stones in the last year; (8) transfer the patient to the ICU; (9) baseline vitamin D levels above 80 ng/ml; (10) baseline magnesium levels above 2.6 mg/dl; and (11) unwillingness of the patient to continue the study.Intervention and comparatorParticipants will be randomly allocated to one of the four following groups: (A) vitamin D (two 50,000 IU capsules at the beginning of the study, two 50,000 IU capsules on the 4th day, one 50,000 IU capsule on the 11th day, and one 50,000 IU capsule on the 17th day) and magnesium supplement (300 mg/day); (B) vitamin D capsule and magnesium placebo; (C) magnesium supplement and vitamin D placebo; and (D) vitamin D placebo and magnesium placebo.Main outcomesThe resolution of clinical symptoms (fever, dry cough, shortness of breath, headache, myalgia, oxygen saturation, and mortality rate) and interpretation of laboratory assays (CRP, MDA, TAC, WBC, neutrophils count, lymphocytes count, ratio of neutrophils to lymphocytes, levels of 25 hydroxyvitamin D and magnesium) will be assessed in the study groups.RandomizationA computer-generated block randomization list is used for randomization.Blinding (masking)Investigators and patients are blinded to group allocation and treatment. A double-blind design is achieved using matched placebos.Numbers to be randomized (sample size)A total of 104 eligible patients are randomized into four groups of 26 subjects (1:1:1:1 allocation ratio).DiscussionWith the rapid prevalence of COVID-19 in recent years, more attention has been paid to effective dietary supplementation to improve clinical symptoms and biochemical parameters in these patients. To our knowledge, this is the first study to evaluate the effects of vitamin D supplementation in combination with magnesium or alone with respect to this infectious disease. The findings of the current RCT will provide evidence regarding the effectiveness of dietary supplementation strategies to improve COVID-19 outcomes.Trial statusEthical approval of the first version of the study protocol was obtained from the medical ethics committee of Hormozgan University of Medical Sciences, Bandar Abbas, Iran on May 30, 2021 (IR.HUMS.REC.1400.085). Currently, the recruitment phase is ongoing since August 23, 2021, and is anticipated to be complete by the end of August 2022.Trial registrationThe study protocol was registered in the Iranian Registry of Clinical Trials (https://www.irct.ir; IRCT20210702051763N1) on August 14, 2021. https://www.irct.ir/trial/57413Full protocolThe full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this letter serves as a summary of the key elements of the full protocol.

Pulmonary radiologic findings based on Warrick score as a predictor of COVID-19 patients’ outcomes

Introduction: Predicting factors related to the severity and mortality of coronavirus disease 2019 (COVID-19) patients can significantly help in better management of their treatment. Objectives: This study aimed to investigate the correlation between pulmonary radiologic findings based on the Warrick score and COVID-19 patients’ outcomes. Patients and Methods: This descriptive-analytical study was conducted on 436 COVID-19 patients hospitalized at Shahid Mohammadi hospital in Bandar Abbas. Pulmonary radiologic findings were scored based on the Warrick score. Outcomes of COVID-19 patients, including disease severity and mortality, were followed. Independent T-test and binary logistic regression were conducted to explore the correlation between the pulmonary radiologic findings and patients’ outcomes. Results: Results showed that the correlation between pulmonary radiologic findings with both disease severity and mortality was significant, since higher pulmonary involvement caused greater severity and mortality. The Warrick score difference between dead and recovered patients and low and high disease severity were significant, therefore greater Warrick score caused more disease severity and mortality. Conclusion: Pulmonary radiologic findings based on the Warrick score can use as a predictor of COVID-19 patients’ outcomes.

Efficacy of N-acetyl Cysteine in Severe COVID-19 Patients: A Randomized Controlled Phase III Clinical Trial

Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objectives: This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Methods: This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital’s ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Results: The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 ± 4.67 vs. 27.37 ± 6.99 /min) and D-dimer (186.37 ± 410.23 vs. 1339.04 ± 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) ≤ 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusions: Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.

The effect of topical olive oil dressing on the healing of grade 1 and 2 diabetic foot ulcers: An assessor-blind randomized controlled trial in type 2 diabetes patients

Background and aimsWe aimed to compare the effect of topical olive oil dressing plus standard care with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes mellitus (T2DM) patients. MethodsThis assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22, 2017. Patients were randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group received standard care, including wound irrigation with normal saline and oral antibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue healing) was recorded weekly and the total wound status was determined at the end of the study. ResultsTreatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group, respectively. ConclusionsTopical olive oil dressing promoted the healing of DFU and it can be recommended as a safe and effective treatment in this regard. Trial registrationIranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/2018. Retrospectively registered, https://www.irct.ir/trial/19460.

The Association of Serum Calcium and Risk of Morbidity and Mortality in ICUAdmitted Patients

Background: Calcium is one of the essential electrolytes in humans, and hypocalcemia is one of the most common disorders in surgical and internal medicine patients requiring ICU. Therefore, we decided to investigate the clinical relationship of calcium level with the rate of mortality and related morbidities, such as sepsis, various organ failures, the need for mechanical ventilation, and the length of stay in the intensive care unit (ICU). Methods: A total of 61 patients admitted to the ICU of Shahid Mohammadi Hospital from 2019 to 2020 were included in the study. After collecting information related to calcium deficiency, patients' mortality, the need for mechanical ventilation and the duration of mechanical ventilation, serum albumin, magnesium, and potassium level, and SOFA and APACHE II prognostic scoring systems; the data were entered into SPSS software and subjected to statistical analysis. Results: Out of 61 patients included in the present research, 37 were women, and 24 were men. In our study, 26.1% of the patients died during hospitalization, and 34.8% needed mechanical ventilation, which was a significant number. Serum calcium level was significant in the examined sepsis and kidney failure patients, but no other significant item was observed in the other patients, including COVID-19 patients. There was a significant relationship between serum calcium level in the studied patients with serum albumin level and SOFA score, but there was no significant relationship between the duration of hospitalization and the need for a ventilator, calcium and potassium serum level and their APACHE score (P-value &gt;0.05). In addition, the serum level of magnesium in the studied patients had no significant relationship with any of the variables of mortality, sepsis, liver and kidney failure, and the need for mechanical ventilation. Conclusions: This study showed a significant relationship between serum calcium level with serum albumin level and SOFA score.There was no significant relationship between serum calcium level with the duration of hospitalization, the need for a ventilator, and the APACHE score. Also, the serum calcium level was not significant for any of the parameters in COVID-19 patients.

The Relationship Between Food Allergens and Migraine Among Patients With Migraine Referring to Shahid Mohammadi Neurology Clinic

Background: Although diet-induced migraines affect many people, the triggering foodstuffs are not fully identified yet. Detecting migraine-triggering foods and susceptible individuals assist in effective headache management. The aim of this study was to determine the relationship between eating allergens and developing or exacerbating migraine. Methods: This was a descriptive-analytical cross-sectional study with 230 migraine patients referring to the neurology clinic of Shahid Mohammadi hospital in Bandar Abbas. They were selected through purposive sampling. After obtaining informed consent from the patients, the required data were collected and then underwent analysis. Results: Overall, 52.4% and 47.6% of participants were females and males, respectively. Their mean age was 40.57±14.04. Based on the results, 61.9% of participants were married, and 60.3% of them had a family history of migraine. The average number of headaches per month and the duration of each headache were 3.16-4.19 times and 3.76-4.41 hours, respectively. Based on the findings, sausages (55.6%), carbonated beverages (0.54%), peanuts (0.46%), beef (44.4%), and canned food, coffee, and eggs (41.3%) are the most common foodstuffs that cause or exacerbate migraines. On the other hand, chicken (15.9%), strawberry, rice, and wheat (17.5%) had the least impact on the onset and exacerbation of migraine headaches. Conclusion: According to the results, identifying food allergens and eliminating them from patients’ diets can be effective in the prognosis of migraine and individuals’ quality of life.

Effect of Propofol Alone and Propofol+Muscle Relaxant Combination on Laryngeal Mask Airway Insertion and Hemodynamic Parameters During Anesthesia Induction: A Randomized Clinical Trial

Background: Successful insertion of a laryngeal mask airway (LMA) requires deep anesthesia, the proper opening of the mouth, and adequate suppression of upper airway reflexes. Propofol injection can effectively reduce laryngeal reflexes. This study aimed to compare the effectiveness of propofol alone versus propofol plus a muscle relaxant on LMA insertion and hemodynamic parameters during the induction of anesthesia. Methods: This randomized, double-blind clinical study was performed on 70 patients in the age range of 18-65 years who were candidates for surgery in the operating room of Shahid Mohammadi Hospital in Bandar Abbas, Iran in 2020. The patients were randomly divided into two groups of 35. The first group received propofol and normal saline, and the second group received propofol plus cisatracurium. The parameters of ease of LMA insertion, jaw opening, cough and gag reflexes, head and limb movement, laryngospasm, and hemodynamic changes were recorded for investigation. Results: The patients were almost matched in terms of demographic variables. No significant difference was found regarding the ease of LMA insertion and hemodynamic parameters. However, the overall score of ease of LMA insertion was considerably higher in the propofol plus muscle relaxant group (P=0.029). The extubation time was significantly shorter (P&lt;0.001) and the surgery duration was considerably longer (P=0.019) in the propofol plus muscle relaxant group. Conclusion: The findings demonstrated that both techniques were suitable for LMA insertion, and no significant hemodynamic changes were found between the two groups. However, the administration of propofol plus a muscle relaxant was more suitable due to ease of LMA insertion and shorter extubation time.

Association of Serum Magnesium and Risk of Morbidity and Mortality in ICU-Admitted Patients Based on COVID-19 Infection Classification

Background: Magnesium (Mg) deficiency is a common clinical electrolyte abnormality in critically ill patients, which is related to higher mortality and is easily ignored. Objectives: We aimed to investigate the association of Mg levels with mortality and comorbidity in patients admitted to the intensive care unit (ICU) based on COVID-19 infection classification. Methods: A total of 69 patients admitted to the ICU of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from June to December 2021were included in the present study. The serum Mg was measured in these patients. Data from sequential organ failure assessment (SOFA), acute physiologic assessment and chronic health evaluation (APACHE), ICU stay length, mechanical ventilation duration, mortality, and comorbidity were determined. Moreover, the COVID-19 infection was detected by PCR. Results: The mean ± SD age of patients (34.8% male) was 52.56 ± 16.43 years. Out of 69 patients, 18 (26.1%) died during hospitalization, and 24 (34.8%) required mechanical ventilation. The prevalence of COVID-19 was 39.1% (27 patients). Our results showed no difference in serum Mg between patients based on mortality and comorbidity status. However, the Mg level of patients with kidney failure was significantly higher than patients without kidney failure (P &lt; 0.05). Based on the COVID-19 classification, there was only a positive correlation between hypomagnesemia and the length of ICU hospitalization in patients without COVID-19 (P &lt; 0.05). Conclusions: Our findings showed no difference in the Mg levels of patients based on mortality status. Patients with kidney failure had higher serum Mg than those without kidney failure. Furthermore, our results showed no difference in the Mg levels of critically ill patients based on COVID-19 infection status.

Diagnostic Performance of Forced Expiratory Volume in Six Seconds for the Detection of Obstructive and Restrictive Pulmonary Diseases in a Population of Young Adults in South of Iran

Background: Forced expiratory volume in 6 seconds (FEV6) is a reliable substitute for forced vital capacity (FVC) to identify pulmonary diseases. This study aimed to determine the diagnostic performance of FEV6 in the detection of obstructive and restrictive spirometric patterns. Methods: In this cross-sectional study, spirometry was performed on patients referred to the occupational medicine clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, 2018. Spirometric parameters, including FEV1, FVC, and FEV6, were recorded for those tests meeting the American Thoracic Society (ATS) standards. Taken as the reference, the FEV1/FVC ratio&lt;70% indicated airway obstruction, and the restrictive pattern was defined as FVC&lt;80%. Results: In general, 1100 spirometries were included after meeting the ATS standards. The optimal cut-off of FEV1/FEV6 for the prediction of airway obstruction was 71.45% with a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 97.22%, 98.22%, 89.17%, 99.57%, and 98.09%, respectively. The best cut-off of FEV6 for the prediction of the restrictive pattern was 79.23% with the corresponding diagnostic indices of 97.29%, 99.05%, 94.11%, 99.57%, and 98.81%, respectively. Based on the FEV1/FEV6 cut-off, the frequency of obstruction was 14.27% (157/1100) compared to 13.09% based on FEV1/FVC. The frequency of restriction was 13.90% (153/1100) according to the FEV6 cut-off compared to 13.45% with respect to FVC. Conclusion: Overall, our results indicated the applicability of FEV1/FEV6 as an accepted surrogate for FEV1/FVC to diagnose airway obstruction, particularly to screen for chronic obstructive pulmonary disease (COPD) among high-risk patients. In addition, FEV6 is potentially an appropriate substitute for FVC to detect a restrictive pattern.