mahnaz montazeri

 This study was conducted with the aim of investigating methods to reduce the use of urinary catheters in hospitalized patients, which can reduce the occurrence of urinary infections.

This prospective study was conducted during 10 months by collecting information from the files of 694 patients (in two groups before and after the intervention) in the non-Intensive Care Unit wards of a university hospital. The required information before and after the educational and managerial interventions were collected and compared.

 In the pre-intervention phase, 217 out of 347 patients (62.5%) and in the post-intervention phase, 199 out of 347 patients (57.3%) were male. Before the intervention, the average duration of hospitalization and urinary catheter utilization days were 8.7 and 7.9 days, respectively, which were decreased to 7.2 and 6.3 days, respectively, after the intervention. After the intervention, the number of catheters that were placed by the doctor's written order increased significantly (P-value: 0.002); Also, after the intervention, the cases of catheterization with indication increased significantly (P-value: 0.001). The most common indication for urinary catheter insertion was before and during surgery and later, was severe weakness of the patient to get out of bed.

 Combination of educational, executive and managerial interventions can reduce the number of urinary catheter insertion without physician's order and the number of urinary catheter insertion without indication. In this study, the number of cases who used catheter due to inability of getting out of bed, did not change significantly by the interventions.

The rational use of antibiotic prophylaxis before surgery can reduce surgical site infection, microbial resistance, and economic burden. Therefore, the present study was carried out to optimize the use of antibiotic prophylaxis before surgery using a ready-made drug package prepared in the pharmacy of Dr. Shariati Hospital. The current study is a semi-experimental intervention type, carried out in two stages before and after on 260 patients hospitalized in the heart surgery and neurosurgery departments of Dr. Shariati Hospital who were candidates for surgery and received antibiotic prophylaxis before surgery. A checklist containing patients ' information was completed before and after the preparation of antibiotic prophylaxis packages. Data were analyzed in spss18 software with descriptive and analytical statistics (p≤0.05). Before and after the optimization of antibiotic use, a statistically significant difference was observed in the two study groups regarding dosage, administration intervals, time, and duration of administration. (P<0.001) A 63.42% reduction in the number of doses of antibiotic prophylaxis was observed after the implementation of optimization. Also, there was a 57.33% reduction in the cost of antibiotic prophylaxis after the implementation of optimization. The use of a ready-made drug package before surgery optimizes the use of antibiotic prophylaxis. Also, the economic burden caused by inappropriate use of prophylactic antibiotics for the patient and the hospital is significantly reduced with this method.

 Invasive fungal infections (IFIs) are a significant cause of mortality and morbidity in patients with hematological malignancies. Given the considerable prevalence and consequences of IFIs, hence revealing the exact cause of fungal infections, their rate, associated risk factors, and complications could contribute to reducing both financial and life costs, choosing targeted antifungal treatment, and avoiding unnecessary toxic treatments in individuals who are not suffering from mycoses.

 This prospective cross-sectional study was conducted in the first semester of 2019. All patients with hematologic malignancies (HM) admitted to Dr. Shariati Hospital were studied. Only those with probable/proven IFIs defined according to the last update of EORTC/MSG criteria were included in the study. The demographic and clinical data were recorded from the hospital information registration system using a questionnaire. Statistical analysis was performed using SPSS software version 24.

Out of 1109 HM patients hospitalized during the study period, 67 (6.04%) IFIs were diagnosed. Of these, 57 (85.04%) were aspergillosis, 7 (10.4%) were mucormycosis, and 3 patients developed other fungal infections. Males constituted 67.2% of the entire IFI population. The mean±SD age of the samples was 43.16 ± 13.8 years. The most common type of malignancy was AML. Lung imaging showed lesions associated with fungal infections in 52 cases (77.6%), with multiple nodules as the most prevalent pattern being observed in 64.2% of cases. Sinus involvement was evidenced in the PNS CT scan of 46 (68.6%) patients. The attributable mortality rate for IFIs was 62.7%. Both the types of IFI and malignancies had no significant relationship with the outcome of patients. Central venous catheter, mucositis, and antibiotic use were the most frequent risk factors.

  IFI represents a frequent complication for HM patients with high mortality. Aspergillus species are the predominant etiology in these settings. Considering our results, in high-risk patients, manifestations of warning signs in the sinus and lungs, which would not be cleared despite receiving antibiotics, should raise the possibility of IFIs.

 Coronavirus disease 2019 (COVID-19) has been associated with a hypercoagulopathy state; however, the efficacy of different anticoagulant regimens in preventing thrombotic events is not clear. We aimed to compare therapeutic versus prophylactic enoxaparin therapy in severe COVID-19 patients.

 In this single-center, open-label, randomized controlled trial, adult patients with severe COVID-19 presentations and an increased D-dimer level of more than 4 times the normal upper limit were randomly assigned to receive either prophylactic or therapeutic dose of enoxaparin. All patients were observed for at least 4 months regarding the overall survival as the primary outcome. Hospitalization duration, the need for intensive care unit (ICU) admission, the need for mechanical ventilation, and major adverse events (MAEs) were also analyzed as the secondary outcomes. Survival analysis was done via Kaplan-Meier curves and the Log-rank test. Cox regression was used, adjusting for baseline variables.

 Overall, 237 patients (152 men and 85 women) were randomized to either arm (121 to prophylactic and 116 to therapeutic groups). The mortality rate was 27 (22.3%) and 52 (44.8%) in prophylactic and therapeutic arms, respectively. Prophylactic enoxaparin was associated with better survival in the log-rank test (P < 0.001; HR, 0.42). Additionally, a significantly lower rate of ICU admission, a lower rate of MAEs, and shorter hospitalization were observed in the prophylactic arm (P < 0.001, P = 0.009, and P = 0.028, respectively).

 The results of the current study were in favor of anticoagulant treatment with prophylactic doses of enoxaparin. Still, due to the limitations of this paper, we suggest that these findings be treated cautiously.

COVID-19 caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has turn into a pandemic and has extended all over the world. Since the virus has the potential ability to severely impair heart and liver, analyzing the biochemical parameters is a suitable approach for clinicians to assess the outcome.

This study was conducted along with 614 recognized COVID-19 patients. All samples were from Emergency department of Sina Hospital in Tehran, Iran, from February to May, 2020.

A total of 614 COVID-19 patients with mean age of 57.8 years (16-94 years) consisting of 385 (62.7%) male and 229 (37.2%) female were studied. Patients with COVID-19 had no significant difference between cardiac and liver parameters on the presentation and discharge time (p-value≥0.05). Patients with COVID-19 had significant correlation in Lactate dehydrogenase (LDH), Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), Alkaline phosphatase (ALP), and Total Bilirubin with recovery and mortality outcome (p-value≤0.05). Also, high sensitivity cardiac Troponin-I, LDH, AST, and ALT in patients with COVID-19 were significantly associated with high in-hospital mortality (p-value<0.05).

Several laboratory parameters may ease the evaluation of COVID-19 in-hospital mortality. Cardiac and liver parameters are critical in assisting COVID-19 cases.

During the coronavirus disease-2019 (COVID-19) pandemic, which was caused by the novel coronavirus, there is an ongoing controversy about the use of corticosteroids. This study aims to investigate the association between Dexamethasone treatment and clinical outcomes in patients with severe COVID-19. In this single-center retrospective cohort study, patients with COVID-19 were enrolled from February 16, 2020, to November 1, 2020. After performing propensity score matching with age, sex, and disease severity. The independent effect of Dexamethasone treatment on in-hospital mortality was evaluated by multivariate proportional hazards regression models. Of 1413 patients with COVID-19 diagnosis, 1172 patients entered the final analysis. 473(40.4%) patients received dexamethasone treatment with a median duration of 6.0[4.0-9.0] days. After matching and adjustment with possible confounders in the multivariate model, administration of dexamethasone significantly increased the survival in severe patients (hazard ratio: 0.25, 95 confidence intervals: 0.16-0.38, P<0.001), but there was no difference in non-severe patients (P:0.888). The administering of dexamethasone was associated with an increased in-hospital survival rate (HR: 0.25 [0.16-0.38]) in severe COVID-19 patients. The survival rate was more significant in severe patients with diabetes mellitus or hypertension after receiving dexamethasone treatment (HR:0.19). On the other hand, patients without severe disease did not benefit from dexamethasone administration.

Remdesivir, an antiviral medication, became an early promising therapeutic candidate for coronavirus disease 2019 (COVID-19) due to its ability to inhibit the virus in vitro. Current evidence about remdesivir treatment has been very controversial, so we aim to evaluate remdesivir to improve our knowledge about COVID-19 management and its long-term effects. In this retrospective cohort study using registered data derived from the Sina Hospital COVID-19 Registry with a 9-month follow-up, we enrolled patients receiving remdesivir and then matched a "control group" which did not receive remdesivir based on age, gender, and severity using propensity score matching. We used multivariant Cox regression to evaluate the remdesivir effect on patients' 9-month and in-hospital survival. We enrolled 227 patients, 116 in remdesivir and 111 in the control group. 213(93.8%) patients developed the severe disease, 88(38.8%) died during the 9-month follow-up, and 84(37.0%) died during hospitalization. In multivariate analysis, remdesivir did not affect the 9-month all-cause mortality and in-hospital mortality. Remdesivir was associated with increased in-hospital survival only in severe patients with diabetes (HR: 0.32; 95% CI: 0.14-0.75; P:0.008), and there was a trend for better 9-month survival in severe patients with diabetes (HR: 0.47; 95% CI: 0.20-1.09; P:0.080). We concluded that remdesivir treatment did not increase the 9-month survival rate either in patients with COVID-19 or patients with severe disease and underlying diseases. On the other hand, we found that remdesivir treatment could increase in-hospital survival only in patients with severe COVID-19 and a history of diabetes mellitus.

Since the initiation of the new coronavirus (COVID-19) in February 2020 in Wuhan, the Health Care System (HCS) has tolerated a lot of morbidities and mortalities all around the world. While the COVID -19 is spreading out the whole world, HCS carries almost all the burden as the first line. However, countries like Iran suffer from a lack of infected Health Care Workers (HCW) population data and statistics, especially the major hospitals for COVID-19 referrals. 

In this single-center cross sectional study, we studied the healthcare personnel infected by COVID-19, from February 2020 to August 2020, in a major tertiary hospital of Tehran, Iran.

Of total 1595 HCW working in Sina hospital, 389 (24%) with the mean age of 35.43 ± 8.2 years were infected by COVID-19, almost one fourth. 238 (61.2%) were women, though 92.5% of the population used Personal Protective Equipment (PPE). 140 (36%) of them were personnel of the wards assigned to the COVID-19, Personnel went on sick leave for 7.76 ± 4.64 days. 51(13.1%)  personnel had an exacerbation of symptoms, and only one of the personnel experienced COVID-19 almost twice in four months.

COVID-19 infection risk is considered to be very low for HCWs in case suitable PPE and social distancing are regarded. In our study, more than 92% of the infected personnel utilized PPE, which indicates that they might have failed to use PPE properly or might not have taken hand-hygienic precautions well. It is necessary to limit working hours and prevent excessive workload so that the staff could adhere more to hygienic precautions in hospitals or in society.

Owing to the imposed burden of the coronavirus disease 2019 (COVID-19),the need for stratifying the prognosis of patients has never been timelier. Hence, we aimed to ascertain the value of CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-M (one point for male instead of female) scores to predict unfavorable outcomes in COVID-19 patients.

We enrolled consecutive patients above 18 years of age with confirmed COVID-19,who were admitted between February 16 and November 1, 2020. The primary endpoint of this study was three-month all-cause mortality. The secondary endpoints were considered four major in-hospital clinical features, including acute respiratory distress syndrome, cardiac injury,acute kidney injury, and mechanical ventilation.

A total of 1,406 hospitalized COVID-19 patients were studied, among which 301(21.40%) patients died during the follow-up period. Regarding the risk scores, CHADS 2≥1,CHA2DS2-VASc≥2, and CHA2DS2-VASc-M≥2 were significantly associated with mortality. The performance of all risk scores for predicting mortality was satisfactory (area under the curve:0.668, 0.668, and 0.681, respectively). Appraising secondary endpoints, we found that all three risk scores were associated with increased risk of acute respiratory distress syndrome, cardiac injury, acute kidney injury, and mechanical ventilation. Lastly, we revealed that all risk scores were significantly correlated with serum levels of laboratory biomarkers.

Our analysis illustrated that the CHADS2, CHA2DS2-VASc, and CHA2DS2-VASc-Mscores could aid prognostication of unfavorable outcomes in COVID-19 patients. Therefore,these easily calculable methods could be integrated into the overall therapeutic strategy to guide the COVID-19 management more accurately.

 Since the outbreak of coronavirus 2019 (COVID-19), identifying risk factors associated with in-hospital mortality has been a global priority. In this study, the purpose was to evaluate the clinical, laboratory, and radiological characteristics of hospitalized patients with COVID-19 to develop a predictive model and scoring system for in-hospital mortality.

In this retrospective cohort study, 611 adult patients with COVID-19, admitted to Sina hospital were enrolled and followed up.

Out of the total number of 611 patients, 104 patients (17%) deceased during hospitalization, including 75 (12.2%) deaths in ICU and 29 (4.7%) deaths in the wards. After multivariate logistic regression analysis, several characteristics including age >55 years, previous history of malignancy, history of cerebrovascular accident, tachypnea on admission, CRP>54 on admission, D-dimer>1300, and bilateral pulmonary consolidation on chest Computed Tomography (CT) were shown to be the main determinants for stratifying the risk for in-hospital death. The factors were finally considered for introducing a new predictive scoring system for COVID-19 related death. 

In-hospital mortality rate in patients with COVID-19 is estimated to be 17%. A new scoring system for predicting in-hospital mortality in such patients was structured based on determinant factors of advanced age, history of malignancy, cerebrovascular accident, tachypnea, raised CRP, raised D-dimer on admission, and bilateral pulmonary consolidation on chest CT scan.

 COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation.

 This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients.

 This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation.

 A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.091), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization.

 A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

We aimed to assess the gastrointestinal (GI) manifestations of patients with severe acute respiratory syndrome coronavirus 2 infection and determine factors predicting disease prognosis and severity among patients with GI symptoms.

In this retrospective study, we evaluated laboratory confirmed (by real-time polymerase chain reaction) inpatient cases of coronavirus-associated disease 2019 (COVID-19), referred to Sina hospital, a tertiary educational hospital of Tehran University of Medical Sciences, from March 10 to May 20, 2020. Demographic and clinical characteristics, laboratory data, outcomes and treatment data were extracted and analyzed using SPSS version 20.

A total of 611 patients (234 women and 377 men) were included with 155 patients having GI symptoms. The most prevalent reported GI symptom was nausea/vomiting in 115 (18.8%) of patients. A total of 20 patients (3.2%) only had GI symptoms (without respiratory symptoms). There was no statistically significant difference in the clinical outcomes, disease severity, intensive care unit (ICU) admission and mortality between patients with and without GI symptoms. Aspartate Aminotransferase level was associated with 446% increased risk of disease severity (adjusted odds ratio: 5.46, 95% CI: 2.01 to 14.81) (P=0.040) among patients with GI symptoms. Additionally, we found that treatment with antibiotics in addition to mechanical ventilation was associated with increased survival among patients with GI symptoms (Pearson Chi square: 6.22; P value: 0.013).

More attention should be paid to patients with only GI symptoms for early patient detection and isolation. Moreover, patients with GI manifestations are not exposed to higher rates of disease severity or mortality.

Antibiotic Prophylaxis is used for prevention of surgical site infection before surgery. The aim of this study is to determine current status of administration of antibiotic prophylaxis in different surgical wards of a teaching hospital, and compare it with standard guidelines.
It is retrospective and descriptive study. 200 patients who had undergone surgery were enrolled to study. Demographic information and parameters of antibiotic therapy such as indication, type of antibiotic, dose, route, the time of administration before surgery and duration of prophylaxis were collected from cases in check list. Then compared to the national and international guidelines.
188 of 200 patients had indications of antibiotic Prophylaxis that all received antibiotics. In 71 cases (37.7%) the type of administered antibiotic was appropriate. Time of administration in 109 cases (58%), dosage in 17 cases (9.3%), route in 181 cases (96.5%), duration in 111 cases (59.4%)was appropriate.Only 11 cases (5.8%) met all the aspects of guidelines for antibiotic prophylaxis.
The time of administration before surgery, type and dosage had the most discrepancy with the guideline. Inappropriate use of antibiotic prophylaxis causes extra costs besides increasing resistant microorganisms and undesired side effects, so preparing guidelines according to economic situation and accessibility to drugs recommended.

The serious influenza-associated complications among immunodeficient individuals such as those who are infected with human immunodeficiency virus (HIV), highlights the importance of influenza vaccination in these people. Therefore, the current study aimed to investigate the antibody responses to influenza vaccine in this group. Two hundred subjects were recruited, during autumn 2010 and 2011, to receive, trivalent inactivated influenza vaccine consisting of A (H1N1), A (H3N2), and B strains. Hemagglutination inhibition assay was used to measure the antibody titer against all strains of the vaccine prior and one month post vaccination. Seroconversion rate for A (H1N1), A (H3N2), and B were found to be 58.5%, 67% and 64.5%, respectively. No correlation was found between antibody titer and demographics factors such as age and gender; however, we found a significant correlation between antibody titer and CD4 cell count. Checking the local and systemic reactions after vaccination, the pain on the injection site and myalgia were the most common local and systemic reactions with 20% and 6.5%, respectively. As vaccination with influenza mount considerable antibody responses in HIV-infected patients, annul influenza vaccination seems to be rational in order to prevent or reduce the severe clinical complications induced by influenza virus.