mohammad sistanizad

Traumatic brain injury (TBI) is one of the most common neurological disorders worldwide. We aimed to investigate the efficacy of high-dose vitamin D3 on inflammatory biomarkers in patients with moderate to severe TBI.  Thirty-five moderate to severe TBI patients were randomly assigned to intervention and control groups. Patients in the intervention group received a single intramuscular (IM) dose of 300,000 IU vitamin D. The primary endpoints were interleukin levels (IL-1β and IL-6), and the secondary endpoints were changes in neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), Glasgow Coma scale (GCS), and Glasgow Outcome Scale-Extended (GOS-E) scores compared between intervention and control arms of the study. The linear Generalized Estimating Equations were used for trend analysis and evaluating the association of independent factors to each outcome. The results revealed a significant decrease in IL-1β levels (-2.71±3.02, in the intervention group: P=0.001 vs. -0.14±3.70, in the control group: P=0.876) and IL-6 (-88.05±148.45, in the intervention group: P=0.0001 vs. -35.54±175.79, in the control group: P=0.325) 3 days after the intervention. The improvement in the GCS score (P=0.001), reduction in NLR (P=0.001) and PLR (P=0.002), and improvement in the GOS-E score (P=0.039) was found to be greater in the vitamin D3 arm of the study than the control group. Administration of high-dose vitamin D3 in the acute phase of TBI could be effective in lowering the inflammatory markers and improving the level of consciousness and long-term performance outcomes.Trial registration number: IRCT20180522039777N2.

Little is known about the impact of sex-related differences on clinical presentation, treatment adherence, and outcomes in patients with acute coronary syndrome (ACS) in developing countries, such as Iran.
 
This observational cross-sectional study used the Coronary Angiography and Angioplasty Registry (CAAR) data. We included all adults who underwent coronary angiography or angioplasty within 1 year, analyzing data from 1548 cases.
 
A total of 1548 patients were included in the analysis. Women were older than men when experiencing ACS and had a higher prevalence of atypical symptoms. Women were also more likely to have comorbid conditions such as hypertension, diabetes, obesity, dyslipidemia, and depression. Still, men were more likely to have a history of smoking and previous myocardial infarction (MI). Investigation of differences regarding invasive therapeutic procedures, culprit arteries, and numbers of diseased vessels showed no significant differences between women and men in the ST-elevation myocardial infarction (STEMI) and non-STEMI groups. However, there was a significant difference between women and men in these factors in patients with unstable angina and stable angina. Men in these groups were more likely to have the involvement of 2 or 3 coronary arteries and were more likely to be recommended for percutaneous coronary intervention and coronary artery bypass graft surgery. Nonetheless, there was no significant difference in acceptance rates of recommended treatment in these groups between men and women.
 
The study findings provide insight into the differences between male and female ACS patients in the Iranian population, highlighting the need for sex-specific approaches in treatment. (Iranian Heart Journal 2024; 25(3): 58-71)

According to the increasing trend of antibiotic consumption all over the world, a rising concern is the emergence of resistant pathogens due to the inappropriate use of antibiotics, which increases the risk of treatment failure and mortality. Antibiotic Order Form (AOF) is an antimicrobial stewardship program protocol recommended to improve rational antibiotic use. We aimed to compare the antibiotic consumption rate, i.e., vancomycin and carbapenems, before and after preprinted AOFs were implemented. This study also evaluated physicians' compliance with AOFs as a secondary outcome. This prospective descriptive study was conducted from July to December 2015 in a 570-bed teaching hospital in Tehran, Iran. AOF includes demographics, microbiological, and clinical data on infection designed for vancomycin and carbapenems, including imipenem and meropenem. Prescribers were asked to fill out predesigned forms after prescribing the selected antibiotics and deliver them to the pharmacy on July 1, 2015. Collected data during this 6-month study period were compared with the same period times years 2011 to 2016 (4 years before and one year after implementation of AOF) to determine the effect of AOFs on the selected antibiotics consumption that had been calculated based on Daily Doses per 100-patients day (DDD/100-bed days). This study showed that although vancomycin had an increasing trend from 2011 to 2014, implementing the AOF program could stop this trend in 2015. vancomycin consumption significantly decreased compared to the previous year (P = 0.039). This effect of the program was not the same on the use rate of carbapenems, and their use was increased nonsignificantly in 2015 (P = 0.606). The acceptance of prescribers in filling out the forms for vancomycin increased from 5.12% in the first month to 57.75% in December. This increase was from 4.20% to 37.26% for carbapenems. According to the increasing trend of antibiotic consumption in hospitals, we recommend improving utilization surveillance of antibiotics by choosing an appropriate antibiotic, optimal dosing, and desired duration of treatment that are important in decreasing the risk of developing resistant microorganisms due to misuse. The forms are much more effective when accompanied by the acceptance of prescribers.

The role of caffeine as a brain stimulant in improving the respiratory characteristics of patients under mechanical ventilation is unclear. This study aimed at determining the effect of oral caffeine in helping to release (Liberation) from the ventilator in intubated patients under mechanical ventilation admitted to the intensive care unit.
General ICU patients with more than 48 hours of dependency on a ventilator were randomly divided into two groups. The intervention group received 200mg caffeine tablets twice a day through a gastric tube, while the control group received a placebo of the same amount. Every day, patients were assessed for the likelihood of being disconnected from the device. If their clinical condition was deemed suitable, the device mode was switched to spontaneous, and their Rapid Shallow Breathing Index (RSBI) was calculated. Based on this information, a decision was made regarding whether to proceed with weaning.
Caffeine use in ICU patients significantly reduced the airway resistance index of patients (P <0.05). However, although this drug reduced the length of hospital stay in the ICU and the duration of intubation of patients, these changes were not statistically significant (P> 0.05).
Caffeine may improve respiratory status and reduce the duration of intubation and hospitalization in the ICU.

The current registry system aims to design a database that can be used for future research as a tool to produce and update new protocols for the diagnosis, treatment, management, and prevention of heart diseases.  

In this hospital-based registry system, established on 27 July 2021, all the adult patients (age ≥18 years old) with signs and symptoms of cardiac diseases under coronary angiography or angioplasty in the cardiac ward of Imam Hossein Hospital of Tehran, Iran were recruited and followed-up until 30 days after discharge in the pilot phase. All data were collected using a researcher-made checklist from face-to-face interviews with patients and their medical records. The data were registered electronically in web-based software. Quality Control (QC) is conducted monthly by the QC team to ensure the documented data's quality.  

among 1265 patients under coronary angiography or angioplasty over a year, 97% (n=1198) of them were Iranian, and 991 (73.33%) patients lived in the country's capital, Tehran. About 55% (n=706) of patients were male. The mean age of the total patients was 60.48 ± 12.01 years. 764 (60.39%) patients were diagnosed with Coronary Artery Disease (CAD). Of all CAD patients, 32.72% (n=250) and 1.18% (n=9) were premature and very early CAD, respectively. During one year, 22.54% (n=279) and 7.02% (n=87) of patients were under PCI and CABG, respectively.  

Since CVDs, especially CADs, are one of the most common and priority diseases in Iran's health system, establishing a coronary angiography and angioplasty registration system is an opportunity to study the epidemiological and clinical process of CVDs in the shape of an accurate registration system.

Colistin is a drug of choice against multidrug-resistance (MDR) bacteria. The most important side effect of colistin is nephrotoxicity, observed in 20 - 54% of patients. According to the studies that examined its antioxidant effect, it can reduce the kidney toxicity of various drugs, including colistin.

This study aimed to investigate melatonin’s effect on reducing colistin-induced kidney toxicity to use this drug with fewer complications.

This double-blind, randomized clinical trials with two groups involved 56 critically ill adults infected by MDR bacteria. The intervention group received 3 mg of oral melatonin simultaneously with intravenous colistin, which continued until the end of the treatment. The control group received placebo orally with IV colistin. We measured urine volume, blood creatinine, and BUN daily and determined the patients with renal failure using the KDIGO guideline. STATA software analyzed data with a P-value of less than 0.05 as the significance level.

Data obtained from recipients were analyzed for age (P-value = 0.357), gender (P-value = 0.945), weight (P-value = 0.438), APACHE score (P-value = 0.162). We did not observe significant difference in AKI criteria between the two groups. Compared to the control group, melatonin did not decrease blood creatinine (P-value = 0.110) and BUN (P-value = 0.567) and, made no change of urinary volume (P-value = 0.913). There was no decrease in kidney failure in the intervention group compared to the control group. As a result, we did not find a significant difference in outcome of the two groups.

We did not reveal any significant difference in the AKI criteria including blood creatinine,BUN,anddaily urinevolume with the addition of melatonin in participants receiving colistin; However, no complication was observed in the intervention group who received melatonin.

Augmented renal clearance (ARC) is a common phenomenon among critically ill patients and creates sub-therapeutic concentrations of antibiotics, due to an increase in renal clearance of them. We evaluated the Pharmacokinetic and Pharmacodynamic (PK/PD) properties of recommended doses of meropenem in critically ill patients with ARC. Adult critically ill patients with confirmed ARC, based on 12-hour Creatinine Clearance (CrCl) (≥130 ml/min/1.73 m2), who received standard doses of meropenem enrolled in this study. Two blood samples were gathered from each participant, at the steady-state time, to determination of peak and trough concentrations. Serum concentrations of meropenem were measured by high-performance liquid chromatography (HPLC) with an ultra-violet (UV) detector. From eighteen paired samples (peak and trough concentrations) that were obtained from 16 critically ill patients, peak concentrations were significantly lower in group 1 (received meropenem 1g every 8 hours) than in group 2 (received meropenem 2g every 8 hours) (mean ±SD, 5.95 ±3.39 µg/mL vs. 11.93± 4.18 µg/mL, respectively, p=0.005). Trough concentrations were sub-threshold (< 2 µg/mL) in 10 patients of group 1 (83.3%) and 3 patients of group 2 (50%). ft > MIC ≥ 50% was achieved in 83.3% of patients in both groups whereas 16.6% of patients of group 1 and 33.3% of patients of group 2 had ft> MIC= 100%. Augmented renal clearance is an essential cause of sub-therapeutic concentrations of meropenem in critically ill patients, and higher than the recommended doses of meropenem administered as an intermittent infusion may be necessary to achieve the PD targets and improve efficacy.

In addition to clinical and technical considerations, patients’ preferences are essential for evaluating interventions such as precision medicine (PM).

This study aimed to identify and prioritize attributes of precision oncology that are important for patients to develop and validate a standard stated preference instrument.

The key attributes of precision oncology and their related levels were extracted from the systematic literature review and were presented on a validated 5-point Likert scale questionnaire to experts (n = 35). In two rounds of Delphi, participants scored and prioritized the attributes through this personally administered questionnaire to identify the five most important ones to develop a discrete choice experiment (DCE) instrument. The developed DCE questionnaire was subsequently validated, providing a robust and standard instrument for evaluating patients’ preferences for precision oncology.

Based on the consensus criteria, the final DCE included four attributes and a total of 14 levels, which were access to treatment (easy/not easy), out-of-pocket (OOP) expenditures (four levels according to treatment costs in the country), change in life expectancy (LE, six levels from an average gain of three months to four years), and change in quality of life (QoL, improvement or no change).

The above-mentioned attributes represent patients’ main preferences from the views of the Iranian experts. The developed DCE questionnaire can be used to assess patients’ preferences and willingness to pay (WTP) in precision oncology.

This study aimed to evaluate the Iranian ophthalmologists’ knowledge of prescribing prophylacticantibiotics to patients with open globe injury (OGI) in Iran. In this cross-sectional study, we utilized a questionnaire to evaluate the ophthalmologists’ knowledgeabout prescribing antibiotics as prophylaxis. This survey was conducted in Tehran and its suburbs. Thequestionnaire included demographic information as well as ophthalmologists’ knowledge levels. Cronbach’salpha was used to determine its validity and reliability. The obtained data were analyzed using SPSS 24.0. Of 192 subjects, 111 (35 women, 76 men) were included. About 65 (58.6%) specialists and 45 (41.4%)subspecialists with different orientations completed the questionnaires. The total knowledge score was13.04±2.96. The following are the results of ophthalmologists’ responses to questions regarding the cornea/scleral injury (1.09±1.72), prophylactic antibiotics administration (2.79±1.11), the infectious agents in eyesurgeries (3.21±1.49), diagnosis and treatment (2.84±0.944), and the effects of ocular antibiotics as well as theirproper dosage (2.96±2.35). There was no significant relationship between some demographic information suchas sex, working hours, workplace, and the number of studied articles (p>0.05). In addition, ophthalmologistswith less work experience had significantly higher levels of knowledge than those with more work experience. The findings indicated that the majority of ophthalmologists had a basic knowledge of prescribingprophylactic antibiotics in OGI.

Hypertension is an important and controllable risk factor for heart diseases, stroke, renal failure and peripheral vascular disease. The aim of this study was to determine the level of awareness of patients with hemorrhagic stroke to control blood pressure and to provide solutions to improve patients’ awareness.

This study is a descriptive cross-sectional study that was conducted to evaluate the knowledge of patients with hemorrhagic stroke about the use of antihypertensives. The study population consists of all patients with hemorrhagic stroke, who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran from September 2020 to March 2021. Data related to blood pressure awareness and drug history was completed by the researcher through the method of direct contact with the patients or their relatives. In this study, 17 patients diagnosed with hemorrhagic stroke due to hypertension who were admitted to the intensive care unit of Imam Hossein Hospital in Tehran, were included. The extent of the exact treatment adherence was assessed using the Morisky questionnaire.

In this study, the median of patients age was 67 and 10 (58.82%) of them were women. The median systolic and diastolic blood pressures were 170 and 95 mmHg on admission. 4(23.53%) subjects were not aware of the disease. Out of 13 people who were aware of their hypertension, 11(64.71%) were under the supervision of a physician. However, 7(63.64%) of the subjects, despite being under the supervision of a physician and acceptable drug adherence, did not have controlled blood pressure and expired.

This study is a warning for patients and health care providers to pay more attention to blood pressure control. Furthermore, educating the community as well as medical staff about the importance of timely diagnosis and accurate treatment of hypertension is highly recommended.

Myocardial infarction (MI), is considered as an important cause of death and disability. About three - quarters of the deaths caused by heart diseases occur in countries with low or middle economic levels. Evaluation of the effective risk factors and medications and the overlap of their compounds on the long - term survival of patients with myocardial infarction

In this retrospective cohort study 21181 patients, hospitalized in coronary care units (CCU) hospitals of Iran enrolled from the MI registry system for the period of 20 March 2013 to 20 March 2014.
Participants were followed up to February 2020 for any cardiovascular disease (CVD) mortality. To evaluate survival rate, difference between groups and to assess factors related to MI death, Kaplan–Meier, Log rank test and Cox Proportional-Hazards Model were used, respectively.

The mean age of patients was 62.10± 13.41. 72.37 % of the patients were men. The rate of survival in the time period in females was less than males. For those patients without the history of coronary diseases, hypertension, and diabetes but with hyperlipidemia and smoking, the 1, 3, 5, and 7-year survival rates were better compared to other patients. The 1, 3, 5, and 7-year survival rates of those in group 6 (Beta blocking agent) were higher compared to other medication groups.

Controlling risk factors can reduce the mortality rate, and the recommendations of doctors and adherence treatment plays an important role in the long - term survival of Myocardial infarction patients.

 Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an effective specific antiviral treatment for coronavirus disease of 2019 (COVID-19) is yet to be identified .We did this study to investigate the safety and efficacy of sofosbuvir as antiviral therapy among hospitalized adult patients with SARS-CoV-2. 

 Patients were randomized into intervention arm receiving sofosbuvir or comparison arm receiving usual antiviral agents in addition to standard of care. The primary end point of the study was clinical recovery as defined by normal body temperature and normal oxygen saturation. The main secondary outcome was all-cause mortality during the admission in hospital or within 14 days after discharge if applicable. Reports of severe adverse events were observed in the intervention arm. 

 Fifty-seven patients enrolled into either the clinical trial arm (n=27) or the comparison arm (n=30). Primary outcome was achieved by 24 (88.9%) and 10 (33.3%) in the intervention and comparison arms, respectively. Median hospital length of stay was significantly shorter in the intervention arm (10 days [IQR: 5-12] vs. 11.5 days [IQR: 8.5-17.75], P = 0.016). All-cause mortality was two and thirteen in intervention and comparison groups, respectively. No serious adverse events were reported by the patients receiving sofosbuvir during the study. 

 Among patients hospitalized with SARS-CoV-2, those who received sofosbuvir had more clinical recovery rate and had a shorter hospital length of stay than those who received usual antiviral agents in the study and these differences were statistically significant.

Gender impacts pre-, intra-, and postoperative parameters and outcomes following coronary artery bypass graft (CABG) with conflicting results. This study aimed to identify differences in preoperative, intraoperative, and postoperative parameters. It also seeks to compare the postoperative complications and mortality between two genders who had CABG surgery.  This prospective observational study included patients who had isolated CABG and were divided based on gender. Demographic information, underlying comorbidities, drug history, clinical and laboratory data at the time of referral, operative characteristics, postoperative variables, and mortality outcomes were tracked during hospitalization and six months after discharge.  Three hundred twenty patients were enrolled in the study during its duration. 71% were male. Women were older (62.40±9.03 vs. 59.99±9.81 years, p= 0.011) and had more dyslipidemia (p=0.003), hypertension (p=0.000), and diabetes (p=0.001), whereas men admitted with more myocardial infarction (MI) (p=0.011) and had lower Ejection fraction (EF) (p=0.001). They also had lower EF post-surgery and six months after discharge (p <0.001, 0.006). However, the number of vessels involved was not different between genders (p=0.589), but the number of grafts was higher in men (p=0.008).There was no statistically significant difference in overall mortality rates between the two groups (4.42% and 6.38% in men and women, respectively, p= 0.464). The women had more underlying comorbidities than men. Furthermore, there were some differences in the intra-operative parameters and postoperative complications between the two genders, but there was no difference in postoperative mortality in our setting.

Currently, there is lack of evidence regarding the long-term follow-up of coronavirus disease 2019 (COVID-19) patients. The aim of this study is to present a 6-month follow-up of COVID-19 patients who were discharged from hospital after their recovery.

This retrospective cohort study was performed to assess the six-month follow-up of COVID-19 patients who were discharged from the hospital between February 18 and July 20, 2020. The primary outcome was 6-month all-cause mortality.

Data related to 614 patients were included to this study. Of these 614 patients, 48 patients died (7.8%). The cause of death in 26 patients (54.2%) was the relapse of COVID-19. Also, 44.2% of deaths happened in the first week after discharge and 74.4% in the first month. Risk factors of all-cause mortality included increase in age (odds ratio [OR]=1.09; P<0.001), increase in neutrophil percentage (OR=1.05; P=0.009) and increase in heart rate (OR=1.06; P=0.002) on the first admission. However, the risk of all-cause death was lower in patients who had higher levels of hematocrit (OR=0.93; P=0.021), oxygen saturation (OR=0.90; P=0.001) and mean arterial pressure (OR=0.93; P=0.001). In addition, increase in age (OR=1.11; P<0.001) was an independent risk factor for COVID-19-related death, while higher levels of lymphocyte percentage (OR=0.96; P=0.048), mean arterial pressure (OR=0.93; P=0.006) and arterial oxygen saturation (OR=0.91; P=0.009) were protective factors against COVID-19-related deaths during the 6-month period after discharge.

Death is relatively common in COVID-19 patients after their discharge from hospital. In light of our findings, we suggest that elderly patients who experience a decrease in their mean arterial pressure, oxygen saturation and lymphocyte count during their hospitalization, should be discharged cautiously. In addition, we recommend that one-month follow-up of discharged patients should be take place, and urgent return to hospital should be advised when the first signs of COVID-19 relapse are observed.

Posterior Cerebral Artery (PCA) aneurysms are a rare group of intracranial aneurysms. Pediatric aneurysms account for approximately 4% of all aneurysms and commonly are associated with an underlying predisposing disorder such as trauma. In contrast to traumatic aneurysms, spontaneous dissecting aneurysms are pointed out as a rare cause of pediatric aneurysms. aimed to present one case of a spontaneous dissecting aneurysm in a 10-month-old female infant.

Augmented Renal Clearance (ARC) reflects a measured creatinine clearance (CrCl) of more than 130 ml/min. Also, there are two scoring systems for the prediction of the ARC phenomenon i.e., the ARC score (ARCS) and the Augmented Renal Clearance in Trauma Intensive Care score (ARCTICs). The objectives of the current study were the evaluation the effect of using both scoring systems, on the chance of identifying this phenomenon and evaluating the accuracy of the three commonly used formulas for estimating glomerular filtration rate (eGFR) in ICU patients.

  In this prospective cross-sectional study, the CrCls of all patients admitted to the ICU were evaluated by using ARCS and ARCTICS, and for high-risk subjects based on scoring systems, a 12-hour urine sample was collected to measure CrCl. Besides, daily serum creatinine was recorded to estimate the daily eGFR.

  During the study period, 810 subjects were evaluated and 145 were categorized as high-risk using scoring systems. The ARC phenomenon was confirmed in 79 patients on the recruitment day and 81.01 and 18.98% of them were recruited by ARCS and ARCTICS, respectively. The ROC curves showed AUCs > 0.5 for CockcroftGault (C-G) and CKD-EPI with the cut-off of 100.48 and 107.05 mL/min/ 1.73m2, respectively; to detect the ARC phenomenon.

We recommend using ARCS and ARCTICS simultaneously to assess critically ill patients regarding the possibility of the ARC phenomenon which should be confirmed by using urinary CrCl, as none of the formulas could accurately detect the ARC phenomenon, neither the 12-hour CrCl.

In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients. 

This study was conducted as a retrospective cohort in which 893 electrocardiograms (ECGs) taken at the time of admission and 328 ECGs taken during hospitalization were evaluated. These ECGs were assessed for cardiac dysrhythmias by a cardiologist. Finally, relationships between clinical characteristics and the occurrence of cardiac dysrhythmias in patients were assessed. 

Most common cardiac dysrhythmias on admission were sinus tachycardia (64.8%), atrial fibrillation (13.5%), and sinus bradycardia (11.3%). Multivariate regression analysis showed that a history of metformin use (RR=0.83; p=0.042) was independently associated with reduced risk of cardiac dysrhythmias on admission, while male sex (RR=1.16; p=0.018), history of cardiovascular diseases (RR=1.16; p=0.017), history of cancer (RR=1.40; p=0.004) and QT prolongation on ECG (RR=1.18; p=0.017) were associated with a higher risk of cardiac dysrhythmias on admission. Also, from the 328 patients that had a second ECG, 185 (56.4%) experienced cardiac dysrhythmias during their hospitalization. Multivariate analysis showed that presence of cardiac dysrhythmias on admission (RR=1.85; 95% CI; 1.49-2.35; p<0.001) was the only independent prognostic factor for the occurrence of cardiac dysrhythmias during hospitalization. no significant relationships were observed between treatment regimens and the incidence of cardiac dysrhythmias. 

The present study showed that more than half of COVID-19 patients have cardiac dysrhythmias on admission. Our analyses illustrated that a history of metformin use was associated with a lower risk of cardiac dysrhythmias on admission, while male sex, history of cardiovascular diseases, history of cancer, and QT prolongation were associated with a higher rate of cardiac dysrhythmias. Hydroxychloroquine use along with azithromycin and Kaletra (Lopinavir-Ritonavir) had no association with the development cardiac dysrhythmias during hospitalization.

Proton pump inhibitors (PPIs) are the most effective medications in acid-related disorders. Inappropriate use of Intravenous (IV) pantoprazole can cause unwanted consequences like hypersensitivity reactions, prolonged duration of treatment, and increased treatment cost. This study aimed to evaluate the effect of the utilization of a preprinted protocol for the use of IV pantoprazole on its appropriate administration.

This prospective, cross-sectional, two-phase study was conducted on the four departments of a tertiary teaching hospital. In the first phase, December 22, 2018, to March 19, 2019, all older than 18-year old patients who were admitted to internal medicine, general surgery, and neurosurgery, and received IV pantoprazole were included in the study. In the second phase of the study, April 4, 2019, to July 6, 2019, the neurology ward was added to the study according to the high consumption of IV pantoprazole. We evaluated the effect of the utilization of a preprinted protocol for the appropriate of IV pantoprazole on its consumption, and the frequency of appropriate administration based on the approved protocol, the need to change the patient's medication regimen, and the physician's feedback on the changes. The consumption of IV pantoprazole was compared with the same period times at the last year of intervention as the pre-intervention phases.

Four hundred forty-six prescriptions of IV pantoprazole were screened during the 2 phases of the study. The utilization of the approved protocol consequent decrease in IV pantoprazole consumption in intervention phases compared with pre-intervention phases in all departments. This difference was statistically significant in the general surgery  (p= 0.016) and neurosurgery (p= 0.012) wards in phase 2. Related data to the comparison of the IV pantoprazole consumption between two phases of the intervention also showed a significant decrease in the neurosurgery ward (p= 0.011). In the total of the two phases, the use of the protocol led to an 8.3% decrease in consumption in comparison with pre-intervention periods. During these six months, we detected that the administration of IV pantoprazole was not based on the protocol in 81.2% of patients and the use of the protocol led to correct 63.89% of physician's orders.

This study showed that the majority of IV pantoprazole prescriptions were inappropriate. Using the preprinted forms to administer the IV pantoprazole could improve its appropriateness in terms of indication for use, dose, and duration of treatment and decrease consumption.

The available literature regarding the rate of readmission of COVID-19 patients after discharge is rather scarce. Thus, the aim in the current study was to evaluate the readmission rate of COVID-19 patients and the components affecting it, including clinical symptoms and relevant laboratory findings.

In this retrospective cohort study, COVID-19 patients who were discharged from Imam Hossein hospital, Tehran, Iran, were followed for six months. Data regarding their readmission status were collected through phone calls with COVID-19 patients or their relatives, as well as hospital registry systems. Eventually, the relationship between demographic and clinical characteristics and readmission rate was assessed.

614 patients were entered to the present study (mean age 58.7±27.2 years; 51.5% male). 53 patients were readmitted (8.6%), of which 47 patients (7.6%) had a readmission during the first 30 days after discharge. The reasons for readmission were relapse of COVID-19 symptoms and its pulmonary complications in 40 patients (6.5%), COVID-19 related cardiovascular complications in eight patients (1.3%), and non-COVID-19 related causes in five patients (0.8%). Older age (OR=1.04; 95% CI: 1.01, 1.06; p=0.002) and increased mean arterial pressure during the first admission (OR=1.04; 95% CI: 1.01, 1.08; p=0.022) were found to be independent prognostic factors for the readmission of COVID-19 patients.

Readmission is relatively frequent in COVID-19 patients. Lack of adequate hospital space may be the reason behind the early discharge of COVID-19 patients. Hence, to reduce readmission rate, extra care should be directed towards the discharge of older or hypertensive patients.

Mucormycosis as a rare but life-threatening disease with 46-96% mortality, which challenged the healthcare system during the COVID-19 pandemic. This study aimed to compare the characteristics of mucormycosis between cases with and without COVID-19.

This cross-sectional study was done in two referral hospitals, Imam Hossein and Labbafinezhad Hospitals, Tehran, Iran, between 21 March to 21 December 2021. Data related to all hospitalized adults subject with the diagnosis of mucormycosis during the study period was collected from patients’ profiles and they were divided into two groups of with and without COVID-19 based on the results of real time PCR. Then demographic, clinical, and laboratory findings as well as outcomes were compared between the two groups.

64 patients with the mean age of 53.40±10.32 (range: 33-74) years were studied (53.1% male). Forty-three (67.2%) out of the 64 subjects had a positive COVID-19 PCR test. The two groups had significant differences regarding some symptoms (cough (p < 0.001), shortness of breath (p = 0.006)), acute presentation (p = 0.027), using immunosuppressive (p = 0.013), using corticosteroid (p < 0.001), and outcomes (mortality (p = 0.018), need for intubation (p < 0.001)). 22 (34.3%) patients expired during hospital admission. Univariate analysis showed the association of in-hospital mortality with need for ventilation (p < 0.001), sinus involvement (p = 0.040), recent use of dexamethasone (p = 0.011), confirmed COVID-19 disease (p = 0.025), mean body mass index (BMI) (p =0.035), hemoglobin A1c (HbA1c) (p = 0.022), and median of blood urea nitrogen (BUN) (p =0.034). Based on the multivariate model, confirmed COVID-19 disease (OR = 5.01; 95% CI: 1.14-22.00; p = 0.033) and recent use of dexamethasone (OR= 4.08, 95% CI: 1.05-15.84, p = 0.042) were independent predictors of mortality in this series.

The mucormycosis cases with concomitant COVID-19 disease had higher frequency of cough and shortness of breath, higher frequency of acute presentation, higher need for immunosuppressive, corticosteroid, and ventilator support, and higher mortality rate. The two groups were the same regarding age, gender, BMI, risk factors, underlying diseases, symptoms, and sites of involvement.

Coronary artery disease is among the first causes of death in Iran. Secondary prevention with drug therapy is recommended following acute myocardial infarction (MI) to reduce the risk of new cardiovascular events and death.

This is a retrospective cohort study on data collected from 21181 cases of MI recorded by the MI Registry of Iran from 2013 to 2014. Ten therapies that were prescribed to patients at the time of discharge were divided into 6 groups. Survival rates were estimated using the Kaplan-Meier method and Cox regression analysis.

The most common MI location was in the anterior wall (31.87%). Anticoagulants, aspirin, clopidogrel were the most common prescribed medications (94.73%). Overall, 28-day (short-term) and 3-year survival rates were 0.95 (95% CI: 0.95–0.96) and 0.82 (95% CI: 0.81–0.82). In non-ST-elevation myocardial infarction (NSTEMI) patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants/ aspirin and clopidogrel, beta-blockers and statins medication were simultaneously taken and the highest short- and long-term survival rates were observed in patients who took anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers and statins medication. In STEMI patients, the lowest short- and long-term survival rates were observed when diuretic, anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were simultaneously taken. The highest short- and long-term survival rates were observed in patients who received anticoagulants, aspirin and clopidogrel, nitrate agent and calcium blockers, beta-blockers, statins, ACEIs and ARBs.

Prescription of the best combination of drugs, in addition to adherence to a healthy lifestyle and medication, can improve the survival rates after MI.

Diabetes mellitus (DM) can influence various aspects of the immune system that may alter the immune response to vaccines. Data about altering the immune response to the rubella vaccine in the presence of diabetes are not enough. We aimed to evaluate the association between the level of glycosylated hemoglobin (HbA1C) and the immunogenicity of the rubella vaccination.

This cross-sectional retrospective study was conducted on the medical records of women who were tested to pre-pregnancy to check their antibody levels against rubella and had plasma levels of HbA1C.

During 3 years, 112 women with anti-Rubella IgG data were finally analyzed. The mean age±SD of participants was 32.10±4.87. According to the data, we detected no correlation between the plasma levels of HbA1C and IgG levels against rubella (Correlation Coefficient 0.219, p = 0.020).

We revealed no correlation between the plasma levels of HbA1C and impaired immunogenicity of the rubella vaccination. We recommended a large-scale controlled clinical trial to evaluate the IgG levels against rubella in patients with high plasma levels of HbA1C compared to the control group.

Viral infections play an important role in the pathogenesis of diabetes mellitus (DM). The association between some viral infections, including cytomegalovirus (CMV) and the development of DM was reported by some articles, but about T. gondii data is limited. We aimed to evaluate the correlation between antiCMV and anti-Toxoplasma gondii (T. gondii) antibodies with the plasma level of glycosylated hemoglobin (HbA1C).

This is a cross-sectional retrospective study conducted on the medical records of women who tested for pre-pregnancy checkups and had antibody levels against CMV and/or T. gondii, and plasma level of HbA1C.

During 4 years, data from 117 patients with anti-CMV IgG, and 186 with anti-T. gondii IgG was finally analyzed. According to the data, we did not detect any correlation between the plasma levels of HbA1C and IgG levels against CMV (Correlation Coefficient 0.150, p = 0.108) and T. gaondii (Correlation Coefficient 0.076, p = 0.300).

In conclusion, we recommended a large-scale controlled clinical trial to compare the plasma level of HbA1C between patients with confirmed CMV or T. gondii infection and the control group.

To describe the levels of troponin I in COVID-19 patients and its role in the prediction of their inhospital mortality as a cardiac biomarker.

The current retrospective cohort study was performed on the clinical records of 649 COVID-19-related hospitalized cases with at leat one positive polymerase chain reaction (PCR) test in Tehran, Iran from February 2020 to early June 2020. The on admission troponin I level divided into two groups of ≤0.03ng/mL (normal) and >0.03ng/mL (abnormal). The adjusted COX-regression model was used to determine the relationship between the studied variables and patient’s in-hospital mortality.

In this study, the median age of subjects was 65 years (54.8% men) and 29.53% of them had abnormal troponin I levels. Besides, the in-hospital mortality rate among patients with abnormal troponin I levels was found to be 51.56%; whereas, patients with normal levels exhibited 18.82% mortality. Also, the multivariable analysis indicated that the risk of death among hospitalized COVID-19 patients displaying abnormal troponin I levels was 67% higher than those with normal troponin I levels (Hazard ratio=1.67, 95% confidence interval=1.08-2.56, p=0.019).

It seems that troponin I is one of the important factors related to in-hospital mortality of COVID-19 patients. Next, due to the high prevalence of cardiac complications in these patients, it is highly suggested to monitor and control cardiac biomarkers along with other clinical factors upon the patient’s arrival at the hospital.

Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. 

Data related to clinical characteristics and cost of hospitalized COVID-19 patients from February 2020 until July 2020, in a public teaching hospital in Tehran, Iran was gathered in a retrospective cohort study. The corresponding factors influencing the diagnostic and therapeutic costs were evaluated, using a generalized linear model. 

The median COVID-19 related diagnostic and therapeutic costs in a public teaching hospital in Iran, for one hospitalized COVID-19 patient was equal to 271.1 US dollars (USD). In patients who were discharged alive from the hospital, the costs increased with patients’ pregnancy (P<0.001), loss of consciousness during hospitalization (P<0.001), a history of drug abuse (P=0.006), history of chronic renal disease (P<0.001), end stage renal disease (P=0.002), history of brain surgery (P=0.001), history of migraine (P=0.001), cardiomegaly (P=0.033) and occurrence of myocardial infarction during hospitalization (P<0.001). In deceased patients, low age P<0.001), history of congenital disease (P=0.024) and development of cardiac dysrhythmias during hospitalization (P=0.044) were related to increase in therapeutic costs. 

Median diagnostic and therapeutic costs in COVID-19 patients, hospitalized in a public teaching hospital in Iran were 271.1 USD. Hoteling and medications made upmost of the costs. History of cardiovascular disease and new onset episodes of such complications during hospitalization were the most important factors contributing to the increase of therapeutic costs. Moreover, pregnancy, loss of consciousness, and renal diseases are of other independent factors affecting hospitalization costs in COVID-19 patients.