Emre Hamurtekin; Ahmet Sami Bo?nak; Forouzandeh Farhoumand; Azadeh Mohebali; Ay?egul Kaymak Ozdemir; Majid Motaghinejad
Volume 24, Issue 12 , 2022
Abstract
Background: Anxiety is common among university students and previous research has highlighted the association between the COVID-19 pandemic and higher anxiety scores in the public.
Objectives: In this regard, this study aimed to evaluate the effect of the COVID-19 pandemic on the anxiety status of pharmacy ...
Read More
Background: Anxiety is common among university students and previous research has highlighted the association between the COVID-19 pandemic and higher anxiety scores in the public.
Objectives: In this regard, this study aimed to evaluate the effect of the COVID-19 pandemic on the anxiety status of pharmacy students studying in Northern Cyprus and analyze the role of some parameters on the observed anxiety scores.
Methods: Anxiety scores of 185 pharmacy students studying at two universities in Northern Cyprus were evaluated using Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder-7 (GAD-7) assessments. Additionally, the information of participants was recorded in terms of sociodemographic and educational characteristics, antidepressants and anxiolytic use, and consumption of vitamin-mineral supplements. The questionnaires were distributed during the COVID-19 pandemic from December 11, 2020, to January 4, 2021, online via the Microsoft Teams® platform. It should be mentioned that responses were anonymous.
Results: The mean BAI and GAD-7 scores of pharmacy students were 13.1±11.2 and 10±6.7, respectively. Based on the results, 6% of the students (n=11) revealed potentially concerning levels of anxiety in their BAI responses. Moreover, 31.9% of the pharmacy students (n=59) demonstrated severe anxiety scores on the GAD-7. Positive COVID-19 cases in the family led to statistically significant increases in anxiety on both instruments. Pharmacy students with five years of education (B.Pharm/M.Pharm) showed significantly higher anxiety scores on the BAI. Besides, age correlated negatively with anxiety scores on the GAD-7. Neither antidepressant and anxiolytic use nor vitamin/mineral supplement use were not related to the anxiety scores of participants.
Conclusion: Results of this study demonstrated an alarming anxiety status among pharmacy students during the COVID-19 pandemic period. Diagnosis of a family member with COVID-19 was observed to be critical in triggering the anxiety of pharmacy students. Data from this study should raise awareness to take action plans for the mental well-being of pharmacy students during pandemics.
Nesa Cheraghbeigi; Somaieh Bosak; Mehdi Sayyah; Erfan Javanmardi; Dariosh Rokhafrooz
Volume 24, Issue 11 , 2022
Abstract
Background: Specific conditions arising from the COVID-19 pandemic may affect the mental health of nursing students.
Objectives: This study aimed to investigate the mental health of nursing students and associated factors during the COVID-19 pandemic at Ahvaz and Kermanshah Universities of Medical Sciences ...
Read More
Background: Specific conditions arising from the COVID-19 pandemic may affect the mental health of nursing students.
Objectives: This study aimed to investigate the mental health of nursing students and associated factors during the COVID-19 pandemic at Ahvaz and Kermanshah Universities of Medical Sciences in Iran.
Methods: This cross-sectional study was conducted on 384 nursing students at Ahvaz and Kermanshah Universities of Medical Sciences in Iran from May 10, 2021, to June 26, 2021. The required data were collected using a web-based questionnaire via social networks, such as WhatsApp and Telegram. Symptom Checklist-25 (SCL-25) was used to measure mental health. Descriptive statistics and stepwise linear regression were used to analyze the data.
Results: The mean total mental health score was 47.48±16.03, and 235 (61.0%) students had good mental health, 124 (32.2%) cases had suspected mental disorders, and 26 (6.8%) respondents had severe mental disorders. Using the stepwise regression method, four variables, including gender, history of mental illness, history of coronavirus infection or being suspected of having coronavirus, and level of trust in statistics about the incidence and mortality rate of COVID-19 had the greatest impact on mental health modeling.
Conclusion: In general, the COVID-19 pandemic may have a negative impact on the mental health of nursing students. Therefore, it is very important to identify and consider the factors that can reduce their mental distress.
Somayeh Fazaeli; Mehdi Yousefi; Mohsen Shokoohizadeh
Volume 24, Issue 11 , 2022
Abstract
Background: Information dashboards are useful tools for up-to-date decision-making by visualizing data.
Objectives: This study aimed to report the development of a dashboard in the emergency department (ED) during COVID-19 in a big hospital in Iran.Methods: The authors developed a dashboard by user-centered ...
Read More
Background: Information dashboards are useful tools for up-to-date decision-making by visualizing data.
Objectives: This study aimed to report the development of a dashboard in the emergency department (ED) during COVID-19 in a big hospital in Iran.Methods: The authors developed a dashboard by user-centered design (UCD) methodology in four phases, namely specification of the context of use, specification of the requirements, creation of design solutions, and evaluation. Indicators were determined by reviewing previous studies and interviewing focus groups with an expert panel. The Power BI Desktop software was used for the development of the dashboard. Users' comments about the dashboard were collected. The dashboard was then developed and revised according to the users' feedback and suggestions. Finally, user satisfaction was evaluated.Results: The authors identified 30 indicators for COVID-19 ED, classified as input, output, and process indicators. The final version of the dashboard was implemented in 2021, and then 28 ED and managerial staff participated in the evaluation of the dashboard. The average score of the system usability scale of the dashboard was 84.10 points, and the situation awareness index was 3.97, which indicates "good" usability and situation awareness.Conclusion: This dashboard presented key managerial and clinical indicators for decision-making in ED. Future studies can be designed to develop dashboards for accidents and burns EDs and create emergency information dashboards for several hospitals for better management in times of crisis.
Maryam Yaghoubi; Mohammad Salimi; Mohammad Meskarpour-Amiri; Sayyed Morteza Hosseini_Shokouh
Volume 24, Issue 10 , 2022
Abstract
Background: The increase in the workload of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic has added further responsibilities for their health.
Objectives: This study was conducted to measure the amount and economic value of COVID-19-related absenteeism and presenteeism and ...
Read More
Background: The increase in the workload of healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic has added further responsibilities for their health.
Objectives: This study was conducted to measure the amount and economic value of COVID-19-related absenteeism and presenteeism and its affecting factors among physicians, nurses, and paramedics working frontline with COVID-19 patients.
Methods: This cross-sectional study was conducted in a COVID-19 tertiary central hospital in Tehran, Iran. Totally, 250 hospital staff who were working frontline with COVID-19 patients between October to December 2020 were entered in the study. The samples included 100 physicians, 96 nurses, and 56 paramedics. The Valuation of Lost Productivity Questionnaire was used to measure job characteristics, absenteeism, and presenteeism. The human capital approach was employed for the valuation of absenteeism and presenteeism. Data were analyzed using ordered logistic regression with backward elimination and the removed value of 0.1 in Stata 14.
Results: Based on the results, the COVID-19 infection rate was 14.4% among healthcare workers, 8% among physicians, 18.6% among paramedics, and 18.7% among nursing staff. A significant association was found between the amount of absenteeism and working in intensive units (odds ratio [OR]: 3.511, P=0.000). A higher amount of absenteeism was related to first-time COVID-19 infection among all participants (OR: 4.918, P=0.000). Current smoker staff, in comparison to quitted smoking staff, was 2.995 times more likely to have a higher amount of presenteeism (OR: 2.995, P=0.030).
Conclusion: COVID-19 had a significant effect on both absenteeism and presenteeism of healthcare workers and its amount and value were unequal among physicians, nurses, and paramedics. Policymakers should do their best to minimize the productivity loss of healthcare workers.
Ali Mohammad Mosadeghrad; Mahya Abbasi; Sajad Ramandi
Volume 24, Issue 10 , 2022
Abstract
Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional ...
Read More
Background: The covid-19 pandemic has affected the health insurance industry in numerous ways.
Objectives: The present study aimed to examine the impacts of the covid-19 on the referral times of insurance policyholders to hospitals and diagnostic centers throughout the country.
Methods: This was a cross-sectional descriptive study conducted on the data collected from a private insurance company. The statistical population included all insured individuals covered by the insurer in 31 provinces throughout the country who have used the services provided in hospitals and other diagnostic centers from March 21, 2019 to September 21, 2019 (1,699,930 insured people), considered as the pre-covid-19 incidence period, and from March 20, 2020 to September 20, 2020 (1,862,657 insured people), as the post-covid-19 incidence period. Data were analyzed using the SPSS and GIS statistical software.
Results: In the 2019 half-year, 10,416,591 medical expense records have been filed in the country, which decreased by 17.1% in the same period in 2020 to 8,633,613 records. The average referral times in the pre-covid-19 period was 7.02, which decreased by 32.9% during the post-covid-19 period, falling to 4.71.
Conclusion: The overall frequency of referrals to receive all services covered by the insurer, including visits, medicine, hospital services (general surgeries), and laboratory services in the post-covid-19 period decreased significantly, compared to a similar period in the previous year. It seems that in many different provinces, non-emergency patients avoided referring to healthcare centers and unnecessary visits to medical centers. Moreover, the number of general surgeries decreased because of the therapists cautiousness and the changing behaviors of the patients, making diagnostic and medical services more real.
Zoya Hadinejad; Fereshteh Araghian Mojarad; Tahereh Yaghoubi
Volume 24, Issue 9 , 2022
Abstract
Background: Coronavirus will not be the first and the last pandemic in the world. Problem-solving and crisis management methods are determined by the ways in which people, statesmen, and experts treat various fields.
Objectives: The present qualitative study was conducted pursuing the goal to illustrate ...
Read More
Background: Coronavirus will not be the first and the last pandemic in the world. Problem-solving and crisis management methods are determined by the ways in which people, statesmen, and experts treat various fields.
Objectives: The present qualitative study was conducted pursuing the goal to illustrate COVID-19 epidemic management learned lessons from the perspective of the managers of the educational and medical centers of Mazandaran University of Medical Sciences, Sari, Iran, in 2022.
Methods: This qualitative study was conducted based on a content analysis type in Mazandaran University of Medical Sciences and its subdivisions (hospitals and educational centers). The data were collected using semi-structured interviews, and interview coding was performed manually by the researcher. To increase the study accuracy, the methods proposed by Lincoln and Goba (1998) were used with such criteria as validity, reliability, verifiability, and transferability.
Results: In total, 15 managers (8 men and 7 women) in the age range of 32-70 years participated in this study and underwent deep and semi-structured interviews. Initially, 1079 semantic units and 85 subcategories were extracted. After reducing, removing, and integrating being conducted at various stages of data analysis, 3 themes and 12 categories were extracted. The present study themes are made up of "Management Challenges", "Personnel Challenges", and "Social Challenges".
Conclusion: One of the factors for promoting quality in planning is benefiting from the prior learned experiences and lessons. Taking advantage of the consulting team, the intra-organizational and extra-organizational coordination, optimally benefitting from the human workforce, paving the ground for virtual training for health system staff, and elevating the quality of public information are critical in the effective management of COVID-19.
Marzie Tajik Jalali; Milad Ahmadi Marzaleh; Fateme Askarian; Seyede Maryam Najibi; Ahmad Soltani; Sajad Delavari
Volume 24, Issue 9 , 2022
Abstract
Background: Rumors concerning various aspects of the fight against COVID-19, vaccination, in particular, have become one of the main challenges for managers and policymakers who have to deal with different aspects of the disease. This necessitates the recognition of the factors that influence the prevention ...
Read More
Background: Rumors concerning various aspects of the fight against COVID-19, vaccination, in particular, have become one of the main challenges for managers and policymakers who have to deal with different aspects of the disease. This necessitates the recognition of the factors that influence the prevention and spread of these rumors.
Objectives: The current study aimed to investigate the link between health literacy among adults and their acceptance of COVID-19 vaccination rumors in Iran.
Methods: This cross-sectional study was conducted from November 15 to December 15, 2021, in different provinces of Iran. The study population included Iranian adults, aged 18 years and older, who were selected using the snowball sampling method. The data collection tools involved two questionnaires: the Health Literacy Questionnaire, which consists of 33 items, and the COVID-19 Vaccine Rumor Questionnaire which assesses 17 rumors related to COVID-19 vaccination collected from various news sources.
Results: The number of completed questionnaires was 1158 out of 2163 questionnaire visits (74% response rate). Univariate analysis showed that health literacy had a statistically significant association with sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of data analysis also demonstrated a significant correlation between the average of rumors acceptance and the sociodemographic variables of gender, marital status, ethnicity, place of residence, and level of education. The results of the Pearson correlation coefficient test showed a significant and negative relationship between health literacy and rumor belief (P= 0.000, r=-0.590), indicating that those with a higher level of health literacy had a lower level of rumor acceptance.
Conclusion: Based on the findings of the present study, health literacy has a significant effect on reducing the credibility of rumors and other misinformation among community members. Macro-level decisions and policies are needed to improve factors such as health literacy and can help individuals identify and track rumors and make decisions based on reliable information on vaccination.
Ali Hosseinzadeh; Abbas Tavakolian; Vahid Kia; Hossein Ebrahimi; Hossein Sheibani; Ehsan Binesh; Majid Rahmati; Maryam Yarmohammadi; Nazanin Aghayan; Seyed Mohammad Mirrezaie; Moslem Jafarisani; Reza Jafari
Volume 24, Issue 8 , 2022
Abstract
Background: Coronavirus pandemic has affected a large population worldwide. Currently, the standard care for individuals who are exposed is supportive care, symptomatic management, and isolation.
Objectives: This study aimed to evaluate the effects of the combined use of ethanol and dimethyl sulfoxide ...
Read More
Background: Coronavirus pandemic has affected a large population worldwide. Currently, the standard care for individuals who are exposed is supportive care, symptomatic management, and isolation.
Objectives: This study aimed to evaluate the effects of the combined use of ethanol and dimethyl sulfoxide (DMSO) as a nasal spray in preventing Coronavirus disease 2019 (COVID-19).
Methods: This randomized controlled trial was conducted on volunteer healthcare workers of medical centers who were at the forefront of the fight against COVID-19 in Shahroud, Iran. In total, 232 participants were randomly assigned to intervention and control groups to receive DMSO/ethanol or routine care, respectively. The subjects were followed for four weeks to determine the incidence of COVID-19 infection in each group based on the RT-PCR test. Finally, absolute risk difference and relative risk were calculated to evaluate the effect of DMSO on COVID-19 prevention.
Results: The results showed that the incidence rates of COVID-19 were 0.07 and 0.008 in the control and intervention groups, respectively. The relative risk was obtained at 0.12 (0.02-0.97) according to the incidence rate in the two groups.
Conclusion: Combined administration of DMSO and ethanol by healthcare providers can considerably prevent COVID-19.
Majid Taati Moghadam
Volume 24, Issue 8 , 2022
Zahra Taati Moghadam; Majid Taati Moghadam
Volume 24, Issue 7 , 2022
Yaser Moradi; Rahim Baghae; Aram Feizi; Reza Hajialibeigloo
Volume 24, Issue 6 , 2022
Abstract
Background: Despite the introduction of e-learning in recent years, it has not been utilized as a major educational method in numerous universities, especially in the area of medical and health sciences, until the crisis of the COVID-19 pandemic.
Objectives: This study aimed at explaining the strengths ...
Read More
Background: Despite the introduction of e-learning in recent years, it has not been utilized as a major educational method in numerous universities, especially in the area of medical and health sciences, until the crisis of the COVID-19 pandemic.
Objectives: This study aimed at explaining the strengths and weaknesses of asynchronous e-learning in nursing education throughout the COVID-19 crisis.
Methods: In this qualitative descriptive study, a total of 14 nursing faculty members were selected using the purposive sampling method. The interviews were conducted face-to-face with semi-structured questions. The researcher recorded all interviews with the participants' consent. Data analysis was conducted in four phases using the content analysis approach (Graneheim and Lundman).
Results: Nursing faculty members cited "low quality of educational content", "cold and soulless education", "low efficiency in clinical education", and "insufficiency in educational assessment process" as the weaknesses and "maintenance of safe education during the COVID-19 crisis" as the strength of asynchronous e-learning in nursing education during the COVID-19 crisis.
Conclusion: Asynchronous e-learning was shown to have various weaknesses in nursing theoretical and clinical education. However, the most striking strengths of this method in the COVID-19 pandemic were found to be the protection of the safety and health of individuals, followed by the maintenance of academic activities and education. Therefore, it is worthwhile for all nurse researchers, academic education policy-makers, and faculties to put conscious effort into developing standard protocols for the preparation of educational content, empowering lecturers in the area of online education, and using other methods to promote dynamic interactions.
Majid Taati Moghadam
Volume 24, Issue 6 , 2022
Maryam Sarkardeh; Amin Dalili; Poorya Etesamyzade; Ali Shamshirian; Zahra Sadrzadeh; Javad Kooshki; Maryam Khoshdast; Alireza Rezapanah
Volume 24, Issue 6 , 2022
Abstract
Background: By the end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The high affinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some ...
Read More
Background: By the end of May 2021, 170 million cases and 3.54 million death from Covid-19 infection have been reported. The high affinity of virus particles to ACE-2 receptors in different body organs can cause varied clinical manifestations and complications. Ischemic colitis and necrosis are some rare complications of Covid-19 infection with high morbidity and mortality resulting from colonic hypoperfusion. Different underlying mechanisms for ischemic colitis in Covid-19 patients have been described, including hypercoagulable state, inflammatory responses, microthrombosis, and non-occlusive intestinal ischemia due to shock, hypoxemia, and low cardiac output.
Case Presentation: here, we presented three patients with ischemic colitis and one rectal necrosis as a rare presentation of gastrointestinal complication of SARS-CoV-2 infection. All of our patients presented with abdominal pain and tenderness and received a standard regimen of antibiotics, anticoagulation, and ventilation support.
Conclusion: Ischemic colitis is one of these rare but with high mortality manifestations, which presents with non-specific signs and symptoms. Hence, ischemic colitis should be kept in mind in patients with Covid-19 infection and abdominal pain, which necessitates further evaluations.
AmirAli Moodi Ghalibaf; Mina AkbariRad; Mehdi Ataee Karizmeh
Volume 24, Issue 6 , 2022
Abstract
In late December 2019, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first presented in the Hubei province of China as pneumonia of unknown cause, which has caused millions of deaths up to now (1). Studies indicated the most common ...
Read More
In late December 2019, the novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first presented in the Hubei province of China as pneumonia of unknown cause, which has caused millions of deaths up to now (1). Studies indicated the most common signs and symptoms of the conventional COVID-19 variants as fever, cough, dyspnea, and fatigue. In advanced stages, this mysterious viral disease leads to acute respiratory distress syndrome, acute cardiac damage, as well as gastrointestinal manifestations (2).
In late 2021, the emergence of the new COVID-19 variant, called the Omicron variant, started a new global pandemic wave and was stated as a "version of concern (VOC)" by the World Health Organization (3). Despite our little knowledge about the COVID-19 Omicron variant, some evidence presented the milder manifestation of this new variant than the previous variants, probably due to the global vaccination effects. However, few new theories and studies indicated the life-threatening aspects of the Omicron variant (3).
As indicated in our previous study, cancer patients are in danger of COVID-19 (4); however, seemingly, the Omicron variant has made a novel situation for these patients. Therefore, in the present study, the authors briefly investigated whether the COVID-19 Omicron variant is threatening cancer patients or not?
Cancer Patients in the COVID-19 Era
Most cancer patients are at an exceptionally high risk of infection with the SARS-CoV-2 with probably higher morbidity and mortality rates, prompting special attention to this populace. Molecular links between most cancers and the COVID-19 have been observed to be related to Angiotensin-Converting Enzyme 2, Transmembrane Protease Serine 2, pro-inflammatory cytokines, and blood coagulation (5). Some anticancer agents are being investigated as a possible treatment for the COVID-19. Based on these findings, new therapeutic options are designed for the treatment of both cancer and the COVID-19. They can manage the extreme outcomes of the COVID-19 and have therapeutic effects on many active cancers (2,5). On the other hand, some investigations have proposed the theory of the COVID-19 associated cancer incidence (4,5). Therefore, according to what is stated and considering the immune-suppressed situation of cancer patients, it is highly advised that clinicians who encounter SARS-CoV-2 infected cancer patients pay special attention to their treatment and follow-up.
Omicron Variant: Danger for Cancer Patients or Not?
The latest findings of the COVID-19 Omicron variant determined its new immune-escape properties, which can potentially enable the virus to infect vaccinated individuals or re-infect anyone (6). Furthermore, these investigations indicated that this VOC has higher transmissibility among people than the Delta and Beta variants. Additionally, its doubling time is approximately one-third of the two other mentioned variants (6). Therefore, due to increased infections, transmissibility, and immune escape, this new VOC has made an alert for healthcare workers and clinicians to severely take care of cancer patients, as an in-danger group. In detail, some of the major reasons and recommendations are as follows (Figure 1):
1- Cancer Patients Vaccination: Based on molecular and serological studies, the serum anti-SARS-CoV-2 S (anti-S) titer has a lower median after two doses of vaccination in cancer patients, compared to the general healthy population. Previous research findings proposed that all cancer patients should receive the third dose of the vaccine three to four months after the second one (7). While receiving the third dose of the COVID-19 vaccine is necessary for all cancer patients, there are controversies about the fourth dose for these patients. Although administrating dose four is probably not highly efficient in cancer patients due to their anti-CD20 treatment, some scientific tips state that the fourth dose can be administrated four months after the last dose in developed countries (7,8).
2- Cancer Patients' Relatives Vaccination: It is highly recommended by scientific studies and societies that relatives of anyone, due to their close contact, could act as a virus transporter. It is advised to administer the third dose for those in contact with cancer patients approximately four months after the second one. Moreover, vaccination of 5-11 years old children, as silent transporters, seems highly important (8).
3- Behavioral Prophylaxis: Scientific studies have approved that the COVID-19 is transmitted through air and droplets. Therefore, it is essential that immune-suppressed people, especially patients with active malignancy, do not gather in populated communities and events. Furthermore, wearing highly protective masks is highly crucial not only for cancer patients but also for everyone else (9).
4- Monoclonal Antibody Prophylaxis: Monoclonal antibody prophylaxis and treatment is not approved for COVID-19 medication. However, some in vitro documents indicated its efficacy on the Delta variant, while this neutralization effect is lower on the Omicron variant. Nevertheless, there is a high controversy about applying monoclonal antibodies for COVID-19 prophylaxis even in cancer patients (10).
In conclusion, although cancer patients have been in danger of COVID-19 infection and its complication, the new Omicron variant needs more attention and protection. It is highly advised that clinicians and cancer patients take the Omicron variant seriously. Complete vaccination, the administration of the third and even the fourth dose, as well as behavioral prophylaxis, are major routes to being safe beyond the other ways to be protected in the COVID-19 Omicron era.
Zeinab Siami; Danial Dehghan; Armin Khavandegar; Mehran Lak; Mahmood Bakhtiyari
Volume 24, Issue 5 , 2022
Abstract
Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir.
Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral ...
Read More
Background: While several antivirals have been considered among the candidate repurposed drugs against SARS-CoV-2 infection, limited evidence exists on Atazanavir/Ritonavir.
Objectives: This trial was designed to assess the efficacy of Atazanavir/Ritonavir compared to Lopinavir/Ritonavir, another antiretroviral drug investigated in the previous studies.
Methods: This randomized, double-blind clinical trial was conducted on hospitalized patients with laboratory or confirmed SARS CoV-2 infection. Patients were randomly assigned (1:1) to receive either Lopinavir/Ritonavir (200mg Lopinavir+50mg Ritonavir, twice a day) or Atazanavir/Ritonavir (300mg Atazanavir+100 mg Ritonavir, once a day) for up to 14 days during their admission along with the standard care. The primary endpoint was total all-cause death in all patients during the hospitalization period. Secondary outcomes included length of hospitalization.
Results: Out of 103 adults included in the analysis 54 and 49 were assigned to Atazanavir/Ritonavir and Lopinavir/Ritonavir groups, respectively. The occurrence of adverse effects, defined as symptoms attributed to the drugs which no longer appear upon the cessation of the drug, was higher for cardiac side effects in Atazanavir/Ritonavir group. No statistically significant difference was observed between the two groups in terms of the length of hospitalization. After adjustment for other covariates in the study, treatment with Atazanavir/ritonavir did not result in a significant reduction in mortality compared to treatment with Lopinavir/Ritonavir.
Conclusion: The efficacy of Atazanavir/Ritonavir in this preliminary study was not superior to Lopinavir/Ritonavir in reducing mortality and length of hospitalization in COVID-19 patients. However, the limited efficacy of both compounds does not support their use in primary care for COVID-19 patients.
Ghazal Ghasempour Dabaghi; Mehrdad Rabiee Rad; Mohammad Eslamian; Maryam Goharian
Volume 24, Issue 4 , 2022
Abstract
Background: Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery ...
Read More
Background: Coronavirus disease 2019 (COVID-19) is a major health problem worldwide. Vascular thrombosis is increasingly observed in COVID-19 patients. This complication seems to be due to coagulopathy and endothelial damage. In this paper, we report a COVID-19 patient with superior mesenteric artery thrombosis and review of 27 COVID-19 cases with acute mesenteric ischemia (AMI).
Case presentation: A 59-years old man with confirmed COVID-19 readmitted to the hospital due to abdominal pain and diarrhea two days after discharge from the emergency department. He was diagnosed with acute mesenteric ischemia by abdominal CT scan with contrast. The patient underwent emergency laparotomy and the ischemic gangrenous bowel was resected. Unfortunately, the patient succumbed one month after the operation.
Conclusion: AMI is a life-threatening thrombotic event rarely seen in COVID-19 patients, so it is vital to diagnose it. Anticoagulant and anti-inflammatory prophylactic therapies might be useful in preventing AMI, especially in the patients with thrombosis risk factor. So, it is crucial to reduce its incidence in COVID-19 patients.
Tooraj Zandbaf; Mohammad Ebrahim Kalantari; Yeganeh Azadmanesh; Hamzeh Sherafati; Ali Akbar Bagherzadeh
Volume 24, Issue 4 , 2022
Abstract
Introduction: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture ...
Read More
Introduction: Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain that is often misinterpreted. Only about 2% of patients who present with acute abdominal pain display this condition. Damage to the superior or inferior epigastric arteries or their branches, as well as direct rupture of the rectus abdominis muscle, causes bleeding into the rectus sheath. In hospitalized COVID-19 patients, anticoagulant prophylaxis with heparin has become a standard part of medical care. This method may raise the risk of bleeding in older people with comorbidities.
Case presentation: The patient was a 60-year-old woman with a history of asthma and diabetes mellitus who was referred to the emergency department with shortness of breath and cough. Chest X-Ray demonstrated Covid-19 pneumonia. On the second day of hospitalization, after the exacerbation of tachypnea, computed tomography (CT) angiography was performed, and the results confirmed pulmonary embolism; therefore, the therapeutic dose of heparin was initiated. On the 21st day of hospitalization, the patient experienced abdominal pain and was visited by a general surgeon. A large ecchymosis was observed in the periumbilical; nonetheless, there was no significant tenderness in the abdominal exam. The patient's hemoglobin dropped to 7.9 mg/dl at this time. An abdominal and pelvic CT scan showed a 45 mm hematoma in the left rectus muscle.
Conclusion: In patients presenting with acute abdominal pain, any physician in the field of emergency or surgery should include RSH in their differential diagnosis list, especially those who have certain predisposing conditions.
Sharareh Borhani; Mohadeseh Zohari; Neda karim; Hamed Rashidi; Shadi Asadzandi
Volume 24, Issue 3 , 2022
Abstract
Background: During the COVID-19 pandemic, telemedicine is applied for various purposes, such as reducing the time of diagnosis and initiating treatment, quarantining and stabilizing patients, enabling the system to closely monitor the citizens at home, and supporting health professionals.
Objectives: ...
Read More
Background: During the COVID-19 pandemic, telemedicine is applied for various purposes, such as reducing the time of diagnosis and initiating treatment, quarantining and stabilizing patients, enabling the system to closely monitor the citizens at home, and supporting health professionals.
Objectives: The present study used Scientometrics analysis to comprehensively analyze the body of research conducted on telemedicine regarding COVID-19.
Methods: By using a searching formula, 900 documents were retrieved from the Web of Science. Co-authorship networks were drawn by CiteSpace and Gephi software that are free and powerful illustrating networks. The selected co-authorship indicators were Degree Centrality, Betweenness Centrality, and Closeness Centrality.
Results: Andrea M. Russo had by far a high degree of centrality, compared to other authors. Regarding the countries, Belgium and Portugal had a larger node, indicating that they had a higher degree of centrality. Neurosciences had a large node, showing the higher degree of centrality of this subject area. Psychology and Clinical Neurology were also the nodes with a higher degree of centrality. The degree of centrality was high for the University of Zurich, University of Barcelona, and King College London, and the connections of these nodes were more and even stronger, compared to other nodes.
Conclusion: This study, which was based on 900 scientific credentials in the field of telemedicine during COVID-19, indicated the level of cooperation among authors, countries, and organizations in 2020. Moreover, by presenting different indicators in these networks researchers, countries, and key organizations were introduced for each indicator.
Emine Fusun Akyuz Cim; Esra Torlak; Gizem Unveren; Gursel Remzi Soybir; Vahit Ozmen; Zeynep ErdoGan Iyigun; Tuba Kayan Tapan; Abdullah Yesilova; Gul Alco; Ebru Yilmaz; Asli Eyrenci; Filiz Elbuken; Ahmet Serkan Ilgun; Tomris Duymaz; Cetin Ordu
Volume 24, Issue 2 , 2022
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe through coughing, sneezing, droplet inhalation, and contact.
Objectives: The current study aimed to assess the impact of the fear of COVID-19 infection on functionality in women with breast cancer.
Methods: The present ...
Read More
Background: Coronavirus disease 2019 (COVID-19) has spread rapidly across the globe through coughing, sneezing, droplet inhalation, and contact.
Objectives: The current study aimed to assess the impact of the fear of COVID-19 infection on functionality in women with breast cancer.
Methods: The present study included women with diagnosed breast cancer (n=75) under treatment in Istanbul Florence Nightingale Hospital and healthy (n=69) women( a total of 144 volunteers). The participants were asked to fill out the Sociodemographic Data Form, Anxiety Sensitivity Index-3 (ASI-3), and Fear of COVID-19 Scale to evaluate the impact of fear of infection and cleaning behavior due to COVID-19 on functionality.
Results: No statistically significant difference was found between the women with and without diagnosed breast cancer regarding the impact of fear of COVID-19 infection on all functionality parameters (all parameters: P>0.05). In the breast cancer group, the effect of Covid-15 anxiety and cleaning behavior on functionality performance was significantly higher in participants with underlying disease (P=0.044, P=0.013) and smoking (P=0.0234, P=0.0147).
Conclusion: As evidenced by the results of this study, smoking and the presence of comorbidity in breast cancer patients may have a negative effect on the functionality effect of fear of Covid-19 infection. In terms of psychiatric intervention, the parameters affected by functionality should be considered.
Amir Hossein Behnoush; Navid Ahmadi; Mehrdad Mozafar; Seyed Peyman Mirghaderi; Alireza Jafari Azad; Amirmasoud Kazemzadeh Houjaghan; Ghazal Behzad; Negin Abiri Jahromi; Shabnam Zahirian; Elham Bazmi; Zahra Khazaeipour
Volume 24, Issue 2 , 2022
Abstract
Background: The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among healthcare workers, especially nurses, due to their more frequent and closer contact with patients.
Objectives: This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection ...
Read More
Background: The coronavirus disease 2019 (COVID-19) epidemic is a great challenge among healthcare workers, especially nurses, due to their more frequent and closer contact with patients.
Objectives: This study aimed to evaluate anxiety, depression, and their causes among nurses with COVID-19 infection in different wards of a hospital.
Methods: This cross-sectional study was carried out between February 1st to October 30th, 2020, among all nurses with COVID-19 infection in different wards of Imam Khomeini Hospital (university hospital), Tehran, Iran. The nurses were contacted by phone, and data were collected using a self-administered, valid, structured questionnaire consisting of sociodemographic characteristics and clinical symptoms. Psychological complications, including anxiety and depression levels, were assessed and their association with other sociodemographic variables was also evaluated.
Results: A total of 158 nurses were entered into the study, out of which 112 (70.2%) cases were females. Among all participants, 72.8% and 42.4% of the subjects reported anxiety and depression, respectively. The frequency of moderate to severe anxiety was significantly greater in women than in men (P<0.001). The infected nurses who worked in low-risk departments experienced a greater proportion of moderate to severe depression (P=0.004). In addition, the most prevalent reason for anxiety and depression was found to be the fear of infecting family members.
Conclusion: Nurses bear a significant psychological burden during the COVID-19 pandemic, markedly when they get infected and experience clinical symptoms. Therefore, the government and other staff should provide some facilities and supportive administrative work for reducing anxiety and depression and improving nurses' psychological health.
Esmat Boshaq; Fereshteh Davoodi; Reza Bahari; Kimia Taheri Aligoodarzi
Volume 24, Issue 1 , 2022
Abstract
Background: Nurses have experienced severe psychological stress which seriously affected their mental health during the Coronavirus disease 2019 (COVID-19) pandemic due to exposure to numerous critically ill patients, increased working time, and their colleagues disease or demise.
Objectives: The present ...
Read More
Background: Nurses have experienced severe psychological stress which seriously affected their mental health during the Coronavirus disease 2019 (COVID-19) pandemic due to exposure to numerous critically ill patients, increased working time, and their colleagues disease or demise.
Objectives: The present study aimed to examine clinical nurses' mental health status and elucidate its relationship with the quality of care provided by them.
Methods: This cross-sectional descriptive study was conducted in 2020 on the nurses working at two hospitals affiliated with Lorestan University of Medical Sciences. A total of 104 nurses were selected from all wards via convenience sampling. The data were collected using the Quality Patient Care Scale and Goldberg and Williams's General Health Questionnaire to check nurses general health status. Statistical tests, including canonical correlation analysis, were used to analyze the data in SPSS software (version 20).
Results: There was a negative correlation between mental health and the quality of care provided by male (=-0.556; P<0.001) and female (=-0.351; P=0.017) nurses. Social dysfunction, anxiety, and insomnia in male nurses, as well as somatic symptoms and social dysfunction in female nurses, had the largest share of their general health, while physical care had the largest share of nursing care quality
Conclusion: As evidenced by the obtained results, female nurses had better mental health status and provided higher-quality nursing care during the COVID-19 pandemic, as compared to male nurses. This higher quality may be attributed to women's better mental health status. The important findings of the current study highlight the necessity of regular programs for the improvement of nurses' mental health, thereby enhancing the quality of nursing care.
Canan Sar?; Leyla Ad?guzel; Birsel Canan Demirba?
Volume 24, Issue 1 , 2022
Abstract
Background: The COVID-19 pandemic has affected all sectors of society, especially education. However, the negative effects are even higher on the students who study in an associate degree program in the field of health for two years.
Objectives: This study aimed to explore the opinions of students studying ...
Read More
Background: The COVID-19 pandemic has affected all sectors of society, especially education. However, the negative effects are even higher on the students who study in an associate degree program in the field of health for two years.
Objectives: This study aimed to explore the opinions of students studying in an associate degree program in health-related departments with skill-based requirements towards web-based distance education during the pandemic.
Methods: This descriptive cross-sectional study was conducted on students who received associate degree education in home care, elderly care, physiotherapy, and first and emergency aid departments of a vocational school. The study data were collected from 264 volunteer students studying at vocational schools using the online questionnaire developed by the researchers.
Results: The study revealed that 72% of the students did not consider web-based distance education as the right education method during the pandemic, 95.8% did not find the opportunity to care for/touch patients during their education, and 74.8% were afraid of working after graduation due to the possibility of malpractice (61.4%).
Conclusion: Based on the study results, it was determined that students studying in departments with skill-based requirements in the field of health had a negative perspective on web-based distance education.
Tahereh Yaghoubi; Yadollah Jannati; Mahmood Moosazadeh; Abolfazl Hosseinnataj; Fereshteh Aaraghian Mojarad
Volume 23, Issue 12 , 2021
Abstract
Background: Coronavirus disease 2019 (COVID-19) has made the grief process more complicated and brought about loads of unexpressed grief.
Objectives: The present study aimed to determine the severity of grief reactions following the death of first-degree relatives (FDRs) due to COVID-19.
Methods: This ...
Read More
Background: Coronavirus disease 2019 (COVID-19) has made the grief process more complicated and brought about loads of unexpressed grief.
Objectives: The present study aimed to determine the severity of grief reactions following the death of first-degree relatives (FDRs) due to COVID-19.
Methods: This analytic cross-sectional study was conducted to determine the grief score of people aged over 18 with the experience of losing one of their FDRs (i.e., father, mother, and siblings) due to COVID-19. Convenience sampling was employed to select the participants. The instrument used in this study was the Grief Experience Questionnaire (GEQ-34) which was completed via phone calls. The inclusion criteria entailed a willingness to participate in the study, the age range of above 18, and experience of FDRs death. On the other hand, the exclusion criteria were severe discomfort and restlessness while talking on the phone. Descriptive statistics and multiple linear regression were employed to diagnose the factors affecting grief using SPSS software (version 22) with a significance level of 0.05.
Results: The findings indicated that the mean score of GEQ was 67.22±19.24 (ranging from 34 to 126). In this study, 54.5%, 40.2%, and 5.3% of subjects experienced low, moderate, and severe levels of grief, respectively. The grief score showed a positive relationship with the gender of the mourners and marital status; nonetheless, it was negatively correlated with subjects employment and the age of their deceased FDRs.
Conclusion: As evidenced by the obtained results, among the subscales of mourning, the highest scores were related to the dimensions of justification, coping, and guilt. Communication and social support were reduced due to the COVID-19 pandemic; therefore, the provision of online mental health services can be a useful way to treat and help the bereaved.
Seyed Alireza Haji Seyed Javadi; Bahare Rezaei; Ali Akbar Shafikhani; Mohammad Ebrahim Sarichloo
Volume 23, Issue 12 , 2021
Abstract
Background: The Covid-19 pandemic has put unprecedented pressure on the medical staff, leading to mental disorders and burnout. Objectives: The present study aimed to compare burnout and other aspects of mental health in medical staff working in Covid-19 and non-Covid-19 wards.
Methods: This cross-sectional ...
Read More
Background: The Covid-19 pandemic has put unprecedented pressure on the medical staff, leading to mental disorders and burnout. Objectives: The present study aimed to compare burnout and other aspects of mental health in medical staff working in Covid-19 and non-Covid-19 wards.
Methods: This cross-sectional study was conducted in the Social Determinants of Health Research Center of Qazvin University of Medical Sciences from 10 December 2020 to 16 April 2021. A total of 384 respondents (187 cases in Covid-19 wards and 197 subjects in non- Covid-19 wards) were selected via the convenience sample method. The Maslach Burnout Inventory (MBI) and the General Health Questionnaire-28 (GHQ-28) were distributed to all participants online. Moreover, sociodemographic data and occupational conditions were collected and analyzed using appropriate statistical methods.
Results: Based on the results, medical staff working in Covid-19 wards had significantly higher GHQ scores, compared to those in non-Covid-19 wards (29.82±11.07 vs. 25.76±11.83; P<.001, respectively). The risk factors associated with high scores in GHQ subscales included more shifts, being a nurse and being a physician (P<0.05). In terms of burnout subscales, the medical staff working in Covid-19 wards had significantly higher depersonalization and emotional exhaustion, as well as lower individual performance (P<0.05). The risk factors associated with burnout subscales included the female gender, being a nurse, being a physician, having children, confirmed Covid-19 infection, and staff relocation during the Covid-19 pandemic (P<0.05).
Conclusion: As evidenced by the results of the present study, individual variables, along with the prevalence of Covid-19, can affect the psychological consequences of medical staff and be considered a risk factor for each of them.
Mahdi Gholian; Mohammad Moghzi; Mohsen Zakerian; Elham Charoghchian Khorasani
Volume 23, Issue 12 , 2021
Abstract
Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of ...
Read More
Dear Editor,
Since March 11, 2020, the Coronavirus (COVID-19) has been declared a global pandemic, and the World Health Organization (WHO) has declared it a public health emergency, countries have borne the brunt of the outbreak and attention has been focused on preventing the disease (1, 2). One of the most effective ways to prevent COVID-19 and control the epidemic is general vaccination, which was introduced as a key intervention against this disease (3, 4). A year after the start of the COVID-19 epidemic, a number of companies have developed a safe vaccine against COVID-19, but the lack of production of these vaccines has created problems for various countries (5).
In Iran, national vaccination began on February 9, 2021, with the priority of healthcare personnel, and gradually expanded with the priority of different vaccination groups. However, the success of vaccination depends on the general acceptance of the vaccine (5, 6). Various studies have shown that vaccination is not popular in low- and middle-income countries (4, 7-9).
With the outbreak of the delta type, it should be noted that its infectivity is more than twice that of the original strain, and the morbidity and mortality have increased. In this regard, regional and local healthcare systems have taken new steps (3). One of the cities in Iran that was affected by the COVID-19 delta virus type was Mashhad, which is located 900 km from the capital, the city has a large margin and a population of about 1,200,000 economically disadvantaged people. The mortality rate in these areas is higher than that in other areas of the city, and they are reluctant to be vaccinated.
In order to increase vaccination coverage in these low-income areas of the city, a coalition was formed between the Basij Organization and the University of Medical Sciences. By conducting need assessments, identifying existing barriers, and using facilitators, this coalition was able to create mobile vaccination bases in mosques in low-income areas to increase the vaccination coverage in such areas of Mashhad. From 14 August 2021, when the project started, to 14 September 2021, the total number of injections was 146,186, which shows a 70% increase, compared to the same period last month, when the number of injections was 86,315.
Barriers to vaccination in these areas were: 1) people's fear of vaccine side effects, 2) people's fear that the vaccine would not work, 3) extensive activity of social networks in creating reluctance in people to get vaccinated, 4) linking the corona pandemic in public opinion to divine destiny and consequently the lack of need for vaccination, 5) low level of health literacy in these areas, and 6) difficult access to fixed corona vaccination centers due to working hours of employed people.
In order to eliminate these obstacles, facilitators were used. These facilitators were 1) inter-sectoral activities: an agreement has been reached between Mashhad Medical University and the Basij Organization. The Basij Organization in Iran is a popular and widespread organization that members of the community trust and the involvement of this organization in vaccination increases people's trust; 2) appropriate technology: use of senior students and graduates of the University of Medical Sciences who have passed the specialized course of vaccination as an hourly contract, use of refrigerated cars to deliver vaccines to the injection site while maintaining and controlling the cold chain, the presence of a general practitioner at the vaccine injection site with resuscitation bags and required medications; 3) people's participation: using popular volunteer groups to carry out service activities, propaganda, inviting people and organizing; 4) easy access: vaccination close to where people live from 8 am to 6 pm even on holidays; 5) gaining people's trust: using religious places, such as mosques as a place for vaccination and specialized mobilization forces in carrying out vaccinations; 6) provision of transparent information for the people: through telephone and WhatsApp systems, using a voice machine in the area, house-to-house invitation of people to get vaccinated and encouraging them to get vaccinated; 7) usage of opinion leaders: identify opinion leaders in the region and justify these leaders to receive the vaccine, showing the vaccination of leaders on TV and social channels and their invitation to be vaccinated, asking religious speakers to encourage people to get vaccinated, the presence of experts and vaccinators in the Friday prayers of Shiites and Sunnis and the use of the tribune of these ceremonies to encourage people to get vaccinated; 8) usage of billboards and banners in suburban squares to encourage vaccinations; 9) usage of communication channels: broadcasting documentaries of activities carried out on the outskirts of Mashhad on television, informing through provincial news, forming channels on social media to answer doubts about vaccination, setting up a telephone system and using faculty and expert members of the University to respond online to vaccine suspicions, and face-to-face contact with people about vaccines; 10) usage of health literacy strategies, such as using a simple and understandable language when educating people, rather than using professional jargon; 11) diversification of vaccines and use of vaccines available in the country; 12) creation of an Android application for electronic health records for the online registration of vaccinations; and 13) vaccination of non-Iranian citizens living on low-income areas of the city.
Conclusion
Vaccination is the most effective way to control the COVID-19 epidemic. In order to increase the coverage of COVID-19 vaccination in low-income areas of Mashhad, a coalition was formed between the Basij Organization and the University of Medical Sciences. Barriers to vaccination were people's fear of the side effects of the vaccine, the ineffectiveness of the vaccine, the widespread activity of social networks in creating a reluctance to get vaccinated, and people's misconceptions. Facilitators were used to overcoming these barriers, which are: inter-sectoral activities, usage of appropriate technology, easy access, provision of transparent information and gaining people's trust, support of religious leaders, effective use of communication channels, use of health literacy strategies, and diversity. Finally, by taking these measures, the number of vaccinations in low-income areas of Mashhad will increase by 70% in 1 month, which can be considered as a model for similar areas.
