Iranian Red Crescent Medical Journal

Reliability and Validity of Persian Version of WHO Mass Gathering COVID-19 Risk Assessment Tool- Generic Events in Iranian Population

2023-01-28T20:19:58+0330

Background: The risk of transmission of COVID-19 infection significantly increases with mass gatherings during the pandemic. According to WHO recommendations, the decision to hold, modify, postpone, or cancel gatherings of any size during the COVID-19 pandemic should rely on a risk-based approach. WHO Mass Gathering COVID-19 Risk Assessment tool-Generic Events, to the best of our knowledge, has not been translated into Persian and its reliability and validity have not been determined in the Iranian population.

Objectives: The present study aimed to assess the reliability and validity of the Persian version of the WHO Mass Gathering COVID-19 risk Assessment tool-Generic Events in the Iranian population.

Methods: The content and face validity of the final Persian version of the WHO Mass Gathering COVID-19 Risk Assessment tool- Generic Event, Version 2 (10 July 2020) was confirmed by five experts and the WHO office in Tehran, Iran. Then, the tool was completed by 17 Iranian adults on two occasions at least two weeks after a hypothetical mass gathering event. The participants were mainly selected from the personnel of the Iranian red crescent society. All of them had a bachelor's or higher university degree in health sciences. The data were analyzed using SPSS software and related statistical tests (Pearson correlation coefficient).

Results: Risk evaluation and risk mitigation questions of the Persian version of the tool had high reliability on two occasions at least two weeks after a hypothetical mass gathering event based on the Pearson correlation coefficient (r=0.81, P-value=0.03 for risk evaluation and r=0.75, P-value=0.04 for risk mitigation questions based on their final scores).

Conclusion: The Persian version of the tool can be used to classify the risk of mass gatherings for COVID-19 infection.

Evaluation of the Genes and Molecular Pathways Involved in Skin Lesions in Patients with COVID-19: Systems Biology and Bioinformatics Analysis Approach

2023-01-03T23:50:06+0330

Background: Coronavirus disease 2019 (COVID-19) was first identified in 2019 in Wuhan, China. Initially, although the number of COVID-19-infected individuals was very low, the infected cases increased as the virus spread worldwide. Skin manifestation is one of the symptoms observed in COVID-19 patients.

Objectives: This study investigated the critical genes and molecular pathways involved in skin manifestations in COVID-19 patients through a biological system approach.

Methods: In this study, the microarray dataset was downloaded from the Gene Expression Omnibus (GEO) database and analyzed for identifying differentially expressed genes (DEGs). The enrichment analysis of DEGs was evaluated using the DAVID database. Afterward, protein-protein interaction (PPI) networks were constructed via the STRING database and visualized using Cytoscape software. The hub genes were recognized using the cytoHubba. The interaction of the microRNA (miRNA)-hub genes, transcription factor (TF)-hub genes, and drug-hub genes was also evaluated in this study.

Results: After analysis, some genes with the highest degree of connectivity, which were involved in the pathogenesis of HELLP syndrome were identified, and they were known as hub genes. These genes are as follows: IFN-γ, CXCL1, CCL2, CCL3, TLR2, IL-1B, CXCL6, IL-6, CCL4, and CXCL2. has-mir-34a-5p, has-mir-20a-5p, and has-mir-27a-3p as miRNA, as well as RELA as TF had the most interaction with the hub genes.

Conclusion: Finally, IL-6 and CXCL10 that were compared to the other hub genes had the highest interaction with other genes; therefore, their role in Shamgir's pathogenesis is significant. Targeting the cited genes would be a strategy to prevent symptom manifestation and better patient management.

The Study of the Organizational Structure of Military Hospitals in Selected Countries of the World Based on the World Bank Model - a Qualitative Study

2022-10-08T08:06:40+0330

Background: The double importance of health in military societies and its importance in the national security of countries has made maintaining, promoting and restoration of the military society’s health has become one of the fundamental concerns of countries.

Methods: The current comparative qualitative study based on Perker and Harding's model has investigated and compared the organizational structure of military hospitals in 9 countries: Germany, Brazil, Turkey, South Korea, South Africa, China, Pakistan, Italy and Iran by means of semi-structured interviews.
Results: The findings of the study showed that in 18 interviews, 61% of the participants were specialist and subspecialist doctors, and the work experience of 39% of the participants was between 25 and 30 years. The World Bank Model (Preker and Harding), for hospital structure, considers five dimensions: decision rights, market exposure, residual claims, accountability and social functions that in the dimension of the decision-making right, the findings indicate the focus of this dimension in the studied countries. Facing the goods and supplies market in a country like South Korea is left to the hospital; however, in South Africa, it is centrally conducted by the Health and Medical Commander. In countries like South Korea, Pakistan, China, and Iran, residual claimant is propelled through creating committees or supervisory boards, while hospitals have some authority on their residual claimant, and in other studied countries, the authority of all residual claimants are with the highest level of military health and treatment sector of the relevant country. In countries such as Germany, Italy, and South Korea, the accountability towards stakeholders has become decentralized. The dimension of social functions is not considered among the military hospitals’ duties; nevertheless, all the studied countries practically had a relatively active presence in the field of social functions and assistances.
Conclusion: Considering the importance of the health of the military community and the lack of available and published data and studies, it is necessary to enable mutual use of the experiences and learnings of this field by conducting studies of the military health system.

Outcomes, Risk Factors, and Incidence of Acute Kidney Injury in Hospitalized COVID-19 Patients

2023-01-21T01:50:25+0330

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) is the virus causing Coronavirus Disease 2019 (COVID-19). Apart from respiratory disease, this virus can affect different organs.

Objectives: Therefore, multiple mechanisms have been hypothesized for Acute Kidney Injury (AKI) in COVID-19. In this study, we evaluate the incidence and prognosis of AKI in COVID-19 patients.

Methods: This retrospective cohort study assessed 397 COVID-19 patients hospitalized between April 1, 2020, and September 30, 2021. Patients with a sudden rise of serum creatinine level, more than 0.3 mg/dl in two days or more than 50% of the initial level in one week, were diagnosed with AKI. Demographic, laboratory, and clinical features were compared in AKI patients with patients without AKI.

Results: A total of 397 patients with a mean age ± standard deviation of 55.42 ± 15.26 years were included in the study. According to diagnostic criteria, 48 (12.1%) patients developed AKI. Old age, a history of hypertension, and chronic renal failure were suggested as risk factors for AKI. High levels of C-Reactive Protein, Erythrocyte Sedimentation Rate, Lactate Dehydrogenase, D-dimer, and serum phosphorus upon arrival were also associated with an increased risk of AKI. In addition, the incidence of hypernatremia and hyperkalemia increased mortality in patients with AKI.

Conclusion: The incidence of AKI in admitted COVID-19 patients affects the duration of hospitalization, the chance of ICU admission, and mortality. It is important to limit the use of nephrotoxic drugs and to maintain water-electrolyte balance to prevent the incidence of AKI and improve the outcome.

Static Analysis and Design of Innovative Porous Lumbar Interbody Cages

2023-02-06T11:08:04+0330

Background: Interbody discs play a major role in maintaining the spine and skeleton structures which may undergo damage. If damage is so severe that the disc cannot be repaired, implants, known as “interbody cages”, should be used.

Objectives: The present study aimed to propose a novel design with proper strength and resistance against axial disc torques.

Methods: The design and analysis of innovative anatomical cages comprised two stages, namely, cage design according to three different models and finite element analysis (FEA). The designs were based on the spine of a 15-year-old teenager without lumbar disc disease. To model the vertebrae, computed tomography )CT( scans and Digital Imaging and Communications in Medicine (DICOM) files were entered into Mimics Version 10.01 (Materialise Inc., Leuven, Belgium); then, the L4 and L5 spinal segments were modeled.

Results: The implants were fixed to the bottom level and subjected to a net force of 1000 N. Additionally, a moment load of 7.5 Nm in flexion, extension, axial rotation, and lateral bending was applied in these three cage models. Considering the application of 1000-N force, maximum and minimum stress and strain distribution rates were presented in three honeycomb, Islamic architecture, and porous gyroid cages.

Conclusion: Novel designs for lumbar cages were considered to achieve damping capacity, light weight, and high resistance. Considering the characteristics of the honeycomb, Islamic architecture, and gyroid structures, optimal designs were proposed for lumbar cages to achieve adequate strength and resistance against axial disc torques under normal conditions.

Preoperative Anxiety and Postoperative Pain in Children with Burn Patients and Their Correlation Analysis

2023-01-20T19:09:31+0330

Background: Burn is a kind of skin tissue damage under the influence of heat source, which is a common type of accidental injury in current society.
Objective: To investigate the status of preoperative anxiety and postoperative pain in children with burn patients, and to analyze the correlation between preoperative anxiety and postoperative pain.
Methods: A total of 108 pediatric patients who underwent burn surgery under general anesthesia in our hospital from October 2020 to August 2021 were selected. FLACC and Facial Expression Pain Scale were used to evaluate the pain of the children, and STAI and YPAS were used to evaluate the anxiety of the children. Correlation was used to analyze the effect of preoperative anxiety on postoperative pain in burn children.
Results: Preoperative anxiety and severe anxiety accounted for more than 50% of burn children, and there was a statistically significant difference in preoperative anxiety and postoperative pain between 1-3-year-old children and 4-12-year-old children. The influencing factors of postoperative pain in children with burns were analyzed, including burn area, depth of burn, and previous operations. The multivariate analysis showed that the risk factors for postoperative pain in children were age, burn area, depth of burn, preoperative anxiety of children, and parental trait anxiety, after statistical test, it shows that each influencing factor has a significant influence on postoperative pain in children (P < 0.05). In the correlation analysis of preoperative anxiety and postoperative pain in children with burns, it was shown that preoperative anxiety in children aged 1 to 3 years had a significant impact on postoperative pain of children, and the correlation analysis showed that preoperative anxiety of children with burns There was a positive correlation between anxiety score and postoperative pain (r=0.479, P=0.001).
Conclusion: The incidence of preoperative anxiety in children with burn patients is high, and the postoperative pain scores are also different in different age groups. In addition, there is a current correlation between preoperative anxiety and postoperative pain in children with burn patients, and the correlation is positively correlated, that is, the higher the patient's anxiety score, the more intense the patient's postoperative pain.

Knowledge and Attitude of Cancer Patients’ Companions towards Chemotherapy and Radiotherapy-induced Oral Complications and Dental Considerations

2023-01-19T23:29:56+0330

Background: Although Knowledge of the side effects of cancer treatments is crucial for everyone, it is more vital for patients' companions. Since they can significantly improve patients' attitudes towards cancer treatments and help them tolerate the disease; Objectives: In this study, we aimed to examine the level of knowledge and attitudes of companions about dental considerations and oral complications related to chemotherapy and radiotherapy.

Methods: In this cross-sectional study, a questionnaire was provided to companions at Kowsar Hospital in Semnan University, Iran, in October 2021. A total of 176 companions were selected by simple sampling method. Inclusion criterion consisted of the companions who were most of the time alongside the patients. The researcher-designed questionnaire included three sections: demographic variables, knowledge of and attitude toward dental considerations, and oral complications related to chemotherapy and radiotherapy (15 and 4 items, respectively). The relationship between knowledge and attitude with variables (e.g., gender, education level, duration of the treatment, and the location of the cancer) was investigated.

Results: Overall, 176 companions participated in this research. A total of 152 (86.4%) individuals had low to moderate knowledge (score 7-14), and only 6 (3.4%) companions had high knowledge (score 15-19). Around 74 (42%) individuals had moderate attitude scores, and 98 (55.7%) had high attitude scores. Companions’ knowledge scores increased significantly with higher education and having head and neck cancer patients. Moreover, companions’ attitude scores decreased significantly with the age and duration of patients’ treatments and increased significantly with higher education and having gastrointestinal cancer patients.

Conclusion: The level of knowledge and attitude of companions was low to moderate about chemotherapy- and radiotherapy-induced oral complications and dental considerations. Therefore, improving the comprehensive education of this group is required.

Melatonin for Clinical Improvement in Patients with Ischemic Stroke: a Randomized Clinical Trial

2023-02-19T13:06:13+0330

Introduction: Ischemic stroke is the most frequent form of the stroke which imposes a lot of cost and disabilities for patients. Melatonin is proved to have anti-oxidant along with anti-inflammatory effects. The goal of this study was to assess effects of melatonin on clinical features of acute stroke in Iranian patients.
Methods: Fifty eight patients with ischemic stroke were randomly assigned to: Group 1: ASA 80mg/day+ Plavix 75 mg/day+ melatonin 3 mg (every night one pill for two months) and Group 2: ASA 80 mg/day+ Plavix 75 mg/day+ placebo (every night one pill for two months). Canadian Neurological Stroke Scale (CNSS) was recorded for all cases before and after treatment.
Results: Mean age, sex, circulation, CVA incidence time and symptoms were not significantly different between two groups. Mean CNSS was significantly higher after treatment in both groups.
Conclusions: CNSS improved more in intervention group than control group. So, Melatonin administration in patients with ischemic stroke will result in better clinical improvement.

Cancer and COVID-19: A Double Burden on the Healthcare System

2023-02-27T11:22:30+0330

The COVID-19 pandemic has placed an unprecedented burden on the healthcare system. In particular, the intersection of COVID-19 and cancer has created a double burden on the healthcare system, presenting challenges in both the diagnosis and treatment of cancer. During the pandemic, overcrowding of hospitals and clinics, shortages of PPE and other medical supplies, and the impact of COVID-19 on healthcare workers have all made it more difficult to care for cancer patients. The challenges in cancer diagnosis and screening during the pandemic have included delays in cancer diagnoses, decreased access to cancer screenings, and a decrease in the number of cancer surgeries being performed. Changes in cancer treatment patterns and access to care during COVID-19 have also impacted the treatment outcomes for cancer patients, with a decrease in the number of cancer patients being treated and an increased risk of poor outcomes for those who are being treated. The impact of COVID-19 on healthcare workers and their ability to care for cancer patients has also been significant, with healthcare workers facing increased exposure to the virus, increased workloads, and increased stress and burnout. The double burden of COVID-19 and cancer on the healthcare system has implications for policy and practice, including the need for improved coordination between cancer and COVID-19 response efforts and the need for increased investment in healthcare infrastructure and resources. In conclusion, the COVID-19 pandemic has created a double burden on the healthcare system, with significant challenges in the diagnosis and treatment of cancer. The impact of COVID-19 on healthcare workers and the healthcare system more broadly highlights the need for improved coordination and increased investment in healthcare resources and infrastructure.

Uterine prolapse as a rare cause of intestinal obstruction, a case report, and literature review

2022-07-26T22:40:25+0430

Introduction: The etiology of pelvic organ prolapse is multifactorial. Especially age and parity are the two most important risk factors for this matter. Small bowel obstruction is one of the most common clinical presentations to the emergency department that can result in significant morbidity and mortality.
Case presentation: A 79-year-old woman with a previous history of uterine prolapse and no previous history of intraabdominal surgery or malignancies presented with nausea and vomiting, abdominal pain, and constipation from 2 days ago. Upright and supine X-rays showed dilated small bowel loops and confirmed bowel obstruction. Due to primary obstruction, the patient was a candidate for surgery. During the surgery, we observed that 100 cm of the terminal ileum and the uterus were protruded in the vaginal canal and the ileal loops were strangulated. we decided to perform a Right Hemicolectomy.
Conclusion: In patients with uterine prolapse, we suggest a careful examination and consideration of the entrapment of small bowel loops in the prolapse site as a rare cause for small bowel obstruction.

Anal Carcinoma in Patients with Crohn's Disease: Three Cases Report and Literature Review

2023-01-18T12:18:24+0330

Background: Anal cancer in patients with Crohn's disease (CD) is rare, and the relationship between infliximab and anal cancer is not clear yet. The present study aimed to report three patients with CD complicated with anal cancer who used infliximab with their basic features.

Case presentation: Three cases were reported, including two females and one male, aged 29-56 years old. All of them developed perianal lesions during the period of Crohn's disease. All three patients had used infliximab for Crohn's disease before the diagnosis of anal cancer, except one patient who stopped using infliximab three times due to allergy; the other two patients had used infliximab until the diagnosis of anal cancer. Two patients had a good prognosis with early therapeutic intervention.

Conclusion: Based on the results, Chinese and Western patients with Crohn's disease who developed anal carcinoma had similar features. Conventional perianal evaluation is important in patients with Crohn's disease. The association between infliximab therapy and anal cancer has not been fully established and needs to be fully evaluated before the use of infliximab in Crohn's disease.