The Prognostic Value of Echocardiographic Findings in Prediction of In-Hospital Mortality of COVID-19 Patients

Introduction: The correlation between echocardiographic findings and the outcome of COVID-19 patients is still under debate. Objective: In the present study it has been endeavored to evaluate the cardiovascular condition of COVID-19 patients using echocardiography and to assess the association of these findings with in-hospital mortality. Methods: In this retrospective cohort study, hospitalized COVID-19 patients from February to July 2020 with at least one echocardiogram were included. Data were extracted from patients’ medical records and the association between echocardiographic findings and in-hospital mortality was assessed using a multivariate model. The findings were reported as relative risk (RR) and 95% confidence interval (95% CI). Results: Data from 102 COVID-19 hospitalized patients were encompassed in the present study (63.7±15.7 mean age; 60.8% male). Thirty patients (29.4%) died during hospitalization. Tricuspid regurgitation (89.2%), mitral valve regurgitation (89.2%), left ventricular (LV) diastolic dysfunction (67.6%), pulmonary valve insufficiency (PI) (45.1%) and LV systolic dysfunction (41.2%) were the most common findings on patients’ echocardiogram. The analyses of data showed that LV systolic (p=0.242) and diastolic (p=0.085) dysfunction was not associated with in-hospital mortality of COVID-19 patients, while the presence of PI (RR=1.85; 95% CI: 1.02 to 3.33; p=0.042) and patients’ age (RR=1.03; 95% CI: 1.01 to 1.08; p=0.009) were the two independent prognostic factors of in-hospital mortality. Conclusions: It seems that LV systolic and diastolic dysfunction was not associated with in-hospital mortality of COVID-19 patients. However, presence and PI and old age are possible prognostic factors of COVID-19 in-hospital mortality. Therefore, using echocardiography might be useful in management of COVID-19

The Effect of Audio-Visual Distraction on Catheterization Pain among School-Age Children

Background: Catheterization is the most common cause of pain and distress in children, which causes physical and psychological dysfunctions and disrupts the treatment. Therefore, the control of this type of pain should be considered as a priority for nursing care. The audio-visual distraction can be used to reduce the intensity of pain. Aim: The purpose of this study was to determine the effect of audio-visual distraction on catheterization pain among school-age children. Methods: This randomized clinical trial included 64 school-age children assigned into intervention and control group in Qods Hospital during 2016. Oucher face pain intensity scale was utilized to evaluate the intensity level of pain.  Catheterization duration was also recorded in this study. Data were analysed in SPSS software (Version.18) through descriptive statistics, t-test, Mann-Whitney U test, and Spearman correlation analyses. Results: The mean ages of the intervention and control groups were 7.8±1.4 and 7.7±1.6, respectively. The results of the Mann-Whitney U test showed that the mean pain intensity was lower in the intervention group after using the three-dimensional glasses (P=0.01). Spearman correlation test results indicated that there were no significant differences between different ethnicities (P=0.37) and birth ratings (r=-0.061, P-value=0.63) in terms of mean pain intensity.  Implications for Practice: According to the results, the use of distraction methods could  reduce the pain. In addition, they facilitated medical procedures. The role of variables, such as age, gender, and duration of catheterization should be considered in pain intensity

COVID-19 related hospitalization costs; assessment of influencing factors

Objective: Our aim is to assess the effective factors on hospitalization costs of COVID-19 patients. Methods: 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. Results: 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. Conclusion: 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

Electrocardiographic Findings and In-Hospital Mortality of COVID-19 Patients; a Retrospective Cohort Study

Background: Although current evidence points to the possible prognostic value of electrocardiographic (ECG) findings for in-hospital mortality of COVID-19 patients, most of these studies have been performed on a small sample size. In this study, our aim was to investigate the ECG changes as prognostic indicators of in-hospital mortality. Methods: In a retrospective cohort study, the findings of the first and the second ECGs of COVID-19 patients were extracted and changes in the ECGs were examined. Any abnormal finding in the second ECG that wasn’t present in the initial ECG at the time of admission was defined as an ECG change. ECGs were interpreted by a cardiologist and the prognostic value of abnormal ECG findings for in-hospital mortality of COVID-19 patients was evaluated using multivariate analysis and the report of the relative risk (RR). Results: Data of the ECGs recorded at the time of admission were extracted from the files of 893 patients; likewise, the second ECGs could be extracted from the records of 328 patients who had an initial ECG. The presence of sinus tachycardia (RR = 2.342; p <0.001), supraventricular arrhythmia (RR = 1.688; p = 0.001), ventricular arrhythmia (RR = 1.854; p = 0.011), interventricular conduction delays (RR = 1.608; p = 0.009), and abnormal R wave progression (RR = 1.766; p = 0.001) at the time of admission were independent prognostic factors for in-hospital mortality. In the second ECG, sinus tachycardia (RR = 2.222; p <0.001), supraventricular arrhythmia (RR = 1.632; p <0.001), abnormal R wave progression (RR = 2.151; p = 0.009), and abnormal T wave (RR = 1.590; p = 0.001) were also independent prognostic factors of in-hospital mortality. Moreover, by comparing the first and the second ECGs, it was found that the incidence of supraventricular arrhythmia (RR = 1.973; p = 0.005) and ST segment elevation/depression (RR = 2.296; p <0.001) during hospitalization (ECG novel changes) are two independent prognostic factors of in-hospital mortality in COVID-19 patients. Conclusion: Due to the fact that using electrocardiographic data is easy and accessible and it is easy to continuously monitor patients with this tool, ECGs can be useful in identifying high-risk COVID-19 patients for mortality

The Prevalence of Obesity and its Associated Demographic Factors in Tehran, Iran

Background: Obesity is one of the most common health problems in the world and its prevalence is increasing in both developed and developing nations with changes in dietary habits and activity levels. The present study aimed to provide population-based data on the prevalence of obesity and some demographic factors associated with obesity. Methods: A community-based, cross-sectional survey was done on 3,000 individuals in Tehran province, Iran, From May 2006 through December 2007. Respondents were asked about their height and weight in the questionnaire. Body mass index was assigned as the measure of overall obesity and was calculated as body weight (kg) divided by height squared (meters). Results: The overall prevalence of overweight and obesity was 38.3% and 17.5%. The combined prevalence of both overweight and obesity was 51.7% in males and 58.3% in females. The mean BMI ± SD for the total population studied was 26.1 ± 4.7 and it was higher in women than in men (P < 0.05). The overall prevalence of overweight and obesity was 39.7% and 12.0% in men, and 37.4% and 20.9% in women. The multivariate analysis showed that there was a higher percentage of obesity among older individuals, females, married and less educated subjects. Conclusion: Our results indicate that the prevalence of overweight and obesity are relatively high in Tehran and must be considered as a significant public health problem especially among women. Keywords: Obesity, Body mass index, Tehra

Frequency of colorectal cancer in healthy individual's relatives: A cross-sectional population-based study

Introduction: Family history of colorectal cancer has been shown to be related to the risk of developing colorectal cancer. This risk depends on the number of affected relatives and the age at diagnosis. In this study we aimed to estimate the frequency of a positive family history of colorectal cancer in a random sample from Tehran population. Materials and Methods: This study was a community-based cross-sectional survey conducted from May 2006 to December 2007 in Tehran province, Iran. A total of 5,500 peoples (age≥20 years) drawn up randomly by random sampling according to postal codes and invited to participate in the study. All participants completed a detailed health data registry form on family history status of colorectal cancer. Results: The mean age of men with a positive family history was significantly different from men with negative family history. There was no significant difference between mean age of women responders with or without positive family history. Among all participants (n=5,500), 162 responders (2.9%) had a history of colorectal cancer. Of 162, 67 responders (1.22%) had one and 4(0.07%) had two or more first-degree relative with colorectal cancer. Of 5,500 participants, 18 subjects (0.33%) reported having two or more first-degree relative with colorectal cancer or one first-degree relative with colorectal cancer diagnosed at age <50 years. Four subjects (0.07%) had three or more first-degree relative with colorectal cancer. Conclusion: Based on the findings, we estimate that more than 570,000 subjects in the Iran in the age group≥20 years have at least two to three times increased risk of developing colorectal cancer which should be identified and encourage to participate in screening and surveillance protocols of colorectal cancer

Cardiac dysrhythmia in COVID-19 patients; occurrence and risk factors

Objective: In this study, we have evaluated the occurrence and risk factors of cardiac dysrhythmia on admission and during hospitalization in COVID-19 patients.&nbsp;Methods: 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.&nbsp;Results: 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&lt;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.&nbsp;Conclusion: 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

Functional Bowel Disorders in Iranian Population using Rome III Criteria

<b>Background/Aim:</b> To study the prevalence and risk factors of functional bowel disorders (FBD) in Iranian community using Rome III criteria. <b> Materials and</b> <b> Methods:</b> This study was a cross-sectional household survey conducted from May 2006 to December 2007 in Tehran province, Iran, including 18,180 participants who were selected randomly and interviewed face-to-face by a validated questionnaire based on Rome III criteria. <b> Results:</b> In all, 1.1&#x0025; met the Rome III criteria for irritable bowel syndrome (IBS), 2.4&#x0025; for functional constipation (FC), and 10.9&#x0025; of the participants had any type of FBD. Among participants with functional dyspepsia, 83.8&#x0025; had FBD; the majority cases were unspecified functional bowel disorder (U-FBD). Of the subjects fulfilling the IBS criteria, IBS with constipation (52&#x0025;) was the most frequent subtype. In the multivariate analysis, women had a higher risk of any FBDs than men, except for functional diarrhea (FD). The prevalence of FBD, FC and FD increased and IBS decreased with increasing age. Marital status was only associated with a decrease in the risk of FBD and FD, respectively. IBS subtypes compared with FC and FD. There was no significant difference between FC and IBS with constipation (IBS-C), except for self-reported constipation; while, IBS with diarrhea (IBS-D) had more symptoms than FD. <b> Conclusion:</b> This study revealed a low rate of FBDs among the urban population of Tehran province. The ROME III criteria itself, and the problems with interpretation of the data collection tool may have contributed in underestimating the prevalence of FBD. In addition the reliability of recall over 6 months in Rome III criteria is questionable for our population