Rationale and Design of a Registry in a Referral and Educational Medical Center in Tehran, Iran: Sina Hospital Covid-19 Registry (SHCo-19R)

Coronavirus disease 2019 (Covid-19) is caused by the novel coronavirus resulting in a highly contagious respiratory tract infection with an increased risk of acute respiratory distress syndrome (ARDS), which was first seen in Wuhan, China. Thus far, this virus has spread to many countries worldwide, including Iran. Multiple studies have assessed disease characteristics, viral genetics, and complications of Covid-19 in the Chinese population. However, there is limited data regarding patient characteristics and outcomes of infected cases outside of China. Besides, risk factors of adverse outcomes are poorly identified in different populations. Due to limited data in the Iranian population affected by the virus, we aimed to design a registry of patients with Covid-19 at Sina Hospital in Tehran, Iran [Sina Hospital Covid-19 Registry (SHCo-19R)] in this regard, to assess patient characteristics, imaging features, laboratory findings, management strategies, and adverse outcomes of Iranian patients with Covid-19 and their differences with other populations

Immune Thrombocytopenic Purpura (ITP) As a Complication of COVID-19: A Case Report

Immune thrombocytopenic purpura (ITP) is a condition that can occur either spontaneously or as a secondary complication of preexisting disorders, often associated with viral infections. In the context of COVID-19, hematological manifestations, including thrombocytopenia, have been observed and linked to increased mortality rates among severely infected patients.Presented here is a case study of a 70-year-old man who recovered from COVID-19 but subsequently developed ITP. The severity of his thrombocytopenia exceeded what is typically observed during COVID-19 infections, leading to a diagnosis of ITP. Treatment with steroids and intravenous immunoglobulin (IVIG) was initiated based on specialist recommendations, resulting in an adequate response

Interferon beta-1a as a Candidate for COVID-19 Treatment; An Open-Label Single-Arm Clinical Trial

Introduction: Since December 2019, an outbreak of Covid-19 has caused growing concern in multiple countries. Researchers around the world are working to find a treatment or a vaccine for Covid-19 and different treatment approaches have been tested in this regard. Objective: This study was designed and conducted to assess the possible efficacy of Interferon beta-1a as a safe and efficient candidate for Covid-19 treatment. Methods: This is an investigator-initiated, open-label, single-arm clinical trial. Twenty patients with suspected Covid-19, who were admitted to Sina hospital in Tehran, Iran, with moderate to severe symptoms, from 6 to 10 March, 2020, were enrolled. Patients were treated with antiviral and hydroxychloroquine combination therapy, along with subcutaneous Interferon beta-1a for 5 consecutive days. Baseline characteristics and findings during the course of admission and 5 days after discharge were recorded for all the patients. Results: In total, 20 patients with suspected Covid-19 were included in this study, 12 (60%) of which were male. The median (Interquartile (IQ) range) of patients’ age was 55.5 (43-63.5). The most common symptom of the patients at onset of disease was fever. The median (IQ range) of duration of hospital stay was 5.0 (3-6) days. Only 2 cases were admitted to ICU. At the time of follow-up, 15 (94%) patients reported that they generally felt good and had oral tolerance, 1 patient had suffered from dyspnea, 5 patients had suffered from cough, none of them had experienced fever and no case of re-admission or death was reported after discharge. Conclusions: Results of the current study are in favor of using Interferon beta-1a in addition to recommended antiviral treatment in Covid-19 patients

Interferon beta-1a as a Candidate for COVID-19 Treatment; An Open-Label Single-Arm Clinical Trial

Introduction: Since December 2019, an outbreak of Covid-19 has caused growing concern in multiple countries. Researchers around the world are working to find a treatment or a vaccine for Covid-19 and different treatment approaches have been tested in this regard. Objective: This study was designed and conducted to assess the possible efficacy of Interferon beta-1a as a safe and efficient candidate for Covid-19 treatment. Methods: This is an investigator-initiated, open-label, single-arm clinical trial. Twenty patients with suspected Covid-19, who were admitted to Sina hospital in Tehran, Iran, with moderate to severe symptoms, from 6 to 10 March, 2020, were enrolled. Patients were treated with antiviral and hydroxychloroquine combination therapy, along with subcutaneous Interferon beta-1a for 5 consecutive days. Baseline characteristics and findings during the course of admission and 5 days after discharge were recorded for all the patients. Results: In total, 20 patients with suspected Covid-19 were included in this study, 12 (60%) of which were male. The median (Interquartile (IQ) range) of patients’ age was 55.5 (43-63.5). The most common symptom of the patients at onset of disease was fever. The median (IQ range) of duration of hospital stay was 5.0 (3-6) days. Only 2 cases were admitted to ICU. At the time of follow-up, 15 (94%) patients reported that they generally felt good and had oral tolerance, 1 patient had suffered from dyspnea, 5 patients had suffered from cough, none of them had experienced fever and no case of re-admission or death was reported after discharge. Conclusions: Results of the current study are in favor of using Interferon beta-1a in addition to recommended antiviral treatment in Covid-19 patients

Influenza vaccination coverage and obstacles in healthcare workers (HCWs) and the follow up of side effects: A multicenter investigation in Iran

Introduction. Influenza is a highly contagious acute respiratory illness. Due to the high exposure of hospital personnel, widespread vaccination of these high-risk groups seems to be a necessity in healthcare centers. To determine vaccination coverage in the personnel of four tertiary referral collegiate hospitals in 2019, and to further investigate individual obstacles for Influenza vaccination. Methods. In this cross-sectional descriptive study, 637 personnel were selected randomly from distinctive hospitals in a list-wised. Ones vaccinated filled the side effects questionnaire and who not vaccinated filled the vaccination obstacles questionnaire. Results. The mean vaccination coverage was 29.4% and the coverage difference among centers was not statistically significant (p=0.192). The following items had the most impact on personnel decision: confidence about one’s immune system (p<0.05), the experience of side effects from previous vaccinations (p=0.011), attitude about vaccination in colleagues (p=0.021) and work experience (p<0.05). About 23% of vaccinated individuals reported side effects following vaccination and the most common side effect was mild cold symptoms with 12.3% prevalence. Conclusion. The results of the current study revealed that influenza vaccination coverage among HCWs is not satisfactory in Iran. Hospital authorities and infection control units should plan to remove the obstacles of influenza vaccination

Prophylactic antibiotic for prevention of posttraumatic meningitis after traumatic pneumocephalus: design and rationale of a placebo-controlled randomized multicenter trial [ISRCTN71132784]

BACKGROUND: The purpose of this study is to compare the efficacy of prophylactic antibiotic for prevention of meningitis in acute traumatic pneumocephalus patients. METHODS: In this prospective, randomized controlled clinical trial, 200 selected head injury patients with traumatic pneumocephalus are randomly assigned to receive intravenous antibiotics (2 grams Ceftriaxone twice a day), oral antibiotics (Azithromycin) or placebo for at least 7 days after trauma. The patients will be followed for one month posttrauma. CONCLUSION: The authors hope that this study helps clarifying the effectiveness and indications of antibiotics in prevention of meningitis in traumatic pneumocephalus after head injury and in specific subgroup of these patients

Study of Relationship between Genetic Pattern and Susceptibility to Terbinafine in Clinical Isolated of Trichophyton rubrum

Background & objectives: Trichophyton rubrum is one of the most common pathogeniccause of dermatophytosis. One of the drugs which have been prescribed widely for fungal infections is terbinafine which belongs to allylamines group of antifungal agents. Recently molecular typing methods have been developed for answering the epidemiological questions and disease recurrence problems. Current study has been conducted on 22 isolates of Trichophyton rubrum obtained from patients randomly. Our aim was the investigation of correlation between genetic pattern and sensitivity to Terbinafine in clinical isolates of Trichophyton rubrum.   Methods: Firstly the genus and species of isolated fungi from patients have been confirmed by macroscopic and microscopic methods, then, the resistance and sensitivity of isolates against drug have been determined using culture medium containing defined amount of drug. In next step fungal DNA has been extracted by RAPD-PCR (random amplified polymorphic DNA) with random sequences of 3 primers.   Results: Each primer produced different amplified pattern, and using each 3 primers differences have been observed in genetic pattern of resistant and sensitive samples using each 3 primers, but there was no bond with 100% specificity.   Conclusion: The 12 sensitive isolates which didn’t grow in 0.1 mg concentration of drug, also had limited growth at the low concentration of drug. Ten resistant isolates which grew in 0.1mg/ml of drug, in lower concentration of drug were resisted. RAPD analysis for molecular typing of Trichophyton rubrum seems to be completely suitable

Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients

Objective: To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients. Methods: This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy. Results: Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count 200 cell/µL). Conclusions: Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis

Discharge against medical advice from a Tehran emergency department

Purpose The purpose of this paper is to identify the main reasons for discharge against medical advice (DAMA) in the emergency department (ED) of a teaching hospital in Tehran, Iran. Design/methodology/approach This cross-sectional study was conducted on all the patients who left the ED of a referral teaching hospital against medical advice (AMA) in 2008. A questionnaire was filled out for each patient to determine the reasons behind patient leaving AMA. Findings In total, 12.8 percent of the patients left the hospital AMA. Dissatisfaction with being observed in the ED, having a feeling of recovery and hospital personnel encouraging patients to leave the hospital were the main reasons for leaving the hospital AMA. Practical implications Like many other centers, the results showed that poor communication skill and work overload were the main contributing factors to DAMA. The center managed to improve patient satisfaction and thus lowered DAMA rates following this study. Considering the similarities reported in the reports and that of other studies, it could be concluded that policy makers in other centers can also benefit from the results to adopt effective approaches to reduce DAMA rate. Originality/value To the knowledge no study has evaluated the rate and the reasons behind DAMA in the Iranian EDs