Clinical Characteristics of Fatal Cases of COVID-19 in Tabriz, Iran: An Analysis of 111 Patients

Introduction: The rapid worldwide spread, in addition to the morbidity and mortality associated with the novel coronavirus disease 2019 (COVID-19), have raised concern throughout the world. Identifying the characteristics of patients who died of COVID-19 is essential to implement preventive measures. Objective: We aimed at investigating these characteristics among the Iranian population in Tabriz. Methods: In this case series, we analyzed clinical characteristics, laboratory parameters, and imaging findings of 111 patients with a reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 diagnosis who died during hospitalization. The studied patients had been admitted to the hospital between February 2020 and May 2020. Results: The median age of patients was 73 years (IQR, 62-82 years) and approximately 70% of them were male. The median oxygen saturation on admission was 88% (IQR, 80-92%) and dyspnea, cough, and fever were the most common presenting symptoms. Among comorbidities, diabetes, hypertension, and cardiovascular diseases were more frequently observed among patients who had a fatal outcome. While ground-glass opacity was the most commonly reported finding on chest computed tomography, 5% of the patients had no abnormal finding on imaging. Chloroquine was the most frequently used medication for treatment. Conclusion: Our results showed that the majority of COVID-19 deaths occurred in male elderly with decreased levels of oxygen saturation and elevated levels of lactate dehydrogenase and erythrocyte sedimentation rate on admission

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Peak-Load Management of Distribution Network Using Conservation Voltage Reduction and Dynamic Thermal Rating

The peak-load management of a distribution network (DN) has gained attention by increasing the electric power consumption on the demand side. By developing smart-grid infrastructures, effective utilization of the DN’s components and proper management of the DN would create a valuable solution for DN operators. Hence, in this paper, a peak-load management framework is proposed in which the real-time rating of the components and voltage-dependent features of the electric loads help the DN operator handle the peak times successfully. In addition to the individual advantages of efficient operation of the DN, more practical results are obtained by combining the conservation voltage reduction (CVR) and dynamic thermal rating (DTR) of the DN’s lines and transformers. Based on the obtained results, compared to the individual implementation of CVR, the cost-saving level is increased significantly during the peak events using the simultaneous utilization of DTR and CVR. Furthermore, a discussion is presented about the current problems of the feeders supplying the voltage-dependent constant-power loads during CVR utilization, which is resolved by the dynamic rating of the DN’s components

Peak-Load Management of Distribution Network Using Conservation Voltage Reduction and Dynamic Thermal Rating

The peak-load management of a distribution network (DN) has gained attention by increasing the electric power consumption on the demand side. By developing smart-grid infrastructures, effective utilization of the DN’s components and proper management of the DN would create a valuable solution for DN operators. Hence, in this paper, a peak-load management framework is proposed in which the real-time rating of the components and voltage-dependent features of the electric loads help the DN operator handle the peak times successfully. In addition to the individual advantages of efficient operation of the DN, more practical results are obtained by combining the conservation voltage reduction (CVR) and dynamic thermal rating (DTR) of the DN’s lines and transformers. Based on the obtained results, compared to the individual implementation of CVR, the cost-saving level is increased significantly during the peak events using the simultaneous utilization of DTR and CVR. Furthermore, a discussion is presented about the current problems of the feeders supplying the voltage-dependent constant-power loads during CVR utilization, which is resolved by the dynamic rating of the DN’s components

Active Health Service Provision Scale up for HIV and Tuberculosis in 16 Prisons, Iran

Background: In most countries, the prevalence of HIV and tuberculosis (TB) among prisoners are higher than those in the general population. Nevertheless, the prison setting presents not only challenges, but also opportunities for the prevention and treatment of TB and HIV. Therefore, this program was designed to scale up a previously piloted guideline to screen and diagnose people living with HIV (PLWH) and those with TB diseases and then provide them actively needed health services. Methods: Since the beginning of March 2015 the program for active health service provision (AHSP) for TB and HIV was started. This guideline was based on a model that provide diagnostic, treatment and follow-up services actively including all aspects of HIV/TB diagnosis, treatment and care services. Also major HIV/TB-related topics are described in it. In order to carry out the scaling up of the implementation of the guideline, following steps were taken: Formation of the Steering Committee, establishing required structures and holding workshops to train staff. Results: The mean number of HIV tests done before the intervention, was 163.9 per season in 16 prisons, while this figure was 1106.5 per season after the intervention. The mean number of patients receiving antiretroviral therapy (ART) increased after the intervention. The numbers are, respectively, 10.8, and 16.4 person per season, before and after the intervention. Conclusion: The changes of target variables before and after the program within 16 prisons in 13 provinces in Iran show the efficiency of AHSP. Since the prevalence of HIV and TB among prisoners are high and HIV infection, itself, is the greatest risk factor for developing TB, prisons as well as challenges are opportunities for the prevention and treatment of TB and HIV. Actively health services provided in prisons show positive results and suggest an efficient way of dealing with these infections

Clinical Characteristics of Fatal Cases of COVID-19 in Tabriz, Iran: An Analysis of 111 Patients

Introduction: The rapid worldwide spread, in addition to the morbidity and mortality associated with the novel coronavirus disease 2019 (COVID-19), have raised concern throughout the world. Identifying the characteristics of patients who died of COVID-19 is essential to implement preventive measures. Objective: We aimed at investigating these characteristics among the Iranian population in Tabriz. Methods: In this case series, we analyzed clinical characteristics, laboratory parameters, and imaging findings of 111 patients with a reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 diagnosis who died during hospitalization. The studied patients had been admitted to the hospital between February 2020 and May 2020. Results: The median age of patients was 73 years (IQR, 62-82 years) and approximately 70% of them were male. The median oxygen saturation on admission was 88% (IQR, 80-92%) and dyspnea, cough, and fever were the most common presenting symptoms. Among comorbidities, diabetes, hypertension, and cardiovascular diseases were more frequently observed among patients who had a fatal outcome. While ground-glass opacity was the most commonly reported finding on chest computed tomography, 5% of the patients had no abnormal finding on imaging. Chloroquine was the most frequently used medication for treatment. Conclusion: Our results showed that the majority of COVID-19 deaths occurred in male elderly with decreased levels of oxygen saturation and elevated levels of lactate dehydrogenase and erythrocyte sedimentation rate on admission

Validity and reliability of the Farsi version of the ascertain dementia 8-item (AD8-F) informant interview in Iranian patients with mild neurocognitive disorder

BACKGROUND: For screening and distinguishing between mild neurocognitive disorder (mNCD) and normal cognitive age-related changes in primary care centers, a simple and practical tool is necessary. Therefore, this study aims to determine the validity and reliability of the Farsi version of the Ascertain Dementia 8-item (AD8-F) informant interview in patients with mNCD. METHODS: This is a study of the psychometric properties of the Farsi AD8. The participants include sixty informant-patient dyads with mNCD and sixty controls with normal cognition. The AD8 was compared to the mini-mental state examination (MMSE) and the Mini-Cog. As a gold standard, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for mNCD was used. The reliability was measured using internal consistency and test-retest. Validity was assessed by evaluating the content, concurrent, and construct validity. Data were analyzed via Cronbach’s α, Pearson correlation, independent t-test, and analysis of variance (ANOVA) and area under the curve (AUC) by statistical package for the social sciences (SPSS) v.23. RESULTS: Cronbach’s α was 0.71. Test-retest reproducibility was 0.8. The AD8 had inverse correlations with the Mini-Cog (r = − 0.70, P  2. Sensitivity and specificity were 80 and 83%, respectively. The positive predictive value was 83%. The negative predictive value was 81%. CONCLUSION: Our results suggest that this tool can be used as a screening tool to detect a mild neurocognitive disorder in primary care centers

COVID-19 in Patients with Rheumatic Disease Using Immunomodulatory Drugs: Imaging Findings and Predictors of Hospitalization

Introduction SARS-CoV-2 causes more severe symptoms in most chronic diseases, and rheumatic disease is no exception. This study aims to investigate whether there is an association between the use of immunomodulatory medications, including conventional disease-modifying agents (csDMARDs), glucocorticoids, and biologic DMARDs, and outcomes such as hospitalization and lung involvement in patients with rheumatic disease with COVID-19.Methods We performed a cross-sectional study on 177 COVID-19 cases with rheumatologic diseases using immunomodulatory drugs as their regular treatment. All patients were evaluated regarding their initial chest computed tomography (CT) scan, COVID-19 symptoms, and comorbidities. We ran predictive models to find variables associated with chest CT-scan involvement and hospitalization status.Results CT findings showed lung involvement in 87 patients with chest CT-scan severity score (C-ss) of less than 8 in 59 (33%) and more than 8 in 28 (16%) of our patients. Of all patients, 76 (43%) were hospitalized. Hospitalized patients were significantly older and had more comorbidities (P = 0.02). On multivariate analysis, older age [odds ratio (OR) 1.90, 95% confidence interval (CI) 1.31-3.08] and comorbidity (OR 2.75, 95% CI 1.06-3.66) were significantly associated with higher odds of hospitalization (P = 0.03). On multivariate analysis, older age (OR 1.15, 95% CI 0.94-2.01), pulmonary diseases (OR 2.05, 95% CI 1.18-3.32), and treatment with csDMARDs (OR 1.88, 95% CI 0.37-1.93) were associated with higher C-ss (P = 0.039).Conclusions This study found that advanced age and comorbidities, similar to the general population, are risk factors for hospitalization in patients with COVID-19 with rheumatic disorders. Administration of csDMARDs, older age, and pulmonary disorders were linked to increased risk of COVID-19 pneumonia in these individuals

Oral health-related quality of life in rheumatoid arthritis: a comparative analysis

Background Compared to the healthy population, the psychological impact of rheumatoid arthritis(RA) on patients' lives could dramatically lower their oral health-related quality of life (OHRQoL). Our goal is to analyze OHRQoL in RA patients and look into the role of disease activity, dental health index, and Temporomandibular disorders score in maintaining their oral health. Methods In a cross-sectional comparative study, we compared a sample of 40 RA patients with 40 age- and gender-matched healthy controls in terms of oral health and OHRQoL. Temporomandibular disorders (TMD), number of decayed, filled, or missing teeth (DMFT), and Oral Health Impact Profile (OHIP) were among the oral health factors studied (OHIP-14). This study also looked at the link between the RA disease activity score (DAS28) and oral health factors. Results RA patients had a significantly higher mean (poorer OHRQol) than healthy controls in total oral function, total psychosocial impact, OHIP-14 sum score, OHIP-14 extent score, TMD score and the number of missed teeth (Mann-Whitney U test, P-value < 0.05). After adjustment for DMFT, only the oral function score of OHIP-14 had a significant correlation with disease activity (Mann-Whitney U test, P-value < 0.05). The TMD sum score significantly correlated with disease activity regardless of adjustment for DMFT (Spearman's Correlation test, P-value < 0.05 for both). The number of decayed teeth and missed teeth showed a positive correlation with increased disease activity (Coefficient = 0.239 and 0.245, P-value < 0.05 for both). Conclusions Patients with RA are less satisfied with their oral health than healthy controls. In RA patients, the number of missing teeth and temporomandibular disorders was substantially greater, and the number of missing teeth and temporomandibular diseases increased significantly with increased disease activity. Although OHRQoL was inversely connected with RA activity, after correcting for decaying, missing, and filled teeth, only the oral function score of OHIP-14 exhibited a slight connection to DAS28