Efficacy of levamisole with standard care treatment vs. standard care in clinical presentations of non-hospitalized patients with COVID-19: a randomized clinical trial

Objective: The aim of this study was to evaluate the influence of adding a 10-day course of levamisole (LVM) to the standard care compared with standard care alone, on the clinical status of COVID-19 patients with mild to moderate disease. Methods:  In this randomized open-label trial, we enrolled non-hospitalized patients with mild to moderate COVID-19 at nine health centers in Tehran province, Iran, in 2021. Patients were randomly assigned to receive a 10-day course of LVM with standard care (n=185) or standard care alone (n=180) in a 1:1 ratio. On days 1 to 10, LVM was administered orally at a dosage of 50 mg. The participants were called and followed on days 1, 3, 5, 7, 9, and 14. The measured parameters were general health condition, hospitalization rate, signs and symptoms, and adverse events. The generalized estimating equations model was used for analysis. Results: Among 507 randomized patients, 473 patients started the experiment and received LVM plus standard care or received the standard care alone; 385 patients included in the analysis; 346 (98%) patients completed the trial. The median age of the patients was 40 years [IQR: 32-50.75]; and ‎201 (55.1%)‎ patiens were male. The mean age, sex ratio, and frequency of the underlying diseases of the patients in the two study groups had no ‎statistically significant differences (P>0.05). Compared to the control group, LVM improved the general health condition of the patients (B=-0.635; 95% CI: -0.041,-0.329; P<0.001). Patients receiving LVM compared with standard care group had significantly lower odds of developing fever (OR=0.260; 95% CI: 0.11‎‎3‎,0.59‎‎9‎; P=0.002), chills (OR=0.223; 95% CI:‎‎ 0.07‎‎6,‎0.64‎‎8‎; P= 0.006), fatigue (OR=0.576; 95% CI:‎ 0.34‎‎6,‎0.96‎‎0‎‎; P=0.034), and myalgia (OR=0.54‎‎4‎; 95% CI:‎ 0.31‎‎7‎,0.93‎‎2‎‎; P=0.027). No significant difference was observed in the rate of hospitalization. Although the intervention group had greater adverse effects than the control group, the difference was not statistically significant. Conclusion: Findings of this study suggest that LVM has clinical benefits in improving patients’ health condition with mild to moderate COVID-19

Distribution of breast cancer risk factors in two groups of healthy people referral to cancer registry and Shahid Mottahari center

The aim of this study is evaluation of breast cancer risk factors distribution in two groups of healthy people referral to cancer registry and Shahid Mottahari center in Iran. This study is cross-sectional study which is part of the study to estimate Gene-Environment Interaction in women with breast cancer with case-control studies in Shiraz. In this study, two control groups have been used. The sample size of 300 was specified for each group. Selection sources of groups include Cancer Registry Center and referred people to surgical and internal ward of Shahid Mottahari Clinic. Information collect tools have included Form No. 1 in Cancer Registry Center which includes information of age, use of oral contraceptives history, breastfeeding history, number of live births, age at menarche, age at first childbirth, etc. Considering the results obtained, it was showed that the highest frequency (144) in the group of Cancer Registry Center belongs to high school education, but the highest frequency of Shahid Mottahari Clinic is related to primary education (176).There is statistically significant difference between the two groups in terms of education, history of breast cancer in first-degree relatives and age at first birth, (P<0.05). Due to the easy availability of data on non-cancer patients referred to the cancer registry center, researchers may be encouraged to use them as a control group, but we must bear in mind that, this Group may be different in terms of some variables, and this difference leads to bias in the estimation of considered exposure effects. Keywords: Breast cancer, Cancer registry, Risk factor, Ira

Ethological Factors of Chronic Back Pain in MRI of a Group of Military Personnel

Background and Aim: Chronic low back pain is one of the most common debilitating occupational diseases. It seems that the frequency of this type of back pain is increasing, especially among young military staff. The aim of this study was to evaluate the causes of chronic low back pain according to interpretation of MRI reports in military personnel of army land forces of the Islamic Republic of Iran. Materials and Methods: In this descriptive cross-sectional study, the data of military personnel with chronic low back pain, referring to the Neurosurgery Council of Khanevadeh Hospital, Tehran in 2016 were extracted. The information included demographic and occupational characteristics of the patients, clinical findings, and MRI reports. We used chi-square and Fischer exact tests for data analysis at the significance level of 95%. Results: 326 male military personnel with chronic low back pain were evaluated. The mean age of the subjects was 37.3 ± 0.6 years. The most common MRI finding was disc herniation which was detected in 174 cases (53.3%). low back pain was most frequent in the combat branch, which included 114 cases (34.9%). There was no statistically significant correlation between MRI findings and types of military branches (P=0.071). The highest frequency of disc herniation belonged to the patients between 20 and 29 years of age (p=0.002) and the highest frequency of degenerative changes was seen in the patients over 50 years of age (p=0.005). Conclusion: The most important finding of this study was the low mean age of the patients with chronic low back pain who were in their active working years. We suggest revision of the trend of periodic examinations of military personnel, ergonomics of the work environment and military training

Development and psychometric properties of the caring behaviors of operating room nurses questionnaire during the COVID-19 pandemic: A mixed-method study

Background: Considering the threats in the operating room during the COVID-19 pandemic, the optimal care and safety of the operating room nurses should be maintained when performing surgery on an acute respiratory patient. It seems necessary to design a tool to measure the caring behaviors of operating room nurses. Therefore, the present study was conducted with the aim to design a valid and reliable tool for measuring the caring behavior of operating room nurses during the COVID-19 pandemic. Materials and Methods: In this sequential, exploratory, mixed-method study, the designing and psychometric evaluation of the caring behaviors of operating room nurses questionnaire during the COVID-19 pandemic were performed in qualitative and quantitative phases from August 2021 to July 2022 in Aja University of Medical Sciences, Iran. In the qualitative phase, the concept of caring behaviors of operating room nurses was explored through interviews and a literature review based on online searches. In the quantitative phase, validity (face, content, and construct), and reliability of the questionnaire were evaluated. Results: The findings supported 21 items in the 5 factors of caring behaviors related to attitude toward patients, knowledge of surgical care, virus prevention principles, self-care knowledge, and self-care performance, which explained 35.92 of the total variance. Scale-Content Validity Index/Average and Cronbach's alpha were calculated to be 0.93 and 0.89, respectively. Conclusions: Given its desirable reliability and validity, simple scoring, and ease of use by operating room nurses, the Caring Behaviors of Operating Room Nurses Questionnaire is applicable and its use is recommended

Comparing intravenous lidocaine and pethidine for pain management in emergency department patients with femoral bone fracture: a randomized controlled trial

Abstract Background Intravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied. Objective This study compared intravenous lidocaine to pethidine for femoral bone fracture pain management. Methods This double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18–70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS. Results Seventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics. Conclusion The administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids. Trial Registration IRCT20231213060355N1 ( https://irct.behdasht.gov.ir/trial/74624 ) (30/12/2023)

Potential Adverse Effects of COVID-19 Vaccines on Iranian Healthcare Workers: Comparison of Four Available Vaccines in Tehran: A Retrospective Cross-sectional Study

Objectives: This study aimed to compare four COVID-19 vaccines for their potential extensive side effects and the relationship between the side effects and age, body mass index (BMI), and history of COVID-19 infection. Methods: This cross-sectional study was conducted from June to August 2021 among 1474 healthcare workers of seven selected hospitals in Tehran, Iran. All the subjects were vaccinated (91.7% received two doses and 8.3% received one dose) with one of four vaccines, Sputnik, Covaxin, AstraZeneca, and Sinopharm, at least 10 days before the study. The incidence of 47 side effects was measured after vaccination. Results: Over half of the participants (59.4%; n = 876) were 20–29 years of age, with the mean and average BMI being 26.1±9.0 and 23.5±3.4, respectively; 36.0% (n = 530) were previously diagnosed with COVID-19. There was no significant relationship between age and the incidence of side effects for AstraZeneca, Sputnik, and Covaxin; however, the occurrence of side effects of Sinopharm was significantly higher (p < 0.001) among younger healthcare workers. There was no significant relationship between BMI and the incidence of side effects for all four vaccines. However, in the group with a history of COVID-19 disease, health care workers vaccinated with the Sinopharm vaccine showed significantly (p < 0.001) more complications. The occurrence rate of at least one adverse effect and referral to medical centers for AstraZeneca, Sputnik, Covaxin, and Sinopharm vaccines were 24.9–93.9%, 18.2–86.0%, 14.8–77.0%, and 3.5–37.2%, respectively. The highest and lowest rates were found for AstraZeneca and Sinopharm showing a significant (p < 0.001) difference. The most commonly observed side effects for the AstraZeneca vaccine included fever (64.4%), fatigue (62.5%), and muscle pain (59.9%); for Sputnik muscle pain (59.8%), fever (49.5%), and fatigue (49.5%); for Covaxin fever (49.2%), topical reaction (41.0), and fatigue (34.4%); and for Sinopharm fever (18.7%), topical reaction (17.9%), and fatigue (16.6%). Inactivated virus vaccines (Sinopharm and Covaxin) showed a lower (39.7%) occurrence rate of side effects compared to viral vector vaccines (AstraZeneca and Sputnik; 90.6%). The most likely time for the vaccines to exert side effects was the first 24 hours after vaccination. Conclusions: We found no significant relationship between age, BMI, history of COVID-19 disease, and the incidence of side effects in healthcare workers vaccinated with any of the four vaccines. All four vaccines are safe and have controlled side effects

The Road Traffic Crashes as a Neglected Public Health Concern; An Observational Study From Iranian Population

<div><p><b>Objective:</b> Traffic crashes are multifactorial events caused by human factors, technical issues, and environmental conditions. The present study aimed to determine the role of human factors in traffic crashes in Iran using the proportional odds regression model.</p><p><b>Methods:</b> The database of all traffic crashes in Iran in 2010 (<i>n</i> = 592, 168) registered through the “COM.114” police forms was investigated. Human risk factors leading to traffic crashes were determined and the odds ratio (OR) of each risk factor was estimated using an ordinal regression model and adjusted for potential confounding factors such as age, gender, and lighting status within and outside of cities.</p><p><b>Results:</b> The drivers’ mean age ± standard deviation was 34.1 ± 14.0 years. The most prevalent risk factors leading to death within cities were disregarding traffic rules and regulations (45%), driver rushing (31%), and alcohol consumption (12.3%). Using the proportional odds regression model, alcohol consumption was the most significant human risk factor in traffic crashes within cities (OR = 6.5, 95% confidence interval [CI], 4.88–8.65) and outside of cities (OR = 1.73, 95% CI, 1.22–3.29).</p><p><b>Conclusions:</b> Public health strategies and preventive policies should be focused on more common human risk factors such as disregarding traffic rules and regulations, drivers’ rushing, and alcohol consumption due to their greater population attributable fraction and more intuitive impacts on society.</p></div