Deep Vein Thrombosis among Intensive Care Unit Patients; an Epidemiologic Study

Introduction: Deep vein thrombosis (DVT) is a major cause of morbidity and mortality in intensive care unit (ICU) patients despite use of prophylactic anticoagulant therapy. The aim of the present study was to determine the incidence of DVT among medical and surgical ICU patients.Methods: In this cross sectional study, patients older than 18 years who were hospitalized in the ICU of Imam Hossein educational Hospital, Tehran, Iran, for ≥ 2 days, during August 2008 to July 2011 were evaluated regarding DVT incidence. Demographic data, comorbidities, acute physiology and chronic health evaluation (APACHE) II scores, ICU length of stay, type of DVT prophylaxis, and patient outcomes were analyzed using SPSS 19.Results: Out of the 1387 reviewed patient files, 500 (36.04%) patients had been classified as potential DVT cases. DVT occurred in 3.5% of them with the mean age of 60 ± 18 years (62.5% male) and mortality rate of 27.1%. Significant independent risk factors of DVT incidence were age (p = 0.02) and length of ICU stay (p = 0.01).Conclusion: The results of this study showed the 3.5% incidence of DVT in ICU admitted patients. Longer ICU stay and older age were independent risk factors of DVT development

Familiarity of Physicians and Nurses with Different Aspects of Oxygen Therapy; a Brief Report

Introduction: Oxygen is a drug and physician and nurses should be familiar with the effects and potential risks of oxygen therapy. The current study aimed to assess familiarity of physicians and nurses with various aspects of oxygen therapy.Method: In this cross sectional study, the familiarity of physicians and nurses with various aspects of oxygen therapy in a teaching hospital was evaluated using a validated questionnaire. The collected data were analyzed using SPSS 21 software.Results: 57 physicians and 79 nurses returned the completed questionnaire (response rate 97.1%). Mean clinical work experience of participants was 6.9±5.7 (1–15) years.98.2% of physicians believed that oxygen therapy can be associated with risk and should be recorded in the patient's medical file. These measures were 92.4% and 98.2% for nurses. 38 (27.9%) participants correctly pointed out the reasons for oxygen therapy. Regarding necessary measurements and monitoring for oxygen therapy, 49 (86%) physicians and 65 (82.3%) nurses chose the correct answer. In addition, regarding necessity of blood gas analysis during oxygen therapy, 44 (77.2%) physicians and 55 (69.6%) nurses chose the correct answer.Conclusion: The findings showed that the familiarity level of participants with some aspects of O2 therapy such as its indications, necessary measurements and monitoring during therapy, and identifying delivery devices was fair to weak (<80%)

Value of Brain Natriuretic Peptide in Predicting Prognosis of Coronary Artery Disease in Myocardial Infarction

Background: Brain natriuretic peptide (BNP) is an important predictor of outcomes in patients with heart failurebut the prognostic value of BNP elevation in patients with myocardial infarction (MI) is not completely defined.This study aims to identify the prognostic value of BNP in patients with MI.Materials and Methods: We studied patients with MI who were hospitalized in the Coronary Care Unit of ImamHossein Hospital. Patients' demographic data, past medical and drug history besides echocardiography report andBNP levels were documented during the hospital stay and echocardiography was repeated after 3 months.Results: This prospective observational cross-section study was done between January 2018 through January2019. During the study period, 124 patients were recruited. There was significant negative correlation betweenBNP levels and ejection fraction (P=0.001), systolic blood pressure (P=0.012), diastolic blood pressure(P=0.003) and ratio between early mitral inflow velocity and early diastolic mitral annular velocity (E/e')(P=0.03) and EF in follow up (P=0.001). The correlation between BNP levels with infarction location (P=0.40),arterial involvement in the left main coronary artery (P=0.15), left anterior descending artery (P=0.53), leftcircumflex artery (P= 0.97), right coronary artery (P=0.50) and hospital stay (P=0.66) were not significant.Conclusion: BNP is a valuable marker for predicting prognosis in patients with the acute coronary syndrome.Also, it could be considered as a prognostic long-term marker for predicting the EF of patients with AMI

Cardiogenic Shock Following Acute Myocardial Infarction: A Retrospective Observational Study

Introduction: Cardiogenic shock is a sudden complication that occurs in 5 to 10% of patients with acute myocardial infarction. According to statistics, mortality and morbidity from this event, despite all hospital care, are approximately 70-80%.Methods: This study was conducted over three years (2012 to 2014) in 28 cases of acute myocardial infarction, which was complicated by cardiovascular shock, before or after admission. We compared the outcomes of patients according to the treatment strategy, thrombolytic therapy, primary percutaneous coronary intervention (PCI), or other medical stabilization. The 30-day follow-up was the first endpoint, and the 3- month follow up was the second endpoint of the study.Results: 28 patients with cardiogenic shock included in this study. The mean (± SD) age of the patients was 62.99 ± 13.99 years. The median time to the onset of shock was 648.75 ± 1393.58 minutes after infarction. Most of the patients who underwent coronary angiography had 3-vessel or left main involvement. Two patients missed in follow up and five (80%) patients who received thrombolytic therapy passed away. Nine (100%) patients in the medical stabilization group and six patients (50%) underwent primary PCI group passed away too. The mortality in the primary PCI group was significantly lower than the other groups (P = 0.04).Conclusion: Although cardiogenic shock is a potential risk of early death, it is important that the thrombolytic in these patients doesn't increase survival and the primary PCI is more effective than thrombolytic agents

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

Errors Related to Medication Reconciliation: A Prospective Study in Patients Admitted to the Post CCU

Abstract Medication errors are one of the important factors that increase fatal injuries to the patients and burden significant economic costs to the health care. An appropriate medical history could reduce errors related to omission of the previous drugs at the time of hospitalization. The aim of this study, as first one in Iran, was evaluating the discrepancies between medication histories obtained by pharmacists and physicians/nurses and first order of physician. From September 2012 until March 2013, patients admitted to the post CCU of a 550 bed university hospital, were recruited in the study. As a part of medication reconciliation on admission, the physicians/nurses obtained medication history from all admitted patients. For patients included in the study, medication history was obtained by both physician/nurse and a pharmacy student (after training by a faculty clinical pharmacist) during the first 24 h of admission. 250 patients met inclusion criteria. The mean age of patients was 61.19 ± 14.41 years. Comparing pharmacy student drug history with medication lists obtained by nurses/physicians revealed 3036 discrepancies. On average, 12.14 discrepancies, ranged from 0 to 68, were identified per patient. Only in 20 patients (8%) there was 100 % agreement among medication lists obtained by pharmacist and physician/nurse. Comparing the medications by list of drugs ordered by physician at first visit showed 12.1 discrepancies on average ranging 0 to 72. According to the results, omission errors in our setting are higher than other countries. Pharmacybased medication reconciliation could be recommended to decrease this type of error

Efficacy and safety of sofosbuvir in the treatment of SARS-CoV-2: an open label phase II trial

Objective: Despite the worldwide spread of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an effective specific antiviral treatment for coronavirus disease of 2019 (COVID-19) is yet to be identified .We did this study to investigate the safety and efficacy of sofosbuvir as antiviral therapy among hospitalized adult patients with SARS-CoV-2. Methods: Patients were randomized into intervention arm receiving sofosbuvir or comparison arm receiving usual antiviral agents in addition to standard of care. The primary end point of the study was clinical recovery as defined by normal body temperature and normal oxygen saturation. The main secondary outcome was all-cause mortality during the admission in hospital or within 14 days after discharge if applicable. Reports of severe adverse events were observed in the intervention arm. Results: Fifty-seven patients enrolled into either the clinical trial arm (n=27) or the comparison arm (n=30). Primary outcome was achieved by 24 (88.9%) and 10 (33.3%) in the intervention and comparison arms, respectively. Median hospital length of stay was significantly shorter in the intervention arm (10 days [IQR: 5-12] vs. 11.5 days [IQR: 8.5-17.75], P = 0.016). All-cause mortality was two and thirteen in intervention and comparison groups, respectively. No serious adverse events were reported by the patients receiving sofosbuvir during the study. Conclusion: Among patients hospitalized with SARS-CoV-2, those who received sofosbuvir had more clinical recovery rate and had a shorter hospital length of stay than those who received usual antiviral agents in the study and these differences were statistically significant

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