A clinical prediction model for predicting the surgical site infection after an open reduction and internal fixation procedure considering the NHSN/SIR risk model: a multicenter case–control study

IntroductionSurgical site infection (SSI) is one of the most common surgical-related complications worldwide, particularly in developing countries. SSI is responsible for mortality, long hospitalization period, and a high economic burden.MethodThis hospital-based case–control study was conducted in six educational hospitals in Tehran, Iran. A total of 244 patients at the age of 18–85 years who had undergone open reduction and internal fixation (ORIF) surgery were included in this study. Among the 244 patients, 122 patients who developed SSIs were selected to be compared with 122 non-infected patients used as controls. At the second stage, all patients (n = 350) who underwent ORIF surgery in a hospital were selected for an estimation of the standardized infection ratio (SIR). A logistic regression model was used for predicting the most important factors associated with the occurrence of SSIs. Finally, the performance of the ORIF prediction model was evaluated using discrimination and calibration indices. Data were analyzed using R.3.6.2 and STATA.14 software.ResultsKlebsiella (14.75%) was the most frequently detected bacterium in SSIs following ORIF surgery. The results revealed that the most important factors associated with SSI following an ORIF procedure were found to be elder age, elective surgery, prolonged operation time, American Society of Anesthesiologists score of ≥2, class 3 and 4 wound, and preoperative blood glucose levels of >200 mg/dl; while preoperative higher hemoglobin level (g/dl) was found to be a protective factor. The evidence for the interaction effect between age and gender, body mass index and gender, and age and elective surgery were also observed. After assessing the internal validity of the model, the overall performance of the models was found to be good with an area under the curve of 95%. The SIR of SSI for ORIF surgery in the selected hospital was 0.66 among the patients aged 18–85 years old.ConclusionNew risk prediction models can help in detecting high-risk patients and monitoring the infection rate in hospitals based on their infection prevention and control programs. Physicians using prediction models can identify high-risk patients with these factors prior to ORIF procedure

Rheumatoid Arthritis Flare-ups Following Immunization with Sinopharm Inactivated Virus-based COVID-19 Vaccine

Introduction: This study aimed to investigate the incidence of rheumatoid arthritis (RA) flare-ups following immunization with the Sinopharm COVID-19 inactivated virus-based vaccine. Methods: We conducted a retrospective observational study at the Rheumatology Clinic of Imam Hossein Hospital, incorporating 200 RA patients in remission undergoing non-biologic Disease-Modifying Antirheumatic Drugs (DMARDs) treatments. A rheumatologist confirmed a flare-up based on patients complain of arthralgia and joint stiffness and complete examination of joints over a three-month period following vaccination. Results: Twelve percent of all included patients experienced symptom recurrence. The average age of patients with flare-ups was significantly higher, but no gender-based differences were observed (p<0.001 and p=0.071, respectively). The second vaccine dose resulted in a higher number of symptom flares compared to the first dose (9.30% vs. 3.0%, p < 0.001). No significant differences were observed between patients experiencing flare-ups after the first dose and the second dose in terms of the number of involved joints (p=0.321) and the time gap from vaccination to symptom recurrence (p=0.526). No patients required hospitalization, and prednisolone dosage adjustments effectively managed symptoms. Conclusion: The occurrence of flare-ups was relatively low after the Sinopharm COVID-19 vaccination in RA patients undergoing treatment with DMARDs during remission. The majority of these flares were mild and no hospitalizations were required

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

Epidemiological and Clinical Aspects of COVID-19; a Narrative Review

There are significant misconceptions and many obstacles in the way of illuminating the epidemiological and clinical aspects of COVID-19 as a new emerging epidemic. In addition, usefulness of some evidence published in the context of the recent epidemic for decision making in clinic as well as public health is questionable. However, misinterpreting or ignoring strong evidence in clinical practice and public health probably results in less effective and somehow more harmful decisions for individuals as well as subgroups in general populations of countries in the initial stages of this epidemic. Accordingly, our narrative review appraised epidemiological and clinical aspects of the disease including genetic diversity of coronavirus genus, mode of transmission, incubation period, infectivity, pathogenicity, virulence, immunogenicity, diagnosis, surveillance, clinical case management and also successful measures for preventing its spread in some communities. Keywords:COVID-19; severe acute respiratory syndrome coronavirus 2; epidemiology; public health; communicable diseases; emergin

Optimizing Outpatient Medication Management: The Impact of Clinical Pharmacists on Identifying and Addressing Drug-Related Problems

Medication Therapy Management Services (MTMS) are effective strategies to reduce Drug-Related Problems (DRPs) and associated healthcare costs. Given the high prevalence of DRPs in outpatient settings and the lack of an effective process to detect such problems in Iran, we decided to evaluate the type and number of DRPs identified by clinical pharmacists in a university-affiliated Pharmacotherapy Clinic in Khuzestan province, South of Iran. In this cross-sectional study, 150 eligible outpatients were included. At a university-affiliated pharmacotherapy clinic, pharmacy students took patients' histories and referred them to clinical pharmacists for DRP evaluation and detection. Appropriate interventions were then implemented in collaboration with patients and their healthcare providers to resolve the problems. Approximately 3.56 DRPs per patient were identified during a nine-month study period. The most prevalent DRPs were lack of education or information (32.40% [174/537]), undertreated indications (17.31% [93/537]), and patient compliance (15.27% [82/537]). Clinical pharmacists detected 537 DRPs, implemented 525 interventions, and performed 0.977 interventions per DRP. The provision of information (57.52% [302/525]) and change of therapy (21.71% [114/525]) were the most frequent types of clinical pharmacist interventions. This study revealed deficiencies and limitations in our healthcare services, resulting in a significant prevalence of DRPs. Implementing pharmaceutical care practice models, such as Pharmacotherapy Clinics, where clinical pharmacists integrate their experience and knowledge in a patient-centered manner, is the most effective method for preventing and managing these issue

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

Rate and Risk Factors of Reinfection, Recurrence, and Hospital Readmission Among SARS-Cov-2 Hospitalized Patients; a National Cohort Study

Introduction: Reinfection and hospital readmission due to COVID-19 were significant and costly during the pandemic. This study aimed to assess the rate and risk factors of SARS-Cov-2 reinfection, recurrence, and hospital readmission, by analyzing the national data registry in Iran. Methods: This study was a retrospective cohort conducted from March 2020 to May 2021. A census method was used to consider all of the possible information in the national Medical Care Monitoring Center (MCMC) database obtained from the Ministry of Health and Medical Education; the data included information from all confirmed COVID-19 patients who were hospitalized and diagnosed using at least one positive Polymerase Chain Reaction (PCR) test by nasopharyngeal swab specimens. Univariate and multivariable Cox regression analyses were performed to assess the factors related to each studied outcome. Results: After analyzing data from 1,445,441 patients who had been hospitalized due to COVID-19 in Iran, the rates of overall reinfection, reinfection occurring at least 90 days after the initial infection, recurrence, and hospital readmission among hospitalized patients were 67.79, 26.8, 41.61, and 30.53 per 1000 person-years, respectively. Among all cases of hospitalized reinfection (48292 cases), 38.61% occurred more than 90 days from the initial SARS-Cov-2 infection. Getting infected with COVID-19 in the fifth wave of the disease compared to getting infected in the first wave (P<0.001), having cancer (P<0.001), chronic kidney disease (P<0.001), and age over 80 years (P<0.001) were respectively the most important risk factors for overall reinfection. In contrast, age 19-44 years (P<0.001), intubation (P<0.001), fever (P<0.001), and cough (P<0.001) in the initial admission were the most important protective factors of overall reinfection, respectively. Conclusion: Reinfection and recurrence of COVID-19 after recovery and the rate of hospital readmission after discharge were remarkable. Advanced or young age, as well as having underlying conditions like cancer and chronic kidney disease, increase the risk of infection and readmission.

Is the prevalence of risk factors, clinical presentations and severity of coronary artery diseases (CAD) in patients with very early and premature CAD are different from mature CAD patients?: A registry- based cross-sectional study

Introduction: The present study aims to compare the risk factors, clinical presentation, and severity of coronary artery involvement in young compared to elderly CAD patients to assess the cardiovascular health status for better disease management and control of these specific patients. Methods: This registry-based cross-sectional study was conducted using Coronary Angiography and Angioplasty Registry (CAAR) patients in east of Tehran, Iran. The data were extracted from 330 patients with confirmed CAD recorded by the CAAR during July 2021 to August 2023. Results: The majority of patients in MCAD (68.2%) and VECAD (80%) were male, while the majority of PCAD patients were female (51.8%). Among PCAD patients, the prevalence of diabetes (38.1%) was higher than in other groups. The presence of IHD history in the father (38.1%) and mother (26.3%) was higher in the VECAD group. The mean total cholesterol, LDL, and LDL/HDL ratio were higher in the VECAD group. Among MCAD group (75.4%) compared to PCAD (58.1%) and VECAD (47.2%) groups, the multi-vessel disease was more common.MCAD patients had the highest median Gensini score compared to PCAD and VECAD patients. Also, in male compared to female the mean Gensini score was higher by 8 units (ß = 8.26, 95%CI = 0.24, 16.28). Conclusion: Modifiable risk factors in young CAD patients are common. High LDL-C levels and smoking were the common modifiable CVD risk factors in young patients, indicating the significant role of these traditional risk factors in early atherosclerosis development alongside inheritable risk-factors such as positive family history that were more common in young CAD patients. While, the severity of coronary artery involvement in individuals with MCAD was higher, but the priority of involvement based on the type of vessel was almost the same in all CAD groups

Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery:a national prevalence study of 11 provinces in Iran

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy that significantly affects perinatal outcomes. Objective: The aim of this study was to determine the prevalence of GDM and its relation with the incidence of stillbirth, preterm birth, macrosomia, abortion and cesarean section (C-section) delivery in pregnant women. Methods: This cross-sectional study was conducted on 3675 pregnant women in 11 provinces across Iran. Cluster sampling was used to select samples from mothers covered by health plans in 11 provinces of Iran. Prevalence of adverse pregnancy outcomes, including preterm delivery, type of delivery, macrosomic preterm birth, miscarriage, stillbirth, infant death, and birth weight were measured, using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software. Results: About four percent of Iranian pregnant women had GDM during pregnancy. Prevalence of C-section was significantly higher in diabetic women than in the non-diabetic ones (53.19 vs 46.81, respectively, P &lt;0.001). Abortion in diabetic mothers was more than twice that of the non-diabetic mothers (P &lt;0.001). In the adjusted logistic regression model, the odds of stillbirth in mothers with GDM were 1.8 (95% CI: 1.11, 2.91, P = 0.018) times higher than that of the non-diabetics. The odds of macrosomia in diabetic women was about 7 times higher than the non-diabetic women (95% CI: 2.81, 17.14, P &lt;0.001). The odds of GDM had an increasing trend according to the BMI (p &lt;0.001). The risk of GDM were significantly lower, according to the daily physical activity (PA) (p &lt;0.001). Conclusion: The GDM prevalence has a decreasing trend in Iran. It increases the adverse pregnancy outcomes such as stillbirth, neonatal deaths, macrosomia, preterm birth, abortion and C-section delivery. As, some of these consequences like macrosomia are not treatable, thus early prevention is very crucial

Comparison of the Eight Different Treatment Regimens for the Hospitalized Patients with COVID-19: A Retrospective Cohort Study

Background: Coronavirus disease 2019 (COVID -19) characterized by a mild to severe respiratory illness, has been affecting the world since late 2019 and leading to an increase in hospitalizations and deaths. There is still no specific highly effective treatment for this disease. This study aimed to compare the efficacy of the eight different treatment regimens for the hospitalized patients with COVID-19. Methods: This retrospective cohort study was conducted on the hospitalized patients who had laboratory-confirmed COVID-19 by a real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of nasopharyngeal samples. Results: Among all patients hospitalized with COVID-19 between March to September 2020, 861 patients were included in the study. This study indicated that treatment protocols included either remdesivir or favipiravir were superior to hydroxychloroquine in reducing the risk of in-hospital mortality of the patients with confirmed COVID-19, especially in critical patients defined as those who were ICU admitted or under mechanical ventilation (HR, 0.43; 95% CI, 0.23 to 0.82; P=0.011 and HR, 0.45; 95% CI, 0.22 to 0.90; P=0.024, respectively). Whereas receiving lopinavir/ritonavir in combination with either hydroxychloroquine plus interferon β and corticosteroids (HR, 1.85; 95% CI, 1.17 to 2.94; P=0.009), hydroxychloroquine plus interferon β (HR, 1.66; 95% CI, 1.01 to 2.74; P=0.046), or interferon β (HR, 1.80; 95% CI, 1.12 to 2.89; P=0.015) was associated with a significant increase in this risk. Conclusion: Our findings indicate that using remdesivir and favipiravir in combination with interferon β and corticosteroids might be beneficial in hospitalized patients with COVID-19, especially in the critical ones