Epidemic size, trend and spatiotemporal mapping of SARS-CoV-2 using geographical information system in Alborz Province, Iran.

BACKGROUND: The first confirmed cases of COVID-19 in Iran were reported in Qom city. Subsequently, the neighboring provinces and gradually all 31 provinces of Iran were involved. This study aimed to investigate the case fatility rate, basic reproductive number in different period of epidemic, projection of daily and cumulative incidence cases and also spatiotemporal mapping of SARS-CoV-2 in Alborz province, Iran. METHODS: A confirmed case of COVID-19 infection was defined as a case with a positive result of viral nucleic acid testing in respiratory specimens. Serial interval (SI) was fitted by gamma distribution and considered the likelihood-based R0 using a branching process with Poisson likelihood. Seven days average of cases, deaths, doubling times and CFRs used to draw smooth charts. kernel density tool in Arc GIS (Esri) software has been employed to compute hot spot area of the study site. RESULTS: The maximum-likelihood value of R0 was 2.88 (95%, CI: 2.57-3.23) in the early 14 days of epidemic. The case fatility rate for Alborz province (Iran) on March 10, was 8.33% (95%, CI:6.3-11), and by April 20, it had an increasing trend and reached 12.9% (95%,CI:11.5-14.4). The doubling time has been increasing from about two days and then reached about 97 days on April 20, 2020, which shows the slowdown in the spread rate of the disease. Also, from March 26 to April 2, 2020 the whole Geographical area of Karj city was almost affected by SARS-CoV-2. CONCLUSIONS: The R0 of COVID-19 in Alborz province was substantially high at the beginning of the epidemic, but with preventive measures and public education and GIS based monitoring of the cases,it has been reduced to 1.19 within two months. This reduction highpoints the attainment of preventive measures in place, however we must be ready for any second epidemic waves during the next months.

The risk factors associated with COVID-19-Related death among patients with end-stage renal disease.

BACKGROUND: The extent to which patients with End-stage renal disease (ESRD) are at a higher risk of COVID-19-related death is still unclear. Therefore, the aim of this study was to identify the ESRD patients at increased risk of COVID-19 -related death and its associated factors. METHODS: This retrospective cohort study was conducted on 74 patients with ESRD and 446 patients without ESRD hospitalized for COVID-19 in Alborz province, Iran, from Feb 20 2020 to Apr 26 2020. Data on demographic factors, medical history, Covid-19- related symptoms, and blood tests were obtained from the medical records of patients with confirmed COVID-19. We fitted univariable and multivariable Cox regression models to assess the association of underlying condition ESRD with the COVID-19 in-hospital mortality. Results were presented as crude and adjusted Hazard Ratios (HRs) and 95% confidence intervals (CIs). In the ESRD subgroup, demographic factors, medical history, symptoms, and blood parameters on the admission of survivors were compared with non-survivors to identify factors that might predict a high risk of mortality. RESULTS: COVID-19 patients with ESRD had in-hospital mortality of 37.8% compared to 11.9% for those without ESRD (P value < 0.001). After adjusting for confounding factors, age, sex, and comorbidities, ESRD patients were more likely to experience in-hospital mortality compared to non-ESRD patients (Adjusted HR (95% CI): 2.59 (1.55-4.32)). The Log-rank test revealed that there was a significant difference between the ESRD and non-ESRD groups in terms of the survival distribution (χ2 (1) = 21.18, P-value < 0.001). In the ESRD subgroup, compared to survivors, non-survivors were older, and more likely to present with lack of consciousness or O2 saturation less than 93%; they also had lower lymphocyte but higher neutrophil counts and AST concentration at the presentation (all p -values < 0.05). CONCLUSIONS: Our findings suggested that the presence of ESRD would be regarded as an important risk factor for mortality in COVID-19 patients, especially in those who are older than age 65 years and presented with a lack of consciousness or O2 saturation less than 93%.

Comparison of electronic versus conventional assessment methods in ophthalmology residents; a learner assessment scholarship study.

BACKGROUND: Assessment is a necessary part of training postgraduate medical residents. The implementation of methods located at the "shows how" level of Miller's pyramid is believed to be more effective than previous conventional tools. In this study, we quantitatively compared electronic and conventional methods in assessing ophthalmology residents. METHODS: In this retrospective study, eight different conventional methods of assessment including residents' attendance, logbook, scholarship and research skills, journal club, outpatient department participation, Multiple Choice Question (MCQ), Objective Structured Clinical Examination (OSCE), and professionalism/360-degree (as one complex) were used to assess 24 ophthalmology residents of all grades. Electronic media consisting of an online Patient Management Problem (e-PMP), and modified electronic OSCE (me-OSCE) tests performed 3 weeks later were also evaluated for each of the 24 residents. Quantitative analysis was then performed comparing the conventional and electronic assessment tools, statistically assessing the correlation between the two approaches. RESULTS: Twenty-four ophthalmology residents of different grades were included in this study. In the electronic assessment, average e-PMP scores (48.01 ± 12.40) were much lower than me-OSCE (65.34 ± 17.11). The total average electronic score was 56.67 ± 11.28, while the total average conventional score was 80.74 ± 5.99. Female and male residents' average scores in the electronic and conventional method were (59.15 ± 12.32 versus 83.01 ± 4.95) and (55.19 ± 10.77 versus 79.38 ± 6.29), respectively. The correlation between modified electronic OSCE and all conventional methods was not statistically significant (P-value >0.05). Correlation between e-PMP and six conventional methods, consisting of professionalism/360-degree assessment tool, logbook, research skills, Multiple Choice Questions, Outpatient department participation, and Journal club active participation was statistically significant (P-value < 0.05). The overall correlation between conventional and electronic methods was significant (P-value = 0.017). CONCLUSION: In this study, we conclude that electronic PMP can be used alongside all conventional tools, and overall, e-assessment methods could replace currently used conventional methods. Combined electronic PMP and me-OSCE can be used as a replacement for currently used gold-standard assessment methods, including 360-degree assessment.

Prevalence of hepatitis C infection in Iranian hemodialysis patients: An updated systematic review and meta-analysis.

BACKGROUND: Hepatitis C virus (HCV) is a major cause of liver disease and a potential cause of substantial morbidity and mortality. This study aims to provide a comprehensive evidence on HCV Infection in Iranian hemodialysis (HD) patients we conducted a systematic review. MATERIALS AND METHODS: In this systematic review and meta-analysis, through a comprehensive search of literature until January of 2016, we estimated the pooled prevalence of hepatitis C infection in Iranian HD patients. Using Medical Subject Headings terms, Emtree, and related equal Persian key words for Iranian databases and also international databases of PubMed and NLM Gateway (for MEDLINE), and SCOPUS. Interest outcome of HCV infection prevalence was confirmed based on positive hepatitis B surface antigen of blood samples. Random effect meta-analysis was used to estimate pooled prevalence of HCV infection in Iranian HD patients, date and language, HD patients, in adult HD patients, Institute of Scientific Information, Iran-doc, irrespective of age, living in Iran. Searches run through main domestic databanks of Iran-Medex, renal transplantation, Scientific Information Database, the relevant literature-searched concentrating on HCV infection. RESULTS: Through searching steps, 305 publications were found from them following the excluding duplicates and overlapping studies 54 studies relevant to HCV prevalence in Iranian HD zcxw patients, with number of 23921 participants, remained in our analyses. The overall results of test of heterogeneity demonstrate sever heterogeneity between reported prevalence (I2 = 96.62%, Chi-square = 1566, P < 0.001). Due to sever heterogeneity results of random effect meta-analysis showed that the estimated pooled prevalence was 11% (95% confidence interval [CI] =10%-13%). The pooled prevalence base on polymerase-chain reaction, recombinant immunoblot assay, and enzyme-Linked Immunosorbant Antibody method were 11% (95% CI = 6%-15%), 9% (95% CI = 5-13) and 12% (95% CI = 10-14), respectively. In line with previous studies, the present finding shows the significant variation in the rate of HCV in dialysis units among the regions in Iran. CONCLUSION: Present paper is the comprehensive updated systematic review on HCV prevalence in the Iranian HD patients. Our findings provide the reliable evidence for promotion of policies and interventional programs.

Effect of Ammonium Chloride in addition to standard of care in outpatients and hospitalized COVID-19 patients: A randomized clinical trial.

OBJECTIVE: The COVID-19 pandemic has called an urgent need for drug repurposing to improve the outcome of the disease. Quaternary ammonium compounds have been demonstrated to have antiviral effects and may be of use against SARS-CoV-2 infections. DESIGN: In this double-blind, single-center study, we enrolled patients with positive PCR test and/or CT findings for COVID-19. The participants of each group were randomly assigned to Diphenhydramine Compound (Diphenhydramine + Ammonium Chloride) plus standard of care or to Diphenhydramine alone and standard of care groups. The primary outcome was all-cause mortality within 30 days of randomization. Secondary outcomes include viral burden, clinical status, assessed by a 5-point ordinal scale, and length of stay in hospitalized patients. RESULTS: A total of 120 patients were included in the trial, 60 of which were assigned to the Ammonium Chloride group. The primary endpoint was not statistically different between the two groups (HR: 3.02 (95% CI, 0.57-16.06; p = 0.195)). Recovery time and viral burden were significantly lower in the Ammonium Chloride group, corresponding to an odds ratios of 1.8 (95% CI, 1.15-2.83; p = 0.01) and 7.90 (95% CI, 1.62-14.17; p = 0.014), respectively. CONCLUSION: The findings of this study advocate the careful addition of Ammonium Chloride to standard of care for COVID-19 patients.

Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease.

BACKGROUND: Diabetes mellitus (DM) and cardiovascular disease (CVD) are present in a large number of patients with novel Coronavirus disease 2019 (COVID-19). We aimed to determine the risk and predictors of in-hospital mortality from COVID-19 in patients with DM and CVD. METHODS: This retrospective cohort study included hospitalized patients aged ≥ 18 years with confirmed COVID-19 in Alborz province, Iran, from 20 February 2020 to 25 March 2020. Data on demographic, clinical and outcome (in-hospital mortality) data were obtained from electronic medical records. Self-reported comorbidities were classified into the following groups: "DM" (having DM with or without other comorbidities), "only DM" (having DM without other comorbidities), "CVD" (having CVD with or without other comorbidities), "only CVD" (having CVD without other comorbidities), and "having any comorbidity". Multivariate logistic regression models were fitted to quantify the risk and predictors of in-hospital mortality from COVID-19 in patients with these comorbidities. RESULTS: Among 2957 patients with COVID-19, 2656 were discharged as cured, and 301 died. In multivariate model, DM (OR: 1.62 (95% CI 1.14-2.30)) and only DM (1.69 (1.05-2.74)) increased the risk of death from COVID-19; but, both CVD and only CVD showed non-significant associations (p > 0.05). Moreover, "having any comorbidities" increased the risk of in-hospital mortality from COVID-19 (OR: 2.66 (95% CI 2.09-3.40)). Significant predictors of mortality from COVID-19 in patients with DM were lymphocyte count, creatinine and C-reactive protein (CRP) level (all P-values < 0.05). CONCLUSIONS: Our findings suggest that diabetic patients have an increased risk of in-hospital mortality following COVID-19; also, lymphocyte count, creatinine and CRP concentrations could be considered as significant predictors for the death of COVID-19 in these patients.

Oncogenic Viral Infections Among Iranian Hemodialysis Patients: A Systematic Review.

INTRODUCTION: Chronic hemodialysis is a lifesaving procedure for end-stage renal failure patients who may lead to the transmission of oncogenic viral infections discussed as a major cause of liver disease and a potential cause of substantial morbidity and mortality. In this regard, the hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most common infections that studied recently. This study aimed to review systematically all available documents on the prevalence of hepatitis D virus (HED), hepatitis E virus (HEV), hepatitis G virus (HGV), human T-lymphotropic virus (HTLV), human immunodeficiency virus (HIV), and Kaposi's sarcoma-associated herpes virus (KSHV) in Iranian hemodialysis patients. METHODS: We conducted a comprehensive systematic review of literature on the prevalence and factors associated with HED, HEV, HGV, HTLV, HIV, and KSHV in Iranian hemodialysis patients. Using Medical Subject Headings (MeSH) terms, Emtree, and related equal Persian key words, irrespective of age, date, and language, the main domestic databanks of Barekat, Scientific Information Database (SID), Iran-doc, and also international databases of PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS searched. Interest outcome of infection prevalence was confirmed based on reported positive tests of blood samples. Since the studied factors are very numerous and there is even a high heterogeneity in each factor, so the meta-analysis was not performed. RESULTS: Based on our search strategy through comprehensive searching, 509 studies were found. From them, 314 articles were from international data bases and others from Iranian data banks. After excluding duplicates and overlapping studies, 41 studies were included in the analysis; 11 studies were relevant to HIV, 10 studies assigned to HEV, and 7 studies belonged to HGV field. The HDV, HTLV1,2, and KSHV were the other research subject areas. The prevalence of HIV, HGV, and HTLV1,2 ranged from 0% to 1.5%, 0% to 24.19%, and 0.6% to 70.4%, respectively, in different provinces. CONCLUSIONS: This is the comprehensive systematic review on oncogenic viral infections prevalence in the Iranian hemodialysis patients. Present findings emphasize on requirement to evidence-based practical intervention for better prevention and control of problem. The findings could be used as a scientific evidence for developing related policies and highlighting the future plan of complementary researches.

Dermatological manifestations in hemodialysis patients in Iran: A systematic review and meta-analysis.

BACKGROUND: Dermatologic complications are common in patients with end-stage renal disease and also have a high diversity. OBJECTIVES: This meta-analysis reviews prevalence of dermatological manifestations among hemodialysis patients in Iran. MATERIALS AND METHODS: Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iran-Medex, Irandoc, and Scientific Information Database, as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of dermatological manifestations (until February 2016). Heterogeneity of reported prevalence's between studies was assessed using the Q test; overall prevalence of dermatological manifestations was estimated using random-effect meta-analysis model. RESULTS: We found 1229 records; from them, a total of eight studies comprising 917 hemodialysis patients were included. In all of studies, skin discoloration, pruritus and xerosis have the highest prevalence. According to random-effect meta-analysis model, the pooled prevalence of skin discoloration, pruritus, ecchymosis, xerosis, and half-and-half nail in hemodialysis patients were 48.03% (95% CI: 45.09-51.01), 52.85% (95%CI: 49.23-56.47), 19.88 (95% CI: 17.57-22.19), 51.14% (95% CI: 48.25-54.02), and 18.50% (95% CI: 16.0-21.0), respectively. CONCLUSIONS: his study shows that the prevalence of dermatological manifestations seems high among the hemodialysis patients in Iran, and skin discoloration, pruritus, and xerosis are more common.

Hepatitis B Virus Infection in Iranian Hemodialysis Patients: a Systematic Review and Meta-Analysis.

INTRODUCTION: Hepatitis B virus (HBV) infection in hemodialysis patients and its associated adverse health consequences are a worldwide health priority. This systematic review aimed to provide evidence on HBV infection in Iranian hemodialysis patients. MATERIALS AND METHODS: Through a comprehensive systematic review of literature, which led to meta-analysis of findings, we estimated the pooled prevalence of HBV infection in Iranian hemodialysis patients. The main international electronic data sources were MEDLINE, Institute of Scientific Information, and Scopus. We also search several Persian-language databases. All cross-sectional and analytical studies conducted in Iran concerning HBV infection were included irrespective of date and language. RESULTS: Of 602 publications retrieved from literature search, 66 met the inclusion criteria, and 36 were eligible for including in the study. The prevalence rate varied from zero to 9.75% across different provinces. The national prevalence of HBV was reported between 2.1% and 18.2%. Significant heterogeneity was found between reported prevalence rates (I2 = 83.5%, P < .001), as a result of which, we used random effect analysis. Results of meta-analysis showed that the estimated pooled prevalence was 4% (95% confidence interval, 3.3% to 4.7%). CONCLUSIONS: To our knowledge, this was the first comprehensive systematic review of HBV infection in the hemodialysis patients of Iran. Results could be useful for informed health policy making and planning further studies in this field.