Comparison the effects and side effects of Covid-19 vaccination in patients with inflammatory bowel disease (IBD): a systematic scoping review.

Covid-19 is a pandemic disease that is more severe and mortal in people with immunodeficiency, such as those with inflammatory bowel disease (IBD). On the other hand, no definitive treatment has been identified for it and the best way to control it is wide spread vaccination. The aim of this study was to evaluate the benefits and side effects of different vaccines in patients with IBD. Three Electronic databases [Medline (accessed from PubMed), Scopus, Science Direct, and Cochrane] were searched systematically without time limit, using MESH terms and the related keywords in English language. We focused on the research studies on the effect and side effects of Covid-19 vaccination in patients with IBD. Articles were excluded if they were not relevant, or were performed on other patients excerpt patients with IBD. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, the studies' findings were assessed and reported. Finally, after reading the full text of the remained articles, 15 ones included in data extraction. All included studied were research study, and most of them (12/15) had prospective design. Totally, 8/15 studies were performed in single-center settings. In 8/15 studies, patients with IBD were compared with a control group. The results were summarized the in two categories: (1) the effect of vaccination, and (2) side effects. The effect of vaccination were assessed in 13/15 studies. Side effects of Covid-19 vaccination in patients with IBD were reported in 7/15 studies. Patients with IBD can be advised that vaccination may have limited minor side effects, but it can protect them from the serious complications of Covid-19 and its resulting mortality with a high success rate. They should be also mentioned in booster doses.

Methanol poisoning during COVID-19 pandemic; A systematic scoping review.

OBJECTIVE: In this systematic scoping review, it was aimed to assess the epidemiology of methanol poisoning, clinical findings and patients' management, causes, and recommendations regarding prevention or reduction of methanol poisoning during COVID-19 pandemic. METHODS: Three Electronic databases [Medline (accessed from PubMed), Scopus, and Science Direct] were searched systematically from December 01, 2019 to September 10, 2020, using MESH terms and the related keywords in English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, the studies' findings were assessed and reported. RESULTS: Total of 86 articles were obtained within the first step of searching, and 64 ones remained after removing the duplications. Through the title and abstract screening, 35 were removed. Finally, after reading the full text of the remained articles, 15 ones included in data extraction. Most of the previous reported evidence (13/15) were letter to editor, commentary and short reports. None of them were interventional, and none of them followed the patients. Findings were summarized in four categories: 1) epidemiology; 2) clinical findings and patients' management; 3) causes; and 4) recommendation regarding prevention or reduction of methanol poisoning during COVID-19 pandemic. CONCLUSION: The recent outbreak is the largest methanol mass poisoning outbreak throughout Iran and the world in recent decades. The causes of methanol poisoning during the COVID-19 pandemic are intertwined, and most of them are modifiable by health policy makers. Building trust, educating and warning, as well as controlling and monitoring are three main recommendation for prevention or reduction of methanol poisoning.

Predictive determinants of overall survival among re-infected COVID-19 patients using the elastic-net regularized Cox proportional hazards model: a machine-learning algorithm.

BACKGROUND: Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning algorithms. METHODS: The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. The model was further reduced to its core features to maximize simplicity and generalizability. RESULTS: The empirical in-hospital mortality rate among the re-infected COVID-19 patients was 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients. CONCLUSION: The results of the machine-learning analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients. We recommend that future machine-learning studies should further investigate these relationships and the associated factors in these patients for a better prediction of OS.

Investigation of plasma exchange and hemoperfusion effects and complications for the treatment of patients with severe COVID-19 (SARS-CoV-2) disease: A systematic scoping review.

Some previous studies suggested that the plasma exchange (PE) and hemoperfusion (HP) played a cardinal role in the treatment of severe coronavirus disease 2019 (COVID-19) cases by diminishing the cytokine storm. This study aimed to assess the effects of PE and HP on cytokine storms in patients with severe COVID-19 through a systematic scoping review. Four Electronic databases (Medline [accessed from PubMed], Scopus, Science Direct, and Cochrane library) were searched systematically on February 2, 2021, using MESH terms and related keywords in the English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, their findings were assessed and reported. A total of 755 articles were obtained within the first step of searching, and 518 remained after removing the duplications. Through the title and abstract screening, 438 were removed. Of the rest, 59 papers were excluded. Finally, after reading the full text of the remained articles, 21 were included in data extraction. Most of the previously reported evidence were case reports and case series. Findings were summarized in two categories. The first category encompassed nine studies regarding HP and continuous renal replacement therapy, and the second category included twelve studies about PE. The results revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients. Highlights Some studies showed that plasma exchange (PE) and hemoperfusion (HP) played an important role in the treatment of patients with severe COVID-19 disease. The results of this systematic scoping review revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID-19 patients.

Diagnosing skull fracture in children with closed head injury using point-of-care ultrasound vs. computed tomography scan.

Diagnostic and therapeutic interventions in children for traumatic brain injury, which is known as the most important complication in trauma, require special attention. This study aimed to evaluate the accuracy of point-of-care ultrasound (POCUS) in diagnosing skull fracture in children with closed head injury in comparison with computed tomography (CT) scan. The current prospective cross-sectional study was conducted on children (0-14 years old), who were referred to the emergency department of a general teaching hospital in Shiraz, southern Iran (January-March 2018), with close head injury and were suspected of bone fracture. The participants were selected using a convenience sampling. The results of POCUS performed by emergency medicine (EM) residents were compared with the results of CT scan, which was reported by radiologists and considered a gold standard. Then, diagnostic tests were calculated. A total of 168 children were enrolled, with the mean ± standard deviation age of 6.21 ± 3.99. The most affected areas in the skull were the frontal (34.5%) and occipital areas (33.3%). POCUS had a sensitivity and specificity of 81.8% (95%CI, 48.2-97.7%) and 100% (95%CI, 97.7-100%), respectively. Positive and negative predictive values were 100% and 98.7%, with an accuracy of 98.8% in comparison with CT scan in the diagnosis of skull fracture.Conclusion: The results showed that POCUS with a portable ultrasonography machine, performed by the EM's physicians, have high diagnostic precision and can be considered a tool in the management of patients with closed head injury. What is Known: • Some studies have investigated the accuracy of ultrasound in diagnosing skull bone fractures in children with closed head injury, but before conducting this survey, no definite evidence recommended POCUS for skull fracture in children with closed head trauma in the ED. What is New: • POCUS with a portable ultrasonography machine, performed by the EM's physicians, has high diagnostic precision and can be considered a tool in the management of patients with closed head injury.

Lung and cardiac ultrasound (LuCUS) protocol in diagnosing acute heart failure in patients with acute dyspnea.

OBJECTIVE: To investigate the accuracy of lung and cardiac ultrasound (LuCUS) protocol in diagnosing Acute Heart Failure (AHF) in patients who refer to Emergency Department (ED) with acute dyspnea. METHODS: This was an interventional study on adult patients, who were referred with chief complaint of undifferentiated acute dyspnea to the ED of Namazi hospital, the largest referral center in southern Iran. The intervention was LuCUS protocol, which was performed by Emergency Physicians (EPs) at the bedside. All patients' files were reviewed separately by two independent specialists, who were blinded to LuCUS results for final diagnosis as gold standard, then the results of LuCUS were compared with it. All data were analyzed and diagnostic tests were calculated (α = 0.05). RESULTS: In 100 patients enrolled in the study, 28% had the final diagnosis as AHF. The LuCUS protocol had the sensitivity of 64% (95%CI, 44%-81%), specificity of 97% (95%CI, 90%-100%), positive predicative value of 90% (95%CI, 69%-97%), negative predicative value of 88% (95%CI, 81%-92%), positive likelihood ratio of 23.14 (95%CI, 5.74-93.3), negative likelihood ratio of 0.37 (95%CI, 0.22-0.6), and accuracy of 88% (95%CI, 80%-94%). CONCLUSION: LuCUS protocol can be used by EPs as a practical tool to differentiate the cardiac and non-cardiac etiologies of acute dyspnea, specifically AHF, as it is more accurate than clinical diagnosis by itself. Hence, it is recommend that while conducting further studies in order to achieve more generalizable results, EPs can employ it alongside their clinical evaluations to have a faster and more accurate diagnosis.

Causes of medical errors and its under-reporting amongst pediatric nurses in Iran: a qualitative study.

OBJECTIVES: To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. DESIGN: A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. SETTINGS: The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. PARTICIPANTS: The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital's ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. MAIN OUTCOME MEASURE(S): Pediatrics nurses' views on the causes of ME and under-reporting. RESULTS: We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. CONCLUSION: Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.

Appropriateness of Congenital Hypothyroidism Screening Program in Fars Province, Iran: A Retrospective Study from 2005 to 2015.

Congenital hypothyroidism (CH) may lead to irreversible mental retardation. To prevent the complication, screening was conducted routinely for all neonates in Iran. This study aimed to evaluate the appropriateness of CH screening programs in Fars province, southern Iran. This retrospective study (February-May, 2017) was conducted in the Health System Research Center of Shiraz University of Medical Sciences (SUMS). The data were obtained from the non-communicable diseases' unit of SUMS regarding congenital hypothyroidism screening of all neonates born in Fars province from 2005 to 2015. We evaluated the coverage of CH screening, the incidence rate of CH, the percentage of the neonates screened for CH in ideal time, and neonates with CH treated in appropriate time. Descriptive statistics were used to determine the indices. To compare the incidence rate of boys and girls, we used Chi-square test. The coverage of CH screening in Fars Province increased from 50.0% in 2005 to 99.7% in 2015. Furthermore, the percentage of the neonates screened in the ideal time and the neonates with CH treated in an appropriate time increased from 26.0% and 78.0% in 2005 to 86.6% and 99.7% in 2015, respectively. In the evaluated period, the coverage of CH screening in Fars province (98.1%) was higher than that of the other provinces of Iran (83.0%). The study showed good screening coverage in Fars Province from 2005 to 2015. The coverage was considerably better than other provinces of Iran and improved during the study period. Also, over the course of time, more neonates were screened in an ideal time and treated in the appropriate time.

Accuracy of three-point compression ultrasound for the diagnosis of proximal deep-vein thrombosis in emergency department.

BACKGROUND: This study aimed to assess the accuracy of three-point compression ultrasonography (3PCUS) performed for the diagnosis of proximal deep-vein thrombosis (DVT) in Emergency Department (ED) compared with the results of duplex US (DUS) (whole-leg compression ultrasound). MATERIALS AND METHODS: The current prospective cross-sectional study with diagnostic test assessment was conducted on adult patients who were referred to the ED of a general teaching hospital in Shiraz, southern part of Iran (September 2016-May 2017), suspected of lower-extremity DVT, using a convenience sampling. The results of 3PCUS performed by ED residents were compared with the results of DUS performed by the radiology residents, which was considered as a criterion standard. RESULTS: A total of 240 patients were enrolled, with a mean (standard deviation) age of 59.46 (16.58). 3PCUS has a sensitivity and a specificity of 100% (95% confidence interval [CI], 96.55%-100%) and 93.33% (95% CI, 87.72%-96.91%), respectively, in comparison with DUS (whole-leg compression ultrasound). Negative predictive value and positive predictive value were 100% and 92.11% (95% CI, 86.12%-95.64%), respectively, with an accuracy of 96.25% (95% CI, 93%-98.27%). CONCLUSION: The results of this study showed that 3PCUS of the lower extremities with a portable US machine, performed by the ED's residents, can accurately identify the presence or absence of lower-extremity DVT.

A New Rapid Approach for Predicting Death in Coronavirus Patients: The Development and Validation of the COVID-19 Risk-Score in Fars Province (CRSF).

BACKGROUND: Patients who are identified to be at a higher risk of mortality from COVID-19 should receive better treatment and monitoring. This study aimed to propose a simple yet accurate risk assessment tool to help decision-making in the management of the COVID-19 pandemic. METHODS: From Jul to Nov 2020, 5454 patients from Fars Province, Iran, diagnosed with COVID-19 were enrolled. A multiple logistic regression model was trained on one dataset (training set: n=4183) and its prediction performance was assessed on another dataset (testing set: n=1271). This model was utilized to develop the COVID-19 risk-score in Fars (CRSF). RESULTS: Five final independent risk factors including gender (male: OR=1.37), age (60-80: OR=2.67 and >80: OR=3.91), SpO 2 (≤85%: OR=7.02), underlying diseases (yes: OR=1.25), and pulse rate (<60: OR=2.01 and >120: OR=1.60) were significantly associated with in-hospital mortality. The CRSF formula was obtained using the estimated regression coefficient values of the aforementioned factors. The point values for the risk factors varied from 2 to 19 and the total CRSF varied from 0 to 45. The ROC analysis showed that the CRSF values of ≥15 (high-risk patients) had a specificity of 73.5%, sensitivity of 76.5%, positive predictive value of 23.2%, and negative predictive value (NPV) of 96.8% for the prediction of death (AUC=0.824, P<0.0001). CONCLUSION: This simple CRSF system, which has a high NPV, can be useful for predicting the risk of mortality in COVID-19 patients. It can also be used as a disease severity indicator to determine triage level for hospitalization.

Lung Injuries Associated with Scapular Fractures in Adult Traumatic Patients.

Background: Scapular fractures are among the orthopedic injuries, which are associated with other injuries, such as lung injuries. This study aimed to evaluate the prevalence of lung injuries associated with scapular fractures in traumatic patients referred to a main trauma center in the south of Iran. Methods: The present retrospective cross-sectional study was conducted from April 2016 to June 2019 on adult traumatic patients, who were referred to one of the main trauma centers in the south of Iran, and their data were recorded in the hospital information system. The patients with chest computed tomography, and those whose scapula fractures were reported and confirmed by a radiologist were included in this study. All patients' data were extracted from their medical files and then analyzed. Results: A total of 100 patients were enrolled, and the majority (78%) of the cases were male. The mean±SD age of the patients was 40.71±14.071 years, and 55% of the cases had lung injuries (P=0.158). Furthermore, most of the causes of scapular fracture were due to car-motorcycle accidents (30%) and car overturning (27%). Lung contusion (31%) and hemothorax (30%) were the most types of lung injuries. The mean±SD duration of hospitalization was estimated at 4.94±7.90 days. The mean age (OR=-0.207, P=0.039) and intensive care unit admission rate (OR=0.267, P=0.007) were statistically different in patients with and without lung injuries. Conclusion: Although scapula fractures were not significantly associated with lung injuries in this study, the occurrence of 55% of the lung injuries was clinically important, which should be considered by emergency physicians.

Medical Error and Under-Reporting Causes from the Viewpoints of Nursing Managers: A Qualitative Study.

Background: Patient safety as a goal can be achieved by reporting medical errors (ME); however, most errors are never reported. The aim of this study is to explore the causes of ME, and the obstacles in reporting them amongst nurses. Methods: We conducted semi-structural interviews, with 12 nursing managers in the biggest teaching hospital in southern Iran (2015-2016). The interview guide concentrated on the causes of ME and barriers in reporting them. All face-to-face interviews were recorded and transcribed verbatim and analysed using thematic analysis. Results: In this study 4 main themes were extracted for the causes of ME: personal/social characteristics, nonprofessional practice, hospital related factors/organization contextual factors, and poor management. Also, 5 main themes (such as; personal characteristics, fear from reporting, nonprofessional practices, cultural and social factors, and error surveillance system features) were obtained with regards to barriers in reporting. Conclusions: ME can be reduced by improving professional practice and better human resource management. Also, reporting errors can be increased by focusing on cultural and social factors.

Unhealthy Lifestyle Predisposed Shiraz Healthcare Workers to Metabolic Diseases.

Background: Poor health condition may increase the risk of occupational problems and reduces an organization's productivity. Also, there is a direct, bilateral relationship between occupation and health. Objective: To evaluate the health status of health care workers (HCWs) in the largest tertiary general and teaching hospital in southern Iran. Methods: This cross-sectional study (Sep2014-Dec2016) was conducted on HCWs, who were referred to Prevention and Health Promotion Clinic of Shiraz Namazee hospital. The participants' health status was assessed and after the risk assessments and necessary physical examinations, the laboratory and para clinic tests were requested. Using descriptive and analytical tests, all data were analyzed. Results: Totally, 963 HCWs were enrolled, that 64.4% were women, with mean ± SD age of 35.51 ± 8.9 years. Eighty-eight percent and 77.4% of the participants had history of ergonomic and psychological exposures. Impaired glucose tolerance and abnormal serum cholesterol were seen in 13.6% and 29.9%, respectively. Body mass index was a predictive factor for abnormal blood pressure (OR: 1.12; 95%CI: 1.02-1.22), impaired glucose tolerance (OR: 1.08; 95%CI: 1.01-1.16), and abnormal serum cholesterol (OR: 1.17; 95%CI: 1.10-1.25), respectively. Male gender (OR: 1.83; 95%CI: 1.08-3.03) was a predictive factor for abnormal serum cholesterol. Conclusions: The health status of HCWs is not good enough in Iran. They did not have an appropriate lifestyle. They were exposed to different occupational hazards. The prevalence of chronic diseases was notable. Overweight, obesity, and inactivity were the most important causes of metabolic diseases.

Burnout among Healthcare Providers of COVID-19; a Systematic Review of Epidemiology and Recommendations.

INTRODUCTION: In the current systematic review, we intended to systematically review the epidemiology of burnout and the strategies and recommendations to prevent or reduce it among healthcare providers (HCPs) of COVID-19 wards, so that policymakers can make more appropriate decisions. METHODS: MEDLINE (accessed from PubMed), Science Direct, and Scopus electronic databases were systematically searched in English from December 01, 2019 to August 15, 2020, using MESH terms and related keywords. After reading the title and the abstract, unrelated studies were excluded. The full texts of the studies were evaluated by authors, independently, and the quality of the studies was determined. Then, the data were extracted and reported. RESULTS: 12 studies were included. Five studies investigated the risks factors associated with burnout; none could establish a causal relationship because of their methodology. No study examined any intervention to prevent or reduce burnout, and the provided recommendations were based on the authors' experiences and opinions. None of the studies followed up the participants, and all assessments were done according to the participants' self-reporting and declaration. Assessing burnout in the HCPs working in the frontline wards was performed in four studies; others evaluated burnout among all HCPs working in the regular and frontline wards. CONCLUSION: Paying attention to the mental health issues, reducing the workload of HCPs through adjusting their work shifts, reducing job-related stressors, and creating a healthy work environment may prevent or reduce the burnout.

Epidemiology of Influenza in Fars Province, Southern Iran; a Population-Based Study (2015-2019).

BACKGROUND: Influenza is one of the most important viral diseases with high mortality and morbidity that can have a great impact on public health and economy. OBJECTIVE: To investigate the clinical and epidemiological features of influenza virus A/H1N1, A/H3N2, and B infection in Fars province, southern Iran, in 2015-2019. METHODS: In this retrospective cross-sectional study, we assessed the archived data of Syndromic Surveillance System of Iran's Health Ministry, allowed access by Communicable Diseases' Unit of Health chancellor of Shiraz University of Medical Sciences, from December 22, 2015 to September 22, 2019. The participants included all patients whose data were recorded as influenza-like illness (ILI) and severe acute respiratory infections/illness (SARI). Influenza viral infection was confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR). RESULTS: Totally, 1269 patients suspected of influenza were sampled. The mean ± SD of age was 29.40 ± 26.91 years. Fever was the most common symptom (68.6%). The highest incidence was in winter (55.9%). Of 928/1269 laboratory's results which were recorded in the registry, 204 (16.08%) samples were positive and 724 (57.05%) were negative. Among 204 positive results, 191 (15.05%) were influenza type A, and 8 (0.63%) influenza type B. Among patients with definite influenza type A, 34 (2.68%) had H1N1/p subtype, 58 (4.57%) H3N2, and one (0.08%) had other subtypes; however, subtypes were not identified in 7.72% of patients. Six (3.0%) patients with confirmed influenza expired. CONCLUSION: The incidence of influenza, especially type A, in Fars province, southern Iran is considerable and requires more attention for prevention in health policy programs.

Transferred Patients by Fars Province's Helicopter Emergency Medical Service (HEMS); A 2-Years Cross-Sectional Study in Southern Iran.

OBJECTIVE: To investigate the patients transferred by helicopters, as well as an emergent medical services that were performed for them. METHODS: In this retrospective cross-sectional study, all patients who were transferred by Fars province of Helicopter Emergency Medical Services (HEMS) to Shiraz hospitals, southern Iran (March 2017-March 2019) were investigated. Patients' information was collected and analyzed includes age, gender, dispatch reason, trauma mechanisms, take hold of emergent medical services, as well as the air transportation time, time between dispatch from the origin hospital and starting the procedures, and patients' outcome. RESULTS: Eighty-three patients were enrolled with the mean±SD age of 36.9±19.47 years that 75.9% had trauma (p<0.0001). Mental status deterioration (25.3%) was the most dispatched indications. The mortality rate was 13.25% totally (11.11% in traumatic vs. 10% in non-traumatic). The mean±SD of air transportation time was significantly lower than ground transportation in both traumatic (p=0.0013) and non-traumatic (p<0.0001) patients. Also, the mean±SD of time between dispatch from the origin hospital and starting the procedures was statistically lower in air transportation in both traumatic (p=0.0028) and non-traumatic (p=0.0017) patients. CONCLUSION: Most of the patients transferred by HEMS were traumatic. The air transportation time as well as the time between dispatches from the origin hospital to the starting of the procedures were significantly lower in HEMS in comparison with ground transportation for both traumatic and non-traumatic patients.