RESUMEN
Background: Many people worldwide have developed a combination of natural and vaccine-induced immunity to COVID-19. This study investigated whether exposure to SARS-CoV-2 before full vaccination promotes protection against a breakthrough infection. Methods: We studied a total of 2,902,545 people in the Isfahan COVID-19 Registry. All the participants had received two doses of either Sinopharm BIBP, ChAdOx1-nCoV-19, Gam-COVID-Vac, or BIV1-CovIran vaccines. A cohort study examined the association between prior COVID-19 infection and the risk of a breakthrough infection for each vaccine. Cohorts in each pair were matched by gender, age group, calendar week of the first dose, the interval between the first and second doses, and the proportion of healthcare workers. The probable virus variant for the previous infections was also considered. Each individual's follow-up started 14 days after their second vaccine dose until either the end of the study censoring date, occurrence of a COVID-19 infection, or death. The breakthrough infection risk was compared between each cohort pair by using the hazard ratio (HR) and incidence rate ratio (IRR). Results: Total breakthrough HRs (95% confidence interval) (previously infected over infection-naïve matched cohort) were 0.36 (0.23-0.55), 0.35 (0.32-0.40), 0.37 (0.30-0.46), and 0.43 (0.32-0.56) for the BIV1-CovIran, Sinopharm BIBP, Gam-COVID-Vac, and ChAdOx1-nCoV-19 vaccine groups, respectively. The breakthrough infection IRRs were approximately similar to the total HRs mentioned above. Conclusion: Prior SARS-CoV-2 infection conferred additive immunity against breakthrough after vaccination, no matter which vaccine brand was injected. Such a result could guide health authorities to codify low-cost high-benefit vaccination protocols and protect the community's well-being.
RESUMEN
BACKGROUND AND AIM: Gestational diabetes mellitus (GDM) is one of the most prevalent disorders occurring during pregnancy, which confers significant risk of short and long-term adverse outcomes in both mothers and offspring. Recently, more attention has been paid to the association of pre-pregnancy and early pregnancy healthy dietary patterns, such as Mediterranean dietary pattern with GDM. However, there is a lack of systematic review and meta-analysis summarizing findings in this regard. Hence, we sought to assess the association of MedDiet and GDM in observational studies by performing a systematic review and meta-analysis. METHODS: A comprehensive systematic literature search of observational studies was conducted via PubMed, Scopus, and Google Scholar, up to August 2023. Studies were included in our review if they evaluated the association of MedDiet and GDM, following an observational study design. RESULTS: Ten studies were included in this study. Combining effect sizes, we found that adherence to MedDiet was inversely associated with GDM risk (OR = 0.64; CI: 0.52-0.78); implying that higher adherence to the MedDiet could reduce the risk of GDM by about 36%. Stratification by the geographic area, Mediterranean countries, time of dietary assessment and study design, showed a consistent significant association between MedDiet and GDM. CONCLUSION: We conclude that adhering to diets resembling MedDiet, before or in early pregnancy, could be associated with lower risks or odds of GDM.
Asunto(s)
Diabetes Gestacional , Dieta Mediterránea , Estudios Observacionales como Asunto , Humanos , Diabetes Gestacional/epidemiología , Diabetes Gestacional/prevención & control , Embarazo , Femenino , Factores de Riesgo , Cooperación del Paciente , Adulto , Patrones DietéticosRESUMEN
BACKGROUND: We carried out the current study to compare COVID-19-related hospitalization and mortality rates between people living with multiple sclerosis (PLWMS) and MS-free controls from the Isfahan general population. METHOD: In this retrospective population-based study, we used available data from four datasets of Isfahan University of Medical Sciences from January 1, 2020, to August 22, 2021. Data on all PLWMS, SARS-CoV-2 polymerase chain reaction (PCR) and rapid antigen test, hospitalization, and death were included. We compared the odds of COVID-19-related hospitalization and mortality between PLWMS and the control group before and after adjustment for age and sex. We categorized all people into young (18-49 years) and old age (50-79 years) groups and compared the hospitalization rate between people with and without MS. RESULTS: In total, 829 PLWMS and 2494 MS-free controls with confirmed COVID-19 were included. Hospitalization rates among PLWMS and MS-free controls were 16.2% and 16.5% (crude OR= 0.978, 95%CI: 0.79, 1.21). In the adjusted model, PLWMS with COVID-19 had 56% increased odds of hospitalization (OR=1.56, 95%CI: 1.23, 1.97). During follow-up, there were 11 (1.3%) and 49 (2%) COVID-19-related deaths among PLWMS and MS-free controls, respectively. No significant difference between people with and without MS in COVID-19-related mortality rate was observed (crude OR= 0.678, 95%CI: 0.351, 1.31; adjusted OR=2.013, 95%CI: 0.95, 4.26). We found increased odds of hospitalization in young PLWMS compared to those without MS at the same age (OR=1.699, 95%CI: 1.289, 2.240). But, no difference between older people with and without MS was detected (OR=1.005, 95%CI: 0.662, 1.524). CONCLUSION: This study revealed higher odds of hospitalization and mortality due to COVID-19 among PLWMS in comparison to age- and sex-matched controls from the general population. Nevertheless, it remains unclear whether the elevated odds are directly associated with MS itself or if they are influenced by factors such as rituximab using, comorbidity, and disease severity.
Asunto(s)
COVID-19 , Esclerosis Múltiple , Humanos , Anciano , Persona de Mediana Edad , COVID-19/epidemiología , SARS-CoV-2 , Estudios Retrospectivos , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/terapia , Comorbilidad , HospitalizaciónRESUMEN
Background: Health-care workers (HCWs) are in the frontline for fighting the coronavirus disease 2019 (COVID-19) pandemic and are at higher risk of acquiring the infection. Therefore, the defining immunity status among HCWs helps mitigate the exposure risk. In this study, we investigated the anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) and also the associated risk factors in the HCWs working in Isfahan University of Medical Sciences COVID-19 referral hospitals. Materials and Methods: In a cross-sectional study, demographics, COVID-19 symptoms during the past 2 weeks, and health-care details were collected from 200 consenting health workers of COVID-center-hospitals of Isfahan University of Medical Sciences from 23 October to 21 December 2020. The recombinant SARS-CoV2 nucleocapsid protein enzyme-linked immunosorbent assay-based IgM, and IgG antibody tests were evaluated. Data were analyzed using Chi-square and independent-t-student tests, and P < 0.05 was considered significant. Results: One hundred and forty-one women and 59 men with a mean age of 36.4 ± 7.77 years participated in the study. IgG Ab and IgM Ab were positive in 77 (38.5%) and 12 (6%) of samples, respectively, and both antibodies were detected in 9 (4.5%). Higher ages, direct contact with the patients with COVID-19, muscle pain, loss of taste and smell, fever, and cough were the factors associated with antibody seropositivity against SARS-CoV2. Conclusion: This study demonstrated that the prevalence of HCWs with antibodies against SARS-CoV-2 is relatively high in Isfahan University referral hospitals. The development of safety protocols and screening and vaccination strategies in the frontline HCWs must be implemented to reduce the burden of infection.
RESUMEN
BACKGROUND: The coronavirus disease 2019 (COVID-19) causes acute respiratory illness and multi-organ failure. The critical roles of magnesium in human health suggest that it could have an active role in the prevention and treatment of COVID-19. We measured magnesium levels in hospitalized COVID-19 patients concerning disease progression and mortality. MATERIALS AND METHODS: This study was conducted in 2321 hospitalized COVID-19 patients. Clinical characteristics from each patient were recorded, and blood samples were collected from all patients upon their first admission to the hospital to determine serum magnesium levels. Patients were divided into two groups based on discharge or death. The effects of magnesium on death, severity, and hospitalization duration were estimated by crude and adjusted odds ratio using Stata Crop (version 12) software. RESULTS: Mean magnesium levels in patients who died were higher than in discharged patients (2.10 vs 1.96 mg/dl, p 0.05). CONCLUSIONS: We found no relation between hypomagnesaemia on COVID-19 progression, although hypermagnesaemia could affect COVID-19 mortality (Tab. 4, Ref. 34).
Asunto(s)
COVID-19 , Humanos , Magnesio , SARS-CoV-2 , HospitalizaciónRESUMEN
Background: Coronavirus disease 2019 has become a public health concern with a high number of fatalities. Thalidomide can target inflammatory mediators and decrease inflammation in SARS-CoV-2. Materials and Methods: An open-label, randomized controlled trial was conducted on patients with compatible lung high-resolution computed tomography scan for COVID-19 pneumonia and moderate involvement. Childbearing-age women were excluded. A total of 20 patients in the control group receiving usual treatment were compared with 26 patients in the case group who in addition to the same regimen also received thalidomide. The primary outcome was time for clinical recovery (TTCR) and intensive-care unit (ICU) admission. Results: From April 25 to August 8, 2020, based on the inclusion criteria, 47 patients were assigned to the study. Patients receiving thalidomide had a mean TTCR of days 5.5 (95% confidence interval [CI], 0.7-10.3), as compared with days 5.3 (95% CI, 1.7-8.9) with control (odds ratio 0.01; 95% CI, -1.58-1.59, P = 0.807). The incidence of ICU admission was 27% in the thalidomide group compared with 20% in the control group (odds ratio 3.89; 95% CI, 0.55-27.4, P = 0.425). The mean length of stay in hospital in both groups was 10 days. Progressive improvement in respiratory rate, fever, and O2 saturation during the study was seen in both groups without a significant difference between the thalidomide and control group (P > 0.05). Conclusion: This study investigated the effects of thalidomide to treat moderate COVID-19 clinical outcomes. The results established that this drug regimen did not add more effect to usual treatment for moderate COVID-19 pneumonia.
RESUMEN
Background: Preeclampsia, a pregnancy-specific complication, has been associated with cytomegalovirus (CMV) infection in observational studies. CMV-specific T cell response plays a major role in viremia clearance. We explored whether CMV-specific cell-mediated immunity (CMI) status is associated with preeclampsia in pregnant women. Materials and Methods: CMV-specific CMI was assessed using CMV-QuantiFERON (QF-CMV) assay in plasma serum of 35 women with preeclampsia as well as 35 normal pregnant controls, retrospectively. Participants were matched for gestational age in a 1:1 ratio. The proportion of reactive results, the mean value of interferon-gamma (IFN-γ) level produced in mitogen and antigen tubes were compared between the cases and controls through Chi-square and Wilcoxon rank-sum tests, respectively. The odds ratio and confidence interval were calculated as well. Results: No significant differences observed between demographic characteristics of the case and control groups. The QF-CMV assay turned reactive (QF-CMV [ + ]) Women with preeclampsia had lower mean IFN-γ levels in antigen tube compared with normal pregnant controls. There were no statistically significant differences in the value of mitogen tube between case and controls women with suppressed CMV-CMI were 6.3 times more likely to have preeclampsia. This result even strengthened after adjustment for age, gestational age, and gravidity. Conclusions: Our findings support an association between suppressed CMV-specific CMI and preeclampsia.
RESUMEN
This study aimed to investigate the effect of role-playing and lecture on improving the attitudes of the Khorramabad suburban population toward the human immunodeficiency virus (HIV). In 2019, 270 people aged 18 and above participated in a randomized controlled trial in Khorramabad, Iran. Individuals were randomly assigned to one of three groups: role-playing, lecture, or control. To collect data before and after the intervention, we used a standard HIV knowledge and attitude questionnaire. Before the educational intervention, three marginalized groups' attitudes toward HIV were stigmatized. After the intervention, the attitudes of both the role-playing and lecture groups improved significantly relative to the control group (P<0.0001); there was no significant difference between the two methods (P>0.05). The correlation between attitude and knowledge scores was positive (P<0.0001). This study demonstrates that education is a fundamental pillar of improving attitudes toward people living with HIV (PLHIV) and can reduce stigma against them, thereby increasing their desire to disclose their condition and seek medical care. Trial registration: The trial registration code is IRCTID: IRCT20190807044467N1 (https://en.irct.ir/trial/41464).
RESUMEN
BACKGROUND: The objective of the present study was to estimate the effectiveness of the BBIBP-CorV vaccine (VE) in preventing SARS-CoV-2 infection, related hospitalization, and death among people living with multiple sclerosis (PLWMS). METHODS: In this population-based retrospective observational study, data on all PLWMS, vaccination, SARS-CoV-2 tests, hospitalization, and deaths were collected in Isfahan, Iran between February 9, 2021, and November 4, 2021. We estimated the hazard ratio between vaccinated (partially and fully) and unvaccinated groups using the Andersen-Gill extension of the Cox proportional hazards model. We also performed Cox proportional hazards analysis to identify risk factors for breakthrough infection and COVID-19-related hospitalization in fully-immunized group. RESULTS: Of the 9869 PLWMS, 1368 were in partially-vaccinated group, 4107 were in the fully-vaccinated group, and 3794 were in the unvaccinated group. In the partially-vaccinated group, the estimated VE against COVID-19 infection was 39.3% (16%, 56.1%), hospitalization was 64.9% (1.3%, 87.5%), and mortality was 92.7% (88.8%, 100%). The respective results for the fully-vaccinated group were 63.9% (56%, 70.3%), 75.7% (57.5%, 86.1%), and 100%. Progressive MS was independently associated with a greater risk of breakthrough infection (HR=1.952, 95%CI: 1.174-3.246, p = 0.010). Older adults (≥50 years vs. 18-49 years, HR=3.115, 95%CI: 1.145-8.470, p = 0.026) and those on rituximab (HR=7.584; 95% CI: 1.864-30.854; p = 0.005) were at an increased risk of COVID-19-related hospitalization. CONCLUSION: This study showed that two doses of the BBIBP-CorV vaccine can effectively prevent COVID-19 infection and hospitalization among PLWMS. Old PLWMS and those who treating with rituximab are at increased risk of hospitalization after receiving two doses of the vaccine.
Asunto(s)
COVID-19 , Esclerosis Múltiple , Vacunas , Humanos , Anciano , COVID-19/prevención & control , ARN Viral , SARS-CoV-2 , Esclerosis Múltiple/complicaciones , Rituximab , Infección IrruptivaRESUMEN
Objectives. To investigate the prevalence, pattern, and socioeconomic risk factors of intimate partner violence (IPV) before and 6 months after the pandemic onset among a cohort of Iranian women. Methods. We conducted a population-based IPV survey among 2502 partnered Iranian women aged 18 to 60 years before (n = 2502) and 6 months after (n=2116) the pandemic's onset. We estimated prevalence and incidence of psychological, physical, and sexual IPV, and the odds of different forms of IPV associated with main exposure variables, adjusted for participant relationship factors. Results. Pandemic prevalence of IPV (65.4%; 95% confidence interval [CI] = 63.4%, 67.4%) was higher than prepandemic prevalence (54.2%; 95% CI = 52.2%, 56.3%). At follow-up, the incidence of IPV was 25.5% (95% CI = 22.9%, 28.4%). The highest incidence was in cases of physical and sexual IPV. Women whose partners lost their employment were at significant risk of new exposure to IPV. Highest socioeconomic status (SES) was associated with less physical IPV (odds ratio = 0.03; 95% CI = 0.01, 0.14). Conclusions. IPV prevalence has risen since the COVID-19 epidemic began with many women who had never experienced IPV now facing it. Unemployment of women or their partners and prepandemic lower socioeconomic status are risk factors of IPV. Monitoring programs should target these populations. (Am J Public Health. 2023;113(2):228-237. https://doi.org/10.2105/AJPH.2022.306839).
Asunto(s)
COVID-19 , Violencia de Pareja , Humanos , Femenino , Irán/epidemiología , Pandemias , Estudios de Cohortes , COVID-19/epidemiología , Parejas Sexuales/psicología , Factores de Riesgo , Factores Socioeconómicos , PrevalenciaRESUMEN
Background: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections. The role of probiotics in preventing VAP is still questionable. This study aimed at evaluating the effect of synbiotic FamiLact 2plus on the prevention of VAP in patients admitted to the intensive care unit (ICU). Methods: A total of 80 mechanically ventilated patients were included and divided into two groups of 40. Group 1 received FamiLact 2plus, and group 2 received placebo. The outcome variables were compared, including the incidence of VAP, the time interval between the onset of ventilation and VAP, the duration of mechanical ventilation, and the length of stay in the ICU. Results: VAP is documented in four patients (10%) in group 1 and 11 patients (27.5%) in group 2 (P = 0.045). The length of stay in the ICU in group 1 was significantly shorter than in group 2, and the time interval between the start of intubation and the onset of VAP in group 1 was longer than in the placebo group. During the intervention, 15 patients in group 1 (37.5%) and 26 patients in group 2 (65%) developed diarrhea, which was a significant difference (P = 0.02). Conclusions: Synbiotic is associated with a reduction in the incidence of VAP as well as a reduction in ICU stay and delayed VAP.
RESUMEN
Background: Cancer patients, as a highly vulnerable population, are receiving a great deal of attention in the current crisis of coronavirus 2019 (COVID-19). To date, shreds of evidence are not sufficient to the description of COVID-19 outcomes in patients with cancer. This study was performed to evaluate the demographic and clinical characteristics and subsequent outcomes of COVID-19 in cancer patients. Materials and Methods: A hospital-based study was conducted involving 66 cancer patients with a confirmed diagnosis of COVID-19 from January 15, 2020, to December 21, 2020, in Isfahan, Iran. The clinical information was collected by interview and medical records. The statistical analyses were performed to describe categorical variables as well as mean, standard deviation, median, and the interquartile range for quantitative variables. Results: In our study, 66 cancer patients with confirmed COVID-19 (age: 17-97 years; 50% female) were included. Leukemia and bone marrow cancer with a frequency of 25.7% were the most common types of cancer among them. Cancer patients mostly complained of fever, cough and fatigue, and shortness of breath. Among 76.9% of patients discharged from the hospital with relative recovery, 23% died; the most common cause of death was acute respiratory distress syndrome. Age, gender, and type of cancer did not affect cancer mortality. COVID-19 had no potential effect to increase the risk of side effects of anticancer therapies. Conclusion: The results of our studies revealed that cancer is an important risk factor for the higher rate of mortality in patients with COVID-19. These findings could help physicians for the management, treatment, and supportive care of COVID-19 cancer patients.
RESUMEN
Background: The Isfahan COVID Cohort (ICC) study was designed to investigate the short- and long-term consequences of patients with COVID-19 in Iran. This report presents the rationale, methodology, and initial results of ICC. Materials and Methods: ICC is a 5-year multicentric prospective cohort study that is ongoing on two groups including 5000 patients hospitalized with moderate or severe and 800 nonhospitalized patients with mild or asymptomatic COVID-19 in Isfahan. The ICC endpoints are morbidity, mortality, incident cases, or worsening of underlying noncommunicable diseases (NCDs) and their risk factors. In the current analysis, we examined the persistent symptoms and incident NCDs or risk factors in 819 previously hospitalized patients who completed 1-year follow-up. Results: The two most common symptoms were joint pain/myalgia (19.7%) and dry cough/dyspnea (18.7%). Around 60% of patients had at least one symptom which was more common among women than men and in middle aged than younger or older patients. Female (odds ratio [OR] =1.88, 95% confidence interval [CI]: 1.39-2.55) and highly-educated patients (OR = 2.18, 95% CI: 1.56-3.04) had higher risk of having any symptom in 1-year follow-up. New cases of hypertension followed by diabetes then coronary heart disease (CHD) were the most common incident NCDs. Conclusion: During 1-year follow-up after hospital discharge, about 60% of patients experienced persistent symptoms. Incident hypertension, diabetes, and CHD were the most common events seen. Close monitoring and extensive health services with integrative approaches are needed to improve the health status of these patients.
RESUMEN
BACKGROUND: We conducted this study to compare the risk of reinfection between multiple sclerosis (MS) patients and a control group without MS. METHOD: In this retrospective study, data of all SARS-CoV-2 tests (n = 793,301) and almost all MS patients (n = 10,639) in Isfahan province were collected from January 01, 2020 to August 22, 2021. Of the 2196 MS patients and 793,301 persons from the general population who had been tested at least once, 3 control for each MS patient were identified, leaving 1560 MS patients and 4680 controls without MS. We compared the risk of reinfection after 90 days of a primary infection between those with and without a previous positive COVID-19 test. RESULTS: 736 (47.2%) MS patients and 2013 (43.0%) control individuals had at least one positive test. A total of 17 (2.3%) and 22 (1.1%) possible reinfections in MS and control groups were observed. The estimated protection against reinfection in all MS patients, MS patients on rituximab, MS patients on DMTs rather than rituximab, and controls were 68.2% (46.2, 81.2%), 57.4% (- 0.1, 83.1%), 71.5% (45.5, 85.2%), and 82.1% (72.1, 88.5%), respectively. We found no statistically significant difference in estimated protection (p = 0.123) and odd of reinfection (adjusted OR: 2.01 [0.98, 4.08]) between all MS patients and control group. Two patients were hospitalized at first infection but none required hospitalization at reinfection event. CONCLUSIONS: MS patients on rituximab may be at a greater risk of reinfection. Further studies are required to assess the risk of the second reinfection among the MS population.
Asunto(s)
COVID-19 , Esclerosis Múltiple , COVID-19/epidemiología , Humanos , Esclerosis Múltiple/epidemiología , Reinfección/epidemiología , Estudios Retrospectivos , Rituximab , SARS-CoV-2RESUMEN
Purpose: There is a lack of information of the difference in sex-aggregated prevalence of comorbid noncommunicable disease (NCD) in patients hospitalized with COVID-19 in Iran. This study aimed to evaluate sex differences in the relation between medical comorbidities and subsequent death in patients hospitalized with COVID-19. Methods: All subsequently hospitalized patients with a diagnosis of moderate to severe COVID-19 since February 19th to June 14th, 2020, in Isfahan, Iran, were recruited in the ongoing I-CORE Registry. Real-time reverse-transcription polymerase chain reaction (RT-PCR) testing was done upon admission. Data on preexisting comorbid NCDs including hypertension, coronary heart disease (CHD), diabetes mellitus (DM), cancers, chronic renal disease (CRD), and chronic respiratory disease were collected through self-reported questionnaires. Results: Overall, 12,620 individuals were enrolled in this registry of which 4,356 were positive for the COVID-19 RT-PCR test. In the whole population, in women, DM, hypertension, and CHD, and in men, DM, CHD, and hypertension were, respectively, the most frequent comorbidities. The frequency of at least one NCD did not differ between men and women, but a greater proportion of women had two or more NCDs. Increasing the number of comorbidities was associated with higher death frequency and mortality risk in the unadjusted model but remained no longer significant after adjustment for age. There was no statistically significant difference in this regard between men and women. Conclusion: Overall, we found that DM, hypertension, and CHD were the most frequent comorbidities. Although comorbidities were more frequent among women, mortality risk did not significantly differ between men and women.
RESUMEN
Background: Since December 2019, the world is struggling with an outbreak of coronavirus disease-2019 (COVID-19) infection mostly represented as an acute respiratory distress syndrome and has turned into the most critical health issue worldwide. Limited information is available about the association between dynamic changes in the naso/oropharyngeal viral shedding in infected patients and biomarkers, aiming to be assessed in the current study. Materials and Methods: This quasi-cohort study was conducted on 31 patients with moderate severity of COVID-19 manifestations, whose real-time polymerase chain reaction (RT-PCR) test was positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) RNA at baseline. RT-PCR was rechecked for patients every 3-4 days until achieving two negative ones. In parallel, biomarkers, including lymphocyte count, lactate dehydrogenase (LDH), and C-reactive protein (CRP), were assessed every other day, as well. Viral shedding also was assessed. Results: Spearman's correlation test revealed a significant direct correlation between the viral shedding from the symptom onset and the time, in which CRP (P = 0.0015, r = 0.54) and LDH (P = 0.001, r = 0.6207) return to normal levels after symptom onset, but not for lymphocyte count (P = 0.068, r = 0.34). Conclusion: Based on the current study's findings, the duration of SARS-CoV-2 RNA shedding was directly correlated with the required time for LDH and CRP return to normal levels. Therefore, these factors can be considered the determinants for patients' discharge, isolation, and return to social activities; however, further investigations are required to generalize the outcomes.
RESUMEN
OBJECTIVE: There is no conclusive evidence to suggest vitamin D level can prevent or treat infection with the new coronavirus disease 2019. This study aimed to investigate the effects of serum level of vitamin D in patients with coronavirus disease 2019 on death, severity, and hospitalization duration. MATERIALS AND METHODS: Baseline characteristic of patients was extracted from the Isfahan coronavirus disease 2019 registry database (I-CORE). Blood samples were taken from all patients to measure the level of vitamin D (25-hydroxyvitamin D) and categorized. The effect of 25(OH) D on death, severity, and hospitalization duration was analyzed by logistic regression. RESULTS: Among our study patients, 5.5% had a severe deficiency of vitamin D, 23.7% deficiency, and 24.8% insufficiency. Of the 107 patients who died, 7.5% were severely deficient in vitamin D. We found that vitamin D deficiency had no significant effect on death, disease severity, and hospitalization (P > .05). However, having at least one comorbidity increased the odds of death five times after adjusting age > 60 years and gender (P < .0001). The results showed that among all comorbidities, diabetes has the greatest impact on the outcomes as it raised the odds of death, disease severity, and length of hospital stay by 2.23,1.72, and 1.48, respectively, after controlling the age > 60 and gender (P = .0002, P=.08, P=.012). CONCLUSIONS: The mortality, disease severity, and hospitalization of coronavirus disease 2019 patients seem to be not affected by the low levels of 25(OH)D. However, the synergy between vitamin D levels and comorbidities, age, and gender could affect the outcome of coronavirus disease 2019 patients.
RESUMEN
INTRODUCTION: Cough is one of the most common presenting symptoms of COVID-19, which can persist for weeks or months. OBJECTIVE: The goal of this study was to evaluate the effectiveness of gabapentin (GBT) alone and in combination with montelukast (MTL) for improving cough. METHODS: In this open-label randomized controlled clinical trial, eligible cases were patients hospitalized with moderate to severe COVID-19 who had cough with a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 2 based on its cough subscale. The participants were randomly assigned to three groups including two experimental groups and one control group. The first and second experimental groups received GBT and GBT/MTL, respectively, whereas the control group received dextromethorphan (DXM). Treatment duration was 5 days in all groups. Before and after the interventions, the severity of cough was evaluated using BCSS scale and Visual Analog Scale (VAS). RESULTS: A total of 180 patients were included; GPT, GPT/MTL, and DXM consisted of 76, 51, and 53 patients, respectively. There was no significant difference between the three groups in terms of age, gender, and comorbidities (P > 0.05). Regarding BCSS and VAS scores, there was significant reduction from the baseline values in all groups (P < 0.0001), with the change rate being significantly higher in DXM group. The amount of reduction of BCSS in the GPT/MTL group was significantly more than the GPT group, whereas there was no significant difference between the two groups regarding VAS score. Although the duration of hospitalization differed between the groups with the GPT/MTL group having the shortest duration, the difference was statistically significant only between the GPT and GPT/MTL groups (P < 0.0001). CONCLUSION: GPT, both alone and in combination with MTL, improves cough frequency and severity in hospitalized patients with COVID-19, with the combination being more efficacious. This regimen may be useful in patients who cannot tolerate opioids.
Asunto(s)
Tratamiento Farmacológico de COVID-19 , COVID-19 , Acetatos , COVID-19/complicaciones , Tos/tratamiento farmacológico , Tos/etiología , Ciclopropanos , Dextrometorfano/uso terapéutico , Gabapentina/uso terapéutico , Humanos , Quinolinas , SARS-CoV-2 , Sulfuros , Resultado del TratamientoRESUMEN
The challenges of the invasive infections caused by the resistant Aspergillus species include the limited access to antifungals for treatment and high mortality. This study aimed to provide a global perspective of the prevalence of amphotericin B resistance (AmBR), geographic distribution, and the trend of AmBR from 2010 to 2020. To analyze the prevalence of in vitro AmBR in clinical Aspergillus species, we reviewed the literature and identified a total of 72 articles. AmBR was observed in 1128 out of 3061 Aspergillus terreus (36.8%), 538 out of 3663 Aspergillus flavus (14.9%), 141 out of 2691 Aspergillus niger (5.2%), and 353 out of 17,494 Aspergillus fumigatus isolates (2.01%). An increasing trend in AmB-resistant isolates of A. fumigatus and a decreasing trend in AmB-resistant A. terreus and A. flavus isolates were observed between 2016 and 2020. AmB-resistant A. terreus and A. niger isolates, accounting for 40.4% and 20.9%, respectively, were the common AmB-resistant Aspergillus species in Asian studies. However, common AmB-resistant Aspergillus species reported by European and American studies were A. terreus and A. flavus isolates, accounting for 40.1% and 14.3% in 31 studies from Europe and 25.1% and 11.7% in 14 studies from America, respectively. The prevalence of AmB-resistant A. niger in Asian isolates was higher than in American and European. We found a low prevalence of A. terreus in American isolates (25.1%) compared to Asian (40.4%) and European (40.1%). Future studies should focus on analyzing the trend of AmBR on a regional basis and using the same methodologies.
Asunto(s)
Anfotericina B , Aspergillus , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , Prevalencia , Pruebas de Sensibilidad Microbiana , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Farmacorresistencia FúngicaRESUMEN
BACKGROUND: One of the most common knee problems is patellofemoral pain syndrome (PFPS). It is of great importance to pay attention to the muscles of the hip area in people with PFPS, especially to the presence of trigger points within the gluteus medius (GM). Accordingly, using therapeutic interventions to eliminate trigger points is required. Therefore, the aim of the present study was to evaluate the effect of GM active trigger point dry needling (TrP-DN) on pain and physical function of non-athlete women with unilateral PFPS. METHODS: 29 young non-athlete women aged between 17 and 40 years old with unilateral PFPS were randomly divided into two groups of experimental (n = 15) and control (n = 14) through the simple and convenience sampling method. Both groups received conventional physiotherapy twice a week up to 6 sessions. The experimental group also received GM active TrP-DN once a week for 3 sessions in addition to the conventional physiotherapy. Pain intensity and physical function of women with PFPS were measured in both groups in three stages of before, immediately after and one week after performing the treatment sessions. FINDINGS: The six-session physiotherapy treatment led to a significant reduction in pain intensity as well as an improvement in physical function in both groups (p < 0.001). In addition, the intergroup comparison showed a significant improvement in physical function of the experimental group after one week from the GM active TrP-DN, compared to the control group (p = 0.048). CONCLUSION: The present study indicated that conventional physiotherapy with or without GM active TrP-DN can reduce pain and improve physical function in non-athlete women with unilateral PFPS. This study also revealed that conventional physiotherapy combined with dry needling can lead to further reduction in pain and a greater improvement in physical function of this group of patients.