Hospital capacities and response to COVID-19 pandemic surges in Iran: A quantitative model-based study.

The coronavirus 2019 (COVID-19) pandemic resulted in serious limitations for healthcare systems, and this study aimed to investigate the impact of COVID-19 surges on in-patient care capacities in Iran employing the Adaptt tool. Using a cross-sectional study design, our study was carried out in the year 2022 using 1-year epidemiologic (polymerase chain reaction-positive COVID-19 cases) and hospital capacity (beds and human resource) data from the official declaration of the pandemic in Iran in February 2020. We populated several scenarios, and in each scenario, a proportion of hospital capacity is assumed to be allocated to the COVID-19 patients. In most of the scenarios, no significant shortage was found in terms of bed and human resources. However, considering the need for treatment of non- COVID-19 cases, in one of the scenarios, it can be observed that during the peak period, the number of required and available specialists is exactly equal, which was a challenge during surge periods and resulted in extra hours of working and workforce burnout in hospitals. The shortage of intensive care unit beds and doctors specializing in internal medicine, infectious diseases, and anesthesiology also requires more attention for planning during the peak days of COVID-19.

Epidemiological features, antimicrobial resistance profile and clinical outcomes of healthcare-associated infections in Islamic Republic of Iran.

Background: Healthcare-associated infections are a major cause of mortality worldwide, especially in intensive care units where severely ill patients have limited physical space. Aims: To investigate the incidence, microbial aetiology, antimicrobial resistance profile, and mortality rate of healthcare-associated infections in intensive care units in the Islamic Republic of Iran. Methods: This observational study retrospectively reviewed the medical records of 1722 intensive care units patients with confirmed healthcare-associated infections at hospitals affiliated with Mashhad University of Medical Sciences in 2017-2019. Data was analysed using SPSS for Windows version 11. Categorical variables were described using frequency and percentage, whereas continuous variables were defined using mean (standard deviation) with 95% confidence interval (CI) for precision. Logistic regression analysis was used to estimate crude odds ratio (OR) and adjusted OR (AOR) with 95% CI, and to identify univariate and multivariate predictors of healthcare-associated infection mortality. Results: In total, 4077 pathogens were isolated, yielding a healthcare-associated infection incidence rate of 22.1%. The most common microorganisms were Acinetobacter spp. (25.0%), Klebsiella spp. (15.1%), Staphylococcus spp. (14.0%), and Candida spp. (12.3%). Ventilator-associated events (39.5%), urinary tract infections (22.7%), and bloodstream infections (14.8%) were the main types of infection. Comorbidities, skin and soft tissue infections, and infections with Acinetobacter spp., Klebsiella spp., Pseudomonas spp., and Candida spp. were significantly associated with higher mortality among intensive care unit patients. Gram-positive bacteria were most resistant to ciprofloxacin (49.2%), clindamycin (38.0%), and erythromycin (37.1%). Gram-negative bacteria were most resistant to ceftazidime (71.0%), ciprofloxacin (65.2%), and cefotaxime (60.5%). The overall mortality rate was 45.2%. Conclusion: Healthcare-associated infections in nearly half of intensive care unit patients were fatal, especially when caused by Acinetobacter spp., Klebsiella spp., Pseudomonas spp., or Candida spp. Therefore, effective strategies must be implemented to combat antibiotic-resistant bacteria, along with stricter adherence to infection control programmes.

Vaccination effects on reducing COVID-19 complications in pregnancy: A large-scale report from Iran.

OBJECTIVE: The objective of this study was to evaluate the effects of maternal coronavirus disease 2019 (COVID-19) vaccination on preventing severe complications of COVID-19 in pregnant women. METHODS: A retrospective study was conducted in pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy and/or for up to 6 weeks postpartum between September 1, 2021, to January 30, 2022. The data was retrieved from a national database. The pregnant women were divided into two groups of vaccinated and unvaccinated. The proposed outcomes (the need for hospitalization, intensive care unit admission, and mechanical ventilation and products of conception complications) were compared between the two groups. RESULTS: Approximately 90 000 pregnant women infected with COVID-19 were included in the study. The data of the vaccinated (19 922) and unvaccinated (70 147) groups were analyzed and compared. Pregnant patients in the vaccinated group had a significantly lower rate of hospitalization (21.2% vs 29.4%) (odds ratio [OR], 0.648 [95% confidence interval (CI), 0.625-0.673], P = 0.0001) and intensive care unit admission (3.7% vs 7.8%) (OR, 0.453 [95% CI, 0.382-0.535], P = 0.0001). The need for mechanical ventilation was also lower, although not statistically significant, in the vaccinated group than in the unvaccinated group (30 of 155 [19.4%] vs 418 of 1597 [26.2%]) (OR, 0.677 [95% CI, 0.448-1.024], P = 0.063). Cesarean section (54.3% vs 58.1%) (OR, 0.856 [95% CI, 0.751-0.977], P = 0.021) and stillbirth (0.4% vs 3.6%) (OR, 0.097 [95% CI, 0.026-0.252], P = 0.0001) were also significantly lower in the vaccinated patients. Most pregnant women in the vaccinated group (18 484-96.14%) received Sinopharm BIBP COVID-19 inactivated vaccine. No significant differences were seen in the effect of different types of COVID-19 vaccines on reducing COVID-19 complications in infected pregnant patients. CONCLUSION: Maternal COVID-19 immunization is effective in reducing COVID-19 complications in infected pregnant women.

The Association of Acute Watery Diarrhea in Iranian Pilgrims of Iraq with Cholera Cases in Iranians.

Background: Despite the advances in the control of infectious diseases like cholera, they can potentially cause epidemics, especially in mass gathering events. One of the most important countries on the walking way of the Arbaeen religious event is Iran, which requires health system preparedness. The aim of this study was to predict the cholera epidemic in Iran by using the syndromic surveillance system of Iranian pilgrims in Iraq. Methods: The data of the Iranian pilgrims with acute watery diarrhea in Iraq during the Arbaeen religious event and the confirmed cholera cases of pilgrims after returning to Iran were analyzed. We used the Poisson regression model of the relationship between the numbers of cases to evaluate acute watery diarrhea and cholera. Spatial statistics and hot spot analysis were used to identify the provinces with the highest incidence. SPSS software Version 24 was used for statistical analysis. Results: The frequency of acute watery diarrhea cases was 2232 and the frequency of cholera in pilgrims after returning to Iran was 641. The results of spatial analysis for acute watery diarrhea cases showed a high number of acute watery diarrhea cases in the Khuzestan and Isfahan provinces, located in hot spots. Using Poisson regression, the relationship between the number of acute watery diarrhea reported in the syndromic surveillance system and the number of cholera cases was confirmed. Conclusion: The syndromic surveillance system is useful to predict the outbreak of infectious diseases in large religious mass gatherings.

Performance of discrete wavelet transform-based method in the detection of influenza outbreaks in Iran: An ecological study.

Background and Aim: Timely detection of outbreaks is one of the main purposes of the health surveillance system. The presence of appropriate methods in the detection of outbreaks can have an important role in the timely detection of outbreaks. Because of the importance of this issue, this study aimed to assess the performance of discrete wavelet transform (DWT) based methods in detecting influenza outbreaks in Iran from January 2010 to January 2020. Methods: All registered influenza-positive virus cases in Iran from January 2010 to January 2010 were obtained from the FluNet web base tool, the World Health Organization website. The combination method that includes DWT and Shewhart control chart was used in this study. All analyses were performed using MATLAB software version 2018a Stata software version 15. Results: The Mean ± SD and median of reported influenza cases from January 2010 to January 2020 was 36 ± 108 and four cases per week. The combination of the DWT and Shewhart control chart with K = 0.25 had the most sensitivity. The most specificity in the detection of nonoutbreak days was seen in the combination of DWT and Shewhart control chart with K = 1.5, K = 1.75, and K = 2, respectively. The combination of DWT and Shewhart control chart with K = 0.5 had the best performance in the detection of outbreaks (sensitivity = 0.64, specificity: 0.90, Youden index: 0.54, and area under the curve [AUC]: 0.77). Conclusion: The DWT-based method in detecting influenza outbreaks has acceptable performance, but it is recommended that this method's performance be assessed in detecting outbreaks of other infectious diseases.

High resolution melting curve analysis for rapid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants.

Since the emergence of the original Wuhan SARS-CoV-2 strain, several new variants of the virus have emerged. Alpha, Beta, Gamma, Delta and the most recent Omicron variants have been introduced during this pandemic. Several methods including, but not restricted to, allele-specific PCR, ligation with rolling circle amplification and real-time PCR with allele-specific probes are able to detect mutations as low as a single nucleotide polymorphism. High-resolution melting curve analysis is ano-ther technique to assess any mutations in a nucleic acid chain. Confirmed samples with SARS-CoV-2 infection were subjected to variant identification using a de novo-designed HRM assay. In order to select for mutations with the highest effect on Tm of the amplicon, deletion mutations of NSP6 (Del 3675-3677), and S1 (Del 144) were chosen for HRM analysis. HRM analysis for the amplicon of the primer set-1 (NSP6) resulted in Tm differences of -0.39°C, +0.4°C, and -0.6°C between Alpha, Delta, and Omicron variants, respectively, in comparison to the original Wuhan strain. Moreover, HRM analysis of the amplification performed by primer set-2 (S1) led to Tm differences of +0.32°C, -0.26°C, and +0.24°C between Alpha, Delta, and Omicron variants, respectively, in comparison to original Wuhan strain. The test was able to specify each sample to its variant group with more than 90 percent of confidence. The results obtained in this study demonstrate that using a single closed-tube strategy with a HRM-equipped machine, screening new variants of the virus is possible in a fast and reliable way. Keywords: high resolution melting; SARS coronavirus 2; mutation; variant; genotyping.

Risk Communication in Early Containment of COVID-19 Pandemic in Iran: Implementation of the World Health Organization Strategic Preparedness and Response Plan (WHO-SPRP).

Background: Health systems must have functional and efficient preparedness and response plans to manage pandemics. Moreover, it is essential to adjust to changing circumstances and the dynamic character of pandemics. The World Health Organization (WHO) introduced the Strategic Preparedness and Response Plan (SPRP), emphasizing 144 measures across 10 pillars, helping governments prepare and respond to the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to determine how the Iranian health system, based on the WHO-SPRP, addresses strategic preparedness and response plan in the COVID-19 pandemic at the national level. Methods: The WHO-SPRP was adopted and translated into Persian by 2 bilingual natives. The chief of the health office requested that authorized officers complete the SPRP. Then, a meeting was held by officers of related units involved in COVID-19 management to address the SPRP at regional and national levels. Results: Our findings suggest that up to August 2020, effective risk communication and community engagement were not fully established. Our response plan lacked evidence-based information and educational messaging to consistently shape public opinion and impression of a respiratory pandemic. Conclusion: The Iranian health care system and services were almost able to address the SPRP and perform the major indicators that the WHO had proposed. However, special attention should be paid to risk communication and community engagement to empower informed decision-making by individuals and communities.

Prevalence and determinants of self-medication consumption of antibiotics in children in Iran: A population-based cross-sectional study, 2018-19.

INTRODUCTION: The prevalence of self-medication of antibiotics has been revealed in various studies. The main aim of this work is to investigate the frequency of self-medication in children under 6 years and the factors affecting it. METHODS: This is a population-based cross-sectional study conducted in the Arak metropolitan in the center of Iran from January 2019 to January 2020. We used stratified random sampling to determine recruitment criteria. As 1754 households were invited to the study that 1483 were approved to participate. Children's data were obtained by the interview with their mothers. In order to define self-medication consumption of antibiotics, it was adapted between annually maternal self-reported consumption of antibiotics among their children and history of received antibiotics registered in insurance services during the same time period. Logistic regression models were exploited to obtain odds ratios and 95% confidence intervals. RESULTS: Mean age of mothers was 31.8 years (SD = 5.4), 52.1% of the children were boys. Annually self-medication of antibiotic consumption was estimated 61.6% (n = 914). Based on the logistic regression analysis, in the adjusted analysis, girls were associated with self-medication consumption of antibiotics lower than boys' children (p = 0.016). Older mothers were lower self-medication consumption of antibiotics than youngers (p = 0.001). Moreover, the permanent job of fathers was associated with lower self-medication consumption of antibiotics than temporarily and unemployment (p = .001). The odds of self-medication consumption of antibiotics were increasing with the increase in age of children (OR: 1.21, CI95%: 1.12, 1.31 and p = 0.001). The increase in parity has been a significant association with the self-medication consumption of antibiotics (OR: 1.64, CI95%: 1.38, 1.95and p = 0.001). CONCLUSION: Results of this study show that some factors such as children's age, gender, mother's age, father's occupational status, and parity are the determinants that significantly impact the self-medication prevalence.

Prevalence of COVID-19 in Different Types of Collagen Vascular Diseases and its Relationship with Drugs Used in these Patients.

Objectives: The outcome of COVID-19 disease in collagen vascular disease and its comparison with other infected people in the community, are not fully understood yet.In this study, we examined whether the prevalence and severity of COVID-19 in these patients is higher than the general population or not? Methods: This cross-sectional study was performed between August and December 2020 on collagen vascular patients referred to the rheumatology clinic of Firouzgar Hospital. Patients were evaluated for a history of COVID-19. The prevalence of the and its relationship with age, sex, type of disease, medications, blood. The history of influenza vaccine was also evaluated in these patients. Results: Among the total of 748 patients, 574 (76.6%) subjects were women, and 174 (23.3%) subjects were men. The mean age of the patients was 47.46 ± 13.56 years old. The prevalence of COVID-19 was 8.0% and its highest prevalence was related to rheumatoid arthritis (36.7%) and the lowest one was for vasculitis (1.7%). Notably, 12.5% of the patients who did not suffer from COVID-19, were vaccinated against influenza (p-value = 0.54). In this regard, a significant relationship was found between COVID-19 prevalence and previous existence of interstitial lung disease (p -value = 0.017). Conclusions: The prevalence of COVID-19 in collagen vascular patients was not higher than the general population. There was also no significant relationship between the prevalence of COVID-19 and its severity and collagen vascular patient's blood group, the type of their disease and drug. More studies are required on the effect of DMARD drugs on the prevalence and severity of COVID-19 disease in collagen patients. Better results could be obtained if this study is done with a larger sample size.

The Relationship Between Population-Level SARS-CoV-2 Cycle Threshold Values and Trend of COVID-19 Infection: Longitudinal Study.

BACKGROUND: The distribution of population-level real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values as a proxy of viral load may be a useful indicator for predicting COVID-19 dynamics. OBJECTIVE: The aim of this study was to determine the relationship between the daily trend of average Ct values and COVID-19 dynamics, calculated as the daily number of hospitalized patients with COVID-19, daily number of new positive tests, daily number of COVID-19 deaths, and number of hospitalized patients with COVID-19 by age. We further sought to determine the lag between these data series. METHODS: The samples included in this study were collected from March 21, 2021, to December 1, 2021. Daily Ct values of all patients who were referred to the Molecular Diagnostic Laboratory of Iran University of Medical Sciences in Tehran, Iran, for RT-PCR tests were recorded. The daily number of positive tests and the number of hospitalized patients by age group were extracted from the COVID-19 patient information registration system in Tehran province, Iran. An autoregressive integrated moving average (ARIMA) model was constructed for the time series of variables. Cross-correlation analysis was then performed to determine the best lag and correlations between the average daily Ct value and other COVID-19 dynamics-related variables. Finally, the best-selected lag of Ct identified through cross-correlation was incorporated as a covariate into the autoregressive integrated moving average with exogenous variables (ARIMAX) model to calculate the coefficients. RESULTS: Daily average Ct values showed a significant negative correlation (23-day time delay) with the daily number of newly hospitalized patients (P=.02), 30-day time delay with the daily number of new positive tests (P=.02), and daily number of COVID-19 deaths (P=.02). The daily average Ct value with a 30-day delay could impact the daily number of positive tests for COVID-19 (ß=-16.87, P<.001) and the daily number of deaths from COVID-19 (ß=-1.52, P=.03). There was a significant association between Ct lag (23 days) and the number of COVID-19 hospitalizations (ß=-24.12, P=.005). Cross-correlation analysis showed significant time delays in the average Ct values and daily hospitalized patients between 18-59 years (23-day time delay, P=.02) and in patients over 60 years old (23-day time delay, P<.001). No statistically significant relation was detected in the number of daily hospitalized patients under 5 years old (9-day time delay, P=.27) and aged 5-17 years (13-day time delay, P=.39). CONCLUSIONS: It is important for surveillance of COVID-19 to find a good indicator that can predict epidemic surges in the community. Our results suggest that the average daily Ct value with a 30-day delay can predict increases in the number of positive confirmed COVID-19 cases, which may be a useful indicator for the health system.

Vaccine hesitancy from the parent perspectives: protocol for a qualitative study in Iran.

INTRODUCTION: WHO declared vaccine hesitancy as a global public health threat in 2019. Since even a slight reduction in vaccine coverage rates can lead to a decrease in herd immunity, it is imperative to explore the underlying factors affecting vaccine hesitancy. This qualitative study protocol aims to explore determinant factors that influence vaccine hesitancy in Iran from the parent's perspective. METHODS AND ANALYSIS: Descriptive-Interpretive Qualitative research will be conducted to gain an insight into vaccine hesitancy in the west of Tehran province in Iran. Participants in the study will be recruited from vaccine-hesitant parents of children under 5 years' old who will be recognised as being hesitant to extract from the national health information system. The semistructured interviews and in-depth questions will be performed both face-to-face in an open space such as a park near their homes and via video call because of the COVID-19 pandemic and social distancing. Interviews will be conducted by a trained qualitative person. Transcribed data will be analysed through thematic analysis. ETHICS AND DISSEMINATION: Ethics approval was obtained from the research ethics committee at the Iran University of Medical Sciences (Approval ID #IR.IUMS.REC.1399.273). The results of the study are expected to be presented by the end of 2022 year. A variety of dissemination methods will be employed to communicate research findings, including presentations at conferences and peer-reviewed publications.

The effect of COVID-19 mRNA vaccines against postvaccination laboratory-confirmed SARS-CoV-2 infection, symptomatic COVID-19 infection, hospitalization, and mortality rate: a systematic review and meta-analysis.

OBJECTIVES: We systematically reviewed the literature to investigate the pooled effect of COVID-19 mRNA vaccination against SARS-CoV-2 infection and its clinical outcomes. METHODS: Scopus, Web of Science, PubMed (Medline), and Embase were searched on 9 September 2021. The odds ratio (OR) of COVID-19 infection and its clinical outcomes in fully/ partially vaccinated versus unvaccinated participants were calculated and pooled by using a random-effects model. RESULTS: The pooled analysis showed that among health care workers and general population, vaccinated participants with one or two doses were less likely to infect with SARS-CoV-2 (OR = 0.16; 95%CI: 0.08-0.32; I2 = 79.86%; 95%CI I2: 68.99-87.21%), to develop symptomatic COVID-19 infection (OR = 0.09; 95%CI: 0.03-0.32; I2 = 80.43%; 95%CI I2: 70.83-89.33%), to admit to the hospital because of COVID-19 (OR = 0.13; 95%CI: 0.06-0.28; I2 = 86.19%; 95%CI I2: 67.80-93.88%), and to die from COVID-19 (OR = 0.14; 95%CI: 0.06-0.35; I2 = 66.76%; 95%CI I2: 54.00-76.99%) than unvaccinated participants. CONCLUSIONS: COVID-19 mRNA vaccines, especially following administration of two doses, are extremely effective. It would be suggested further studies with large sample size and different ethnicities to be conducted among the general population to warrant these results.

Adverse effects following COVID-19 vaccination in Iran.

BACKGROUND: Vaccination is a key intervention to prevent COVID-19. Many vaccines are administered globally, yet there is not much evidence regarding their safety and adverse effects. Iran also faces this challenge, especially as data regarding the Sputnik V vaccine is sparse. Therefore, the aim of this study is to determine the adverse effects of the most commonly used vaccines in Iran. METHODS: Using a retrospective cohort study design, 6600 subjects aged 18 years or older who had received two doses of any of the three COVID-19 vaccines (Sinopharm, AstraZeneca, and Sputnik V) were selected using a random sampling method between March and August 2021. Subjects were asked about any adverse effects of the vaccines by trained interviewers via telephone interview. Vaccine-related adverse effects in individuals during the first 72 h and subsequently following both doses of the vaccines were determined. The demographic variables, type of administered vaccine, adverse effects, and history of the previous infection with COVID-19 were collected. Descriptive statistics (mean, standard deviation) and analytical statistics (Chi-squared and Wilcoxon tests) were performed at a 95% significance level using STATA software version 15 (STATA Corp, College Station, TX, USA). RESULTS: From 6600 participants, 4775 responded (response rate = 72.3%). Of the participants, 1460 (30.6%) received the AstraZeneca vaccine, 1564 (32.8%) received the Sinopharm vaccine and 1751 (36.7%) received the Sputnik V vaccine. 2653 participants (55.56%) reported adverse effects after the first dose and 1704 (35.7%) after the second dose. Sputnik V caused the most adverse effects with 1449 (82.7%) vaccine recipients reporting symptoms after the first or second dose, compared with 1030 (70.5%) for AstraZeneca and only 585 (37.4%) for the Sinopharm vaccine. The most common adverse effects after the first dose were fatigue (28.37%), chill/fever (26.86%), and skeletal pain (22.38%). These three adverse effects were the same for the second dose, although their prevalence was lower. CONCLUSIONS: In this study, we demonstrate that the Sputnik V vaccine has the highest rate of adverse effects, followed by the AstraZeneca and Sinopharm vaccines. COVID-19 vaccines used in Iran are safe and there were no reports of serious adverse effects.

Involvement of Pseudomonas aeruginosa in the occurrence of community and hospital acquired diarrhea, and its virulence diversity among the stool and the environmental samples.

Transmission of Pseudomonas aeruginosa along the food chain could cause gastrointestinal infections. To show this involvement, the prevalence, putative virulence genotype, and antibiotic resistance phenotype of P. aeruginosa isolates from stool of 1482 patients with community and hospital acquired diarrhea were compared with 87 isolates from the environmental samples. The results showed infection with P. aeruginosa in 3.4% of the cases, while 57.4% of vegetable samples were contaminated. Significantly higher frequency of lasB (98%), aprA (98%), exoY (98%), and exoS (90%), but lower rate of exoT (39.2%), was detected among the stool isolates. Multi-drug resistance (MDR) phenotype was detected in 25.5% and 4% of the stool and vegetable isolates, respectively. A higher rate of studied virulence genes was detected among the MDR strains vs non-MDR strains. These results indicate P. aeruginosa as a causative agent of diarrhea either among the hospitalized patients and those with community-acquired diarrhea.

The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data.

BACKGROUND: Many factors contribute to the spreading of hospital-acquired infections (HAIs). OBJECTIVE: This study aimed to standardize the HAI rate using prediction models in Iran based on the National Healthcare Safety Network (NHSN) method. METHODS: In this study, the Iranian nosocomial infections surveillance system (INIS) was used to gather data on patients with HAIs (126,314 infections). In addition, the hospital statistics and information system (AVAB) was used to collect data on hospital characteristics. First, well-performing hospitals, including 357 hospitals from all over the country, were selected. Data were randomly split into training (70%) and testing (30%) sets. Finally, the standardized infection ratio (SIR) and the corrected SIR were calculated for the HAIs. RESULTS: The mean age of the 100,110 patients with an HAI was 40.02 (SD 23.56) years. The corrected SIRs based on the observed and predicted infections for respiratory tract infections (RTIs), urinary tract infections (UTIs), surgical site infections (SSIs), and bloodstream infections (BSIs) were 0.03 (95% CI 0-0.09), 1.02 (95% CI 0.95-1.09), 0.93 (95% CI 0.85-1.007), and 0.91 (95% CI 0.54-1.28), respectively. Moreover, the corrected SIRs for RTIs in the infectious disease, burn, obstetrics and gynecology, and internal medicine wards; UTIs in the burn, infectious disease, internal medicine, and intensive care unit wards; SSIs in the burn and infectious disease wards; and BSIs in most wards were >1, indicating that more HAIs were observed than expected. CONCLUSIONS: The results of this study can help to promote preventive measures based on scientific evidence. They can also lead to the continuous improvement of the monitoring system by collecting and systematically analyzing data on HAIs and encourage the hospitals to better control their infection rates by establishing a benchmarking system.

COVID-19 Infection and Mortality Rates within Medical Specialists and General Practitioners and Its Comparison with the General Population: A Longitudinal Nationwide Study.

BACKGROUND: We aimed to provide data regarding COVID-19 infection and mortality rates within different specialties of physicians and general medical practitioners in a longitudinal nationwide study and to compare the results with general population. METHODS: Data on COVID-19 infection and mortality of medical physicians in Iran was actively gathered through the Iranian Medical Council (IRIMC). Population COVID-19 cumulative incidence and mortality data were extracted from WHO situation analysis reports and data on Iranian population were obtained from the Statistical Center of Iran. RESULTS: As of Jul 27th 2020, COVID-19 infection and mortality rates were 0.680% and 0.0396% among 131223 physicians. The highest cumulative infection rates as of 27th July 2020, were observed in specialists of infectious diseases (3.14%) followed by neurology (2.18%), and internal medicine (2.13%). The highest cumulative mortality rates as of Nov 3rd 2020 were observed in specialties of forensic medicine (0.314%), anesthesiology (0.277%), urology (0.237%), and infectious diseases (0.20%). Male physicians comprised 95% of cumulative mortality as of Nov 3rd. The physicians' COVID-19 mortality in July and November were 49% and 23% higher than the general population respectively. CONCLUSION: Infection and mortality rates in Iranian physicians were higher than the general population, however the magnitude of difference was narrowing in longitudinal investigation. Provision of personnel protective equipment should be prioritized to specialists of infectious diseases, forensic medicine, anesthesiology, internal and emergency medicine, and urology.

Iran COVID-19 Epidemiology Committee: A Review of Missions, Structures, Achievements, and Challenges.

BACKGROUND: Since the beginning of the coronavirus disease 2019 (COVID-19) epidemic in Iran, the control and management of the epidemic were headed by the National Headquarter for the Control of COVID-19 Epidemic through setting up different scientific committees, including the COVID-19 National Epidemiology Committee. The present study reviews the missions, structures, achievements, and challenges of the Epidemiology Committee. STUDY DESIGN: A rapid review . METHODS: All relevant reports, documents, guidelines, published literature, and surveillance data related to the establishment, visions, missions, roles, activities, and outputs of the COVID-19 Epidemiology Committee were critically reviewed in this study. RESULTS: The efforts of the committee's working groups may have impacted improvements in data registration/usage, provincial data quality at provincial levels, and perception of the epidemic situation in the provinces. The committees have also played role in informing the policies in different stages of the epidemic through routine or problem-based data/evidence analyses, epidemic investigations, and mathematical modeling. CONCLUSION: The structure and experience gained by the committee can be used in similar situations within and outside the country. To further improve the impacts of our activities, it is essential to have effective interaction, collaboration, and data flow between the committee and a broad range of organizations within and outside the Ministry of Health and Medical Education.

Interdisciplinary Approaches to COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has been a significant concern worldwide. The pandemic has demonstrated that public health issues are not merely a health concern but also affect society as a whole. In this chapter, we address the importance of bringing together the world's scientists to find appropriate solutions for controlling and managing the COVID-19 pandemic. Interdisciplinary cooperation, through modern scientific methods, could help to handle the consequences of the pandemic and to avoid the recurrence of future pandemics.

Survival rate in patients with ICU-acquired infections and its related factors in Iran's hospitals.

BACKGROUND: Hospital-acquired infections (HAIs) are a well-known cause of morbidity and mortality in hospitalized patients. This study aimed at investigating the survival rate in patients with ICU-acquired infections (ICU-AIs) and its related factors in Iran's hospitals. METHODS: Data were obtained from the Iranian Nosocomial Infections Surveillance (INIS), which registers all necessary information on the main types of infection from different units of each included hospital. One thousand one hundred thirty-four duplicate cases were removed from the analysis using the variables of name, father's name, age, hospital code, infection code, and bedridden date. From 2016 to 2019, 32,998 patients diagnosed with ICU-AI from about 547 hospitals. All patients were followed up to February 29, 2020. RESULTS: The median age of patients with ICU-AIs was 61 (IQR = 46) years. 45.5, 20.69, 17.63, 12.08, and 4.09% of infections were observed in general, surgical, internal, neonatal and pediatric ICUs, respectively. Acinetobacter (16.52%), E.coli (12.01%), and Klebsiella (9.93%) were the major types of microorganisms. From total, 40.76% of infected patients (13,449 patients) died. The 1, 3, 6-months and overall survival rate was 70, 25.72, 8.21 1.48% in ICU-AI patients, respectively. The overall survival rate was 5.12, 1.34, 0.0, 51.65, and 31.08% for surgical, general, internal, neonatal and pediatric ICU, respectively. Hazard ratio shows a significant relationship between age, hospitalization-infection length, infection type, and microorganism and risk of death in patients with ICU-AI. CONCLUSIONS: Based on the results, it seems that the nosocomial infections surveillance system should be more intelligent. This intelligence should act differently based on related factors such as the age of patients, hospitalization-infection length, infection type, microorganism and type of ward. In other words, this system should be able to dynamically provide the necessary and timely warnings based on the factors affecting the survival rate of infection due to the identification, intervention and measures to prevent the spread of HAIs based on a risk severity system.

The national rate of intensive care units-acquired infections, one-year retrospective study in Iran.

BACKGROUND: Hospital-acquired infections (HAIs) in intensive care units (ICUs) are among the avoidable morbidity and mortality causes. This study aimed at investigating the rate of ICU-acquired infections (ICU-AIs) in Iran. METHODS: For the purpose of this multi-center study, the rate of ICU-AIs calculated based on the data collected through Iranian nosocomial infections surveillance system and hospital information system. The data expanded based on 12 months of the year (13,632 records in terms of "hospital-ward-month"), and then, the last observation carried forward method was used to replace the missing data. RESULTS: The mean (standard deviation) age of 52,276 patients with HAIs in the ICUs was 47.37 (30.78) years. The overall rate of ICU-AIs was 96.61 per 1000 patients and 16.82 per 1000 patient-days in Iran's hospitals. The three main HAIs in the general ICUs were ventilator-associated events (VAE), urinary tract infection (UTI), and pneumonia events & lower respiratory tract infection (PNEU & LRI) infections. The three main HAIs in the internal and surgical ICUs were VAE, UTI, and bloodstream infections/surgical site infections (BSI/SSI). The most prevalent HAIs were BSI, PNEU & LRI and eye, ear, nose, throat, or mouth (EENT) infections in the neonatal ICU and PNEU & LRI, VAE, and BSI in the PICU. Device, catheter, and ventilator-associated infections accounted for 60.96, 18.56, and 39.83% of ICU-AIs, respectively. The ventilator-associated infection rate was 26.29 per 1000 ventilator-days. Based on the Pabon Lasso model, the lowest rates of ICU-AIs (66.95 per 1000 patients and 15.19 patient-days) observed in zone III, the efficient area. CONCLUSIONS: HAIs are common in the internal ICU wards. In fact, VAE and ventilator-related infections are more prevalent in Iran. HAIs in the ICUs leads to an increased risk of ICU-related mortality. Therefore, to reduce ICU-AIs, the specific and trained personnel must be responsible for the use of the devices (catheter use and ventilators), avoid over use of catheterization when possible, and remove catheters earlier.