Predictors of the chest CT score in COVID-19 patients: a cross-sectional study.

BACKGROUND: Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient's signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings. METHODS: All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0-25). RESULTS: Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period. CONCLUSIONS: Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran.

Background. Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification.Methods. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan.Results. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased.Conclusions. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.

HIV and risk behaviors among visitors of inmates at the Great Tehran Prison, Iran, 2018.

OBJECTIVES: The objective of the present study was to determine the prevalence of HIV and risk behaviors among the inmates' visitors at the Great Tehran Prison in 2018.This population is more likely to be infected with HIV due to their relationship with inmates. However, they have not been prioritized to the other populations in comparison to inmates who are usually prioritized over others. METHOD: Using a convenient sampling method, we recruited inmates' visitorsat the Great Tehran Prison in 2018. An anonymous questionnaire collected information on the participant's demographic characteristics, relationship withinmate, imprisonment history, drug-related risk behaviors, and HIV-related risk behaviors.Rapid HIV blood test detected HIV positive people. To examine the association between risk behaviors and HIV infection, we used a multivariate logistic regression model to calculate the adjusted Odds Ratio (OR)(adjusted Odds ratio of 23.140, 95% CI OD: 1.994-268.5). RESULTS: 1131 visitors were asked to participate in the study; out of which 1120 consented (99%).Out of the 1120 participants, 55.2% were female, and the majority (72.4%) aged older than 35 years. Of those who had a sexual partner, 50% did not usea condom in the last 6 months. Overall, HIV prevalence was 0.4% in the inmate visitors, but it was significantly higher among those with a history of drug injection(p=0.003). CONCLUSION: Our findings indicated that overall the HIV prevalence is low amonginmates' visitors; Subgroups with a history of injection have high HIV prevalence which needs to beprioritized for HIV screening and treatment.

Undergraduate medical education programme renewal: a longitudinal context, input, process and product evaluation study.

The purpose of this study was to utilize the Context, Input, Process and Product (CIPP) evaluation model as a comprehensive framework to guide initiating, planning, implementing and evaluating a revised undergraduate medical education programme. The eight-year longitudinal evaluation study consisted of four phases compatible with the four components of the CIPP model. In the first phase, we explored the strengths and weaknesses of the traditional programme as well as contextual needs, assets, and resources. For the second phase, we proposed a model for the programme considering contextual features. During the process phase, we provided formative information for revisions and adjustments. Finally, in the fourth phase, we evaluated the outcomes of the new undergraduate medical education programme in the basic sciences phase. Information was collected from different sources such as medical students, faculty members, administrators, and graduates, using various qualitative and quantitative methods including focus groups, questionnaires, and performance measures. The CIPP model has the potential to guide policy makers to systematically collect evaluation data and to manage stakeholders' reactions at each stage of the reform in order to make informed decisions. However, the model may result in evaluation burden and fail to address some unplanned evaluation questions.

Utility of QuantiFERON-TB Gold In-Tube Test in the Diagnosis of Latent TB in HIV-Positive Patients in a Medium-TB Burden Country.

BACKGROUND: The authors aimed to compare TST with QuantiFERON-TB Gold In-Tube (QFT) for detecting latent tuberculosis infection (LTBI) in HIV-infected patients in Iran as a TB-medium endemic country. METHODS: In a cross-sectional design,130 HIV-positive patients in HIV clinic of Tehran University were studied. Patients screened for LTBI with QFT and TST simultaneously. Concordance between 2 tests results and variables associated with tests discordance were assessed. RESULTS: Positive results found in 24.6% for TST and 7.7% for QFT. Overall agreement between them was 73.85% (Kappa = 0.083). History of imprisonment was associated with more positive TST (P = 0.014) and QFT (P = 0.01). Patients with intravenous drug use (IDU) history had significant discordant results (0.018). CONCLUSION: The authors recommend QFT for all negative cases of TST in HIV-positive patients especially who had history of IDU.

Effectiveness of motivational interviewing in promoting hand hygiene of nursing personnel.

BACKGROUND: Motivational interviewing (M.I.) is an option for modifying an individual's behavior. It is used as an educational method in recent years. The aim of our study was to indicate whether or not education, using lecture alone and lecture with M.I., would affect the performance of nursing personnel regarding their hand hygiene. If so, which of these two methods were most effective for this purpose? METHODS: This was an interventional study conducted in Bahrami Pediatric Hospital in Tehran. The study population consisted of all nursing personnel in the hospital. Considering the responsibilities of different nurses and their educational status, we divided them into three classes. The participants of each class were randomly assigned to either the control or experiment groups training lecture alone or lecture with M.I., respectively. We used Independent-t, Paired-t, Mann-Whitney U and Wilcoxon signed ranks tests for analysis. RESULTS: Education using lecture alone improved the hand hygiene performance of nursing personnel only in the first and third classes (P = 0.002 and P = 0.001, respectively). Similarly, lecture combined with M.I. improved the hand hygiene performance of personnel in the first and third classes (P < 0.001 and P = 0.004, respectively). The latter method was more effective compared to lecture alone in the first and third classes (P < 0.001 and P = 0.013, respectively). CONCLUSIONS: Education based on lecturing improves hand hygiene performance among nursing personnel. It will be more effective if combined with M.I.

The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study.

Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study, we examined the effects of MBSR upon psychological, physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study, we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3, 6, 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 +/- 7.7 yrs. There was no significant difference in MSCL scores after MBSR and in 3, 6, 9 and 12 months compared to those before MBSR (P>0.05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0.05). Nevertheless, in 3, 6, 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0.05). The means of CD4 count, before and after MBSR, and in 3, 6, 9 and 12 months were 549 +/- 173.6, 640.2 +/- 189.4, 655.3 +/- 183.4, 638 +/- 167.4, 619.3 +/- 163.2, and 595.2 +/- 165.6, respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0.05). In our study, MBSR had positive effects on psychological status and CD4 count. However, more studies with large sample size are necessary.