Evaluation of the Response Rates of Hospitals in the Prevention and Control of COVID-19 in Hamadan Province of Iran.

The COVID-19 pandemic has challenged the capacity of health systems in various countries. This study was designed to evaluate the response rates of hospitals in the prevention and control of COVID-19 in Hamadan province, Iran. In this cross-sectional study, all 20 hospitals in Hamadan province were monitored in February 2020. The instrument used in this study was the WHO checklist, entitled "Infection prevention and control health-care facility response for COVID-19." In each hospital, the hospital infection control officials completed the checklists under the supervision of the hospital managers and were then provided to the project manager. Data analyzed by SPSS 22 software. There were 3482 hospital beds (the average beds of each hospital was 174) in the studied hospitals. Of 15 055 patients admitted to all hospitals, 2196 (14.6%) individuals were COVID-19 patients. The total average score obtained from the checklist was 62.25. Among 7 domains studied, the lowest scores belonged to 2 domains of "infrastructure and equipment" and "patient screening and triage." The scores of domains "IPC programs" and "visitors" were significantly higher in hospitals with ICU beds than other hospitals (P-value = .03 in both domains). A comparison between university-teaching hospitals with other hospitals and those in Hamadan city with other cities revealed no significant differences in any of the domains. The mean response rate (62.25) of hospitals in terms of COVID-19 in Hamadan province indicates their relative readiness to prevent and control the COVID19 pandemic. The shortage of infrastructure and equipment and screening and triage problems of patients were the main challenges of hospitals in managing the COVID-19 pandemic in Hamadan province, Iran.

Predictors of COVID-19 Mortality in Hemodialysis Patients, Hamadan Province, Iran.

BACKGROUND: Identification of the predictors of coronavirus disease 2019 (COVID-19)-related death in hemodialysis patients plays a key role in the management of these patients. In this regard, the present study aimed to evaluate the predictors of death among COVID-19 infected hemodialysis patients in Hamadan province, Iran. STUDY DESIGN: A cross-sectional study. METHODS: This cross-sectional study investigated 50 COVID-19 infected hemodialysis patients who were confirmed by polymerase chain reaction (PCR) test and referred to hemodialysis wards of hospitals located in Hamadan province, Iran, from March 2019 and January 2020. In order to compare the demographic characteristics and clinical variables between survived and deceased patients, the independent student t test and chi-square test were applied. RESULTS: Out of 50 confirmed COVID-19 hemodialysis patients, 27 (54%) cases were male, 38 (76%) subjects were urban residents, and 4 (8%) individuals were smokers. A significant relationship was observed between patients' gender, age, acute respiratory distress syndrome (ARDS) status, and body mass index (BMI) with the treatment outcome (P < 0.05). A significantly higher level of serum albumin was observed in the survived patients (3.49 ±â€…0.37 vs. 3.17 ±â€…0.42, P =  0.030). Moreover, in terms of lactate dehydrogenase (LDH) level, a significantly higher level of LDH was observed in the patients who died (1471.1 ±â€…1484.89 vs. 670.86 ±â€…268.85, P =  0.005). CONCLUSIONS: It can be concluded that some demographic characteristics of the patients, including age, gender, ARDS status, BMI, co-morbidities, and laboratory signs and symptoms are associated with disease outcomes in COVID-19 infected hemodialysis patients. Therefore, awareness about the predictors of death in these patients can help make better and direct clinical decisions and inform health officials about the risk of COVID-19 mortality among hemodialysis patients.

Effect of Convalescent Plasma Therapy on Clinical Improvement of COVID-19 Patients: A Randomized Clinical Trial.

Background: Due to the critical condition of COVID-19, it is necessary to evaluate the efficacy of administrating convalescent plasma to COVID-19 patients. Therefore, we decided to design a clinical trial to investigate the effect of convalescent plasma of patients recovered from COVID-19 on the treatment outcome of COVID-19-infected patients. Materials and Methods: In this parallel randomized controlled clinical trial, patients in the intervention group received standard treatment plus convalescent plasma of patients recovered from COVID-19. We allocated 60 patients to each treatment group through balanced block randomization. Then, COVID-19 outcomes, vital signs, and biochemical parameters were compared between the two treatment groups by the independent t test and ANCOVA. Results: The mean age (SD) of the patients in the intervention and standard treatment groups was 52.84 (15.77) and 55.15 (14.34) years, respectively. Although patients in the intervention group reported more hospitalization days (11.45±5.86 vs. 10.42±6.79), death rates (26.67% vs. 18.13%), ICU admission (45 vs. 41.67%), and ARDS (11.67% vs. 3.33%), these differences were not statistically significant (P>0.05). Moreover, the two groups were homogenous in vital signs and biochemical parameters before and after treatment (P>0.05). Conclusion: The present study indicated that convalescent plasma therapy has no significant effect on the survival, hospitalization, and ICU admission of COVID-19 patients.

Maternal death due to COVID-19 and high BMI: A case report from Hamadan, Iran.

Pregnant women suffering chronic illness or obstetric complications such as obesity are prone to severe pneumonia and COVID-19. Obesity in pregnancy is associated with many complications for both mother and fetus. Here, we report the death of an obese mother with COVID-19.

Intention to get Vaccinated against COVID-19 in Iranian Hospital Staff: Application of the Theory of Planned Behavior.

Background: This study aimed to identify the predictors of the intention to receive the COVID-19 vaccine among Iranian health care workers (HCWs) based on the Theory of Planned Behavior (TPB). Methods: The study was a descriptive cross-sectional study that was conducted on 473 personnel working in hospitals of Hamadan, in May 2021 and before COVID-19 vaccination on hospital staff. The multi-stage sampling method was used for choosing participants. The survey included socio-demographic, questions related to TPB dimensions, and intention to receive a COVID-19 vaccine. Qualitative and quantitative data analyses were performed using the Chi-square test and T-test, respectively. Predictors of COVID-19 vaccination intention were determined using the logistic regression model. Results: Seventy percent of 361 eligible respondents stated their willingness to receive COVID-19 vaccine. The participants with the intention to receive COVID-19 vaccine had higher scores of attitude (7.25 ± 3.92 vs. 4.40 ± 5.14) and norm (3.04 ± 2.92 vs. -0.5 ± 3.18) (P < 0.001). Having an underlying disease and being married were significantly associated with the intention to receive COVID-19 vaccine (P < 0.05). Higher attitude and norm scores as a construct of the TPB were associated with an increase in intention to receive COVID-19 vaccine. Conclusions: The results of this study showed that the vaccination intention was affected by social, demographic, health, and behavioral features, such as age, marital status, underlying diseases, subjective norms, and attitude. Therefore, age groups below 50, single people, and those with no underlying diseases were eligible to be the target of interventional programs.

Predictors of death in patients with COVID-19: A cross-sectional study in West of Iran.

Background: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly identified coronavirus. Our knowledge about the survival rate and prognostic factors of the disease is not established well. The purpose of this study was to evaluate the predictors of COVID-19 mortality in Hamadan province in western Iran. Methods: In this study, we included all laboratory-confirmed COVID-19 cases with known treatment outcomes in Hamadan province, Iran, between 20, 2020, to May 10, 2020. Demographic, clinical, laboratory data, and treatment outcomes were obtained from computerized medical records and compared between survived cases and patients with death outcomes. Univariable and multivariable logistic regression models were used to determine the predictors of death. Results: From 749 investigated patients, 77 patients (10.28%) died during the treatment. The Mean age of patients was 53.97±19.04 years. Multivariable logistic regression showed that males had 2.07 (95% CI: 1.73, 2.54) fold higher odds of death. Those with 60 years old and more had 6.49 (95% CI: 4.53, 7.93) fold higher odds of death. Patients with an underlying disease had 7.14 (95% CI: 6.94, 7.38) fold higher odds of death, and patients who were hospitalized in the ICU ward had 2.24 (95% CI: 1.75, 2.90) times higher odds of COVID-19 related mortality. Conclusion: The potential predictors of death in COVID-19 cases, including the male gender, older age, and having an underlying disease could help physicians to identify patients with poor prognoses at an early stage and better management of them.

Pregnancy outcomes among SARS-CoV-2-infected pregnant women with and without underlying diseases: a case-control study.

This study aimed to examine the pregnancy outcomes in women infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without underlying diseases in western Iran. This case-control study compared 49 pregnant women with Coronavirus disease (COVID-19) with underlying diseases (the case group) and 49 women with COVID-19 without underlying diseases (the control group). The groups were pregnant women with COVID-19 admitted to Hamadan hospitals for delivery. COVID-19 was diagnosed by using the reverse transcriptase-polymerase chain reaction (real-time RT-PCR). Data were evaluated using a checklist. Further, the Statistical Package for the Social Sciences (SPSS) version 16 was used for data analysis. A value of p<0.05 was considered statistically significant. The odds of preterm labor were five times higher in women with underlying diseases (OR=5.95, 95% CI (3.01, 7.15), p=0.034). Moreover, the odds of preeclampsia and eclampsia in women with underlying diseases was (OR=3.35, 95% CI (1.18, 4.93), p=0.048) and (OR=2.65, 95% CI (1.43, 3.54), p=0.035), respectively. The results revealed that preterm labor, preeclampsia, and eclampsia were significantly higher in women with COVID-19 and underlying diseases compared to those without underlying diseases. Thus, the need to identify and educate pregnant mothers on underlying diseases and attention to prenatal care, particularly in high-risk groups, is necessary for the COVID-19 pandemic.

Evaluating Clinical Course and Risk Factors of Infection and Demographic Characteristics of Pregnant Women with COVID-19 in Hamadan Province, West of Iran.

BACKGROUND: COVID-19 is a new viral disease with a rapid outbreak. Pregnant women are at a higher risk of contracting viral infections including COVID-19. We aimed to evaluate the clinical course and risk factors of pregnant women diagnosed with COVID 19 in Hamadan Province, west of Iran. STUDY DESIGN: A retrospective cohort study. METHODS: The convenience sampling was performed using 50 papers and electronic files of pregnant women diagnosed with COVID-19 according to the WHO's temporary guidelines. They were hospitalized in health centers and clinics of Hamadan Province. The data-collecting tool employed was a researcher-made questionnaire. The data were analyzed via SPSS software version 19. RESULTS: The mean age of pregnant women with COVID 19 was estimated to be 29.20 ± 5.8 yr and their average gestational age estimated to be 28.8 ± 8.20 weeks. About 32% of them had an underlying disease, 32% a history of influenza, and 40% recently traveled to infected areas. The most common findings were CT scans and multiple mottling and ground-glass opacity chest radiology. The most common symptoms were fever, cough, and shortness of breath. About 8% of the women required ICU hospitalization and the average length of hospital stay was 4.04 ± 2.38 and 29% had premature births. Moreover, 28% of infected mothers had a normal delivery and 20% had a cesarean section. CONCLUSION: Early diagnosis of Covid-19 disease is essential in pregnant women. Because there is a possibility of worsening complications in the mother and fetus.

Distance Learning Can Be as Effective as Traditional Learning for Medical Students in the Initial Assessment of Trauma Patients.

Distance learning is expanding and replacing the traditional academic medical settings. Managing trauma patients seems to be a prerequisite skill for medical students. This study has been done to evaluate the efficiency of distance learning on performing the initial assessment and management in trauma patients, compared with the traditional learning among senior medical students. One hundred and twenty senior medical students enrolled in this single-blind quasi-experimental study and were equally divided into the experimental (distance learning) and control group (traditional learning). All participants did a written MCQ before the study. The control group attended a workshop with a 50-minute lecture on initial management of trauma patients and a case simulation scenario followed by a hands-on session. On the other hand, the experimental group was given a DVD with a similar 50-minute lecture and a case simulation scenario, and they also attended a hands-on session to practice the skills. Both groups were evaluated by a trauma station in an objective structured clinical examination (OSCE) after a month. The performance in the experimental group was statistically better (P=0.001) in OSCE. Distance learning seems to be an appropriate adjunct to traditional learning.