Comparison of the effects of preoperative celecoxib and gabapentin on pain, functional recovery, and quality of life after total knee arthroplasty: A randomized controlled clinical trial.

Background: Acute pain is one of the main complaints of patients after total knee arthroplasty (TKA), which causes delayed mobility, increased morphine consumption, and subsequently increased costs. Therefore, the present study was performed to evaluate the preventive effect of preoperative celecoxib and gabapentin on reducing patient pain as a primary outcome after TKA surgery. Materials and Methods: This randomized, double-blind controlled clinical trial was performed on 270 patients with osteoarthritis that were candidates for TKA surgery allocated into three groups. In the first group, 900 mg of gabapentin was administered orally on a daily basis for 3 days before surgery. In the second group, 200 mg of oral celecoxib was administered twice daily for 3 days before surgery. In the third group, oral placebo was administered twice daily for 3 days before the surgery. The patients' pain score and knee and its functional score were recoded. Results: The mean of reduction pain in gabapentin and celecoxib groups was significantly lower than that of the control group at 12, 24, and 48 h after surgery (P < 0.001); however, two groups were not significantly different from each other (P > 0.05). Furthermore, the two medication groups were not significantly different in this regard (P > 0.05). In addition, the knee score in the gabapentin group with the means of 85.40 ± 5.47 and the celecoxib group with the means of 87.03 ± 3.97 were significantly higher than those of the control group with the means of 78.90 ± 4.39 in the 1st month after the surgery (P < 0.001). Conclusion: According to the results of the present study, the preventive administration of gabapentin and celecoxib showed a significant and similar effectiveness on reducing patient pain after TKA surgery and on improving the KSS and quality of life scores.

Post-discharge health assessment in survivors of coronavirus disease: a time-point analysis of a prospective cohort study.

PURPOSE:  The objective of this study was to quantitatively evaluate psychological and quality of life-related complications at three months following discharge in hospitalized coronavirus disease 2019 (COVID-19) patients during the pandemic in Iran. METHODS: In this time-point analysis of prospective cohort study data, adult patients hospitalized with symptoms suggestive of COVID-19 were enrolled. Patients were stratified in analyses based on severity. The primary outcomes consisted of psychological problems and pulmonary function tests (PFTs) in the three months following discharge, with Health-related quality of life (HRQoL) as the secondary outcome. Exploratory predictors were determined for both primary and secondary outcomes. RESULTS: 283 out of 900 (30%) eligible patients were accessible for the follow-up assessment and included in the study. The mean age was 53.65 ± 13.43 years, with 68% experiencing a severe disease course. At the time of the final follow-up, participants still reported persistent symptoms, among which fatigue, shortness of breath, and cough were the most common. Based on the regression-adjusted analysis, lower levels of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio was associated with higher levels of depression (standardized ß = - 0.161 (SE = 0.042), P = 0.017) and stress levels (standardized ß =- 0.110 (SE = 0.047), P = 0.015). Furthermore, higher levels of anti-SARS-CoV-2 immunoglobulin-M (IgM) were associated with significantly lower levels of depression (standardized ß = - 0.139 (SE = 0.135), P = 0.031). CONCLUSIONS: There is an association between lung damage during COVID-19 and the reduction of pulmonary function for up to three months from acute infection in hospitalized patients. Varying degrees of anxiety, depression, stress, and low HRQoL frequently occur in patients with COVID-19. More severe lung damage and lower COVID-19 antibodies were associated with lower levels of psychological health.

Association of RASis and HMG-CoA reductase inhibitors with clinical manifestations in coronavirus disease 2019 patients: Results from the Khorshid Coronavirus Disease Cohort Study.

Background: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEinhs) may deteriorate or improve the clinical manifestations in severe acute respiratory syndrome coronavirus 2 infection. A comparative, cross-sectional study was conducted to evaluate the association of ARBs/ACEinhs and hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (HMGRis) with clinical outcomes in coronavirus disease 2019 (COVID-19). Materials and Methods: From April 4 to June 2, 2020, 659 patients were categorized according to whether they were taking ARB, ACEinh, or HMGRi drugs or none of them. Demographic variables, clinical and laboratory tests, chest computed tomography findings, and intensive care unit-related data were analyzed and compared between the groups. Results: The ARB, ACEinh, and HMGRi groups significantly had lower heart rate (P < 0.05). Furthermore, a lower percent of O2 saturation (89.34 ± 7.17% vs. 84.25 ± 7.00%; P = 0.04) was observed in the ACEis group than non-ACEinhs. Mortality rate and the number of intubated patients were lower in patients taking ARBs, ACEinhs, and HMGRis, although these differences failed to reach statistical significance. Conclusion: Our findings present clinical data on the association between ARBs, ACEinhs, and HMGRis and outcomes in hospitalized, hypertensive COVID-19 patients, implying that ARBs/ACEinhs are not associated with the severity or mortality of COVID-19 in such patients.

Is Chronic Kidney Disease, a Predictor of In-Hospital Mortality in Coronavirus Disease 2019 (COVID-19) Patients?

Background: Chronic kidney disease (CKD) is an important comorbidity in Coronavirus Disease 2019 (COVID-19) patients considering its high prevalence. We aimed to figure out the relationship between CKD and COVID-19 mortality in this study. Materials and Methods: In total, 116 CKD patients (estimated glomerular filtration rate [eGFR] lower than 60 mL/min/1.73 m2) and 147 control subjects confirmed with COVID-19 were studied. Data regarding demographics, sign and symptoms, laboratory findings, and chest computed tomography were collected. Association between CKD and in-hospital mortality were analyzed using logistic regression models adjusted for confounders. Results: Mortality rate was significantly higher in CKD than non-CKD (30.17 vs 4.76, P < 0.001) COVID-19 patients. Multivariate logistic regression showed that CKD was significantly correlated with in-hospital mortality in the total sample (Odds ratio (OR) = 8.64, confidence interval (CI): 3.67-20.35) and gender subgroups (females: OR = 4.77, CI: 1.38-16.40, males: OR = 13.43, CI: 3.85-46.87) (P < 0.05) of COVID-19 patients in the crude model. Whereas, the correlation did not remain significant in the fully adjusted model in the total sample (OR = 1.70, CI: 0.35-8.19) and gender subgroups (females: OR = 1.07 CI: 0.06-19.82, males: OR = 0.87, CI: 0.07-10.33) (P > 0.05) of COVID-19 patients. Conclusion: This study suggested an independent association between CKD and in-hospital mortality in COVID-19 patients. Therefore, more intensive surveillance of COVID-19 patients with CKD is to be warranted.

Comparing the effect of cup placement between true and false acetabula in total hip arthroplasty in patients with Crowe type 3 dysplastic hip: A randomized clinical trial.

Background: Hip dysplasia is one of the most widespread hip disorders. Total hip arthroplasty (THA) is the preferred treatment in patients with cup placement choices in true or false acetabulum. The objective of this research was to compare the effectiveness of the two mentioned procedures. Materials and Methods: This study was a randomized, open-label, parallel-group clinical trial, in which 46 patients/51 hips with Crowe type 3 dysplastic hip having THA were assigned to two groups: Group 1 - patients who had cup placement in the true acetabulum and Group 2 - patients who underwent cup placement in the false acetabulum. The variables that were evaluated and analyzed included severity of pain using the visual analog scale (VAS), range of motion (ROM), gait ability, the need for repeated joint replacement, and the Harris Hip Score (HHS). Results: Forty-six patients/51 hips were included in the present study. The patients who were evaluated included 30 (65.2%) males and 16 (34.8%) females. The mean age in the population under study was 71.0 ± 10.22, and the mean body mass index of participants was 26.34 ± 2.22 kg/m2. The basic parameters in the two research groups were similar (P > 0.05). There were no significant differences between the two groups in terms of the mean values of VAS and ROM (P > 0.05); however, the mean HHS was significantly higher in the true acetabulum group, 57.90 ± 18.47 versus 48.29 ± 13.80 (P = 0.04). Conclusion: The effectiveness of cup placements both in the true and false acetabula was similar in all of the evaluated variables in terms of clinical outcomes except for HHS which was higher in the true acetabulum group. To further support the results of this research, it is recommended that more research be done on a greater population.

Contrast-enhanced weighted-T1 and FLAIR sequences in MRI of meningeal lesions.

Magnetic resonance imaging (MRI) is widely used in meningeal lesions due to rapid and accurate diagnosis and prevention of serious complications. The aim of the present study was to compare these two sequences after injection of a contrast agent into meningeal lesions. This is a descriptive-analytical study that was performed in 2018-2020 on patients referred to the radiology ward with detection of any meningeal involvements in the MRI images. In addition to T1-W, FLAIR sequence imaging was also performed. Images were initially evaluated by two expert radiologists and a neurologist. The diagnostic values of the sequences were compared. Overall, a total number of 147 patients with meningeal lesions in their brain MRI entered the study. 57.1% of cases (84 patients) had an infectious etiology and 42.9% (63 patients) had a tumoral etiology. T1-W images without contrast were able to diagnose 78 cases of meningitis (92.8% of them), and FLAIR sequences could diagnose 82 patients (97.6% of them). Without contrast injection on MRI, the diagnostic value of T1-W sequence was higher than FLAIR sequence for tumoral lesions (P < 0.01). The enhancement degree of T1-W was higher for tumoral findings (P < 0.01). In contrast, the enhancement degree of the FLAIR sequence was higher for infectious findings, which was also statistically significant (P = 0.015). FLAIR sequences had 92% sensitivity and 85% specificity for diagnosis of brain inflammatory diseases. Similar analysis showed that T1 sequence had 82% sensitivity and 73% specificity for diagnosis of brain inflammatory diseases.

Association of demographic variables and smoking habits with the severity of lung function in adult smokers.

Background: This study aims to evaluate the association between demographic and smoking variables with the severity of lung function loss (Stage I to IV) and spirometry data in smokers. Materials and Methods: Three hundred and fifty smoker men over the age of 20 who had visited in AL-Zahra hospital were involved. Spirometry tests were performed for measuring forced vital capacity (FVC), FEV1, and FEV1%FVC. COPD was categorized into four stages by the (Global Initiative for Chronic Obstructive Lung Disease) criteria of postbronchodilator FEV1/FVC <0.70. FEV1/FVC <70%, in combination with FEV1 ≥80% (Stage I), or 50%≤FEV1 <80% (Stage II), or 30%≤FEV1 <50% (Stage III), or FEV1 ≤30% (Stage IV). Independent t-test, Spearman correlation analysis was used for data analysis. To determine the predicting factors for pulmonary function multiple regressions analysis was performed. Results: 43 (19.5%) of men were defined as Chronic Obstructive Lung Disease (COPD) which 7% of them were Stage I, 23.3% were Stage II, 39.5% were III and 30.2% were stage IV. In 60 (27.1%) of men, the index of Fev1/FVC was <80%. The criteria of PRIS in 74 (33.5%) of the patients and BDR in 59 (26.7%) of participation was positive. There were significant differences in the mean of FEV1 with respect to history of lung disease in relatives (P = 0.035), lung disease hospitalization (P < 0.001) and previous diagnosis of asthma variables (P < 0.001). The mean of FVC was significantly different in patients categorized based on lung disease hospitalization (P < 0.001) and previous diagnosis of asthma (P = 0.018). Furthermore, there was a significant difference in the mean of FEV1/FVC for variables as follows: Time to start smoking after waking up (P = 0.007), lung disease hospitalization (P < 0.001) and previous diagnosis of asthma (P < 0.001). There was a significant association between stages of lung function loss and age of onset of smoking (ß-0.355 P = 0.019) and pack per year (ß = 0.354 P = 0.02). A linear regression model showed that lung disease hospitalization and age were the influential variables on FEV1 with (B = -21.79 confidence interval [CI]: -28.7, -14.87, P < 0.001and B = -0.418 CI: -0.63, -0.21, P < 0.001), respectively. The only significant influential variable on FVC was lung disease hospitalization (B = -15.89 CI: -21.49, -10.296, P < 0.001). Body mass index, lung disease hospitalization, time to start smoking after waking up in the morning and age had significant relationship on FEV1/FVC with (B = 0.71CI: 0.32, 1.11, P < 0.001, B = -14.29, CI: -19.61,-8.97, P < 0.001, B = 6.54, CI: 2.26, 10.82, P = 0.003 and B = -0.44, CI: -0.59, -0.28, P < 0.001), respectively. Conclusion: The age of onset of smoking and pack-year appears to be associated with the severity of COPD. Hospitalization history due to lung disease, age, the time between waking up in the morning and first cigarette use, BMI, lung disease history in relatives, previous diagnosis of asthma have a negative relationship with lung function.

Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy.

BACKGROUND: The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome. MATERIALS AND METHODS: An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated. RESULTS: A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission. CONCLUSION: Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.

Absolute mortality risk assessment of COVID-19 patients: the Khorshid COVID Cohort (KCC) study.

BACKGROUND: Already at hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis. METHODS: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on the following variables, which can simply be measured at hospital admission: sex, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead. RESULTS: Cause-specific hazard regression models show that these baseline variables are associated with both death, and discharge hazards. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC = 0.872 [CI 95%: 0.835-0.910]). CONCLUSIONS: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions.

Dietary nutrients' intake and sleep quality in peritoneal dialysis patients.

Sleep disturbances are common in dialysis patients. However, there is a lack of information on nutritional determinants of sleep disorders in dialysis patients. The objective of the current study was to investigate the association between nutrients' intake and sleep quality in peritoneal dialysis patients. The cross-sectional study was done on 114 peritoneal dialysis patients referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Information on sleep quality and dietary intakes were collected using Pittsburgh sleep quality index and 168-item food frequency questionnaire respectively. Anthropometric measurements were done by a trained dietitian based on standard protocols. Socio-demographic and clinical data were obtained through a structured questionnaire. The binary logistic regression model was used to detect the association between nutrients' intake and sleep quality. Our results indicated that there was not any significant difference in basic (socio-demographic and clinical) characteristics between peritoneal dialysis patients with good and poor sleep quality (p>0.05). The results of logistic regression indicated a positive significant association between dietary intake of carbohydrate (OR:3;95% CI:1.32-6.81; p<0.05), fat (OR:3;95% CI:1.32-6.81; p<0.05), and fiber (OR:2.53;95% CI: 1.12-5.67; p<0.05) with poor sleep quality in crude and adjusted models (p<0.05). However, there was not any significant association between dietary intake of protein and poor sleep quality (p>0.05). The results of the present study indicated that dietary intake of nutrients affect sleep quality in dialysis patients. These results help healthcare professionals in making nutritional interventions to improve sleep quality in dialysis patients.

Management of orthopedic patients during COVID-19 outbreak.

Coronavirus Disease 2019 (COVID-19) pandemic was declared on March 11, 2020, which led to the massive economic and social crisis in the world. Hospitals and healthcare systems faced the most changes during this time. As for any other medical departments, orthopedic departments were affected by this situation. Trauma and musculoskeletal injuries require emergency action or even operation which would not stop due to COVID-19 crisis. Special protocols and guidelines were used to minimize infection risks in Kashani educational trauma center. Here we explain the changes and protocols in the following sections: Outpatient-Clinic, emergency department, Operation room and Orthopedic Ward. These strategies included: reducing the number of admitted patients in clinics, changing the decoration of waiting rooms, screening the patients at the entrance and personal protection equipment for staff. We also dedicated special emergency rooms for patients suspicious to COVID-19 infection and also special operation rooms and corridor for patients with COVID-19 infection. Changes in discharging protocols and continuous consultations with infectious diseases specialists brought us the ability to manage these patients. Here in the present paper, we described different strategies of the management of patients in Kashani hospital during COVID-19 outbreak. We hope that our experience of patient's management could help other physicians and hospitals.

Omega-3 Supplementation Improves Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients: A Crossover Randomized Pilot Clinical Trial.

OBJECTIVE: Pruritus is a prevalent skin condition in end-stage renal disease patients. Omega-3 fatty acids have been shown to reduce pruritus in hemodialysis patients. Our objective was to assess the effect of 3 g/day omega-3 supplementation on pruritus among continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS: In this two-period, two-sequence crossover randomized clinical trial, 40 eligible subjects (CAPD patients who complained of pruritus for more than 8 weeks) were randomized to 3 g of omega-3 (n = 20) or identical placebo capsules (n = 20) for 4 weeks. After a wash-out period of 6 weeks, patients were crossed over to the alternate treatment option. Pruritus intensity was assessed using the visual analog scale (VAS) at baseline, 2-and 4-weeks post-intervention in each study period. Both patients and investigators were blinded to the study protocol. FINDINGS: No significant carry-over effect was detected. The mean pruritus score (VAS) in the omega-3 group compared with placebo group after the first (-3.02 vs. -0.48, P < 0.001) and second (-4.09 vs. -0.43, P < 0.001) intervention periods showed higher significant decrease. CONCLUSION: In summary, omega-3 supplementation is an effective treatment for pruritus alleviation in CAPD patients. Further studies are needed to determine the mechanisms underlying antipruritic effects of omega-3.