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1.
Eur J Med Res ; 26(1): 75, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34256840

RESUMO

BACKGROUND: The aim of this study was to evaluate the expression of four up/down-regulated inflammatory miRNAs and their mRNA targets in the serum samples of COVID-19 patients with different grades. Also, we investigated the relative expression of these miRNAs and mRNAs during hospitalization. METHODS: In this cross-sectional study, 5 mL of blood sample were taken from COVID-19 patients with different grades and during hospitalization from several health centers of Yazd, Tehran, and Zahedan province of Iran from December 20, 2020 to March 2, 2021. The relative expression of miRNAs and mRNAs was evaluated by q-PCR. RESULTS: We found that the relative expression of hsa-miR-31-3p, hsa-miR-29a-3p, and hsa-miR-126-3p was significantly decreased and the relative expression of their mRNA targets (ZMYM5, COL5A3, and CAMSAP1) was significantly increased with the increase of disease grade. Conversely, the relative expression of hsa-miR-17-3p was significantly increased and its mRNA target (DICER1) was significantly decreased with the increase of disease grade. This pattern was exactly seen during hospitalization of COVID-19 patients who did not respond to treatment. In COVID-19 patients who responded to treatment, the expression of selected miRNAs and their mRNA targets returned to the normal level. A negative significant correlation was seen between (1) the expression of hsa-miR-31-3p and ZMYM5, (2) hsa-miR-29a-3p and COL5A3, (3) hsa-miR-126-3p and CAMSAP1, and (4) hsa-miR-17-3p and DICER1 in COVID-19 patients with any grade (P < 0.05) and during hospitalization. CONCLUSIONS: In this study, we gained a more accurate understanding of the expression of up/down-regulated inflammatory miRNAs in the blood of COVID-19 patients. The obtained data may help us in the diagnosis and prognosis of COVID-19. TRIAL REGISTRATION: The ethics committee of Zahedan University of Medical Sciences, Zahedan, Iran. (Ethical Code: IR.ZAUMS.REC.1399.316) was registered for this project.


Assuntos
COVID-19/genética , Perfilação da Expressão Gênica , MicroRNAs/genética , RNA Mensageiro/genética , COVID-19/sangue , COVID-19/virologia , Proteínas de Transporte/genética , Colágeno/genética , Estudos Transversais , RNA Helicases DEAD-box/genética , Hospitalização/estatística & dados numéricos , Humanos , Irã (Geográfico) , Proteínas Associadas aos Microtúbulos/genética , Proteínas Nucleares/genética , Ribonuclease III/genética , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença
2.
Maturitas ; 150: 42-48, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34274075

RESUMO

OBJECTIVE: The aim of this study was to determine the relationship between carbohydrate quality intake and menopausal symptoms. STUDY DESIGN: This is a cross-sectional study of 393 postmenopausal women attending municipality health houses and health centers in the south of Tehran, Iran, from September 2016 to January 2017. MAIN OUTCOME MEASURES: The dietary intake and menopausal symptoms of the participants were assessed with a validated food frequency questionnaire and a menopause rating scale (MRS) carbohydrate quality index (CQI) was calculated using three indices: dietary fiber, glycemic index, and the ratio of solid carbohydrates to total carbohydrates. Linear and logistic regressions were used to assess the relationship between CQI and menopausal symptoms. RESULTS: After adjustment for age, education, time passed since menopause, body mass index, physical activity and energy intake, an inverse association was found between CQI and total MRS score (TMRSS) (ß -0.61; p <0.001), somatic score (SS) (ß -0.27; p <0.001) and psychological score (PS) (ß -0.37; p <0.001) in multivariable linear regression. In addition, logistic regression analysis revealed that compared with the lowest quartile of CQI, participants in the highest quartile of CQI had a lower TMRSS (odds ratio (OR) 0.36, 95% confidence interval (CI) 0.19-0.68). Moreover, CQI was inversely related to SS (OR 0.34; 95% CI 0.17-0.68) and PS (OR 0.32; 95% CI 0.16-0.61). However, there was no significant association between CQI and urogenital score (US). CONCLUSIONS: Higher-quality carbohydrate intake was found to be associated with lower somatic and psychological symptoms of menopause. These findings suggest that CQI may be an important basis for developing an effective dietary modification for reducing menopausal symptoms.


Assuntos
Dieta Saudável , Dieta , Carboidratos da Dieta/administração & dosagem , Menopausa , Pós-Menopausa , Ansiedade/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Depressão/epidemiologia , Ingestão de Energia , Exercício Físico , Feminino , Fogachos/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Transtornos da Memória/epidemiologia , Pessoa de Meia-Idade , Distúrbios do Início e da Manutenção do Sono/epidemiologia , Inquéritos e Questionários
3.
Biol Lett ; 17(7): 20210222, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34256582

RESUMO

Mummified remains have long attracted interest as a potential source of ancient DNA. However, mummification is a rare process that requires an anhydrous environment to rapidly dehydrate and preserve tissue before complete decomposition occurs. We present the whole-genome sequences (3.94 X) of an approximately 1600-year-old naturally mummified sheep recovered from Chehrabad, a salt mine in northwestern Iran. Comparative analyses of published ancient sequences revealed the remarkable DNA integrity of this mummy. Hallmarks of postmortem damage, fragmentation and hydrolytic deamination are substantially reduced, likely owing to the high salinity of this taphonomic environment. Metagenomic analyses reflect the profound influence of high-salt content on decomposition; its microbial profile is predominated by halophilic archaea and bacteria, possibly contributing to the remarkable preservation of the sample. Applying population genomic analyses, we find clustering of this sheep with Southwest Asian modern breeds, suggesting ancestry continuity. Genotyping of a locus influencing the woolly phenotype showed the presence of an ancestral 'hairy' allele, consistent with hair fibre imaging. This, along with derived alleles associated with the fat-tail phenotype, provides genetic evidence that Sasanian-period Iranians maintained specialized sheep flocks for different uses, with the 'hairy', 'fat-tailed'-genotyped sheep likely kept by the rural community of Chehrabad's miners.


Assuntos
Múmias , Animais , DNA Antigo , Genoma , Irã (Geográfico) , Fenótipo , Ovinos/genética
4.
BMC Med Res Methodol ; 21(1): 146, 2021 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-34261439

RESUMO

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.


Assuntos
COVID-19 , Estudos de Coortes , Mortalidade Hospitalar , Hospitalização , Humanos , Irã (Geográfico) , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2
5.
Adv Exp Med Biol ; 1327: 49-59, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34279828

RESUMO

The emerging COVID-19 disease affects not only the physical health but also the emotional and psychological health of patients. This study aimed to explain the experiences of 22 recovered COVID-19 patients in Baqiyatallah hospital, Tehran, Iran. Data were collected through in-depth semi-structured interviews. All interviews were recorded and transcribed and then analyzed using the conventional content analysis method. This resulted in emergence of 3 themes "emotional-sensational paradox", "spiritual growth", and "experienced mental-psychological effects", with 11 main categories and 33 subcategories. The results of the study can be used to develop instructions and guidelines for the families of patients as well as healthcare teams to provide effective measures and interventions to minimize the suffering of patients and the damage to mental health.


Assuntos
COVID-19 , Hospitais , Humanos , Irã (Geográfico) , Pesquisa Qualitativa , SARS-CoV-2
6.
Adv Exp Med Biol ; 1327: 139-147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34279835

RESUMO

Background and aims Non-contrast chest computed tomography (CT) scanning is one of the important tools for evaluating of lung lesions. The aim of this study was to use a deep learning approach for predicting the outcome of patients with COVID-19 into two groups of critical and non-critical according to their CT features. Methods This was carried out as a retrospective study from March to April 2020 in Baqiyatallah Hospital, Tehran, Iran. From total of 1078 patients with COVID-19 pneumonia who underwent chest CT, 169 were critical cases and 909 were non-critical. Deep learning neural networks were used to classify samples into critical or non-critical ones according to the chest CT results. Results The best accuracy of prediction was seen by the presence of diffuse opacities and lesion distribution (both=0.91, 95% CI: 0.83-0.99). The largest sensitivity was achieved using lesion distribution (0.74, 95% CI: 0.55-0.93), and the largest specificity was for presence of diffuse opacities (0.95, 95% CI: 0.9-1). The total model showed an accuracy of 0.89 (95% CI: 0.79-0.99), and the corresponding sensitivity and specificity were 0.71 (95% CI: 0.51-0.91) and 0.93 (95% CI: 0.87-0.96), respectively. Conclusions The results showed that CT scan can accurately classify and predict critical and non-critical COVID-19 cases.


Assuntos
COVID-19 , Aprendizado Profundo , Humanos , Irã (Geográfico) , Pulmão , Estudos Retrospectivos , SARS-CoV-2 , Tomografia Computadorizada por Raios X
7.
Arch Iran Med ; 24(4): 333-338, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196195

RESUMO

BACKGROUND: Decision-making on allocating scarce medical resources is crucial in the context of a strong health system reaction to the coronavirus disease 2019 (COVID-19) pandemic. Therefore, understanding the risk factors related to a high mortality rate can enable the physicians for a better decision-making process. METHODS: Information was collected regarding clinical, demographic, and epidemiological features of the definite COVID-19 cases. Through Cox regression and statistical analysis, the risk factors related to mortality were determined. The Kaplan-Meier curve was used to estimate survival function and measure the mean length of living time in the patients. RESULTS: Among about 3000 patients admitted in the Taleghani hospital as outpatients with suspicious signs and symptoms of COVID-19 in 2 months, 214 people were confirmed positive for this virus using the polymerase chain reaction (PCR) technique. Median time to death was 30 days. In this population, 24.29% of the patients died and 24.76% of them were admitted to the ICU (intensive care unit) during hospitalization. The results of Multivariate Cox regression Analysis showed that factors including age (HR, 1.031; 95% CI, 1.001-1.062; P value=0.04), and C-reactive protein (CRP) (HR, 1.007; 95% CI, 1.000-1.015; P value=0.04) could independently predict mortality. Furthermore, the results showed that age above 59 years directly increased mortality rate and decreased survival among our study population. CONCLUSION: Predictor factors play an important role in decisions on public health policy-making. Our findings suggested that advanced age and CRP were independent mortality rate predictors in the admitted patients.


Assuntos
COVID-19/diagnóstico , COVID-19/mortalidade , Adulto , Fatores Etários , Idoso , COVID-19/complicações , Tomada de Decisão Clínica , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
8.
BMC Infect Dis ; 21(1): 636, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215207

RESUMO

BACKGROUND: This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. METHODS: We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. RESULTS: 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015-2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. CONCLUSIONS: The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options.


Assuntos
Bacteriemia/complicações , Bactérias/patogenicidade , Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Neoplasias/mortalidade , Sepse/complicações , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Terapia Combinada , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/patologia , Estudos Retrospectivos , Fatores de Risco , Sepse/microbiologia
9.
Ann Glob Health ; 87(1): 51, 2021 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-34221904

RESUMO

Background: Nurses working in treating patients with COVID-19 are exposed to various stressors, such as fear of COVID-19, stress, and high workload, leading to burnout. Objectives: This study aimed to identify the level of burnout and its predictors in nurses working in hospitals for COVID-19 patients. Methods: Participants in this study were nurses working in 11 hospitals for COVID-19 patients in the Fars province of Iran. The Maslach burnout and the UK Health and Safety stress questionnaires were used to assess burnout and stress, respectively. Analysis, using multiple regression in the SPSS21 software, aimed to identify the factors affecting burnout. Findings: The mean level of burnout in the nurses at the COVID-19 hospitals was 57 out of 120, and burnout was affected by workload (ß = 0.69, p < 0.001), job stress (ß = 0.25, p < 0.001) and inadequate hospital resources for the prevention of COVID-19 (ß = -0.16, p < 0.001). These three variables explained 87% of the variance in burnout. Conclusions: The burnout of nurses directly exposed to COVID-19 patients is more than nurses in other wards, and workload is the most significant cause of burnout in them. Therefore, necessary measures such as hiring more nurses, reducing working hours and increasing rest periods are necessary to reduce workload. In addition, the job stress of these nurses should be managed and controlled, and the hospital resources needed to prevent this disease should be provided.


Assuntos
Esgotamento Profissional , COVID-19 , Enfermeiras e Enfermeiros , Estresse Ocupacional , Tolerância ao Trabalho Programado/psicologia , Carga de Trabalho , Adulto , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/prevenção & controle , Esgotamento Profissional/psicologia , COVID-19/epidemiologia , COVID-19/enfermagem , COVID-19/psicologia , Medo/psicologia , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/métodos , Irã (Geográfico)/epidemiologia , Masculino , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/provisão & distribuição , Estresse Ocupacional/complicações , Estresse Ocupacional/prevenção & controle , SARS-CoV-2 , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
10.
BMC Infect Dis ; 21(1): 656, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233638

RESUMO

BACKGROUND: Coronavirus Disease 2019 (Covid-19) is expanding worldwide. The characteristics of this infection in patients varies from country to country. To move forward, clinical data on infected patients are needed. Here, we report a comparison between fatalities and recovery of patients with severe Covid-19, based on demographic and clinical characteristics. METHODS: Between 5 March and 12 May 2020 in Mashhad, Iran, 1278 of 4000 suspected Covid-19 patients were confirmed positive by real-time reverse-transcriptase-polymerase-chain-reaction assay of upper respiratory specimens. We compared the demographic, exposure history and clinical symptoms of 925 survivors and 353 fatal cases with confirmed disease. RESULTS: Mean (SD) age for all confirmed patients was 56.9 (18.7) years, 67.1 (15.9) years in fatal cases and 53.0 (18.3) years in survivors. Multivariate logistic regression analysis showed that the outcome of patients was associated with age (odds ratio = 1.049, P = 0.0001, 95% CI = 1.040-1.057). Despite a high burden of Covid-19 infections in the 30-39 and 40-49 year age groups, most of these (89.6 and 87.2%, respectively) recovered. The median (IQR) duration of hospitalization was 9.0 (6.0-14.0) days. The most prevalent co-morbidities were cardiovascular disorders (21%) and diabetes (16.3%). Dyspnoea (72.7%), cough (68.1%) and fever (63.8%) were the most frequent clinical symptoms. Healthcare workers, of whom two (3%) died, comprised 5.2% of infected cases. Combination antiviral and antibiotic therapy was used in 43.0% of cases. CONCLUSIONS: The characteristics of severe Covid-19 varied substantially between fatal cases and survivors, with diabetes and cardiovascular disorders the most prevalent co-morbidities. In contrast to other studies, there were a higher number of fatalities in younger patients in our setting.


Assuntos
COVID-19/diagnóstico , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , COVID-19/mortalidade , Doenças Cardiovasculares/epidemiologia , Criança , Pré-Escolar , Comorbidade , Tosse/etiologia , Estudos Transversais , Diabetes Mellitus/epidemiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , SARS-CoV-2 , Resultado do Tratamento , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-34199573

RESUMO

Soccer is a popular team sport and highly demanding activity that requires high effort and long-term training plans. The goals of this study were to compare the accelerations, decelerations and metabolic power between official and friendly full matches, between the first and second halves of the matches, and between both halves of official and friendly matches. Twelve professional soccer players (age, 28.6 ± 2.7 years; height, 182.1 ± 8.6 cm; body mass, 75.3 ± 8.2 kg; BMI, 22.6 ± 0.7 kg/m2) participated in this study. A total of 33 official and 10 friendly matches were analyzed from the Iranian Premier League. All matches were monitored using GPSPORTS systems Pty Ltd. The following variables were selected: total duration of the matches, metabolic power, accelerations Zone1 (<2 m·s-2) (AccZ1), accelerations Zone2 (2 to 4 m·s-2) (AccZ2), accelerations Zone3 (>4 m·s-2) (AccZ3), decelerations Zone1 (<-2 m·s-2) (DecZ1), decelerations Zone2 (-2 to -4 m·s-2) (DecZ2) and decelerations Zone3 (>-4 m·s-2) (DecZ3). The major finding was shown in metabolic power, where higher values occurred in friendly matches (p < 0.05 with small effect size). Furthermore, total duration, AccZ3, DecZ1, DecZ2, and DecZ3 were revealed to be higher in official matches, while AccZ1 and AccZ2 were higher in friendly matches. The second half of the official matches revealed higher values for total duration compared to friendly matches (p < 0.05, moderate effect size). In conclusion, this study observed higher values of metabolic power in friendly matches compared to official matches. AccZ3, DecZ1, DecZ2, and DecZ3 were higher in official matches, while AccZ1 and AccZ2 were higher in friendly matches.


Assuntos
Desempenho Atlético , Corrida , Futebol , Aceleração , Adulto , Desaceleração , Sistemas de Informação Geográfica , Humanos , Irã (Geográfico) , Estações do Ano
12.
BMC Public Health ; 21(1): 1373, 2021 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-34247616

RESUMO

BACKGROUND: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) emerged initially in China in December 2019 causing the COVID-19 disease, which quickly spread worldwide. Iran was one of the first countries outside China to be affected in a major way and is now under the spell of a fourth wave. This study aims to investigate the epidemiological characteristics of COVID-19 cases in north-eastern Iran through mapping the spatiotemporal trend of the disease. METHODS: The study comprises data of 4000 patients diagnosed by laboratory assays or clinical investigation from the beginning of the disease on Feb 14, 2020, until May 11, 2020. Epidemiological features and spatiotemporal trends of the disease in the study area were explored by classical statistical approaches and Geographic Information Systems. RESULTS: Most common symptoms were dyspnoea (69.4%), cough (59.4%), fever (54.4%) and weakness (19.5%). Approximately 82% of those who did not survive suffered from dyspnoea. The highest Case Fatality Rate (CFR) was related to those with cardiovascular disease (27.9%) and/or diabetes (18.1%). Old age (≥60 years) was associated with an almost five-fold increased CFR. Odds Ratio (OR) showed malignancy (3.8), nervous diseases (2.2), and respiratory diseases (2.2) to be significantly associated with increased CFR with developments, such as hospitalization at the ICU (2.9) and LOS (1.1) also having high correlations. Furthermore, spatial analyses revealed a geographical pattern in terms of both incidence and mortality rates, with COVID-19 first being observed in suburban areas from where the disease swiftly spread into downtown reaching a peak between 25 February to 06 March (4 incidences per km2). Mortality peaked 3 weeks later after which the infection gradually decreased. Out of patients investigated by the spatiotemporal approach (n = 727), 205 (28.2%) did not survive and 66.8% of them were men. CONCLUSIONS: Older adults and people with severe co-morbidities were at higher risk for developing serious complications due to COVID-19. Applying spatiotemporal methods to identify the transmission trends and high-risk areas can rapidly be documented, thereby assisting policymakers in designing and implementing tailored interventions to control and prevent not only COVID-19 but also other rapidly spreading epidemics/pandemics.


Assuntos
COVID-19 , Idoso , China/epidemiologia , Cidades , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Oriente Médio , SARS-CoV-2
13.
Virol J ; 18(1): 134, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210325

RESUMO

BACKGROUND: The persistence of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) RNA in the body fluids of patients with the novel coronavirus disease 2019 (COVID-19) may increase the potential risk of viral transmission. There is still uncertainty on whether the recommended quarantine duration is sufficient to reduce the risk of transmission. This study aimed to investigate the persistence of SARS-CoV-2 RNA in the nasopharyngeal, blood, urine, and stool samples of patients with COVID-19. METHODS: In this hospital-based longitudinal study, 100 confirmed cases of COVID-19 were recruited between March 2020 and August 2020 in Guilan Province, north of Iran. Nasopharyngeal, blood, urine, and stool samples were obtained from each participant at the time of hospital admission, upon discharge, 1 week after discharge, and every 2 weeks until all samples were negative for SARS-CoV-2 RNA by reverse transcription-polymerase chain reaction (RT-PCR) assay. A survival analysis was also performed to identify the duration of viral persistence. RESULTS: The median duration of viral RNA persistence in the nasopharyngeal samples was 8 days from the first positive RT-PCR result upon admission (95% CI 6.91-9.09); the maximum duration of viral shedding was 25 days from admission. Positive blood, urine, and stool RT-PCR results were detected in 24%, 7%, and 6% of the patients, respectively. The median duration of viral persistence in the blood, urine, and stool samples was 7 days (95% CI 6.07-7.93), 6 days (95% CI 4.16-8.41), and 13 days (95% CI 6.96-19.4), respectively. Also, the maximum duration of viral persistence in the blood, urine, and stool samples was 17, 11, and 42 days from admission, respectively. CONCLUSION: According to the present results, immediately after the hospitalized patients were discharged, no evidence of viral genetic materials was found. Therefore, appropriate treatments were selected for the patients at this hospital. However, we recommend further investigations on a larger sample size in multi-center and prospective randomized controlled trials (RCTs) to evaluate the effects of different drugs on the shedding of the virus through body secretions.


Assuntos
Fezes/virologia , Hospitalização/estatística & dados numéricos , Nasofaringe/virologia , RNA Viral/sangue , RNA Viral/urina , SARS-CoV-2/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/mortalidade , COVID-19/transmissão , COVID-19/virologia , Teste de Ácido Nucleico para COVID-19 , Feminino , Humanos , Irã (Geográfico) , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , RNA Viral/análise , Análise de Sobrevida , Eliminação de Partículas Virais
14.
Environ Monit Assess ; 193(8): 482, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34241689

RESUMO

Determination of the water quality monitoring network (WQMN) is a vital stage for surveying ecosystem health. Studies have been done in determining the optimal number and location of sampling points, but seasonality of water quality, especially for heavy metals, has been rarely studied. For the first time, this study proposes a framework to determine the optimal location of sampling points to monitor lead (Pb). This study was conducted for the Karoun River, located in southwestern Iran. First, hydraulic characteristics of the river were simulated by implementing of MIKE11 software as well as water quality(variation of Pb concentration). Nash­Sutcliffe coefficient were 0.91 and 0.91 for discharge calibration and validation, respectively. Second, 16 potential sampling points were proposed using modified Sanders' approach considering seasonality. For a better accuracy in the WQMN layout and a more efficient site selection of sampling points, a 1-km buffer is stretched along the river for determining non-point source pollution sources and prioritizing candidate points. This leads to considering different land uses in the study area, while GIS software has been employed. Seasonal changes and land use have a significant impact on the location of optimal sampling points. The presented framework can be used to improve water quality and support watershed protection efforts.


Assuntos
Metais Pesados , Poluentes Químicos da Água , Ecossistema , Monitoramento Ambiental , Hidrodinâmica , Irã (Geográfico) , Metais Pesados/análise , Rios , Poluentes Químicos da Água/análise , Qualidade da Água
15.
BMC Musculoskelet Disord ; 22(1): 609, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229641

RESUMO

BACKGROUND: Categorizing different injury patterns of the talus, describing demographic data, mechanisms of injury and associated fractures are important issues in orthopedic trauma surgeries. Injuries of the talus require careful attention with appropriate treatment approaches in order to reduce possible complications. METHODS: In a cross-sectional study, the demographic characteristics, mechanism of injury, fracture type, and associated fractures were compiled from all patients' files and operation notes with diagnosis of talar injuries from January 2014 to December 2019. RESULTS: Among 367 patients, 317 (86.4%) males and 50 (13.6%) females with mean age of 31.8 ± 11.6 years were identified. There were three (0.8%) patients with bilateral talar fractures. The most common mechanism of injury was motor vehicle accident (MVA) (46.1%), followed by falls (43.3%), direct trauma (6.2%) and sport injuries (4.4%). About half of the patients injured in MVAs were motorcyclists. Isolated talar body fractures (21.9%) were more common than isolated talar neck (19.2%) or combined body & neck fractures (14.6%). Isolated lateral process fracture is the most frequent fractured process of the talus (14.3%). Hawkin type IIA (39.2%) was the most common type of talar neck, followed by Hawkin type III (22.3%), type I (21.5%), type IIB (14.6%) and type IV (2.3%). Medial malleolus, fibula and calcaneus were the most common associated fractures, respectively. CONCLUSIONS: The population that is most affected by talar injury are active young men who are involved in motor vehicle accidents, especially motorcycle crashes, with fracture of body and/or neck of talus being the most common type.


Assuntos
Fraturas Ósseas , Tálus , Adulto , Estudos Transversais , Feminino , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Tálus/diagnóstico por imagem , Tálus/cirurgia , Centros de Traumatologia , Adulto Jovem
16.
BMC Health Serv Res ; 21(1): 662, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229665

RESUMO

BACKGROUND: Organizational reforms of hospitals in Iran are mainly aimed at improving efficiency, reducing government spending on health care, and improving the quality of services. These reforms began with hospital autonomization and have continued with other initiatives such as formation of board of trustees, independent and corporatized hospitals. OBJECTIVE: The purpose of this scoping review was to summarize and compare the results of studies conducted on organizational reform of hospitals in Iran to paint a more clear picture of the status quo by identifying knowledge gaps, inform policymakers, and guide future studies and policies. METHOD: This review's methodology was inspired by Arksey and O'Malley's methodological framework to examine the extent, range, and nature of research activity about organizational hospital reforms in Iran. A literature search was performed using PubMed, Scopus, Web of Science, and Google Scholar for English papers as well as SID, IranDoc, Magiran, and the Social Security Research Institute Database for Persian papers from 1991 to April 2020. RESULTS: Twenty studies were included in the review. Studies were grouped by the types of organizational reform, study's objective, setting, methodology, data collection and analysis techniques, and key findings. Thematic construction was used based on the types of organizational reform to present a narrative account of existing literature. CONCLUSIONS: The autonomy granted to the hospitals was unbalanced and paradoxical in terms of key effective dimensions. Poor governance and regulatory arrangements, low commitment to corporate governance, Inappropriate board composition, weak internal controls, unsustainable financing and inefficient payment mechanisms, poor interaction with stakeholders and ignoring contextual factors have been cited as the main reasons for the failure of organizational reforms in Iran. The limited use of evidence and research was obvious at different stages of policymaking, especially in the policy formulation phase and evaluation of its results.


Assuntos
Hospitais Públicos , Formulação de Políticas , Orçamentos , Atenção à Saúde , Irã (Geográfico)
17.
Reprod Health ; 18(1): 146, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229710

RESUMO

BACKGROUND: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births. METHODS/DESIGN: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members. RESULTS: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique. CONCLUSION: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.


Assuntos
Parto Obstétrico/psicologia , Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Mulheres/psicologia , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Irã (Geográfico) , Parto/etnologia , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Confiança
18.
Trials ; 22(1): 435, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229729

RESUMO

OBJECTIVES: To evaluate the effect of recombinant erythropoietin on hospitalised COVID-19 patients. TRIAL DESIGN: Concealed, randomized, single-blinded, phase 2 controlled clinical trial with two arm parallel-group design of 20 patients allocated with 1:1 ratio and using the placebo in the control group. PARTICIPANTS: This study will be performed at Shahid Mohammadi Hospital in Bandar Abbas, Hormozgan in Iran. All positive (PCR confirmed) COVID-19 patients ≤65 years old who have Hb≤9 and at least one of the severe COVID-19 symptoms (tachypnea (breathing rate> 30 beats per minute), hypoxemia (O2 ≤93 saturation, the partial pressure ratio of arterial oxygen <300), Lung infiltration (> 50% of lung field within 24 to 48 hours), progressive lymphopenia, LDH>245 U/I, CRP>100) and are willing to cooperate in this project will be included in the study. Patients with a history of coronary heart disease, thrombosis, deep vein thrombosis, chronic lung disease, diabetes mellitus, weakened immune system, end-stage renal disease, liver disease, and patients with a history of taking oral contraceptive pills, systolic blood pressure more than 160 mm Hg, diastolic blood pressure more than 90 mm Hg and age over 65 and erythropoietin above 500 are excluded. INTERVENTION AND COMPARATOR: Patients will receive the standard of care (SOC) based on the treatment protocols of the Iranian National Committee of COVID-19 and recombinant erythropoietin (EPREX Manufactured by Johnson and Johnson Pharmaceutical Company) 300 units / Kg or 4000IU as subcutaneous (SQ) injection three times a day for 5 days and simultaneously Enoxaparin 1 mg/kg SQ daily is also taken to prevent thrombosis in the intervention group. Patients' blood pressure, along with other vital signs, are checked regularly and at regular intervals. In the control group, patients received SOC and the placebo (distilled water) is given as a subcutaneous injection three times a day for 5 days. We use sterile water for injection (EXIRpharmaceutical company) as the placebo. To the same appearance of the placebo and the recombinant erythropoietin, they are taken in a separate room in the same size syringes and cover with labels before injection. MAIN OUTCOMES: The main outcome for this study is a composite endpoint for Patient clinical symptoms (Respiratory rate, Oxygen saturation state and arterial oxygen partial pressure ratio, Lung infiltration status, blood pressure), Laboratory tests (LDH, CRP, Lymphocyte count, Endogenous erythropoietin, and Haemoglobin level). All of these will be assessed at the beginning of the study (before the intervention) and day 5 after the intervention. The study will also evaluate side effects and how to manage them. RANDOMISATION: Eligible participants (20) will be randomized in two arms in the ratio of 1: 1 (10 per arm) by permuted block randomization method using online web-based tools. BLINDING (MASKING): Patients participating in the study will not be aware of the assignment to the intervention or control group. The principal investigator, health care personnel, data collectors, and those evaluating the outcome are aware of patient grouping. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 20 patients will participate in this study, who are randomly allocated to the 2 arms with a 1:1 ratio; 10 patients in the intervention group will receive SOC and recombinant erythropoietin, and 10 patients in the control group will receive SOC and placebo. TRIAL STATUS: The protocol version is 3.0, approved by the Deputy of Research and Technology and the ethics committee of Hormozgan University of Medical Sciences on 6th June 2020, with the local grant number of 990108. The expected recruitment end date was on 21th December 2020 but since we had a wide and careful exclusion criteria because of the adverse reactions of the medication, the recruitment (for both cases and controls) was not so easy and did not finish on the expected date and we are still recruiting now. Recruitment began on 17th August 2020 and the updated expected recruitment end date is 1st August 2021. TRIAL REGISTRATION: The protocol was registered before starting subject recruitment under the title: Evaluation of the effect of recombinant erythropoietin on the improvement of COVID-19 patients, IRCT20200509047364N1, at Iranian Registry of clinical trials ( https://en.irct.ir/trial/49282 ) on 2020/08/09. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Assuntos
COVID-19 , Eritropoetina , Idoso , Eritropoetina/efeitos adversos , Pessoal de Saúde , Humanos , Irã (Geográfico) , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento
19.
Trials ; 22(1): 434, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229742

RESUMO

OBJECTIVES: This study aims to investigate the efficacy of curcumin-piperine co-supplementation on oxidative stress factors, clinical symptoms, and mortality rate in patients with coronavirus (COVID-19) admitted to the intensive care unit (ICU). TRIAL DESIGN: This study is a randomized, placebo-controlled, double-blind, parallel-arm clinical trial. PARTICIPANTS: The study participants will be recruited from patients admitted to the ICU of Al-Zahra hospital with a definitive diagnosis of COVID-19. The inclusion criteria are aged between 20 and 75 years, confirmation of COVID-19 based on the PCR test, and admitted to the ICU. The exclusion criteria include the present use of parenteral nutrition support, a history of underlying diseases such as congenital disorders, immune diseases, renal and hepatic insufficiency, and pancreatitis, a history of sensitivity to herbal remedies such as turmeric and pepper, and regular use of anticoagulant drugs such as warfarin. This study will be performed in the Al-Zahra hospital, an academic hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. INTERVENTION AND COMPARATOR: Sixty eligible patients will be randomly assigned, in a 1:1 ratio, to receive curcumin-piperine capsules (three capsules/day; each capsules containing 500 mg curcumin plus 5 mg piperine; in total 1500 mg curcumin and 15 mg piperine/daily) for seven days (n=30) or matching placebo capsules (three capsules/day; each capsules containing 505 mg maltodextrin; totally 1515 mg, maltodextrin/ daily) for same duration (n=30). Capsules will be administered after oral or enteral feeding at 9, 15 and 21 o'clock. MAIN OUTCOMES: The primary outcome is the time from initiation of supplementation (curcumin-piperine or placebo) to normalization of fever, respiratory rate, and blood oxygen saturation. The secondary outcomes are the mortality rate, length of stay in ICU, temperature, levels of blood oxygen saturation, ventilator dependency, respiratory rate, levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), levels of liver markers (ALT, AST, LDH), and levels of kidney function markers (BUN, Creatinine). FOLLOW UP: All of the parameters will be assessed at baseline and end of the study (7 days intervention). In addition, the rate of mortality will be collected after 4 weeks (28 days' mortality in the ICU, 4 weeks follow up). RANDOMISATION: Eligible patients will be randomly assigned to either the intervention group (Curcumin-piperine) or the control group (Placebo). Randomization sequences will be generated using an electronic table of random numbers to allocate the included participants into either control or intervention groups (in a 1:1 ratio) using the stratified block randomization method. Stratification was conducted according to sex (male and female), with a block size of four. The allocation sequences will be prepared by an independent statistician and will be kept inside sealed, opaque, and consecutively numbered envelopes. Participants, investigators, nurses, and physicians will be unaware of the trial-group assignment. BLINDING (MASKING): This study is a double-blind clinical trial (participants, investigators, nurses, and physicians). The curcumin-piperine and placebo supplements will be similar in the terms of texture, taste, color, odor, and weight. Both tablets will be provided in containers that are completely identical in weight, shape, labeling, and packaging. All participants, investigators, nurses, and physicians will be unaware of the trial-group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The sample size is estimated at 60 participants, including 30 patients in the intervention group and 30 patients in the placebo group. TRIAL STATUS: The protocol is Version 2, registered on May 13, 2021. Recruitment began May 20, 2021, and is anticipated to be completed by September 20, 2021. TRIAL REGISTRATION: This trial has been registered in Iranian Registry of Clinical Trials (IRCT) with the title of "Evaluation of the effect of curcumin-piperine supplementation in patients with coronavirus admitted to the intensive care unit (ICU): a double-blind clinical trial study". IRCT registration number is IRCT20121216011763N52 . The registration date was May 13, 2021. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (File 1). In the interest of expediting the dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
COVID-19 , Curcumina , Adulto , Idoso , Estado Terminal , Curcumina/efeitos adversos , Suplementos Nutricionais , Feminino , Humanos , Unidades de Terapia Intensiva , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Estresse Oxidativo , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Resultado do Tratamento , Adulto Jovem
20.
BMC Geriatr ; 21(1): 409, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215206

RESUMO

BACKGROUND: Social support is a key factor in public health. Since the precise evaluation of it is critical, the current study has been developed to evaluate the psychometric properties of the MOS-SSS questionnaire's abbreviated form (MSSS-5-item) among the Iranian older adults. METHODS: This cross-sectional and methodological study was conducted on 420 community older adults (age ≥ 60) through random multi-stage sampling. The questionnaire was first translated into Persian through the Forward & Backward method based on WHO guidelines. Next, the validity of scales was investigated by calculating face validity, content validity, Known-group validity, explanatory factor analysis, and confirmatory factor analysis indices. The reliability of the questionnaire was calculated by internal consistency, test-retest, and absolute reliability. Moreover, the scalability of the questionnaire was checked through the Mokken scale analysis. The software packages SPSS version 22, AMOS version 22, and R (Mokken package) were employed to analyze the data. RESULTS: the face validity was conducted using interviews with older adults and gathering the specialists' opinions. Then, the items were grammatically and lexically corrected accordingly. The CVI index of the overall scale was 0.94, and for every single item above 0.89. The results of the independent t-test showed that the current questionnaire well distinguished between the older adults who do and do not feel lonely (p < 0.001). Two components were recognized according to the explanatory factor analysis. They together explained 67.78% of the total variance of the questionnaire. The CFA showed that the two-factor model had acceptable fit indices. The questionnaire had desirable internal consistency (α = 0.78), stability (ICC = 0.98), and absolute reliability (SEM = 0.56, MDC = 1.57). Furthermore, the Mokken scale proved that MSSS-5-item was a strong scale (H = 0.51, se = 0.03). CONCLUSION: The present study results showed that the MSSS-5-item questionnaire had suitable validity and reliability to be used among Iranian older adults.


Assuntos
Apoio Social , Idoso , Estudos Transversais , Humanos , Irã (Geográfico)/epidemiologia , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
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