Caspian Journal of Internal Medicine
Volume:11 Issue: 1, Winter 2020

New Coronavirus which is called 2019-nCoV (2019-Novel-Coronavirus) or SARS-Cov-2 (Severe Acute respiratory Syndrome-Coronavirus 2) causes deadly pneumonia that first appeared in December 2019 in Wuhan city in China. This virus spreads all over the world quickly and made several problems for the community and healthcare system. Several drugs have been tried to manage COVID-19; however, our knowledge of this virus is not complete. At any rate, effective treatment or vaccine for this disease has not been discovered yet. Furthermore, to achieve this goal, more studies are needed on the structure of the virus and its pathogenesis mechanism. In this article, we summarized several articles suggesting treatments of COVID-19.

COVID-19 caused a global pandemic problem. No confident management is introduced for it yet. This study aimed to propose a dietary protocol for hospitalized patients with the diagnosis of acute respiratory infectious disease caused by COVID-19 based on Persian Medicine.

This study was conducted in three phases. In the first phase, any diseases that could be matched with the clinical features of infection with COVID-19 were searched in selected PM references. In the second phase, medicinal herbs and foods that were available and could be used in the hospital diet were extracted and summarized. In the third phase, the new documentation of these pharmaceutical and food items was conducted.

The signs and symptoms of infectious respiratory disease caused by COVID-19 can be categorized in the field of Zato al-rieh that can mainly be matched with pneumonia. Based on the described criteria, some nutrients and medicinal materia medica have been introduced for acute respiratory infection including Cydonia oblonga, Honey, Citrus sinensis, Malus domestica, Citrus medica, Crocus sativus, Raisin, Rosa Damas Cena, D.Carota, Camellia Sinensis, Anethum graveolens dhi, Punica granatum, Petroselinum Crispum, Coriandrum sativum, Urtica dioica, Allium sativum, Sesamum indicum

Most materia medica has documents in current articles including anti-cough suppressants, antiviral properties, anti-bacterial, anti-inflammatory, antioxidant, immunomodulatory etc. A protocol of hospital diet for patients with infectious respiratory syndrome caused by COVID-19 has been introduced in this manuscript.

The COVID-19 pandemic caused stress and anxiety in many people that can be reduced by regular physical activity. Regular physical exercise is essential for health. In the absence of COVID-19 symptoms, no limitation in physical activity is recommended.  However, parameters such as frequency, intensity, type, and time need to be considered to prescribe the program and obtain the best results. Consequently, The level of physical activity that should be done during the outbreak has always been one of the most important and common questions.

 The 2019 coronavirus disease (COVID-19) is threatening public health in many ways. The psychological situation of individuals is important and limited data is available from Iran. In this study, we aimed to illustrate the psychological distress of the general population and evaluate factors affecting it. 

 An online cross-sectional survey was done from 29th to 31st March 2020 in South Khorasan province, affected later than other parts of the country. We included sociodemographic questions, Hospital Anxiety, and Depression Scale (HADS) questionnaire and questions addressing various symptoms and diseases. Most questions had multiple choices to be chosen from and some were open questions. Univariate and multivariate analysis in SPSS software were used to find significant relationships.

 A total of 844 responses were collected, from which 788 records were included in the analysis. The mean age of responders was 36.61 ± 10.97 (age range: 18-88) and 484 (61.4%) of them were female. The mean scores in the anxiety and depression subscale of the HADS questionnaire were 7.01±3.68 and 6.72±3.71 respectively. Experiencing cardiovascular and COVID-19 related symptoms was significantly associated with a higher number of individuals having abnormal anxiety and depression results (p value<0.001). Widowed individuals, females and those experiencing above-stated symptoms showed a significant association with increased anxiety and depression in multivariate analysis.

 Although many existing elements influence the psychological well-being of society during a pandemic, experiencing symptoms related to other diseases or having multiple chronic diseases may cause an extra burden on the psychological state of the society.

The ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns in terms of public health. Literature that focuses on the risk factors of this issue is limited especially in developing countries. This study aimed to determine the predictors of COVID-19 infection in the west region of Iran.

This case-control study was conducted from February to April 2020 in Nahavand county, western Iran. Cases were all patients were positive for coronavirus and, the controls included people who had clinical signs consistent with COVID-19, but their test results were negative. Two controls were selected for every case. Multivariate logistic regression was used to estimate the effects of epidemiological characteristics on the incidence of COVID-19.

Significant risk factors for COVID-19 infection based on the multivariable logistic regression model were male gender (OR = 1.82, p = 0.0.15), age group over 60 years (OR = 2.04, p = 0.017), living in urban areas (OR = 1.79, p = 0 .018), being married (OR = 2.08, p = 0.022), having history of contact with the corona patients (OR = 5.61, p = 0.009), and comorbidities (OR = 1.78, p = 0.031).

This study highlighted factors associated with the occurrence of COVID-19 infection. These findings may help to guide recommendations for the protection of high-risk groups.

The purpose of this study is to prevent the prevalence of infectious diseases in vulnerable groups by anticipating the role of actors in implementing decision-making models in conditions of uncertainty in medical universities.

This research is an applied research by combining qualitative and quantitative methods based on the foundation data theory (Grand Theory). To determine the dimensions of the model, the statistical population included crisis management managers and faculty members of Mazandaran University of Medical Sciences. The data collection has been done through targeted sampling and interviews, semi-structured interviews, analysis method,  and coding method. The statistical population to present the model include senior and middle managers of Mazandaran University of Medical Sciences. The simple random sampling method based on the sample size was determined by Cochranchr('39')s method, and the collected date from the researcherchr('39')s questionnaire was analyzed through nonparametric statistical experiments, Kolmogorov test Smirnov, SPSS SMARTPLS, Excel and the method of modeling structural equations with the least squares approach has been partial.

The path coefficient of each dimension in explaining the decision model in uncertainty conditions based on T statistic and p value and SRMR value was 0.137, which was a good value and the main actors in implementing the model were policymakers, managers and staff.

The implementation of this model will lead to a change in the decisions made by health system authorities in conditions of uncertainty, and will increase the ability of managers of medical universities and the resilience of the health system.

The pandemic situation created an overwhelmed needs for ICU facilities, according to this problem, the need of accurate the management of facilities represents bold. In this study, prognostic risk factors for ICU admission among COVID-19 hospitalized patients were evaluated.

From 22 February to April 20, 2020. Totally,214 COVID-19 patients participated in this study. The included patients were between 18- 80 years old, and the patients who previously admitted for COVID-19 were excluded. The comorbid medical conditions, admission laboratory, demographic data, and first manifestations were analyzed between two groups, including ICU and non-ICU admitted patients. The statistical analysis, univariate and multivariate analysis were afforded. The value of the predictors in risk assessment of ICU admission were estimated.

55 patients (25.7%)  were admitted in ICU. The ICU admitted patient’s mortality rate was about 68%. The age was significantly higher among ICU admission group (P=0.03). Admission O2 saturation was significantly lower among ICU admitted patients (P=0.00). The kidney disease and malignancy history were more frequent in ICU-admitted patients (P=0.04, P=0.00). Myalgia was the clinical manifestation that significantly presented more frequent in ICU-admitted patients. INR, CRP, ESR, HB, and Lymphocyte were significantly different between two groups. After multivariable analysis, admission O2 saturation, hematocrit, CRP and myalgia could significantly predict the risk of ICU admission. Furthermore, the value of predictors was estimated in our study.

Based on our results, the admission O2 saturation, HCT, CRP levels at first admission and myalgia presentation could be considered as the valuable predictors of ICU admission.

Liver is one of the target organs for COVID-19 infection. The liver damage in critically ill patients was investigated in previous studies, but there is no available data about liver injury in mild to moderate form of infection with COVID019. In this study, we estimated the prognostic factors related to liver injury in NON-ICU admitted patients infected with COVID-19.

in this retrospective study, 102 eligible adult participants admitted in the ward were included. Demographic characteristics, admission duration, underlying disease, manifestations of infection, and laboratory data were analyzed. Then, with statistical, univariate, and multivariate analysis, the associated and independent factors were estimated.

the mean age of the study population was 55.13± 17.02 years old. The most common symptom was fever (45.8%). The most frequent co-morbidity was hypertension (25%). 65 patients had liver injury (63.72%). According to statistical analysis CRP were significantly higher in liver injury group (P=0.01, respectively). Univariate analysis reported ALKP, and CRP associated significantly with liver injury (P=0.04, OR= 1.003, Cl 95%= 1.000-1.007; P=0.03, OR= 1.009, Cl 95%= 1.000- 1.017, respectively). No independent factor was detected in multivariate analysis. Based on Spearman’s rank correlation coefficients CRP and lymphocyte correlated significantly with AST (r=0.22, P=0.00; r=-0.13, P=0.09, respectively). Moreover, neutrophil, CRP, and lymphocyte correlated with ALT (r=0.27, P=0.01; r=0.23, P=0.02; r= -0.19, P=0.05, respectively).

Although in the current study, no independent factor was detected, CRP had a significant association with liver injury. It appears the role of inflammatory pathways in the severity of this infection.

In the current COVID-19 pandemic, there is a rising need for a rapid and reliable diagnostic tool. We hypothesized that chest computed tomography (CT) can be a potential alternative for reverse transcription-polymerase chain reaction (RT-PCR).
The aim of this study was to compare the diagnostic value of chest CT and RT-PCR in Iranian patients with suspected COVID-19.

In a retrospective, single-center case series, 568 consecutive hospitalized or outpatient patients with suspected COVID-19 underwent chest CT and/or RT-PCR testing at Imam Reza Hospital, the tertiary teaching hospital of Tabriz University of Medical Sciences in Iran, from February 21 and March 28, 2020.

The sensitivity of chest CT for signifying COVID-19 was 64% (95% CI: 56%–71%) on the basis of positive RT-PCR results as a standard method. CT imaging also had a specificity of 77% (95% CI: 73%–81%), positive predictive value of 35% (95% CI: 0.31–0.39), negative predictive value of 66% (95% CI: 0.61–0.69), positive likelihood ratio of 2.79 (95% CI: 2.26–3.46), and negative likelihood ratio of 0.47 (95% CI: 0.38–0.57).

Chest CT had higher specificity than RT-PCR in the diagnosis of COVID-19, . Therefore, it can play a crucial role in the early diagnosis. Similar to the previous studies, the typical CT features were patchy ground-glass opacities as well as peripheral aspects of the lungs consolidations.

The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis given the role of complete blood counts in the COVID-19 prognosis.

COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population who were matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study.

The number of participants in the case and control groups was 527. Of these, 464 (44%) were females. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (p = 0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P = 0.000). NLR had a significant relationship with severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P = 0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06) respectively.

NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those died and recovered from COVID-19.

This study aimed to evaluate the efficiency of pre-hospital triage tools including the qSOFA, NEWS, and PRESEP in determining the prognosis of probable COVID-19 patients.

In this diagnostic accuracy study, all probable COVID-19 patients older than 16-year-old who were transferred to the hospital by the Tehran Emergency Medical Services (EMS) during the first month of the pandemic, entered to the study. The scores of qSOFA, NEWS, and PRESEP were calculated using data gathered while providing pre-hospital care. The primary outcome was death; and the secondary outcomes were ICU admission, length of stay in the ICU, and length of hospital stay.

The data of 557 individuals with the mean age of 56.93±18.31 were analyzed of whom 67.5% were males. The area under the ROC curve (AUC) of qSOFA, NEWS, and PRESEP for ICU admission was 0.553, 0.557, and 0.551, respectively. The AUC of qSOFA, NEWS, and PRESEP for death was 0.596, 0.566, and 0.604, respectively. The best obtained cut-off point for qSOFA was a score >0 (the sensitivity and specificity were 25.0 and 85.68%, respectively), for NEWS was a score >2 (the sensitivity and specificity were 83.61 and 32.67%, respectively), and for PRESEP was a score >1 (the sensitivity and specificity were 54.10 and 55.56%, respectively).

Based on the findings of the current study, it is likely that the available pre-hospital triage tools (qSOFA, NEWS, and PRESEP) do not have proper efficacy to predict death, ICU admission, and disease severity of COVID-19 patients.

A few studies compared the epidemiologic features of the first and second waves of coronavirus disease 2019 (COVID-19) outbreak. This research was carried out to compare the 1st and the 2nd waves of the epidemics in the northern Iran.

In this observational research, demographic, clinical and laboratory characteristics of the patients with COVID-19, admitted to four government hospitals affiliated to Babol University of Medical Sciences during the 1st and the 2nd waves of COVID-19 epidemics have been compared. The period from May 21, 2020 to September 21, 2020 was considered as the second wave of the epidemics while from February 19, 2020 to May 20, 2020, as the first wave of the outbreak in this region.

Out of 6691 total hospitalized cases, 4374 (65.37%), including 1532 (49.6%) people in the first wave and 2842 (78.9%) in the second wave had RT-PCR test for disease confirmation. Among those who were examined with RT-PCR test, 2322 patients (53.1%) including 728 (31.4%) persons in the first wave and 1594 (68.6%) in the second wave were positive for SARS-CoV-2 RNA. 414 (56.9%) of the confirmed cases in the first wave and 767 (48.1%) in the second wave were males (p<0.001). Gastrointestinal symptoms were more incidental in the second wave of the disease. However, severe respiratory conditions were more common during the first wave (p<0.001). Crude mortality rate was lower in the second wave of the outbreak (p<0.001).

Different epidemiologic characteristics were found in the second wave of COVID-19 outbreak in comparison with the first wave of the epidemics in northerrn Iran.

Coronavirus disease 2019 (COVID-19) has rapidly emerged as a threatening pandemic. Clinical features of this pandemic involve a wide range of manifestations and are not completely known. Here, we present six cases of thrombotic events in patients with COVID-19.

In this case series, we present six patients with confirmed COVID-19, according to real-time polymerase chain reaction, who were referred to our emergency department and were found to have thrombotic events. Pulmonary thromboembolism was diagnosed in three patients by computed tomography (CT) angiography. One patient was found to have deep vein thrombosis in Doppler ultrasonography. Another patient who presented with loss of consciousness, was finally diagnosed with cerebrovascular accident using brain CT. One of the patients had developed a myocardial infarction that was evident in the electrocardiography.

It is ostensible that COVID-19 puts the patients at an increased risk for developing thrombotic conditions, possibly through formation of hyper-inflammatory and hyper-coagulative states. However, further prospective studies are recommended to confirm these findings.

There are very few reports about the neurological complications of COVID-19.We describe two COVID-19 patients with neurologic presentations.

Herein we present neurological manifestations in 2 hospitalized patients with COVID-19. The patients showed most common symptoms of COVID-19 along with common conflicts in CT scans of lung such as ground-glass opacities (GGOs). First case revealed two episodes of generalized tonic–clonic seizures; brain CT scan in second patients revealed an extensive hypodense lesion in the left cerebellar hemisphere. All cases received supportive care, antibiotics, and antiviral medications. All cases were discharged with a good general condition.

The current case series report the association between neurological involvements and COVID-19. Clinicians should be aware of neurologic symptoms in the setting of COVID-19, which might even be the first presentations of this infection.

Of all patients infected with COVID-19, 95% have mild symptoms, but 5% may experience severe illness. There are reports of myocardial injury associated with the COVID19 infection in middle aged and old people with baseline cardiac conditions. Acute myocardial injury has been suggested as a marker for disease severity. Sometimes it is hard to differentiate between acute coronary syndrome and acute myocarditis; hence detailed history taking, lab tests and imaging will be necessary.

Herein, we described two young patients presenting with chest pain and no significant respiratory symptoms, one without cardiovascular risk factors and another one with diabetes mellitus and cigarette smoking. COVID-19 was documented with real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR).

Early Chest CT scan besides coronary CT angiogram (if available) in suspicious cases can help physician to make fast decisions. These two cases both had complication-free hospital stay. Despite markedly high on-admission troponin levels, which is known as a marker of poor prognosis they discharged in good condition. One month follow-up was also uneventful.

 The clinical presentation of SARS-CoV-2 infection was initially dominated by respiratory symptoms. However the clinical spectrum is wide and neuropsychiatric syndromes are also a source of medical concern. Our aims are to present an atypical clinical presentation of SARS-CoV-2 infection characterized by auditory hallucinations and unusual behavior and to emphasize the diversity of clinical manifestations of SARS-CoV-2 infection.

  A 33-year-old woman was admitted to the emergency department (ED) with a one-day history of auditory hallucinations, unusual behavior, changes in her sleeping habits and incoherent speech. No other symptoms were reported. Blood examinations confirmed high elevated white cell count and C-reactive protein. The head CT scan was normal but the chest scan showed right ground-glass opacities in the lower zones. The oropharyngeal swab was positive for SARS-CoV-2.  Based on these results, the diagnosis of SARS-CoV-2 infection was retained. The patient received no specific treatment for SARS-CoV-2 infection and only needed oxygen therapy support for 7 days. Additional dose of Olanzapine 10 mg daily was initially prescribed but the patient was back to her usual self on day 14 of hospital admission leading to its discontinuation. This clinical course was consistent with a first episode of psychosis triggered by SARS-CoV-2 infection.

Neuroinflammation owing to SARS-CoV-2 infection could be responsible for a wide and unknown spectrum of neuropsychiatric manifestations. During this pandemic, special attention should be given to patients with no previous history of psychiatric disorders presenting to ED with neuropsychiatric syndromes of unknown etiology.

The outbreak of coronavirus disease 2019 (COVID-19) has become a global crisis, as the World Health Organization (WHO) declared COVID-19 as a global pandemic. Complete heart block, resulting from an abnormal heart rhythm, is a rare presentation of this infection, which can be life-threatening due to possible progression into ventricular tachycardia.

We report a critical case of COVID-19 in a young woman without any medical history. She was admitted to the hospital with a rare, but serious presentation of temporary complete heart block with a skin rash after three weeks of treatment with an antiviral agent and hydroxychloroquine. The result of cardiac monitoring, using a Holter monitor, was normal, and her sinus rhythm returned to normal without any interventions.

This case emphasized the importance of regular follow-ups for patients with COVID-19 and highlighted the need for attention to unusual presentations, such as brief episodes of unconsciousness and chest pain.

COVID-19 pandemic is a global concern. In this study we suggest using a novel three-dimensional treatment mainly based upon immune system modulation to revolve the virus chaos, regarding to the cytokine storm introduced as the main character of COVID-19 infection scenario.

A young man infected by 2019-nCoVwho suffered from respiratory arrest and loss of consciousness(On March 27,2020), undergoes cardiopulmonary resuscitation and then Endotracheal  intubation and upon ICU administration and confirmed diagnosis of COVID-19, Considering critical condition of the young patient, plasmapheresis was performed once on a daily basis, three doses of interferonbeta(IFN-β-1b) was injected subcutaneously every other day and dexamethasone was given at a dose of 4 mg every 8 hours (TID).After 2 days, the patient was extubated and transferred from the ICU to the ward (March 31,2020) where plasmapheresis was performed 4 times daily for 4 days.Finally ,after 7 days of hospitalization, the patient was discharged with a good general condition.

we modulated immune system through plasmapheresis to sweep out the released cytokines and corticosteroid along with interferon andcommon antiviral treatments. Our data suggest this combined method to be effective for critically ill COVID-19 patients.

The current pandemic disease, COVID-19, is making fear and affecting the quality of life in 2020. The mentioned disease can spread human to human, especially by asymptomatic carriers. Healthcare providers and surgeons are at the risk of conferring with COVID-19. Surgical history in pandemic situations is rare.

In this regard, the present study designed for suggesting practical and fundamental issues around the efficacy of surgery at the time of COVID-19 pandemic.

This information and recommendations could be as a valuable source for surgeons in low and middle-income countries.

Prone positioning is a conventional method to enhance oxygenation in Acute Respiratory Distress Syndrome (ARDS) patients who need mechanical ventilator . It is proven that oxygenation is significantly more beneficial in prone position compared to the supine position. Furthermore, numerous evidences have confirmed that prone positioning could prevent lung injuries caused by ventilators

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the newly emerging SARS-CoV-2 virus that was first reported in December 2019 and was announced as a pandemic disease on March 11th, according to a World Health Organization (WHO) warning (1). SARS-CoV-2 is mainly transmitted through respiratory droplets and close contact, accordingly, requires treatment in isolation. It has been reported that many patients developed sleep disturbances due to isolation treatment or medication use, which can lead to pathological events and impaired immunity, and need to prescribe hypnotic medications (2). Also, some patients may have taken hypnotic medications before developing COVID-19 and may be dependent on these medications, and now, with the onset of COVID-19 and the addition of new drugs for its treatment, they need to change their hypnotic medications.