Acta Medica Iranica
Volume:59 Issue: 8, Aug 2021

There is conflicting evidence about factors associated with Clinical course and risk factors for mortality of adult inpatients. We aimed to identify the demographic, clinical, treatment, and laboratory data factors associated with mortality in the Khoy district. We performed a retrospective cohort study including COVID-19 infected patients who were admitted to Qamar-Bani Hashim hospital from 2 November 2020 to 4 December 2020. We used random forest methods to explore the risk factors associated with death. The applied method was evaluated using sensitivity, specificity, accuracy, and the area under the curve. Age, pulmonary symptoms, patients need a ventilator, brain symptoms, nasal airway, job were the most important risk factors for mortality of COVID-19 in the random forest (RF) method. The RF method showed the highest accuracy, 82.9 and 79.3, for training and testing samples, respectively. However, this method resulted in the highest specificity (89.5% for training and 95.7% for testing sample) and the highest sensitivity (91.9% for training and 94.5% for testing sample). The potential risk factors consisting of older age, pulmonary symptoms, the use of a ventilator, brain symptoms, nasal airway, and the job could help clinicians to identify patients with poor prognosis at an early stage.

The aim of this research was to look at the clinical differences between Afghan refugees and the Iranian community, as well as the evaluation of healthcare inequalities against Afghan refugees. ‎This was a 1:2 matched case-control study carried out at two tertiary hospitals of Jahrom city, southern Iran, from January 2020 to December 2020. Cases were COVID-19 infected Afghans, and controls were Iranian patients. Demographic data, Self-reported symptoms, disease history, and initial symptom to referral length were extracted from medical records. CT scans being conducted and receiving ICU treatment were assessed for evaluation of racial inequality in health care. In this study, 132 Afghan refugees were compared to 266 Iranian controls. There were multiple self-reported symptoms being statistically differently manifested in Afghan refugees in comparison to Iranian COVID-19 patients. There was no difference in probability of being evaluated by HRCT or receiving ICU treatment (P=0.173, 1, respectively) even after being adjusted for symptoms or co-morbidities that were manifesting differently between Afghan vs. Iranian patients (P=0.476, 0.881, respectively). Ten (7.57%) subjects died in the case group and 18 (6.76) in the control group. There wasn’t any significant difference in the death rate between the groups (P=0.766). Our study revealed huge differences in symptoms of Afghan vs. Iranian COVID-19 patients, while these differences did not affect the probability of receiving proper health care. Jahrom city was a case of equality in COVID-19 health care toward the ethnic minorities.

The growth rate of the population aging is increasing worldwide. To assess antimicrobial susceptibility of extended-spectrum β-lactamase- (ESBL-) producing Klebsiella pneumoniae Isolated from Patients aging in Rasool Akram, Hospital, as well as to identify AmpC genes. 100 K. pneumoniae strain isolated from different clinical samples. Isolates resistant to oxyimino-cephalosporins and to cefoxitin evaluated to phenotypic ESBL production and to phenotypic AmpC production, respectively. Detection of resistance genes was then performed using primers specific for AmpC genes. Piperacillin/tazobactam and carbapenems remained the active β-lactam antibiotic against K. pneumoniae. ESBLs were detected among 40 (40%) of K. pneumoniae isolates. CMY-1 gene was detected in 34.3% of all AmpC-positive isolates, whereas CMY-2 and FOX genes were 14.2% and 28.6%, respectively. The consumption of Carbapenem family drugs is high in Iranian hospitals which are used as a first line of treatment without antibiotic susceptibility testing. Therefore, increase in antibiotic resistance to this family drugs is unavoidable in the near future. Therefore, it is necessary to take the necessary measures to modify the administration and use of antibiotics.

The aim of this study was to investigate the prevalence of insulin resistance (IR) according to the phenotypic subgroups of polycystic ovary syndrome (PCOS) and to determine the associations of TSH levels and body mass index (BMI) with IR in infertile women with PCOS. In this cross-sectional study, we included 400 infertile women with a diagnosis of PCOS according to Rotterdam criteria who were referred to the infertility clinic of amir-al-Momenin University Hospital from April 2018- to January 2020. They were classified into four different phenotypic subgroups according to ESHRE guidelines. The homeostasis model (HOMA-IR) was used to measure IR. The prevalence of insulin resistance was 39.3% in infertile women with PCOS. Among women with PCOS, the commonest phenotype was type I (68%), with type II (18.2%), type III (8.8%), and type IV (5%), respectively. Furthermore, there was no significant difference in the prevalence of IR among different phenotypes of PCOS. Logistic regression analysis showed that the chance of insulin resistance was higher in overweight (OR: 1.76, 95% CI: 1.07, 2.88, P=0.024) and obese PCOS women (OR: 3.25, 95% CI: 1.86, 5.67, P<0.001) compared with those who were normal or underweight. Moreover, the chance of IR was higher in PCOS women with TSH ≥2.5 μIU/ml as compared with those who had TSH <2.5 μIU/ml (OR: 2.00, 95% CI: 1.18, 3.40, P<0.001). Insulin resistance is a prevalent disorder among infertile Iranian women with PCOS BMI, and serum levels of TSH ≥2.5 μIU/ml are independent predictors of IR.

Educational interventions are helpful strategies to empower communities encountering the threat of pandemics like Covid-19. This study was carried out to examine the effect of educational intervention on anxiety control and improvement in public quality of life. A quasi-experimental study. The study was conducted among individuals referred to healthcare centers of Qazvin province, Iran, in 2020. Given that Qazvin consists of nine urban healthcare centers, two centers were selected by a simple random selection method. After considering inclusion and exclusion mentioned criteria, 240 individuals were selected to participate in the research and were randomly assigned into two groups of experimental and control. Following the educational intervention, all study variables, including knowledge score, anxiety level, and quality of life, improved significantly in the experimental group compared to the pre-intervention phase (P<0.05). The most significant change was in knowledge score with a nearly large effect size (0.63), presenting an increase of 40.09% from 11.1 to 18.8 exactly after intervention and 12.2 after passing one month from the date of educational intervention; while the quality of life presented a 3.2% increase with a small effect size (0.28). Our findings have implications for the development and implementation of psychological interventions, particularly educational programs. During the outbreak, such strategies can empower the public and diminish the negative emotional effects of the pandemic, helping people to cope with the current situation, and decrease the risk of suffering future psychological disorders.

To capture lapses in management, active surveillance of pediatric intensive care unit (PICU) admissions should consider as an essential tool to bring a better outcome with available resources, while there is a scarcity of data from comparatively newly set up peripheral PICU in developing countries. An observational record-based cross-sectional study was conducted in a peripheral medical college PICU over one year to evaluate morbidity pattern, outcome, and predictors of mortality. Binomial logistic regression (SPSS version-25) was used for analysis. The confidence interval (CI) of Odd’s ratio was used to report the strength of association between dependent and independent variables. Pneumonia was the major cause of admission (27%), followed by septicemia (25.5%), congenital heart diseases (12.2%), bronchiolitis (6.6%), seizure disorders (8.6%), encephalitis (5%), and meningitis (4%). 51.7% were discharged, 14.6 %were referred, 3.2% were left against medical advice, and 30.4% were expired. Pneumonia (46.44%) was the most common cause of death, followed by sepsis (42.07%), congenital heart disease (15.3%), and bronchiolitis (6.01%). The mean duration of stay in PICU was five days (range 1-31 days). Patients who required ventilation (40%) or Inotropes (55.6%) had increased risk of mortality by 14 and 8 times, respectively. Age below one year, presence of bronchiolitis, pneumonia, ARDS, encephalitis, anemia, sepsis, dyselectrolytemia, and requirement of inotropes or ventilation were statistically significant risk factors for mortality (P<0.05). These predictors of morality will help to identify severe cases, prioritize resources and focus on the preventable methods in the public such as a vaccine, creating awareness about diseases, and proper referral.

Chronic constipation is one of the most common problems in children. It can cause anxiety and psychological problems in patients and parents. The purpose of this study was to investigate the relationship between obsessive-compulsive disorders (OCD) in children with chronic functional constipation. This is a case-control study performed at the gastroenterology clinic of Besat Hospital Sanandaj for one year. The children aged 7-14-year-old with chronic functional constipation were selected as a case group, and the healthy children were recruited as a control group, who referred for growth control. Then, the Maudsley questionnaire for obsessive-compulsive disorders was completed by a trained assistant. With this questionnaire, the presence or absence of OCD and its type can be determined. Forty-three children were selected as the case group and sixty-seven children as the control group. The mean age of the case and control group was 9.3±1.5 and 8.8±1.6 years, respectively. Based on the results, there was a significant difference between the groups in terms of checking, cleaning, slowness, doubting, and total obsessive score (P˂0.05). Therefore, all five types of obsessive-compulsive disorder in the case group were greater than the control group. Obsessive-compulsive disorders were more common in children with functional constipation, and the total obsessive score in these children than the healthy children was a significant difference.

Predicting survival time has many Effective implications in life quality management for the remainder of the patient's life. Also, survival data are highly variable and make accurate predictions difficult or impossible. Random Survival Forest by repeated tree construction on Bootstrap samples and averaging on the results of these trees reduce the prediction error and cause further generalization of these results. In this retrospective study, the records of 141 patients with epithelial ovarian cancer who were referred to the oncology and radiotherapy ward of Imam Hossein Hospital in Tehran from 2007 to 2018 were used. Random Survival Forest was fitted to the data to investigate the key factors affecting the first recurrence of epithelial ovarian cancer. The mean age of the patients in our study was 52 (23-82) years and the median time to the first recurrence in these was 17 (0.5-127) months, respectively. According to RSF results, using variable importance criterion (VIMP) metastatic tumor with relative importance 2.665 and also using minimal (MD) by depth 2.349, tumor stage with relative importance 1.993 and depth 2.678, and maximum platelet count with relative importance 2.132 and depth 2.683 were the most important variables affecting in the first recurrence of Epithelial Ovarian Cancer. One of the disadvantages of classical methods is the inappropriate fitting of many variables and the need for specific assumptions. More advanced methods such as RSF without the need for any specific assumptions with less prediction error can well explain event variations when exposed to high-dimensional data.

Generalized pustular psoriasis is a rare variant of pustular psoriasis. During the pandemic of COVID-19, every patient referred to medical centers with fever or other flu-like symptoms would be first evaluated for COVID-19. Here, we report a case of pustular psoriasis who were under biologic immunosuppressive treatment (Infliximab) and was admitted to take her every eight weeks injection of infliximab. During evaluations before the injection, persistent fever and high CRP was detected. Due to these findings, she was suspected of having COVID-19, and this suspicion delayed routine medical care and infliximab infusion for her main disease, pustular psoriasis. After two negative results of the COVID-19 PCR test, Infliximab infusion was done, and surprisingly the fever disappeared, and CRP level decreased.

Coronavirus disease-2019 (COVID-19) became a serious public health problem and caused a rapid pandemic. Fever, dry cough, and dyspnea are the most common symptoms of COVID-19. In addition to the respiratory symptoms, gastrointestinal manifestations of COVID-19 are also increasingly recognized. Herein, the authors present a patient with COVID-19 complicated with acute pancreatitis.