Trauma Monthly
Volume:27 Issue: 1, Jan-Feb 2022

There is a need to prepare clinical guidelines for conducting elective or emergency spinal cord surgeries in people who may be carriers of the COVID-19. Therefore, the study aimed to design a guideline for conducting elective spinal cord surgeries during the COVID-19 pandemic. The clinical guidelines and systematic reviews providing recommendations for elective and emergency spinal cord surgeries were collected by an initial search. A group of nine experts were designed a domestic preliminary guideline using six available guidelines presented in four studies. Scoring was conducted based on the AGREE (Appraisal of Guidelines Research and Evaluation) tool. The guideline was prepared in eight subscales, including outpatient visit and counseling, protective measures for health personnel, surgical considerations during the coronavirus pandemic, intraoperative considerations, managing aerosol producing activities, elective and emergency spinal cord surgery, and patient intubation and cardiopulmonary resuscitation. Each of these subscales included several specific recommendations. It recommended to reduce the capacity of inpatient wards to half during the coronavirus pandemic, give priority only to emergency surgeries, presence of skilled residents (senior year residents), use personal protective equipment, use the least number of people in the operating room, and reduce the length of surgery without compromising its quality.

Evaluation of health care workers' mental status is critical in the trend of covid-19 pandemic; because it helps to investigate their real needs and expectations and helps them to present useful services. This study aimed to the prediction of possibility of developing post-traumatic stress disorder (PTSD) based on demographic variables, levels of exposure to Covid-19, the anxiety of Covid-19, and dimensions of sleep quality in health care workers. A descriptive correlational study was conducted on a sample of 180 health care workers (129 females and 51 males). The researcher-made demographic questionnaire, Pittsburgh Sleep Quality Index, Post Traumatic Stress Disorder, Checklist and Covid-19 Anxiety Scale were recorded. A convenience sampling method was applied, and data was collected through the Google form platform. Data analysis was performed in SPSS version 24 software by using one-way analysis of variance (ANOVA), Scheffe Post Hoc test, independent samples t-test, Pearson correlation, and binary logistic regression. The results indicated that 51.7% of health care workers showed severe symptoms of post-traumatic stress (pcl-5> 33). The severity of PTSD symptoms varied in different work shifts and levels of education. The morning shifts and master's degrees had the lowest mean scores of PTSD symptoms. There was a significant positive correlation between PTSD symptoms and Covid-19 anxiety and between PTSD symptoms and all dimensions of sleep quality (p <0.05). The Enter logistic regression analysis results showed that sleep medication use (OR = 3.21) and covid-19 anxiety (OR = 1.13) were risk factors that predicted the severity of PTSD symptoms (percentage correct = 85.5%). It is suggested extensive attempts have been made to PTSD symptoms screening. Also, informing the health care workers about methods to reduce anxiety is helpful, and it is proposed to administer online workshops to train and increase sleep hygiene.

COVID-19 has infected more than 196717202 people and killed more than 4203769 cases worldwide ever since its emergence until July 29th, 2021. The creation of centers for prehospitalization and post-hospitalization of patients as makeshift hospitals were principal actions for Covid-19 management. The study aimed to assess the safety of the largest makeshift Hospital for COVID-19 management in Iran. This cross-sectional study was conducted in Iran, from March 29, 2020, through May 20, 2020. Ever since the outbreak of COVID-19, the IRAN MALL complex dedicated a part of its exhibition space to the Medical Center in the COVID-19 disaster to help the national campaign. The research team designed a makeshift hospital risk assessment tool based on COVID-19 and visited the big makeshift hospital in Iran to evaluate its non-structural and functional situation. Also, dimensions of setting up a convalescent home and the importance of structural or non-structural items were investigated. The non-structural safety, functional and managerial safety points were calculated separately. The total safety rating was determined at 870 as a very high safety level. In this makeshift hospital, there were 16 items with ultra-low, nine items with low, 18 with moderate, 28 with high, and 134 with very high safety. Most of the low to ultra-low safety issues were related to non-structural items. The non-structural and functional safety is an essential factor to be resilient in disasters and pandemics.  Strengthening health infrastructure, empowering health care providers, using new technologies in early warning, assessing the phenomenon, and providing services, will reduce the workload and financial burden of health effects and lead to health system adaptation.

COVID-19 crisis can affect the mental health of individuals. Anxiety and depression are two of many consequences of the COVID-19 pandemic. The present study aimed to investigate the anxiety and depression of nurses and the general population during the COVID -19 pandemic in Iran. The statistical population was all of the Tehran general population, and nurses were working in the Tehran province of Iran. A total of 2060 general population and 516 nurses completed the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7). The anxiety (8.73± 4.52) and depression (9.03±5.87) revealed that the anxiety and depression of nurses were mild. The anxiety (7.75±4.96) and depression (8.33±6.33) showed that the anxiety and depression of general participants were mild. The mean of anxiety in nurses was significantly higher than the general population (P=0.021). Also, the average anxiety in nurses was significantly higher than the general population (P=0.031). The anxiety and depression of emergency nurses are higher than the general population. It means they need more attention in supportive programs such as mental health-promoting interventions during the COVID-19 pandemic.

Evidence shows increased identification of cardiac involvement in patients with COVID-19 with a more critical prognosis. The study aimed to assess the outcomes of COVID-19 patients with pericardial effusion (PE) disease in comparison with a control group. Sixty-One COVID-19 patients who were referred to Shariati hospital in Tehran, Iran, from June 2020 to June 2020 were included. The diagnosis of COVID-19 was according to WHO interim guidance. Eleven cases were with pericardial effusion, and two patients were with a diagnosis of tamponade and pericardial synthesis. Other forty-six Covid-19 cases were as the control group. The majority of patients (54.0%) were in the age group of 50–70 years. Also, 62.2% of cases were male. In PE group compared to non-PE group patients had ESR>50 mm/hour [13(86%) vs. 3(66%), P=0.045), hypernatremia [4(26%) vs. 1(2.1%) P=0.007].  In non-PE group compared to PE group patients had PCT>ULN (ug/L) [21(42) vs. 4(26.7), P=0.035].  There was no significant difference between results of lung CT scan (ground glass (GG), pericardial effusion, and pleural effusion) and tachypnea, positive RT-PCR, and lab in the mild PE group compared to the tamponade group. The incidence of shock (or SBP<100) was more in the mild PE group compared to the tamponade group (P=0.048). There was no significant difference in outcomes (all-cause mortality, discharge, ICU admission and duration, shock, MI intubation, and time of admission) between PE and non-PE groups and subgroups of PE (P>0.05). The results showed pericardial effusion involvement could happen with COVID-19 patients even without differences in all-cause mortality, discharge, ICU admission and duration, MI, time of admission, and intubation. Although, there was a significant difference in hypernatremia and increased ESR level in the PE group. Also, our data provide some reassurance that PE is not a poor prognostic factor in COVID-19 infection.

COVID-19 pandemic produced a health predicament for the world in later 2019. The study aimed to compare lung Computed Tomography (CT) findings in COVID-19 patients with underlying lung disease and healthy cases. Overall, 374 COVID-19 patients were included, that 49 (13.1%) patients had underlying lung disease. Chest CT outcomes were assessed in the positive reverse-transcription polymerase chain reaction (RT-PCR) assay cases referred to the Taleghani and Modares hospitals in Tehran from September 2019 to February 2020. The mean age of patients was 57.01±17.20 years old, and 222 patients (59.4%) were males. The mean age of patients was 65.83±16.59 years in Underlying lung disease cases and was 55.68±16.92 years in the control group (P<0.001). Lobes of the left lung were more affected by COVID-19 in both groups than the right lung. Also, there were no differences between groups in distributing of lobes involving (P>0.05). There was no significant difference between the two groups regarding distribution, density, internal stricture, fibrosis, effusion (P>0.05). The mean Lymph Node Para tracheal of patients was 9.43±2.56 mm in Underlying lung disease cases and was 120, 8.09±2.41mm in the control group (P=0.014). There was no significant difference between the two groups regarding carinal and Para aortic (P>0.05). The results showed that underlying lung disease cases were older than the control group. Lobes of the left lung were more affected by COVID-19 in both groups than the right lung. Distributing of lobes involving, density, internal stricture, fibrosis, effusion, carinal and Para aortic were similar. The mean Lymph Node Para tracheal of patients was higher in Underlying lung disease cases than in the control group.

COVID-19 pneumonia is one of the critical health system challenges in the world. This study aimed to compare the imaging and staging findings of the COVID-19 pneumonia CT scan in patients with and without cancer.

In this case-control study, 109 cancer patients as the case group and 214 non-cancer patients as the control group were included. Covid-19 patients with and without cancer referred to Amir Al-Momenin, and Khansari Hospital in Arak city from June 2020 to July 2021 were included. The data were organized into demographics, underlying medical conditions, ICU admission, and imaging findings.

Overall, 323 Covid-19 patients were included in the analysis, and 109 cases of them were cancer patients. The mean age was 63.12±15.38 years, and 53.87% were female. Intensive Care Unit (ICU) admission rate (41.28% vs 41.28%12.62%) was significantly higher in the cancer group than in the control group (P<0.001). The involvement of lung lobes in the cancer group was higher than in the control group (P=0.011) (70.56% in the left lung and 71.1% in the right lung of cancer patients than 77.40% in the left lung and 83.10% in the right lung). The presence of Ground Glass Opacities (GGO) was higher in CT images of the cancer group in all lobs. This difference in the right upper lobe (RUL) lob was significant (P=0.011) and consolidation (CON) was higher in CT images of the control group, but the differences were not significant (P>0.05). The mean total score in the cancer group was 6.23±2.76 and in the control group was 5.87±2.23 (P=0.202). The mean score in the cancer group of left lower lobe (LLL) lung lobes was 1.46±0.94 and in the control group was 1.21±0.76 (P=0.010) (Table 2).

The results showed that GGO and consolidation were common findings in CT images. GGO was higher in cancer patients. The involvement of lung lobes in the cancer group was higher than in the control group. ICU admission rate was significantly higher in cancer patients.

World Health Organization (WHO) declared a novel HCoVs (COVID-19) to be a public health emergency of international concern on 30 January, 2020. Typical clinical symptoms of patients include fever, dry cough, breathing difficulties (dyspnea). CT is the most sensitive radiological technique for the diagnosis of COVID-19, showing spectrum of lung features. The purpose of this study was to investigate clinical and laboratory outcomes and chest CT futures of patients to recognize prognostic factors for COVID-19. Clinical and laboratory findings and chest CT futures were evaluated from 226 admitted patients with the initial diagnosis of COVID-19 who were recovered or died due to the disease and its complications. The association between vital status and categorical variables was evaluated. The single and multiple logistic models were used for assessing the impact of study variables on the hazard of occurring death. The prediction power of some variables were significant. The highest AUCs were observed for GGO pattern, age, lymphocyte count, Creatinine, CRP, LDH, and Systolic Blood Pressure. This study was reached an accurate for predicting vital status among COVID-19 patients. In this study, we evaluated and presented CT feature parameters as well as clinical and laboratory markers as a model that predicts vital status among COVID-19 patients.

The present study aimed to assess the association of religious/spiritual perfectionism and mental health during the COVID-19 pandemic in Iran. This cross-sectional study recruited 852 individuals in Iran from June 2021 to July 2021. The Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and Spiritual/Religious Perfectionism Scale were used for data gathering. Overall, 852 participants were included. The mean age of participants was 36.92±12.07 years, and 70.5% of participants were female. The levels of anxiety (mean ±SD, 8.10±4.91) and depression (mean ±SD, 8.34±6.56) were mild. The mean Spiritual/Religious perfectionism score was 52.20±14.89. The Depression coefficient was the strongest significant predictor for Spiritual/Religious perfectionism (P<0.001, β=-0.19). Moreover, this negative coefficient shows the negative relationship between depression and Spiritual/Religious perfectionism. The results showed that the levels of anxiety, depression, and Spiritual/Religious perfectionism were mild, and depression negatively correlated to Spiritual/Religious perfectionism during the COVID-19 pandemic.

The new coronavirus disease, which started in Wuhan, quickly transformed into a pandemic and a life-threatening global infection. Understanding Covid-19-specific views can facilitate defining more accurate CT scan diagnostic criteria for this disease. These views include ground-glass opacity (GGO), consolidation, interlobular septal thickening, reticular, and crazy paving. This case series aimed to assess six Covid-19 patients displaying the target sign view in lung CT scans.

The COVID-19 pandemic has led to rising demand for hospital beds and the shortage of medical equipment and supplies. It is necessary to identify the factors that influence the length of stay of COVID-19 patients to accurately predict the number of beds needed at each level of care. This study systematically reviewed influential factors on the hospitalization of COVID-19 patients to provide evidence for risk classification and improvement of clinical outcomes and recommendation solutions for reducing the length of stay.

With the appropriate keywords and a clearly defined search strategy, relevant databases such as PubMed, Embase, and Cochrane Library were searched for cohort studies and randomized control trials to November 10, 2020. The Newcastle-Ottawa Scale (NOS) was used for assessing the quality of studies. Data including influencing factors length of stay, age, sex, country were extracted based on a checklist developed by the researchers. Data obtained due to differences in measurement criteria were qualitatively analyzed.

The systematic search resulted in 48 relevant studies.  Dependence of the severity of disease on age and comorbidities is the principal determinant of increased length of stay. Secondary bacterial infections, obesity, diabetes, and uncontrolled hyperglycemia in COVID-19 patients are likely to increase their length of stay. Special attention to liver damage has also been recommended in SARS-CoV-2 infections since pharmacological factors are independent risk factors for liver damage in non-severe patients. Neurological complications at presentation or during the hospital stay significantly increase the risk of prolonged hospitalization. Shortage of re-sources could decrease stay among COVID-19 patients, which indicates that intensive care is either delayed, deferred, or abbreviated.

Overall, demographic and epidemiological factors, dietary factors and diabetes, neurological conditions, liver damage, acute cardiovascular diseases, and social factors contribute to the length of hospital stay in COVID-19 patients. The present results can provide insights for policymakers regarding the factors that influence the length of stay of COVID-19 patients and practical solutions that can be employed to manage these factors.

Increasing knowledge in nursing and existing contradictions is the main challenge for the health system in a pandemic such as a corona pandemic. Knowledge translation is an effective strategy in strengthening the acceptance and application of research results in the field. Interaction between researchers (research nurses) and users (nursing caregivers) is one of the main features of knowledge translators. This study was conducted to explain the need for a knowledge translation model in Iranian nursing.

The systematic review studies about knowledge translation were searched between 2005 and 2020 in the valid databases Medline, PubMed, Scopus with keywords included COVID-19 , Knowledge Translation Model, Knowledge translation in Nursing, Knowledge‐ to ‐ Action Cycle. Overall, 1231 documents were extracted, and after removing irrelevant and duplicate articles, 46 articles related to the subject were included.

Knowledge translation in nursing needs a model to develop testable and useful interventions. Despite the need to develop theory and model in the last four decades, there is currently no complete and satisfactory model of knowledge translation in nursing. Many people who believe that change should take place after the production of knowledge, believe that due to the various obstacles in the process, the factors affecting the knowledge translation in nursing should be presented as a model.

Research about the knowledge translation process in nursing, and health policymakers' reaction, increase insight into the problems and shortcomings of this process. At present, there are no coherent models appropriate to the local conditions in nursing in Iran to explain the model of knowledge translation in such a way that the conditions prevail over the three areas of policy-making, academic and clinical in general.