Previous investigations have demonstrated that interleukin-6 (IL-6), C reactive protein (CRP), tumor necrosis factor- alpha (TNF-alpha), in Coronavirus disease 2019 (COVID-19) patients are considerably increased, and their progressive elevation are clinical threat indicators of disease severity. The purpose of this systematic review is to evaluate the efficacy of physiotherapy, specifically chest physiotherapy, on different cytokines in Covid-19 and non-covid-19 patients. The main complications and symptoms of this virus are as follows; a dry cough, fever, and progressive dyspnea. Quickly, the coronavirus, which is named SARS-CoV-21, has spread worldwide, causing severe lung inflammation, respiratory distress syndrome, cardiac and renal injury, especially in comorbidities patients. Approximately 96% of the cases experience mild respiratory symptoms; some progress to pneumonia, respiratory insufficiency, acute respiratory distress syndrome, and multiorgan failure. The overall mortality rate per number of diagnosed cases is 4.6%; it can range from 0.2% to 15% according to age and health problems. Combination MeSH and text terms were used to perform the search strategy. Interventions in RCTs and clinical trials with or without comparison were assessed. Six studies met the inclusion criteria. Studies demonstrated that physiotherapy could have an effect on TNF-alpha, IL-6, IL-10, IL-1β and CRP.
Following the crisis of coronavirus outbreak in numerous regions of the world, this epidemic enhanced promptly in most countries, including Iran, and sent a host of patients in need of medical services to hospitals. This study aimed to investigate the challenges of operational management of a reference military hospital during the pandemic COVID-19. Methods: This research is a qualitative study with the content analysis method with a deductive and guided approach. Data collection was conducted through a semi-structured interview method and utilizing a questionnaire designed based on the management functions of the Hospital Incident Command System (HICS). The targeted sampling method and participants in this study included senior-middle managers working in organizational positions of the reference hospital in 2020 employed during the organizational position in Covid-19 Pandemic. Classifications and coding were performed employing MAXQDA 2018 software. Results: The findings of this study were explored in the form of strengths, weaknesses, and challenges. Weaknesses included taking surprise, early and non-missionary entry into the COVID-19 crisis, lack of appropriate depot, instant management, deficiencies in the training of patients and staff, poor functioning of the crisis management system, deficiencies in monitoring, and poor provision of psychological support. The strengths were the devoted and altruistic presence of the medical staff and managers, the financial support of the headquarters, the effective field research of the management team of the organization, and the proper management of the volunteer forces. The most significant challenge was the poor coordination with the relevant organizations, including the headquarters, the Defense Organization, and the Ministry of Health. Conclusions: The findings of this study demonstrate that in the peak period of the COVID-19 pandemic to promote the operational management of the hospital, sticking to the general policies of the organization, structured coordination with internal and external organizations, organized management of equipment and human resources, generating a robust documentation structure and decision-making based on the evidence, effective and practical use of the crisis management system, systematic training of staff and patients, prioritizing the safety of patients and staff, organized dissemination of information and systematic monitoring as well as evaluation are the most significant points to deal with the epidemic crisis.
Trust in health care professionals is considered as a basis for patients’ care. This study aimed to compare the level of patients' trust in physicians and nurses in both general and COVID-19 wards in a reference hospital in Tehran during the pandemic. This was a cross-sectional descriptive study. The study population comprised patients from Baqiyatallah Hospital in 2022. The data collection tool was the scale of patients’ trust in nurses and the Wake-Forest physician trust scale. Data analysis was performed using SPSS-26 software. The level of patients’ trust in physicians in COVID-19 wards was significantly lower than in Non-COVID-19 wards (P<0.001), but there was no difference between the two groups in the trust of nurses. The lowest level of trust was in the receiving of required information from nurses, which had a lower score compared to other questions in the questionnaire, and the average amount of receiving required information for patients in general wards was significantly lower than that of patients in COVID-19 (P=0.006). Trust in nurses and physicians in both COVID-19 and general wards was optimum. During the COVID-19 pandemic, the medical staff worked tirelessly and despite the difficulties and complications of the pandemic, patients have high trust in physicians and nurses.
We wanted to evaluate the efficacy of intravenous immunoglobulin (IVIG) treatment in Covid-19 patients in the intensive care unit (ICU). Sixteen (66.7%) male and 8 (33.3%) female adult severe Covid-19 patients who were treated with IVIG in the tertiary ICU between April 2020 and October 2021 at Ankara City Hospital were retrospectively reviewed. The median age of the patients was 63 (interquartile range (IQR):19). The patients were evaluated in terms of laboratory values and clinical results before and after IVIG treatment. There was no statistically significant difference between survived and deceased Covid-19 patients treated with IVIG in terms of age, gender, the onset of symptoms, presence of concomitant diseases, APACHE-II scores, duration of mechanical ventilator support, and length of stay in the ICU. When the laboratory values before and after IVIG treatment were compared, a significant decrease was identified only in alanine transaminase levels (p=0.01). However, there was a statistically significant difference in mortality in 5 patients with Guillain-Barré syndrome who all survived (p=0.001). IVIG treatment was effective in Covid-19 patients with Guillain-Barré syndrome. However, IVIG treatment did not have a statistically significant effect on pre and post-treatment laboratory values, morbidity, and mortality of severe Covid-19 patients in the ICU.
Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections and an important cause of morbidity and mortality worldwide. The objective of the study was to identify the predictive factors for unfavorable evolution and deaths among patients with CDI. Materials and methods: We conducted a retrospective, observational, non-randomized study on 202 patients diagnosed with CDI in the Clinical Emergency Hospital of Bucharest, Romania, for a period of two years. For the statistical analysis, the R program was used, with p-values <0.05 being considered statistically significant. Results: The average age of the patients included in the study was 70.8 years, the average duration of hospitalization was 18.4 days, and the mortality rate was 25.7%. During the follow-up period, only 5% of the patients presented a recurrence of CDI. Multiple binomial logistic regression defined as independent risk factors for death among CDI patients: advanced age, comorbidities such as chronic obstructive pulmonary disease (p=0.008), chronic kidney disease (p=0.007), or COVID-19 (p=0.036), leukocytes ≥ 16,755/mm3 (p=0.009) and serum albumin < 2.83 g/dL (p<0.001). Conclusions: The identification of certain negative prognostic factors in patients with CDI requires a careful follow-up of the patients, for an early identification of complications and adaptation of therapeutic management.
Background and Objectives: Chronic Kidney Disease (CKD) affects 6,7% of the adult population in Romania and is associated with high morbidity. About one out of three adults with diabetes has kidney disease. According to current literature data, the prevalence of diabetes is very high, up to 11,6%, of whom 2,4% had undiagnosed diabetes, and is the leading cause of kidney damage and the need for renal replacement therapy (RRT). COVID-19 has brought with it a lot of unanswered questions, regarding the risk factors, the disease evolution, and the treatment possibilities. It became clear that diabetic kidney disease (DKD) is among the independent risk factors that predict unfavorable outcomes upon SARS-CoV-2 infection, so we aimed to evaluate the characteristics of diabetic and non-diabetic dialyzed patients, COVID-19 positive. Materials and Methods: It is an observational, single-center study that analyzed type 2 diabetes mellitus and non–diabetic patients in maintenance hemodialysis hospitalized for SARS CoV-2 infection. Results: A total of 101 adult dialyzed patients were admitted with a SARS-CoV-2 RT-PCR positive test, out of which 42 had a long history of diabetes mellitus type 2 and 59 of them have been known with other etiologies of CKD. Hypertension and heart disease were the most commonly associated comorbidities. Inflammatory markers and anemia were significantly increased in diabetic patients compared to non-diabetic. Conclusions: We found that anemia was more severe in patients COVID-19-positive MHD T2DM patients.
: Social responsibility and, is an indicator that is important in the epidemic of diseases with high prevalence and death rates. The current study aims at determining the relationship between social responsibility and COVID-19 in the population covered by health centers in Iran. Methods: 500 people participated in this descriptive-analytical study. The data was collected using a researcher-made social responsibility questionnaire in the context of the Covid-19 pandemic in three areas general, individual, and social responsibility. The quantitative content validity method was used to measure the validity of the questionnaire and Cronbach's alpha calculation method was used to measure its reliability. The data were analyzed using SPSS21 software. Findings: Among the participants, 4.32% of them had a history of covid-19, and the history of complications was more in men (51.9%) and the mean social responsibility score of women was higher (P<0.001). The average responsibility score was higher in people without a history of Covid-19 than in people with a history of Covid-19 (P=0.006). Conclusion: Individuals with higher social responsibility observed more health protocols and had lower rates of covid-19 infection among them. Therefore, in the design of educational interventions, planning should be done to increase people's sense of social responsibility
COVID-19 has not been adequately investigated in patients with psoriasis. We wanted to evaluate the effect of COVID- 19 and COVID-19 vaccines on disease course in patients with psoriasis. We retrospectively reviewed the medical records of patients who were admitted for the treatment of psoriasis between March 2020 and May 2022. Afterward, patients were contacted by telephone call to collect data on COVID-19. This study included 257 patients, 118 females, and 139 males. 238 (92.6%) patients were vaccinated against COVID-19. The mean age of the vaccinated and unvaccinated patients was 49.23±14.60 and 40.37±11.66 years, respectively (p=0.010). Exacerbation of psoriasis after COVID-19 vaccination was detected in 32 (13.4%) patients. 114 (44.4%) patients had been diagnosed with COVID-19 and 18.4% of them stated exacerbation of psoriasis after COVID-19. No association was detected between COVID-19 and having an accompanying disease and psoriasis treatment (p=0.843, p=0.845, respectively). Hospitalization was required in 12 (10.5%) patients. Unvaccinated patients with psoriasis were significantly younger than those who were vaccinated. Exacerbation of psoriasis was reported in 13.4% of vaccinated patients and in 18.4% of patients after COVID-19. Nevertheless, accompanying disease and conventional or biological agent treatment were associated neither with COVID-19 nor COVID-19-related hospitalization.
Background: Lung tissue changes following COVID-19 may persist for a long time after discharge and recovery, but not enough information is available about these chronic pulmonary sequels. We addressed to evaluation of chronic pulmonary sequels on CT scans of patients with COVID-19. Methods: This cross-sectional study was conducted on 94 patients with COVID-19 who were evaluated by CT scan at the time of discharge and also underwent continuous evaluation by CT scan of the lungs for at least three months. Through reviewing the hospital archive files, patients' backgrounds and three-month follow-up information were collected. Results: Chronic pulmonary involvement during the follow-up of patients was found in 83%. Peripheral and diffuse involvements were revealed in 79.8% and 3.2% respectively. Also, single-lobar and multi-lobar involvements were found in 69.1%% and 13.8% respectively. In terms of abnormal lung findings on CT scan, ground-glass opacity was found in 20.2%, Crazy- paving pattern in 2.1%, reticulation in 3.2%, parenchymal band in 12.8%, consolidation in 1.1% and bronchiectasis in 3.2%. The mean CT score was also 4.21 ± 3.45. The appearance of findings in CT patients was strongly influenced by the patients 'age, body mass index, underlying comorbidities, and also, the severity of initial COVID-19. Conclusion: Within at least three months of disease recovery in hospitalized patients with COVID-19, evidence of pulmonary involvement in 83% in the form of chronic pulmonary sequels can be expected. The most common findings related to pulmonary involvement included GOO in 20.2% and parenchymal band in 12.8% of cases.
The study aims to assess the frequency of ESKAPE pathogens and their antimicrobial resistance profile during the COVID- 19 pandemic in a multidisciplinary hospital. Based on microbiological reports, the present study retrospectively evaluated the frequency and antimicrobial resistance (AMR) profile of ESKAPE microorganisms during 2020-2022 in a multidisciplinary hospital in Romania. There were reported 1117 bacterial isolates during the study and ESKAPE pathogens account for 33.5% of the strains. The specific AMR of ESKAPE pathogens cumulates 30.9%, while antimicrobial multidrug resistance characterizes 21% of all ESKAPE strains. The AMR profile of K. Pneumoniae, followed by S. aureus, and P. aeruginosa are alarming on ESKAPE surveillance. The most frequent bacterial isolates and antibiotic resistance reports were identified in the urology department. Based on the local AMR data we suggest the first-line antibiotic recommendations when ESKAPE pathogens are suspected. The directions of the near future antibiotic stewardship program focus on revising the clinical protocols of diagnosis and treatment in each department, increasing the bacteriological samples collection, improving the microbiological diagnostic techniques for AMR identification, and intensifying the epidemiological actions of surveillance, control, and education.
