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B ackground: According to the World Health Organization, preventive measures are the o nly non-pharmacological method to combat the COVID-19 epidemic. This study aimed t o investigate the relationship between perceived social support and preventive behaviors mediated by the variables of life expectancy and mental wellbeing. Materials and Methods: This study is applied in terms of purpose and was conducted by survey method. The statistical population included women living in Tehran City, Iran, with a sample size of 428. The study data were collected using the preventive behavior scale, mental wellbeing scale, Snyder hope scale, and multidimensional perceived social support scale. The obtained data were analyzed using SPSS 25 and AMOS 23 software. Results: The study results showed a positive and significant relationship between perceived social support and mental wellbeing, between perceived social support and life expectancy, and between mental wellbeing and life expectancy. Also, life expectancy and mental wellbeing variables mediate between perceived social support and preventive behaviors. Conclusion: Considering the critical role of women in family management and preventive measures during the COVID-19 epidemic, strengthening social support networks, hope, and mental wellbeing should be considered. [ABSTRACT FROM AUTHOR]

The COVID-19 has placed pandemic modeling at the forefront of the whole world's public policymaking. Nonetheless, forecasting and modeling the COVID-19 medical waste with a detoxification center of the COVID-19 medical wastes remains a challenge. This work presents a Fuzzy Inference System to forecast the COVID-19 medical wastes. Then, people are divided into five categories are divided according to the symptoms of the disease into healthy people, suspicious, suspected of mild COVID-19, and suspicious of intense COVID-19. In this regard, a new fuzzy sustainable model for COVID-19 medical waste supply chain network for location and allocation decisions considering waste management is developed for the first time. The main purpose of this paper is to minimize supply chain costs, the environmental impact of medical waste, and to establish detoxification centers and control the social responsibility centers in the COVID-19 outbreak. To show the performance of the suggested model, sensitivity analysis is performed on important parameters. A real case study in Iran/Tehran is suggested to validate the proposed model. Classifying people into different groups, considering sustainability in COVID 19 medical waste supply chain network and examining new artificial intelligence methods based on TS and GOA algorithms are among the contributions of this paper. Results show that the decision-makers should use an FIS to forecast COVID-19 medical waste and employ a detoxification center of the COVID-19 medical wastes to reduce outbreaks of this pandemic. [ABSTRACT FROM AUTHOR]

The Covid-19 outbreak changed travel behaviour in many ways. This paper evaluates these changes in Tehran, Iran, from a transportation sustainability perspective. It uses data from travel surveys before and during the pandemic to evaluate changes in travel activity and their impacts on public transportation (PT) system costs and revenues, air quality and traffic crashes. A structural equation model (SEM) is used to assess the potential impact of passengers' characteristics, details of each transportation mode and the severity of Covid-19 on travel behaviour. Hypothesis testing is used to compare the changes that occurred in air quality and traffic crashes. SEM outputs indicate that the frequency of trips previously made by sustainable modes and changes in regular trips have the highest impact on the sustainability of trips made during the Covid-19 pandemic. Air quality declined in many city districts. The pandemic caused reductions in PT ridership and an increase in private car use, which threaten the long-term sustainability of public transit services. Crash fatalities declined slightly, particularly during periods of movement restrictions. However, motorcycle fatal crashes increased in comparison with the reduction in motorcycle trips, apparently due to increased traffic speeds. The government did not use the pandemic as an opportunity to promote sustainable and low-contagion modes. This analysis infers that the Covid-19 outbreak reduced the overall transportation sustainability in Tehran. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to investigate the effects of COVID-19 regarding the efficiency of industries based on data in the Tehran stock market. A hybrid model of Data Envelopment Analysis (DEA) and data mining techniques is used to analyze the investment behavior in Tehran stock market. Particularly during the COVID-19 pandemic, many companies face financial crises. That is why companies with inferior performance must be benchmarked with efficient companies. First, the financial data of investments on selective companies are analyzed using data mining approaches to recognize the behavioral patterns of investors and securities. Second, customers are clustered into 3 selling and 4 buying groups using data mining techniques. Then, the efficiency of active companies in stock exchange is evaluated using input-oriented DEA. The results indicate that, among 23 industries listed on the stock market in Iran, solely nine were efficient in 2019. Moreover, in 2020, the number of efficient industries further decreased to six industries. Comparing the obtained results with those of another study which was conducted in 2018 by other researchers revealed that COVID-19 strongly affects the performance of an industry and some industries which were efficient in the past such as the bank industry became inefficient in the following year. [ABSTRACT FROM AUTHOR]

The Islamic Republic of Iran reported its first COVID-19 cases by 19th February 2020, since then it has become one of the most affected countries, with more than 73,000 cases and 4,585 deaths to this date. Spatial modeling could be used to approach an understanding of structural and sociodemographic factors that have impacted COVID-19 spread at a province-level in Iran. Therefore, in the present paper, we developed a spatial statistical approach to describe how COVID-19 cases are spatially distributed and to identify significant spatial clusters of cases and how socioeconomic and climatic features of Iranian provinces might predict the number of cases. The analyses are applied to cumulative cases of the disease from February 19th to March 18th. They correspond to obtaining maps associated with quartiles for rates of COVID-19 cases smoothed through a Bayesian technique and relative risks, the calculation of global (Moran's I) and local indicators of spatial autocorrelation (LISA), both univariate and bivariate, to derive significant clustering, and the fit of a multivariate spatial lag model considering a set of variables potentially affecting the presence of the disease. We identified a cluster of provinces with significantly higher rates of COVID-19 cases around Tehran (p-value< 0.05), indicating that the COVID-19 spread within Iran was spatially correlated. Urbanized, highly connected provinces with older population structures and higher average temperatures were the most susceptible to present a higher number of COVID-19 cases (p-value < 0.05). Interestingly, literacy is a factor that is associated with a decrease in the number of cases (p-value < 0.05), which might be directly related to health literacy and compliance with public health measures. These features indicate that social distancing, protecting older adults, and vulnerable populations, as well as promoting health literacy, might be useful to reduce SARS-CoV-2 spread in Iran. One limitation of our analysis is that the most updated information we found concerning socioeconomic and climatic features is not for 2020, or even for a same year, so that the obtained associations should be interpreted with caution. Our approach could be applied to model COVID-19 outbreaks in other countries with similar characteristics or in case of an upturn in COVID-19 within Iran. Author summary: Iran was among the first countries reporting a rapid increase in the number of COVID-19 cases. Spatial epidemiology is useful to study the spatial distribution of a disease and to identify factors associated with the number of cases of such disease. By applying these methods, we aimed to identify whether there are clusters of regions in Iran with high or low number of COVID-19 cases and the association of different factors with these numbers, considering spatial relationships and maps representing these associations. Interestingly, we found regions of high number of cases and that more COVID-19 cases were present in provinces with more urbanization, aging population, number of physicians, efficient communications, and greater average temperatures, whereas less COVID-19 cases were present in provinces with more literacy. This study allowed us to understand the spatial behavior of the disease and the importance of having adequate health policies, literacy campaigns, and disseminating health information to the population. [ABSTRACT FROM AUTHOR]

In February 2020, the first sample test was confirmed as positive for corona virus in Masih Daneshvari Hospital that is the reference center in Iran for all pulmonary and respiratory diseases. The decisions made in a hospital or organization to manage a crisis is very vital. Success in managing any crisis requires a scientific and scholarly attitude. This paper was distilled from experiences gained in Masih Daneshvari Hospital in Tehran, capital of Iran, in March 2020 at the stubborn time of coping and managing corona virus crisis. This study was conducted using participatory action research, a methodology which identifies problems in practice, and finds methods to solve them. This Action research involves five stages: statement of the problem, planning, data interpretation and analysis, action, and evaluation of the research process during performing the study. The whole hospital was equipped for corona virus patients in 10 phases during one week and 250 active beds were equipped for these patients. Three models, namely, "corona virus crisis management model", "Pharmaceutical care management in coronavirus crisis model" and "nursing in coronavirus crisis model" were planned and implemented. During one month of implementing these three models, the supervision team monitored the accurate implementation of instructions and resolving or revising the possible deficiencies and faults. The Masih Daneshvari crisis management model in coronavirus, can be a useful and applicable model in other corona virus centers. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 pandemic posed significant risks to children worldwide. This study aimed to assess the COVID-19 protection status of children and explored the relationship between household socio-economic status and COVID-19 morbidity and preventive measures, including vaccination and mask-wearing, in two cities in Iran. Method: A population-based cross-sectional study was conducted from July to October 2022 among 7 to 18-year-old children and their families in Tehran and Karaj. A total of 3,022 samples were selected using stratified multistage cluster sampling. Data were collected through interviews with children and adults, using questionnaires and was analyzed with Stata software version 14. Results: The analysis focused on 2,878 children with a median age of 12. Over half (54%) reported that the pandemic negatively affected their family's financial status, with 45% describing its impact on children's needs as negative or very negative. Just under 50% of respondents consistently wore masks during the study period, and around 54% had received at least one dose of the COVID-19 vaccine. Reasons for not getting vaccinated included concerns about side effects, ineligibility for the target age group, and overcrowding at vaccination sites. The odds of not getting vaccinated were significantly lower for children aged 15–18, with boys more likely to refuse vaccination than girls. Conclusion: The financial impact of the pandemic in Iran affected families' ability to meet their children's needs. Moreover, low vaccination acceptance rates increased children's vulnerability to health problems and contributed to COVID-19 infections. Efforts should be made to increase vaccination acceptance, particularly among immigrant populations. [ABSTRACT FROM AUTHOR]

Background: Perceived social support (PSS) plays a considerable role in mental health. The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used scales, leading to much research evidence. The present study investigated its measurement model, equivalence across gender (male and female) and age groups (older patients= above 60 and non-older patients= below 60), and concurrent validity. Methods: A cross-sectional survey was conducted between March and October 2020, on patients hospitalized due to COVID-19 in Tehran, Iran. The scales were administered to 328 COVID-19 patients (54.6% male, aged 21 to 92) from two general hospitals; participants completed MSPSS (including friends, family, and significant others subscales), Pittsburgh Sleep Quality Index (PSQI, include sleep latency, subjective sleep quality, habitual sleep efficiency, sleep duration, use of sleep medication, daytime dysfunction, and sleep disturbances subscales), and the Perceived Stress Scale-10 (PSS-10, to assess patients' appraisal of stressful conditions). Results: The MSPSS three-factor structure was confirmed among COVID-19 patients by Confirmatory Factor Analysis (CFA). The results support the MSPSS internal consistency and configural, metric, and scalar invariance across gender and age groups. Nevertheless, small but significant differences were found across ages based on the latent factor mean of the MSPSS from friends, with a lower mean level in older patients. The coefficients of Cronbach's alpha (ranging from.92 to.96), the ordinal theta (ranging from.95 to.98), and Omega (ranging from.93 to.97) suggested high internal consistency of MSPSS. The concurrent validity of MSPSS was evidenced by its significant negative correlation with PSS-10 (Γb = -.13, p <.01) and also subjective sleep quality (Γb = -.22, p <.01), sleep disturbances (Γb = -.26, p <.001), and daytime dysfunction (Γb = -.26, p <.001). Conclusions: The MSPSS was valid and reliable for measuring individuals' perception of social support between males and females and older and non-older COVID-19 patients. [ABSTRACT FROM AUTHOR]

Objectives: Comparison of the effect of hydroxychloroquine with placebo to prevent infection from the COVID -19 virus among healthcare professionals TRIAL DESIGN: Single centre, 2-arm, double-blind randomised (ratio 1:1) placebo-controlled trial PARTICIPANTS: Treatment staff who are in contact with patients and have at least 3 shifts a week in Arash hospital affiliated with Tehran University of Medical Sciences, in Iran and who consent to participate in the study. Exclusion criteria include: History of COVID -19 virus infection, clinical symptoms such as fever, nausea, dyspnea and myalgia in the past two months, history of underlying diseases hypersensitivity to hydroxychloroquine and G6PD enzyme deficiency.Intervention and Comparator: Intervention group: Hydroxychloroquine 200 mg tablet of Amin Pharmaceutical.Control Group: placebo which is completely similar in form and taste to 200 mg hydroxychloroquine tablet and is manufactured by the same factory (Amin Pharmacy). The dosage is two tablets daily, once a week for one to three months (based on the duration of the Coronavirus epidemic in Tehran).Main Outcomes: Confirmed COVID-19 virus infection using Polymerase chain reaction (PCR) test is the primary outcome. The time period for measuring the primary outcome is any infection within the trial period up to one month after taking the last dose.Randomisation: The randomized block allocation method was developed using Stata version 15 software by an independent researcher, using a block size of six. Allocation to the two treatment groups will be conducted by this researcher using paper labels (random 10-digit codes) in a 1:1 ratio t The labels will be attached to the drug packages in order of randomization. Drug packages will be arranged in a box according to the randomization list.Blinding (masking): Participants and caregivers are blinded to group assignment and the data will be analyzed by an independent statistical expert who is unaware of the treatment allocation.Numbers To Be Randomised (sample Size): A total of 282 participants will be randomised with 141 participants the Hydroxychloroquineeach intervention group and 141 participants to the placebo control group TRIAL STATUS: The protocol version number is 99-1-101-47091 and the approval ID is IR.TUMS.VCR.REC.1399.001 and recruitment began April 7, 2020, and is anticipated to be complete by August 7, 2020.Trial Registration: The name of the trial register is Iranian registry of clinical trial (IRCT), registration number is IRCT20120826010664N6, date of trial registration is April 7, 2020, 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. [ABSTRACT FROM AUTHOR]

The present study was done to evaluate the prevalence of intestinal parasitic infections (IPIs) in patients with COVID-19 in health care centers (Imam Reza and Golestan hospitals), Tehran, capital of Iran. By designing a matched case-control study, 200 fecal samples were collected for each of the COVID-19 patients and healthy individuals. Nasopharyngeal/oropharyngeal swab samples were collected from all participants for the diagnosis of COVID-19. RNA extraction was performed, and then real time reverse-transcription polymerase chain reaction (rRT-PCR) assay was applied to detect viral RNA. Considering the lung complications, 25%> lung complications was detected in 49 patients, 25–49% in 42 patients, and 50%≤ in 109 patients. Fecal samples were examined using different parasitological techniques. After nested-PCR, sequencing was applied to identify Cryptosporidium spp. and microsporidia spp. A relatively lower prevalence of IPIs was detected among control group (7.5%), than in COVID-19 patients (13%), though not significant P = 0.13 . The most prevalent parasite among patients was Blastocystis sp. (6%). Also, 13.76% of IPIs were detected in inpatients with more than 50% lung complication. As well, a remarkably significant difference in IPIs was observed among diarrheic COVID-19 patients, in comparison with nondiarrheic patients P < 0.00001 . Moreover, the isolated sequences in the present study belonged to C. parvum subtype IIa and Enterocytozoon bieneusi genotypes D and Peru 8. In conclusion, more epidemiological and clinical research studies are needed to better understand the status and interaction of IPI in COVID-19 in Iran and other countries. [ABSTRACT FROM AUTHOR]

With the severe outbreak of the novel coronavirus (COVID-19), researchers are motivated to develop efficient methods to face related issues. The present study aims to design a resilient health system to offer medical services to COVID-19 patients and prevent further disease outbreaks by social distancing, resiliency, cost, and commuting distance as decisive factors. It incorporated three novel resiliency measures (i.e., health facility criticality, patient dissatisfaction level, and dispersion of suspicious people) to promote the designed health network against potential infectious disease threats. Also, it introduced a novel hybrid uncertainty programming to resolve a mixed degree of the inherent uncertainty in the multi-objective problem, and it adopted an interactive fuzzy approach to address it. The actual data obtained from a case study in Tehran province in Iran proved the strong performance of the presented model. The findings show that the optimum use of medical centers' potential and the corresponding decisions result in a more resilient health system and cost reduction. A further outbreak of the COVID-19 pandemic is also prevented by shortening the commuting distance for patients and avoiding the increasing congestion in the medical centers. Also, the managerial insights show that establishing and evenly distributing camps and quarantine stations within the community and designing an efficient network for patients with different symptoms result in the optimum use of the potential capacity of medical centers and a decrease in the rate of bed shortage in the hospitals. Another insight drawn is that an efficient allocation of the suspect and definite cases to the nearest screening and care centers makes it possible to prevent the disease carriers from commuting within the community and increase the coronavirus transmission rate. [ABSTRACT FROM AUTHOR]

Air pollution has very damaging effects on human health. In recent years the Coronavirus disease (COVID-19) pandemic has created a worldwide economic disaster. Although the consequences of the COVID-19 lockdowns have had severe effects on economic and social conditions, these lockdowns also have also left beneficial effects on improving air quality and the environment. This research investigated the impact of the COVID-19 lockdown on NO2 and O3 pollutants changes in the industrial and polluted cities of Arak and Tehran in Iran. Based on this, the changes in NO2 and O3 levels during the 2020 lockdown and the same period in 2019 were investigated in these two cities. For this purpose, the Sentinel-5P data of these two pollutants were used during the lockdown period from November 19 to December 05, 2020, and at the same time before the pandemic from November 19 to December 05, 2019. For better results, the effect of climatic factors such as rain and wind in reducing pollution was removed. The obtained results indicate a decrease in NO2 and O3 levels by 3.5% and 6.8% respectively in Tehran and 20.97% and 5.67% in Arak during the lockdown of 2020 compared to the same time in 2019. This decrease can be caused by the reduction in transportation and socio-economic and industrial activities following the lockdown measures. This issue can be a solid point to take a step toward controlling and reducing pollution in non-epidemic conditions by implementing similar standards and policies in the future. [ABSTRACT FROM AUTHOR]

Background: The impacts of caring for hospitalized COVID-19 patients on nurses are wide and varied and have not been comprehensively explained in the existing literature. The aim of this study was to explore the nurses' perception of the impacts of caring for hospitalized COVID-19 patients. Materials and Methods: In this qualitative descriptive study, data were collected via semi-structured interviews with 20 nurses and head nurses of emergency/internal wards and Intensive Care Units (ICUs) of 2 hospitals in Tehran, Iran. The purposive sampling method was used, and data analysis was performed using a conventional content analysis approach. Results: After data analysis, 12 subcategories, 3 main categories, and 1 theme (professional resilience) were extracted. The three main categories included "complex care," "professional development," and "caring self-efficacy." Caring for hospitalized COVID-19 patients was complex for nurses; however, the care provided to these patients could also lead to the nurses' professional development and caring self-efficacy. Conclusions: Health organizations and nursing managers can better manage the COVID-19 pandemic and other similar future crises through strategies such as providing nurses with adequate and diverse resources and facilities, encouraging and supporting nurses in various dimensions, providing positive media advertisements for the nursing profession and nurses, and providing nurses with necessary and applicable knowledge and skills. [ABSTRACT FROM AUTHOR]

Background: The medium and long-term problems of COVID-19 survivors after hospital discharge are currently unknown, but new evidence is emerging. This study was conducted with the aim of the effectiveness of mindfulness-based cognitive therapy (MBCT) on resilience and psychological distress of recovered patients from COVID-19 in Tehran City, Iran, in 2021. Methods: The study was a quasi-experimental type of pre-test-post-test design with a control group with a 2-month follow-up. The statistical population included all patients 25-55 years in Tehran City in 2021 with 4 to 8 weeks of discharge. The sample included 30 people who recovered from COVID-19 who had symptoms of depression, anxiety, and stress (based on [depression, anxiety and stress scale] DASS-21 scores) and was selected by purposive sampling and based on the inclusion criteria, and then matching assigned to an experimental (MBCT) and a control group (n=15each). The experimental group received 8 sessions of 60 minutes of mindfulness-based cognitive therapy (individual and online) but the control group received no intervention. The research tools were the DASS21 and Connor-Davidson resilience scale (CD-RISC). Data were analyzed using a mixed analysis test and Ben Foroni post hoc test using SPSS version 23 software. Results: The results showed that MBCT in the post-test positively affected the resilience (F=30.31, P=0.001) and negatively affected the psychological distress (F=120.70, P=0.001) of those who Recovered from COVID-19. This therapeutic effect continued until the follow-up phase. According to the results, MBCT is effective in increasing resilience and reducing psychological distress and a significant difference is observed between the experimental and control groups (P=0.01). Conclusion: Based on the findings, MBCT is effective in increasing resilience and reducing psychological distress after illness and the use of this model can be useful in the psychological rehabilitation of those who have recovered from COVID-19. [ABSTRACT FROM AUTHOR]

Background: The first human case of COVID-19 was reported on 19 February 2020 in Iran, since then the number of infected cases has dramatically increased to about 1.800 million and about 62 000 deaths, also elderly people have accounted for the largest frequency of mortality. Objective: This study aims to evaluate the prevalence of Covid-19 RT-PCR positive among Iranian patients and to evaluate the most important clinical symptoms of identified patients based on age, gender, and their background diseases to be used as an aid for early diagnosis. Methods: During 9 months, swab samples of 11 034 patients' nasopharynx and oropharynx secretions were obtained and were referred to the laboratory for Covid-19 RT-PCR test. In addition, the history of signs and symptoms from patients was recorded. Results: In total, 11 034 Covid-19 RT-PCR tests that performed, 3358 samples had positive results (30.4%). Headache was the most commonly reported, which was found in 42.5% of our cases. Fever was the second most common symptom among the patients studied, with a prevalence rate of 36.2%. Conclusion: In this study, almost 30% of symptomatic patients had positive Covid-19 RT-PCR test results. Headache was the most common symptom; also diarrhea and nausea were the least common symptoms among patients under this study. [ABSTRACT FROM AUTHOR]

Background: It remains crucial to understand socio-demographic determinants of COVID-19 infection to improve access to care and recovery rates from the disease. This study aimed to investigate the urban and sub-urban disparities associated with COVID-19 in patients visiting healthcare facilities in the province of Tehran, Iran.Methods: Data from 234 418 patients who were diagnosed with COVID-19 infection from March 2020 to March 2021 in the province of Tehran were used in this analysis. Descriptive statistics were used to describe the characteristics of the study population. Chi-Squared test was applied to examine the association of study variables with residing area. Independent samples t-test was performed to compare mean age of patients in urban and sub-urban areas. Multiple Logistic Regression model was applied to examine the association of study variables with disease outcome.Results: Overall, most patients resided in the urban settings (73%). Mean age of patients was significantly lower in sub-urban areas compared to their counterparts in urban settings (49 ± 23.1 years versus 53 ± 21.1 years, P < 0.001). Positive PCR test results were more common in urban areas (48.5% versus 41.3%, P < 0.001). Yet, sub-urban settings had higher rates of positive chest CT scan reports (62.8% versus 53.4%, P < 0.001). After accounting for age and sex covariates, residing in urban areas was associated with higher likelihood of being admitted to an ICU (OR = 1.27, CI: 1.240-1.305). Yet, a greater vulnerability to fatal outcome of COVID-19 infection was shown in patients living in sub-urban areas (OR = 1.13, CI: 1.105-1.175).Conclusions: This study revealed a clear disparity in the health outcome of patients infected with COVID-19 between urban and sub-urban areas. [ABSTRACT FROM AUTHOR]

By applying multivariate regression to 2020 survey data from four Tehran hospitals, we measure eight recognized sources of Coronavirus disease 2019 (COVID-19) pandemic-related anxiety among 723 healthcare workers (HCWs) with diverse sociodemographic characteristics employed across different hospital areas and positions. The most prominent anxiety source identified is the risk of workplace COVID-19 contraction and transmission to family, followed by uncertainty about organizational support for personal and family needs in the event of worker infection. A supplemental qualitative analysis of 68 respondents in the largest hospital identifies four additional anxiety sources, namely, health, finances, workload, and leadership. This evidence of the multifaceted nature of anxiety sources among HCWs highlights the differentiated approaches that hospital policymakers must take to combat anxiety. [ABSTRACT FROM AUTHOR]

Background:There were no documents about the non-lung involvement of COVID-19, even in the absence of lung involvement. The present study aimed to report a single-centre experience of liver involvement caused by COVID-19 disease in Iran. MaterialsandMethods:We recorded information of 120 patients who suffered COVID-19 disease, and they were admitted to the intensive care unit at Taleghani hospital in Tehran, Iran, between March and May 2020. Along with clinical and diagnostic parameters, the outcome of patients concerning improvement, disease progression or death was also assessed. Results:In total, 68 patients (56.7%) had abnormal liver dysfunction. The most common changes in liverrelated parameters were elevated international normalized ratio (INR) (mean serum level of 2.5) followed by elevated alkaline phosphatase (ALP) (mean serum level of 412 mg/dl). The mean level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) increased 4 and 9 times more than the standard limit. The overall death rate in COVID-19 patients was 38 patients (55.88%, n=68). Conclusion:Liver injuries are common findings in patients suffering COVID-19 infection and leading to poorer outcomes. Serum bilirubin level of more than 3mg/dl was associated with higher mortality in patients with liver damage. [ABSTRACT FROM AUTHOR]

Background: Defining socio-demographic factors, clinical presentations and underlying diseases associated with COVID-19 severity could be helpful in its management. This study aimed to further clarify the determinants and clinical risk factors of the disease severity in patients infected with COVID-19.Methods: A multi-centre descriptive study on all patients who have been diagnosed with COVID-19 in the province of Tehran from March 2020 up to Dec 2020 was conducted. Data on socio-demographic characteristics, clinical presentations, comorbidities, and the health outcomes of 205,654 patients were examined. Characteristics of the study population were described. To assess the association of study variables with the disease severity, the Chi-Squared test and Multiple Logistic Regression model were applied.Results: The mean age of the study population was 52.8 years and 93,612 (45.5%) were women. About half of the patients have presented with low levels of blood oxygen saturation. The ICU admission rate was 17.8% and the overall mortality rate was 10.0%. Older age, male sex, comorbidities including hypertension, cancer, chronic respiratory diseases other than asthma, chronic liver diseases, chronic kidney diseases, chronic neurological disorders, and HIV/AIDS infection were risk markers of poor health outcome. Clinical presentations related with worse prognosis included fever, difficulty breathing, impaired consciousness, and cutaneous manifestations.Conclusion: These results might alert physicians to pay attention to determinants and risk factors associated with poor prognosis in patients with COVID-19. In addition, our findings aid decision makers to emphasise on vulnerable groups in the public health strategies that aim at preventing the spread of the disease and its mortalities. [ABSTRACT FROM AUTHOR]

Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients' clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 JMIR Res Protoc 2021;10(2):e23316 doi:10.2196/23316 We help JMIR researchers to raise funds to pursue their research and development aimed at tackling important health and technology challenges. If you would like to show your support for this author, please donate using the button below. The funds raised will directly benefit the corresponding author of this article (minus 8% admin fees). Your donations will help this author to continue publishing open access papers in JMIR journals. Donations of over $100 may also be acknowledged in future publications. Submit Suggested contribution levels: $20/$50/$100 [ABSTRACT FROM AUTHOR]

During the last months of the coronavirus pandemic, with all those public restrictions and health interventions, the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears now to have been raised in some countries around the world. Iran was one of those first countries facing the second wave of coronavirus, due to the lack of appropriate public restrictions because of economic problems the country is facing. The clinical and demographic characteristics of severe cases and non-severe cases of Coronavirus Disease (COVID-19) in 192 patients in Tehran, Iran, between June 16 and July 11, 2020, were investigated. The patients were divided into severe cases (n = 82) and non-severe cases (n = 110). Demographic and clinical characteristics were compared between the two study clusters. The mean age was 54.6 ± 17.2 years, and the most common presenting symptom was persistent cough (81.8%) and fever (79.7%). The logistic regression model revealed that age, BMI, and affected family members were statistically associated with severity. Patients with complicated conditions of disorders faced more hospitalization days and medical care than the average statistical data. As the coronavirus spike in the case and death reports from June 2020, we observed the rise in the incidence of severe cases, where 42.7% (82/192) of cases have resulted in severe conditions. Our findings also suggested that the effect of IFB (Betamethasone) was more valid than the other alternative drugs such as LPV/r and IVIg. [ABSTRACT FROM AUTHOR]

Objectives: This study will evaluate the main hypothesis that supplementation with vitamins A, B, C, D, and E significantly improves the severity and mortality rate in ICU patients with COVID-19.Trial Design: This study is a randomized, single-blinded, two-arm (1:1 ratio) parallel group clinical trial.Participants: We are conducting this study in patients with COVID-19 admitted to intensive care units at the Imam Khomeini Hospital Complex in Tehran, Iran. The inclusion criteria are as follows: (1) aged between 20 and 60 years, (2) both male and female patients with COVID-19, (3) clinical or definitive diagnosis (using polymerase chain reaction (PCR) test), (4) patients have not participated in other clinical trials, and (5) no renal or hepatic abnormalities. The exclusion criteria are as follows: (1) patients with specific and rare viral diseases such as HIV and (2) patients who have been undergoing chemotherapy for the past month.Intervention and Comparator: Duration of intervention: 7 days from randomization Intervention in the treatment group: Vitamin A 25,000 IU daily Vitamin D 600,000 IU once during study Vitamin E 300 IU twice daily Vitamin C is taken four times per day B vitamins are taken as a daily Soluvit [which included thiamine nitrate 3.1 mg, sodium riboflavin phosphate 4.9 mg (corresponding to vitamin B2 3.6 mg), nicotinamide 40 mg, pyridoxine hydrochloride 4.9 mg (corresponding to vitamin B6 4.0 mg), sodium pantothenate 16.5 mg (corresponding to pantothenic acid 15 mg), sodium ascorbate 113 mg (corresponding to vitamin C 100 mg), biotin 60 μg, folic acid 400 μg, and cyanocobalamin 5 μg] The control group will not receive any supplements or placebo. All supplements are made in Iran except for Soluvit (from Fresenius Kabi, New Zealand).Main Outcomes: 1. Weight, height, and BMI 2. Severity of pulmonary involvement according to CT scan 3. Respiratory support (invasive or non-invasive) 4. Percentage of oxygen saturation (SpO2 level) 5. Serum levels of WBC, CRP, ESR, IL6, IFN-G, and TNF-α 6. The patient's body temperature 7. The presence or absence of involvement of organs other than the lungs (e.g., heart, liver, kidneys) 8. Duration of hospitalization 9. Mortality rate RANDOMIZATION: At baseline, eligible patients were randomly assigned to a 1:1 ratio to one of two groups: intervention and control. Block randomization is used based on the gender of patients.Blinding (masking): Patients are unaware of being placed in the intervention or control groups after signing consent. All treatment staff will be aware of which group each of the patients is in due to the specific conditions of the ICU and the absence of placebo for the control group.Numbers To Be Randomized (sample Size): The researchers plan to include 60 patients in total, with 30 patients in each group.Trial Status: This is the first version of the protocol which started on April 2, 2020. Recruitment began April 2, 2020, and is expected to be complete by July 4, 2020.Trial Registration: The Iranian Registry of Clinical Trials IRCT20200319046819N1 . Registered on April 4, 2020 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 (Fig. 1, Table 1). [ABSTRACT FROM AUTHOR]