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BACKGROUND: Anxiety and depression can prolong the treatment process and impose financial burdens on the health system in chronic obstructive pulmonary disease. Dignity therapy is one of the methods of eliminating these symptoms. The present study was conducted to investigate the effect of dignity therapy on the severity of anxiety and depression in patients with chronic obstructive pulmonary disease. MATERIALS AND METHODS: This clinical trial was conducted on 62 patients with chronic obstructive pulmonary disease, referring to the comprehensive respiratory clinic of Khorshid Hospital (Isfahan, Iran) in 2021. The patients were randomly allocated to intervention and control groups. Each patient of the intervention group underwent dignity therapy for four 45–60-min sessions, whereas no intervention was performed in the control group. Data were collected using demographic information questionnaire and Hospital Anxiety and Depression Scale (HADS), before the intervention and one month after the completion of the intervention in two groups. Data were analyzed using SPSS version 18 (SPSS Inc., Chicago, IL, USA) as well as descriptive (mean, standard deviation, frequency, and percentage) and inferential (Chi-square, independent t-test, and paired t-test) statistics. RESULTS: The mean score of anxiety of the patients before the intervention was not significantly different between the two groups (P = 0.18); but one month after the intervention, it was significantly lower in the intervention group than in the control group (P = 0.05). Also, the score of depression was not significantly different between the two groups before (P = 0.68) and one month after the intervention (P > 0.05). CONCLUSION: Dignity therapy could reduce anxiety in patients with chronic obstructive pulmonary disease; thus, it could be used as a nonpharmacological, cost-effective and probably without side effects method.

Background: Pulmonary Rehabilitation (PR) is recommended as a standard, effective, and important treatment for COVID-19 survivors who remain symptomatic after the acute phase. Therefore, we aimed to compare the effect of mobile phone-based PR application with face-to-face PR on the quality of life, anxiety, depression, and daily life activities of COVID-19 survivors. Materials and Methods: A quasi-experimental was conducted on 65 COVID-19 survivors during 2022. Convenient sampling was done based on the inclusion criteria. The intervention group (n = 31) received PR through a mobile phone application, and the control group (n = 34) received face-to-face PR. Data were collected before and after the intervention in both groups using a demographic information questionnaire, SF-12, the hospital anxiety and depression scale, and Barthel scale. For all tests, a maximum error of 5% was considered. Results: The two studied groups had no statistically significant difference with respect to all the investigated variables at baseline (p > 0.05). After the intervention, the mean anxiety and depression score of the patients in the control group was significantly lower than the intervention group (t = −3.46, f = 63, p = 0.01). After our intervention, there was no statistically significant difference in the mean quality of life and daily life activity scores between the two groups (t = −0.68, f = 63, p > 0.05). Conclusions: The application of PR does not show a statistically significant difference in terms of improving the quality of life and daily activities compared with the face-to-face method; we suggest that the PR application be used as a cost-effective method when face-to-face PR is not possible.

Background: Encountering the coronavirus disease 2019 (COVID-19) pandemic, nurses face many challenges due to various strategies and resources that can compromise the quality of care. This study aimed to identify nursing care challenges for patients with COVID-19 from nurses' viewpoint in Iran. Materials and Methods: This descriptive qualitative study was conducted in one of the main admission centers in Isfahan to treat patients with COVID-19. Data were collected through semi-structured in-depth interviews with 19 nurses from April 2020 to June 2020. The recorded interviews were transcribed and then analyzed through inductive content analysis. Results: The challenges of nursing care for patients infected with COVID-19 from the nurses' viewpoint were categorized into 11 subcategories and four main categories: work overload in disaster (lack of nurses with adequate clinical qualification and restrictions on the compliance of the infection control protocols), immersion in an ocean of psychological and social tensions (personal and family tensions, work environment tensions, perception of organizational injustice, and social stigma), quality of care in fragile condition (self-preservation rather than patient care and contradictory patient care standards), and disaster preparedness, response, and management (passive resource management, information system challenges, and lack of guideline-supported protocols). Conclusions: The findings of this study suggest that policymakers should actively participate in supporting nurses in the form of reducing physical and mental stress in pandemics such as COVID-19. Having the right perception of the challenges nurses face in such crises can contribute to providing patient safety, improving the quality of care, maintaining organizational resources, and properly managing the disaster.

Background: Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEinhs) may deteriorate or improve the clinical manifestations in severe acute respiratory syndrome coronavirus 2 infection. A comparative, cross-sectional study was conducted to evaluate the association of ARBs/ACEinhs and hydroxy-3-methyl-glutaryl-CoA reductase inhibitors (HMGRis) with clinical outcomes in coronavirus disease 2019 (COVID-19). Materials and Methods: From April 4 to June 2, 2020, 659 patients were categorized according to whether they were taking ARB, ACEinh, or HMGRi drugs or none of them. Demographic variables, clinical and laboratory tests, chest computed tomography findings, and intensive care unit-related data were analyzed and compared between the groups. Results: The ARB, ACEinh, and HMGRi groups significantly had lower heart rate (P < 0.05). Furthermore, a lower percent of O2 saturation (89.34 ± 7.17% vs. 84.25 ± 7.00%; P = 0.04) was observed in the ACEis group than non-ACEinhs. Mortality rate and the number of intubated patients were lower in patients taking ARBs, ACEinhs, and HMGRis, although these differences failed to reach statistical significance. Conclusion: Our findings present clinical data on the association between ARBs, ACEinhs, and HMGRis and outcomes in hospitalized, hypertensive COVID-19 patients, implying that ARBs/ACEinhs are not associated with the severity or mortality of COVID-19 in such patients.

Background: Coronavirus disease 2019 has become a public health concern with a high number of fatalities. Thalidomide can target inflammatory mediators and decrease inflammation in SARS-CoV-2. Materials and Methods: An open-label, randomized controlled trial was conducted on patients with compatible lung high-resolution computed tomography scan for COVID-19 pneumonia and moderate involvement. Childbearing-age women were excluded. A total of 20 patients in the control group receiving usual treatment were compared with 26 patients in the case group who in addition to the same regimen also received thalidomide. The primary outcome was time for clinical recovery (TTCR) and intensive-care unit (ICU) admission. Results: From April 25 to August 8, 2020, based on the inclusion criteria, 47 patients were assigned to the study. Patients receiving thalidomide had a mean TTCR of days 5.5 (95% confidence interval [CI], 0.7–10.3), as compared with days 5.3 (95% CI, 1.7–8.9) with control (odds ratio 0.01; 95% CI, −1.58–1.59, P = 0.807). The incidence of ICU admission was 27% in the thalidomide group compared with 20% in the control group (odds ratio 3.89; 95% CI, 0.55–27.4, P = 0.425). The mean length of stay in hospital in both groups was 10 days. Progressive improvement in respiratory rate, fever, and O2 saturation during the study was seen in both groups without a significant difference between the thalidomide and control group (P > 0.05). Conclusion: This study investigated the effects of thalidomide to treat moderate COVID-19 clinical outcomes. The results established that this drug regimen did not add more effect to usual treatment for moderate COVID-19 pneumonia.

Background: Inflammatory cell death, PANoptosis, has been suggested to orchestrate the lymphocyte decrement among coronavirus disease-2019 (COVID-19) patients. The main aim of this study was to examine the differences in the expression of key genes related to inflammatory cell death and their correlation with lymphopenia in the mild and severe types of COVID-19 patients. Materials and Methods: Eighty-eight patients (36 to 60 years old) with mild (n = 44) and severe (n = 44) types of COVID-19 were enrolled. The expression of key genes related to apoptosis (FAS-associated death domain protein, FADD), pyroptosis (ASC (apoptosis-associated speck-like protein containing caspase activation and recruitment domains (CARD)), the adapter protein ASC binds directly to caspase-1 and is critical for caspase-1 activation in response to a broad range of stimuli), and necroptosis (mixed lineage kinase domain-like, MLKL) genes were examined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) assay, and compared between the groups. The serum levels of interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay (ELISA) assay. Results: A major increase in the expression of FADD, ASC, and MLKL-related genes in the severe type of patients was compared to the mild type of patients. The serum levels of IL-6 similarly indicated a significant increase in the severe type of the patients. A significant negative correlation was detected between the three genes' expression and the levels of IL-6 with the lymphocyte counts in both types of COVID-19 patients. Conclusion: Overall, the main regulated cell-death pathways are likely to be involved in lymphopenia in COVID-19 patients, and the expression levels of these genes could potentially predict the patients' outcome.

BACKGROUND: One of the crises facing human beings is coronavirus disease. This disease was identified in December 2019 in Wuhan, China. With the death of two patients with respiratory complications in Qom Hospital on February 20, 1998, and the confirmation of their positive test, the arrival of COVID-19 disease in Iran was officially confirmed and Khorshid Medical Center as the main reception the Medical Center for patients with COVID-19 from August 3, 2010. The purpose of this study is to document the experiences of Khorshid Training Center in coronavirus crisis management to improve crisis management knowledge. MATERIALS AND METHODS: This research was conducted qualitatively with grounded theory method in the period from March 1998 to the end of May 1999. The study population was Khorshid Educational and Medical Center. Sampling was done purposefully among medical staff, support, and hospital officials. The number of samples with the mentioned conditions reached 44 people. Data were collected using a semi-structured questionnaire and analyzed in the style of grounded theory in the style of Strauss and Corbin. RESULTS: Data collected after sorting, analysis, conceptual analysis; they were coded and categorized into four groups of challenges, weaknesses, strengths, and actions based on the specific objectives of the research in 5 natures, reorganization, accident control system, medical equipment and supplies, human resources, and clinical approaches. CONCLUSION: According to the points classified in the challenges and weaknesses, it was found that the hospital has faced several problems in corona crisis management. The management team, taking advantage of strengths in various areas, has taken effective measures to improve corona crisis management. It has led to the provision of appropriate services to the patients of the Medical Center.

Background: Obesity hypoventilation syndrome (OHS) is associated with increased mechanical load on respiratory system. Here, we aimed to investigate and evaluate the effects of noninvasive ventilation (NIV) on physical and mental status of patients with OHS. Materials and Methods: The current study is an observational study that was performed in 2020 on 50 patients with OHS in Isfahan, Iran. Beck's Depression Inventory (BDI-II) and Hospital Anxiety and Depression Scale (HADS) questionnaires were also filled for all patients assessing their depression levels that were confirmed by psychiatrists. PO2 and PCO2 of patients were evaluated using venous blood gas (VBG) before interventions. Patients with a definite diagnosis of OHS and depression entered the study and underwent treatments with NIV. One month after the interventions with NIV, the blood gases of patients were evaluated using VBG and BDI-II, and HADS questionnaires were also filled for all patients, evaluating their depression. Results: The mean age of the subjects was 63.5 ± 13.5. The mean blood oxygen after the use of NIV in patients with OHS increased significantly (P = 0.001). The mean of carbon dioxide after using NIV in patients with OHS decreased significantly (P = 0.001). Based on the BDI-II and HADS scales, the mean score of depression after using NIV decreased significantly (P = 0.001 for both). Conclusion: NIV therapies are associated with improvements in blood oxygen and CO2 of patients with OHS. The levels of depression also decreased after treatments that were confirmed by psychiatrists.

Background: The aim of the study is to explore the risk factors of mortality for hospitalized patients in three designated hospitals in Isfahan province. Materials and Methods: This retrospective cohort study was conducted on all positive coronavirus disease (COVID)-19 patients admitted to Khorshid, Isabn Maryam, and Amin hospitals in Isfahan province. The demographic, clinical, laboratory, and outcome data of patients who were died or discharged from February 24, 2020, to April 18, 2020, were extracted from patient's medical records. Results: Overall 1044 COVID-19 patients were included in this analysis. Based on the findings of this study, older age (≥65 years) (adjusted hazard ratio [aHR]: 2.06; 95% confidence interval [CI]: 1.13–3.76), chronic obstructive pulmonary disease (COPD) history (aHR: 2.52; 95% CI: 1.09–5.83), white blood cell (WBC) counts more than 10 × 10^3/L (aHR: 3.05; 95% CI: 1.42–6.55), Hb level

Background: The concurrence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is known as overlap syndrome (OS). The obstruction of the upper airway leads to OSA and the obstruction of the lower airway leads to COPD. The aim of this study was to compare polysomnographic findings of patients with OS according to severity of lower airway obstruction.Materials and Methods: Seventy-two patients were included in this cross-sectional study. Patients with COPD referred to a sleep clinic with suspicion of OSA were evaluated by polysomnography (PSG). PSG findings were interpreted based on the American Academy of Sleep Association criteria (2012). COPD severity was categorized into four groups based on GOLD criteria using forced expiratory volume in the first second (FEV1). PSG findings also were compared between patients regarding severity of lower airway obstruction (FEV1 ≥50% and FEV1

Background: With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs. Materials and Methods: This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs. Results: Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely. Conclusion: Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.

Background: Promoting quality of life (QoL) in patients with bronchiectasis, as a chronic disease, is a part of therapeutic principles. This study aimed to investigate QoL and its determinants in patients with noncystic fibrosis (CF) bronchiectasis. Materials and Methods: This cross-sectional study was conducted on 62 patients (38.7% male, mean age: 44) with non-CF bronchiectasis and involvement of ≥2 lobes in Qazvin, Iran. QoL was evaluated using the St. George's Respiratory Questionnaire (SGRQ). The relationships of QoL subscales with clinical (cough, dyspnea, and sputum volume) and paraclinical (spirometry, computerized tomography scan, sputum microbiology, and 6-min walk test [6-MWT]) were assessed using Pearson's correlation coefficient and multiple linear regression analyses. Results: The mean SGRQ total score was 53.1 (standard deviation 19.8) out of 100. The level of dyspnea (r = 0.543, P < 0.001), cough (r = −0.594, P < 0.001), 6-MWT (r = −0.520, P < 0.001), sputum volume (r = 0.423, P = 0.002), and number of exacerbations (r = 0.446, P = 0.009) had significant correlation with SGRQ total score. In multiple regression analysis, forced expiratory volume in 1 s was an independent predictor of the symptom (β = −0.22, P = 0.048) and activity (β = −0.43, P = 0.03) subscales, whereas cough was an independent predictor of the symptom subscale (β = −2.1, P = 0.002). Conclusion: In patients with non-CF bronchiectasis, the extent of lung impairment has a lower effect on the QoL than clinical symptoms. It seems that the QoL can be improved through the proper treatment of clinical symptoms and rehabilitation for promoting 6-MWT.

Paraquat has been recognized as a highly toxic agent for pest removal and is used worldwide.In adults, paraquat poisoning for suicidal attempts is much more common than accidental exposure poisoning. Approximately 20' of patients with paraquat poisoning develop pneumomediastonium as a complication with a mortality rate of approximately 100'. A 19-year-old man patient was admitted to the poisoning emergency department of Khorshid hospital, who had ingested paraquat. He had nausea and vomiting and had normal vital signs and examination in admission. Initial treatment for the patient was done. The patient signs got worsened on the 21st day of hospitalization and had severe emphysema of the superficial and deep spaces of the neck, followed by bilateral pneumothorax, and severe pneumomediastinum. Unfortunately, the patient died on the 27th day of hospitalization. Purpose of the current study is to raise awareness of rare paraquat toxicity complications, treatment, and especially its lethal complications, including pneumomomediastonium.

Background: The new coronavirus outbreak quickly filled hospital beds and stunned the world. Intensive care is required for 5% of patients, and the mortality rate for critically ill patients is 49%. The “cytokine storm” is considered as the main cause of pathogenesis for coronavirus disease-19 (COVID-19)-related respiratory failure, hemoperfusion may be a modality for treatment of disease. Materials and Methods: Thirty-seven an patients with positive real-time polymerase chain reaction for SARStions2 in an upper respiratory tract sample or typical chest computed tomography lesion were eligible for this case–control study. Patients meeting the criteria for hemoperfusion including clinical and laboratory indices, were evaluated for outcomes such as hospitalization length and mortality. Patients were divided into three groups, i.e., patients who received hemoperfusion without a need for mechanical ventilation (MV), patients who received hemoperfusion before MV, and patients who received hemoperfusion after MV. Results: Among 37 patients with COVID-19 respiratory failure, 32% were female with a mean age of 55.54 (standard deviation 14.1) years. There was no statistically significant difference between the three groups in terms of length of hospital stay and intensive care unit (ICU) stay (P-tayns: 0.593 and 0.243, respectively, confidence interval [CI]: 95%). Heart rate, respiratory rate, PaO2/FIO2, high-sensitivity C-reactive protein, and ferritin significantly improved after the application of hemoperfusion in all groups (P < 0.05, CI: 95%). Conclusion: It seems that applying hemoperfusion in the inflammatory phase of the disease, especially before the intubation, reduce the need for MV. However, hemoperfusion does not have any impacts on the duration of hospital and ICU stay.