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Objectives The aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS. Methods This was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant. Results Fifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05). Conclusion Our data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients. [ABSTRACT FROM AUTHOR]

Background: As the pandemic unfolds, major concerns remain with those in disadvantaged positions who may be disproportionately affected. This paper aimed to present the characteristics of COVID-19 immigrant patients and investigate whether they were disproportionately affected by COVID-19 pandemic. Methods: A cross-sectional study was performed using data on 589,146 patients diagnosed with COVID-19 in Iran. Descriptive analyses were used to summarize the study population's characteristics. Chi-squared test and logistic regression model were applied. Results: After accounting for possible confounding covariates, being an immigrant was significantly associated with increased risk of death due to COVID-19 (OR 1.64, CI 1.568–1.727). When compared to Iranian-born patients, the prevalence of low blood oxygen levels on admission was higher among immigrant patients (53.9% versus 47.7%, P value < 0.001). Moreover, greater proportions of immigrants who were diagnosed with COVID-19 were admitted to an ICU (17% versus 15.8%, P value < 0.001). Patients aged 65 and above were the largest age category in both populations. However, there was a significant difference between the age profiles of patients, with children under the age of eighteen presenting 16% of immigrant patients vs 6.6% of Iranian-born patients (P value < 0.001). In both groups, more men were affected by COVID-19 than women, yet the sex bias was more prominent for migrant patients (P value < 0.001). Conclusion: The evidence from this study revealed that immigrant patients infected with COVID-19 were more likely to suffer from severe health outcome of the disease compared to Iranian-born patients. [ABSTRACT FROM AUTHOR]

Introduction: Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks within these years and faced many inadequacies and shortages of resources and hospital beds. Hence the healthcare system started using in-hospital medication such as Remdesivir in outpatients to reduce the load of patients admitted to the hospital. This study aimed to evaluate and compare the reported signs, symptoms, and outcomes of COVID-infected hospitalized and out-patients receiving Remdesivir. Methods: In this retrospective cohort study, 214 patients (121 outpatient and 93 hospitalized) with moderate levels of Covid infection between October 2021 and February 2022 were studied. Both groups were treated with 200mg of Remdesivir, followed by 100 mg daily intravenous injections for five days; signs and symptoms, such as pain, shortness of breath, cough, fever and etc., of patients at the initiation and the end of treatment were recorded. Moreover, the patients' blood oxygen saturation was assessed two to three times a day, and the mean of the recorded measures was considered as the daily oxygen saturation. The outpatient group had to visit the hospital daily for treatment and assessment. At the treatment's end, mortality rates, disease signs, and symptoms alleviations were compared between the groups. Results: The outpatient and hospitalized group's mean age was 40.30 ± 12.25 and 37.70 ± 12.00 years, and 51.2% and 55.9% were males, respectively. There was no statistical difference between baseline and clinical characteristics in the outpatients and hospitalized groups. After adjusting for oxygen saturation at baseline and gender in the multivariable Cox regression analysis, the risk of death did not statistically differ between the hospitalized and outpatient group (hazard ratio: 0.99, 95% confidence interval: 0.39–2.50)) at the end of the study. Conclusion: Based on the results of this study, the outcome, signs, and symptoms of inpatient and outpatient Remdesivir treatment groups did not differ significantly. Hence in COVID-19 surges where we have limitations in admitting patients, outpatient Remdesivir treatment for those without any underlying diseases can be a proper management method. [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: Incorrect belief about opioid efficacy is a major cause of acute pediatric poisonings in Iran. We report a rare case of topical opium application that caused death in a 4-year-old child. Case: A 4-year old girl was examined with burns over her abdominal area and lower extremities. Her parents had applied opium on burned area to relieve her pain. She was in delirium state and apnea without any evidence of infection. Immediately, she was administered a single dose of Naloxone (2 mg). Results: While blood oxygen saturation was improving, she aspirated her vomitus into the lungs and became hypotensive and pulseless. Her condition deteriorated and the treatment team's efforts to resuscitate her failed. On her autopsy, there were no other abnormal findings, but codeine and morphine were detected in the autopsied tissue sample. Conclusion: The plausible contributing factors may include: change in morphine pharmacokinetics in the burned skin; the low toxic dose of opium in children due to thin abdominal skin, and high blood perfusion in the burned areas. [ABSTRACT FROM AUTHOR]

Introduction: Patients under mechanical ventilation are usually in the supine position due to various arterial/venous tubes attached to them. Although many studies emphasize the advantages of prone position for oxygenation, some studies enumerate its disadvantages. Objective: The aim of the present research was to determine the effect of prone position on oxygenation of patients with Acute Respiratory Failure (ARF) under mechanical ventilation in the Intensive Care Unit (ICU). Methods: The present study is a single-group clinical trial (pretest-posttest), which was performed in 2017 in Ahvaz, Iran. The population of the study included 58 patients with ARF under Mechanical Ventilation (MV) in ICU in the Golestan Hospital of Ahvaz City. Patients were asked to lie in a supine position for 2 hours, and their physiological signs were measured twice at one-hour intervals. Arterial Blood Gas was tested at the end of the second interval. Afterward, they lied in the prone position and their physiological signs were again measured twice at one-hour intervals and Arterial Blood Gas (ABG) was tested at the end of the second interval. Collected data were statically analyzed by SPSS v.22. Findings: The prone position had a significant relation to Oxygen Arterial Blood (Sao2) and Pressure of Arterial Oxygen (pao2), (p-value<0.05). Also, on days one and two, there was no significant relationship between the prone position and physiological signs; however, this relation was significant on day three (p-value<0.05). Conclusions: Results showed that the prone position improves sao2 and pao2 without adverse effect on physiological signs. [ABSTRACT FROM AUTHOR]

Pain is an unpleasant feeling and experience that is caused by a potential or practical injury and its control is so important that the American Pain Society has introduced pain as the 5th vital sign for emphasizing the importance of pain and controlling it. Almost all humans have experienced moderate to severe pain and most of the time the experience has happened following surgical procedures, medical conditions or trauma. When pain manifests in a clinical condition, health care staff are responsible for following it and relieving it as a goal and responsibility. Pain affects all individuals regardless of age, sex, race, and socioeconomic status and untreated pain can negatively affect various systems of the body and lead to many consequences. Increase in serum level of cortisol, nor epinephrine, and renin angiotension, hyperglycemia, decrease in insulin, manifestation of anxiety, cardiac effects such as ischemia, dysrhythmia, increase in pulse, increase in cardiac load, increased oxygen uptake, increased blood coagulation potential, hypertension especially in patients with head injuries, decreased blood oxygen level, increased body fluid volume, drop in blood potassium, fatigue, muscle cramps, decreased immune system function, decreased ability for wound healing and etc. are among the undesirable side effects of pain. In addition, not treating acute pains also leads to bearing unnecessary pain, elongated duration of hospitalization, increased medical costs and probability of acute pain progressing and developing into chronic pain. The financial burden of not treating pain in America has been estimated to be about 100 billion dollars per year. Pain is a common complaint and makes up a considerable portion of reasons that patients call pre-hospital emergency services and is usually present in the injured and trauma patients. Study results showed that 20% to 31% of the patients presenting via ambulances had moderate and severe pain. Additionally, with 52% to 86% prevalence in emergencies, pain is a key topic in health care of various countries. Pre-hospital emergency staff members are the first in line among health care staff that face patients at times of disaster and accident and are more exposed to the patients' pain. Despite the quantitative growth of pre-hospital emergency bases to 1900 bases throughout Iran, observations of researchers and evidence and instructions of emergency medical services (EMS) of Iran are indicative of not using enough analgesic drugs, especially opioid analgesic drugs, as a means to relieve patients' pain in EMS ambulances. Some studies have mentioned that about one third of the pre-hospital patients and more than 80% of patients with bone fractures report moderate to severe pain and on the other hand the positive effect of using pain killers in the regions that used them have been shown to be obvious in most patients. It seems that using analgesics in EMS is a very important topic and researchers express that proper pain management is an important principle in pre-hospital care and opioid analgesics such as morphine and fentanyl have a special place in the instructions of EMS as treatments for acute trauma and non-trauma pains, especially cardiac chest pains, in some advanced countries regarding emergency care. Considering the afore-mentioned points concerning the importance of pain and its treatment, especially the importance of treating pain in traumatic and ischemic cardiac diseases, high prevalence of pain in pre-hospital missions, severity and type of pre-hospital missions, which are mostly associated with pain, high costs of not treating pain and the obvious need for using pain killers in trauma and ischemic cardiac diseases, isn't it time to introduce a more effective and scientific approach in EMS? Isn't it better to add a few types of analgesics and opioid drugs to the equipment provided at patients' bedside, at least for ischemic cardiac diseases and severe trauma? Although the result of a study carried out in Khuzestan province showed that EMS staff members were weak regarding drug information and calculations and other studies have also expressed that drug dosage and use of opioid drugs might not be done correctly or opioid drugs might be abused in some cases, none are convincing reasons for not using these drugs. These problems could be solved by more and better training for EMS staff, creating offline and online protocols and useful programs for preventing abuse of analgesic drugs and these drugs could be effectively used in EMS. Therefore, we again note that this treatment priority should not be overlooked for any reason. [ABSTRACT FROM AUTHOR]

Background: During health care in the neonatal intensive care unit (NICU), infants undergo extremely painful procedures, which may cause problems, if not controlled, such as changes in the pattern of respiratory rate, heart rate, and blood oxygen saturation. The present study aimed to find the effect of melody on the physiological responses of neonates' heel stick pain. Materials and Methods: This quasi-experimental study was conducted in Alzahra Hospital (Isfahan, Iran) for 5 months. Fifty infants were selected through convenient sampling method and were randomly assigned in equal numbers to two groups (n = 25). In the melody group (intervention), a selected melody was played for the infants at a distance of 1 m from them, with a sound intensity of 65 dB, from 3 minutes before, during, and after the heel stick procedure, respectively, and their physiological responses were observed with a monitoring system and recorded atthe afore-mentioned time periods. Physiological responses were also recorded in the control group (no intervention) 3 min before, during, and after the heel stick procedure, respectively. Results: Means of respiratory and pulse rates in the melody and control groups showed a significant difference at different time points. But the mean blood oxygen saturation in the melody group showed no significant difference at different time points, although the difference was significant in the control group. Conclusions: The results showed that melody could maintain more balance in some physiological responses of infants, such as the respiratory rate and pulse rate during the Guthrie test. Therefore, melody is recommended to be used to prevent the destructive effects of pain in infants during painful procedures. [ABSTRACT FROM AUTHOR]