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Objective: To evaluate the effectiveness of the Partnership Care Model (PCM) on health-related quality of life (HRQoL) in adults with chronic diseases. Methods Data Sources/Study Setting: Existing literature dealing with the effect of HRQoL on chronic patients according to the HRQoL outcomes based on SF36 questionnaires. Study Design: Systematic review and meta-analysis. Data collection: Medline, PubMed, Scopus, Web of Science, Embase, Cochran database and Persian databases, including SID, Magiran, Iranmedex, and Irandoc, were searched according to the MeSH terms until May 15, 2022. Data analysis was made by using the random effects model and heterogeneity by I2 index, and all analyses were made by STATA vers.16 (Stata Corp, College Station, Texas, USA). Principal findings: Three studies were included in the meta-analysis. Computing the common effect size, there was a significant intervention effect in all HRQoL dimensions, physical and mental subscales, as well as HRQoL total score. The results showed that there was significantly moderate to high substantial heterogeneity between studies except for vitality (I2=45.9%, P=0.157) and physical functioning (I2=30.9%, P=0.235) dimensions. Conclusions: According to the results of the study and realizing the efficiency of PCM on the eight dimensions of quality of life of chronic patients, it can be stated that this national model, which is in line with the culture and context of Iran, is effective, simple, efficient and reliable. It can be used in the promotion and improvement of various dimensions of HRQoL in chronic diseases.

To study the possibility of using acoustic parameters, i.e., Acoustic Voice Quality Index (AVQI) and Maximum Phonation Time (MPT) for predicting the degree of lung involvement in COVID-19 patients. This cross-sectional case-control study was conducted on the voice samples collected from 163 healthy individuals and 181 patients with COVID-19. Each participant produced a sustained vowel/a/, and a phonetically balanced Persian text containing 36 syllables. AVQI and MPT were measured using Praat scripts. Each patient underwent a non-enhanced chest computed tomographic scan and the Total Opacity score was rated to assess the degree of lung involvement. The results revealed significant differences between patients with COVID-19 and healthy individuals in terms of AVQI and MPT. A significant difference was also observed between male and female participants in AVQI and MPT. The results from the receiver operating characteristic curve analysis and area under the curve indicated that MPT (0.909) had higher diagnostic accuracy than AVQI (0.771). A significant relationship was observed between AVQI and TO scores. In the case of MPT, however, no such relationship was observed. The findings indicated that MPT was a better classifier in differentiating patients from healthy individuals, in comparison with AVQI. The results also showed that AVQI can be used as a predictor of the degree of patients' and recovered individuals' lung involvement. A formula is suggested for calculating the degree of lung involvement using AVQI.

IntroductionThe aim of this meta-analysis was to assess the effect of ongoing statin treatment on susceptibility to influenza virus infection and on influenza-associated mortality.Material and methodsStudies investigating the impact of statin treatment on influenza prevalence and mortality were searched in PubMed-Medline, Scopus, ISI Web of Knowledge, Embase, Proquest, OVID, EBSCO and CINAHLdatabases (up to June 30, 2020). Fixed- and random-effects model and generic inverse variance method were used for quantitative data synthesis.ResultsIn the meta-analysis of 15 arms of 3 eligible studies including flu-vaccinated and unvaccinated patients, treatment with statins was associated with a reduction of influenza virus prevalence [Odds Ratio (OR) 0.85, 95% Confidence Interval (CI) 0.73-0.99; p 0.040]. No significant effect of statins on the susceptibility to influenza infection was observed in the distinct communities of either vaccinated or unvaccinated subjects. Among 9 arms of 6 eligible studies, the use of statins among patients with influenza was associated with a reduced mortality [OR (95% CI), 0.68 (0.56, 0.82); pConclusionsA reduced influenza prevalence and anincreased survivalfrom influenza infection was observed in patients on ongoing statin treatment. Further research is needed to define the possible role of statins as adjunctive therapy in patients with influenza infection.

Purpose Modified Nutrition Risk in the Critically Ill (NUTRIC) score (mNUTRIC score) have been validated as screening tool for quantifying risk of adverse outcome critically ill patients admitted to the intensive care units (ICUs). The aim of this study was to evaluate the prognostic value of mNUTRIC score to assess outcomes in this population. Materials and methods This prospective, observational study was conducted on adult patients admitted to the general ICUs of two university affiliated hospital in northwest of Iran. The association between the mNUTRIC score and outcomes was assessed using the univariate and multivariate binary logistic regression. The performance of mNUTRIC score to predict outcomes was assessed using the receiver operating characteristic (ROC)-curve. Results In total 445 ICU patients were enrolled. Based on mNUTRIC score, 62 (13.9%) and 383 (86.1%) individuals were identified at high and low nutritional risk, respectively. The area under the curve (AUC) for predicting ICU mortality, using vasopressor, duration of vasopressor, and mechanical ventilation (MV) duration were (AUC: 0.973, 95% CI: 0.954–0.986, P Conclusions An excellent and good predictive performance of the mNUTRIC score was found regarding ICU mortality and using vasopressor, respectively. However, this predictive was fair for MV and vasopressor duration and poor for ICU and hospital length of stay.

IntroductionIn critically ill patients, acute kidney injury (AKI) is a common complication with the very high mortality rates. We aimed to analyzse whether pre- and perioperative statins might prevent AKI and improve overall prognosis in patients in ICU.Material and methodsFollowing a systematic search of the literature, we performed a meta-analysis of selected clinical studies investigating the impact of statin treatment on the development and the clinical outcomes of AKI among subjects undergoing surgeries. The pooled odds ratios (OR) with 95% confidence intervals (CI) for the development of AKI and AKI-associated mortality, as well as the pooled mean differences (MD) and 95% CI for mean ICU stay and overall hospital length of stay were calculated for statin users compared to nonusers.ResultsOur results showed a highly significant association between statin use and the decrease in mortality of patients with AKI (OR 0.73, 95% CI: 0.69 - 0.77; pConclusionsOur analysis showed a significant association between statin therapy and overall mortality of critically ill surgical patients diagnosed with AKI, while at the same time the use of statins did not affect the length of their stay in ICU.

Aims Survival rates after in‐hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in‐hospital cardiac arrest after discharge from the intensive care unit. Methods and results This study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real‐time feedback device. Parametric and semi‐parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log‐normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found. Conclusions Implementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours.

Background. Although vaccine rollout for COVID-19 has been effective in some countries, there is still an urgent need to reduce disease transmission and severity. We recently carried out a meta-analysis and found that pre- and in-hospital use of statins may improve COVID-19 mortality outcomes. Here, we provide an updated meta-analysis in an attempt to validate these results and increase the statistical power of these potentially important findings. Methods. The meta-analysis investigated the effect of observational and randomized clinical studies on intensive care unit (ICU) admission, tracheal intubation, and death outcomes in COVID-19 cases involving statin treatment, by searching the scientific literature up to April 23, 2021. Statistical analysis and random effect modeling were performed to assess the combined effects of the updated and previous findings on the outcome measures. Findings. The updated literature search led to the identification of 23 additional studies on statin use in COVID-19 patients. Analysis of the combined studies ( n = 47 ; 3,238,508 subjects) showed no significant effect of statin treatment on ICU admission and all-cause mortality but a significant reduction in tracheal intubation ( OR = 0.73 , 95% CI: 0.54-0.99, p = 0.04 , n = 10 studies). The further analysis showed that death outcomes were significantly reduced in the patients who received statins during hospitalization ( OR = 0.54 , 95% CI: 0.50-0.58, p < 0.001 , n = 7 studies), with no such effect of statin therapy before hospital admission ( OR = 1.06 , 95% CI = 0.82 -1.37, p = 0.670 , n = 29 studies). Conclusion. Taken together, this updated meta-analysis extends and confirms the findings of our previous study, suggesting that in-hospital statin use leads to significant reduction of all-cause mortality in COVID-19 cases. Considering these results, statin therapy during hospitalization, while indicated, should be recommended.

This study aimed to develop an artificial intelligence (AI)-based tool for screening COVID-19 patients based on the acoustic parameters of their voices. Twenty-five acoustic parameters were extracted from voice samples of 203 COVID-19 patients and 171 healthy individuals who produced a sustained vowel, i.e., /a/, as long as they could after a deep breath. The selected acoustic parameters were from different categories including fundamental frequency and its perturbation, harmonicity, vocal tract function, airflow sufficiency, and periodicity. After the feature extraction, different machine learning methods were tested. A leave-one-subject-out validation scheme was used to tune the hyper-parameters and record the test set results. Then the models were compared based on their accuracy, precision, recall, and F1-score. Based on accuracy (89.71%), recall (91.63%), and F1-score (90.62%), the best model was the feedforward neural network (FFNN). Its precision function (89.63%) was a bit lower than the logistic regression (90.17%). Based on these results and confusion matrices, the FFNN model was employed in the software. This screening tool could be practically used at home and public places to ensure the health of each individual's respiratory system. If there are any related abnormalities in the test taker's voice, the tool recommends that they seek a medical consultant.

The aim of this study was to evaluate the effect and safety of N-acetylcysteine (NAC) inhalation spray in the treatment of patients with coronavirus disease 2019 (COVID-19). This randomized controlled clinical trial study was conducted on patients with COVID-19. Eligible patients (n = 250) were randomly allocated into the intervention group (routine treatment + NAC inhaler spray one puff per 12 h, for 7 days) or the control group who received routine treatment alone. Clinical features, hemodynamic, hematological, biochemical parameters and patient outcomes were assessed and compared before and after treatment. The mortality rate was significantly higher in the control group than in the intervention group (39.2% vs. 3.2%, p 0.001). Significant differences were found between the two groups (intervention and control, respectively) for white blood cell count (6.2 vs. 7.8, p 0.001), hemoglobin (12.3 vs. 13.3, p = 0.002), C-reactive protein (CRP: 6 vs. 11.5, p 0.0001) and aspartate aminotransferase (AST: 32 vs. 25.5, p 0.0001). No differences were seen for hospital length of stay (11.98 ± 3.61 vs. 11.81 ± 3.52, p = 0.814) or the requirement for intensive care unit (ICU) admission (7.2% vs. 11.2%, p = 0.274). NAC was beneficial in reducing the mortality rate in patients with COVID-19 and inflammatory parameters, and a reduction in the development of severe respiratory failure; however, it did not affect the length of hospital stay or the need for ICU admission. Data on the effectiveness of NAC for Severe Acute Respiratory Syndrome Coronavirus-2 is limited and further research is required.

IntroductionUsing ozone therapy to manage COVID-19 patients has been accompanied by conflicting results in prior studies. Therefore, we aimed to widely assess the effects of ozone as adjuvant therapy in COVID-19 patients.MethodsPubMed, Scopus, Web of Science, Cochrane, ProQuest, Springer, and Sage journals were searched systematically until April 2022. Mortality rate, ICU admission, hospital-length stay, negative PCR, pulmonary, renal, and hepatic functions, as well as inflammatory and blood systems were pooled to compare the efficacy of ozone as adjacent therapy (OZ) and standard treatment (ST). Analyses were run with the random/fixed models, sub-group analysis, funnel plot, and sensitivity analysis using comprehensive meta-analysis (CMA) software version 2.0.ResultsThe results of four randomized clinical trials (RCTs) and four case-control studies with a total of 371 COVID-19 positive patients were analyzed. The OZ group patients had a shorter length of hospital stay (P > 0.05), lower ICU admissions (P > 0.05), and lower mortality rates (P < 0.05) than the ST group cases. After treatment, 41% more COVID-19 patients had negative PCR tests than the ST group (P < 0.05). Serum creatinine and urea levels were not modified in either group (P > 0.05). Moreover, except for albumin serum levels, which decreased significantly in the OZ group, serum bilirubin, ALT, and AST were not modified in either group (P > 0.05). Both arms did not show a decrease in C-reactive protein blood levels (P > 0.05), but the OZ group showed a significant modification in LDH serum levels (P < 0.05). Unlike the d-dimer and WBC serum levels (P > 0.05), platelet levels were increased in the OZ group (P < 0.05). No negative side effects were demonstrated in either group.ConclusionOzone therapy was effective significantly on PCR test and LDH serum levels, as well as mortality based on overall estimation. Concerning the length of hospital stay and ICU admissions, although the results were insignificant, their effect sizes were notable clinically. More RCT studies are needed to show the efficacy of ozone therapy on other studied variables.

Background: The study of neuromuscular blocking agents (NMBAs) in the management of acute respiratory distress syndrome (ARDS) has provided conflicting results in terms of their effect on mortality. Objectives: The main purpose of this study was to evaluate mortality in ARDS patients who underwent NMBA. Methods: A retrospective secondary analysis of 4200 patients with ARDS was collected from two academic medical centers, Tehran, Iran. This study was performed to assess the impact of NMBAs use in ARDS patients with different subgroups including mild and moderate-to-severe ARDS, age more and less than 65 years, having medical turnover vs. not-having, and high acute nursing care vs. moderate to low nursing care. Results: Intensive care unit (ICU) mortality has occurred in 1169 (27.8%) participants. The mortality rate was 28.6% and 27.5% in patients with mild and moderate-to-severe ARDS, respectively. In the subjects without medical turnover, the moderate dose of NMBAs significantly reduces the mortality of patients (P=0.044). In patients who need high acute nursing care, increasing the NMBAs dose significantly reduces patients’ mortality (P=0.010). In addition, increasing the NMBAs doses significantly reduces ICU length of stay (LOS). Conclusion: This study provides evidence that the administration of different doses of NMBAs had no effect on patients’ mortality with mild or moderate-to-severe ARDS. However, higher doses of NMBAs than low doses increased the risk of mortality in patients over 80 years and can reduce the risk of death in patients less than 55 years.

Extracorporeal membrane oxygenation (ECMO) support has been suggested to improve the survival rate in patients with refractory in- and out-of-hospital cardiac arrest (IHCA and OHCA). Several factors predict outcome in these patients, including initial heart rhythm and low-flow time. Literature shows variable survival rates among patients who received EPCR. The objective of this study is to analyze the outcomes (survival rate as well as neurological and disability outcomes) of patients treated with ECPR following refractory OHCA and IHCA.This single-center, retrospective cohort study was conducted on patients with refractory cardiac arrest treated with ECPR between February 2016 and March 2020. The primary outcomes were 24-h, hospital discharge and 1-year survival after CA and the secondary endpoints were neurological and disability outcomes.48 patients were included in the analysis. 11/48 patients are In Hospital Cardiac Arrest (IHCA) and 37/48 patients are Out of Hospital Cardiac Arrest (OHCA). Time from collapse to CPR for 79.2% of the patients was less than 5 minutes. The median CPR duration and collapse to ECMO were 40 and 45 minutes, respectively. The rate of survival was significantly higher in patient who presented with initial shockable rhythm (p=0.006) and to whom targeted temperature management (TTM) post cardiac arrest was applied (p=0.048).This first descriptive study about ECPR in the middle east region shows that 20.8% of ECPR patients survived until hospital discharge. Our analysis revealed that initial shockable rhythm and TTM are most important prognostic factors that predicts favorable neurological survival.

There is still an urgent need to develop effective treatments to help minimize the cases of severe COVID-19. A number of tools have now been developed and applied to address these issues, such as the use of non-contrast chest computed tomography (CT) for evaluation and grading of the associated lung damage. Here we used a deep learning approach for predicting the outcome of 1078 patients admitted into the Baqiyatallah Hospital in Tehran, Iran, suffering from COVID-19 infections in the first wave of the pandemic. These were classified into two groups of non-severe and severe cases according to features on their CT scans with accuracies of approximately 0.90. We suggest that incorporation of molecular and/or clinical features, such as multiplex immunoassay or laboratory findings, will increase accuracy and sensitivity of the model for COVID-19 -related predictions.

ObjectiveThere is a limited understanding of the impact of the family-centered empowerment model (FCEM) on the psychological symptoms in post-myocardial infarction (MI). This study aimed to evaluate the effectiveness of the FCEM on the psychological improvement of patients with MI.MethodsThe present study was a randomized controlled trial (RCT) where patients experienced a standard home cardiac rehabilitation (CR) or CR utilizing the FCEM approach. The empowerment of patients was estimated during nine assessments, such as pre- and post-intervention. Factors, such as quality of life (QoL), state and trait anxiety, and perceived stress, were evaluated. A Bayesian multivariate mixed-effects model was used to simultaneously investigate the effect of the intervention group on study outcomes across the time.ResultsAmong all the participants in this study, 24 (34.3%) were women with a total mean ± standard deviation (SD) of 61.40 ± 12.83 and 24.87 ± 3.80 for age and body mass index (BMI). The participants who were in the FCEM group had a significantly higher mean level of perceived stress (β = 28.80), state anxiety (β = 16.20), trait anxiety (β = 3.65), physical (β = 38.54), and mental QoL (β = 42.14). Moreover, the individuals in the FCEM group had a significantly higher mean level of general health (β = 31.64) in the physical dimension of QoL, vitality (β = 15.04), mental role limitation (β = 21.84), and mental health (β = 18.16) in the mental dimension of QoL.ConclusionsThe FCEM can be a valuable treatment mechanism for patients with post-MI to improve their stress, anxiety, and QoL.

Background: Ethical decision‑making and behavior of nurses are major factors that can affect the quality of nursing care. Moral development of nurses to making better ethical decision-making is an essential element for managing the care process. The main aim of this study was to examine and comparison the effect of training in ethical decision-making through lectures and group discussions on nurses' moral reasoning, moral distress and moral sensitivity.Methods: In this randomized clinical trial study with a pre- and post-test design, 66 nurses with moral reasoning scores lower than the average of the community were randomly assigned into three equal groups (n=22) including two experimental groups and one control group. Ethical decision-making training to experimental groups was provided through the lectures and group discussions. While, the control group did not receive any training. Data were collected using sociodemographic questionnaire, the nursing dilemma test (NDT), the moral distress scale (MDS) and the moral sensitivity questionnaire (MSQ). Unadjusted and adjusted binary logistic regression analysis was reported using the odds ratio (OR) and 95% confidence intervals.Results: In adjusted regression analysis after intervention, the nursing principled thinking (NPT) score was significantly increased in group discussions vs. lectures group (OR: 13.078, 95%CI: 3.238-15.954, P=0.008), lectures group vs. control group (OR: 14.329, 95%CI: 2.005-16.171, PConclusions: The results of this study indicate that ethical decision-making training is effective on empowerment of ethical reasoning. Whereas the group discussion was also effective on increasing the ethical sensitivity, it is recommended the training plan provided in this study to be held as workshop for all nurses in health and treatment centers and placed in curricular plan of nursing students.Registration: This randomized clinical trial was registered in Iranian Registry of Clinical Trials under code (IRCT2015122116163N5) in 02/07/2016.

BACKGROUND: In each community, health problems’ patterns and geographical changes are of prime importance to determine high and low-risk areas. OBJECTIVES: This study aimed to investigate the Spatial patterning of occupational stress and its related factors in Iranian critical care nurses using a hierarchical Bayesian technique METHODS: The current research was a cross-sectional descriptive-analytical study. The data includes the number of critical care unit nurses who show a high stress level based on a questionnaire. We used variables such as age, gender, collaboration status, working time, marital status, clinical experience, education, supervisor support, stress score, and working on holiday days for this study. The survey participants had to be at least 18 years old, a registered nurse, and working in the intensive care unit (ICU). OpenBUGS version 3.2.3 was used to implement the Bayesian hierarchical Poisson model and find partial patterning of occupational stress and its related factors. RESULTS: The final sample size was 17414 nurses. The overall prevalence of occupational stress in ICU nurses was estimated at 70%. The lowest and highest prevalence was 65.8% in the North Khorasan province and 75.2% in Golestan province. Occupational stress had a statistically significant association with collaboration status, but with demographic variables, shift work, supportive supervisor, and working on holidays had no statistically significant association. CONCLUSIONS: According to the findings, it is necessary to eliminate or reduce job stress and increase efficiency in Iranian nurses, encourage teamwork and collaboration as an essential element of a healthy workplace environment.

Background The development of evidence-based training standards can help improve the quality of educational programs for novice intensive care unit (ICU) nurses. This study was conducted to assess the application of a training course on competency development of nurses in relation to oral hygiene care in ICU patients and to develop a checklist for evaluating the competence performance. In addition, to achieve a certain level of oral hygiene competence, as well as to assess the relative importance of predicting factors and learning competency patterns in oral hygiene care, we used standard learning curve. Methods This quasi-experimental study with time series design was conducted on newly registered ICU nurses of a teaching hospital affiliated with Tehran University of Medical Sciences, Iran, between 2016 and 2018. In the first phase of this study, we designed a checklist to assess nurses' professional competence in oral hygiene care in three stages: before, during, and after care. Then, in the second phase, the level of competence of nurses in repeated times of oral hygiene care was determined based on checklist items and recorded in the learning curve. Results The greatest increase of oral hygiene care competency due to repetition was observed in the first and fourth times of repetition in comparison to the subsequent and previous steps. In the linear regression model, demographic variables predicted 12–19% of changes related to skill scores in repetitions. Conclusion According to the learning curve, newly registered ICU nurses can reach an acceptable competency after 6 repetitions of oral hygiene care.

This study was conducted to compare the predictive ability of the macrocirculation (mean arterial pressure, heart rate and central venous pressure), microcirculation markers (capillary refill time and peripheral perfusion index) and also fluid balance, lactate and clearance lactate on outcomes of patients with septic shock during initial resuscitation. This was a single-center observational study of 100 adult patients with septic shock who were admitted to the intensive care unit (ICU) at a university affiliated hospital in northwest of Iran. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used. The AUCs for the macrocirculation and microcirculation markers for predicting mortality ranged from 0.517 to 0.770 and 0.695 to 0.993, respectively. Among the macrocirculation markers, the best predictive values for mortality were related to the central venous pressure and mean arterial pressure markers at baseline, with AUCs of 0.770 and 0.753, respectively. The microcirculation markers had a better predictive accuracy value for mortality in patients with septic shock than macrocirculation markers which the PPI is the best one. The combination of markers had a greater AUC with higher sensitivity and specificity than the marker alone to predict outcomes.

BackgroundUse of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery.MethodsIn this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups.ResultsThe end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, p > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, p p = 0.219).ConclusionOur results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings.Clinical Trial RegistrationCurrent Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.

BackgroundModified Early Warning Score (MEWS) and National Early Warning Score (NEWS) are widely used in predicting the mortality and intensive care unit (ICU) admission of critically ill patients. This study was conducted to evaluate and compare the prognostic value of NEWS and MEWS for predicting ICU readmission, mortality, and related outcomes in critically ill patients at the time of ICU discharge.MethodsThis multicenter, prospective, observational study was conducted over a year, from April 2019 to March 2020, in the general ICUs of two university-affiliated hospitals in Northwest Iran. MEWS and NEWS were compared based on the patients’ outcomes (including mortality, ICU readmission, time to readmission, discharge type, mechanical ventilation (MV), MV duration, and multiple organ failure after readmission) using the univariable and multivariable binary logistic regression. The receiver operating characteristic (ROC) curve was used to determine the outcome predictability of MEWS and NEWS.ResultsA total of 410 ICU patients were enrolled in this study. According to multivariable logistic regression analysis, both MEWS and NEWS were predictors of ICU readmission, time to readmission, MV status after readmission, MV duration, and multiple organ failure after readmission. The area under the ROC curve (AUC) for predicting mortality was 0.91 (95% CI = 0.88–0.94, P < 0.0001) for the NEWS and 0.88 (95% CI = 0.84–0.91, P < 0.0001) for the MEWS. There was no significant difference between the AUC of the NEWS and the MEWS for predicting mortality (P = 0.082). However, for ICU readmission (0.84 vs. 0.71), time to readmission (0.82 vs. 0.67), MV after readmission (0.83 vs. 0.72), MV duration (0.81 vs. 0.67), and multiple organ failure (0.833 vs. 0.710), the AUCs of MEWS were significantly greater (P < 0.001).ConclusionNational Early Warning Score and MEWS values of >4 demonstrated high sensitivity and specificity in identifying the risk of mortality for the patients’ discharge from ICU. However, we found that the MEWS showed superiority over the NEWS score in predicting other outcomes. Eventually, MEWS could be considered an efficient prediction score for morbidity and mortality of critically ill patients.

Background: Endotracheal intubation (EI) associated with mechanical ventilation (MV) is frequently performed in critically ill patients admitted to intensive care unit (ICU) with sepsis. Objectives: This study aimed to assess the impact of important factors on the duration of tracheal intubation in patients with sepsis at the ICU admission. Methods: Adult patients admitted to the mixed medical–surgical ICUs with sepsis at the ICU admission who needs prolonged mechanical ventilation (PMV) (≥ 21 days) were included in this retrospective secondary analysis study. The primary outcome was ICU mortality. Baseline demographic and clinical characteristics of all patients were assessed as risk factors associated with the duration of MV by univariate and multivariate Binary logistic regression. Results: Eighty-five patients required more than 21 days of MV. Out of the 85 patients, 52 (61.2%) patients were intubated within 30 to 34.50 days and 33 (38.8%) patients had intubation within 34.51 to 65 days, and categorized as PMV and very prolonged MV groups, respectively. Two parameters were significantly associated with very prolonged MV which are as follows: older age 1.229 (95% CI: 1.002-1.507, P=0.048) and long hospital stay (LOS) 2.996 (95% CI: 1.676-5.356, P

Background: Sepsis is a very common serious medical condition among patients admitted to the intensive care units (ICUs) that increases with age and ICU length of stay (LOS). Objectives: The primary goal of this study was to estimate the mortality rate due to sepsis among adult patients admitted to the mixed medical–surgical ICUs for a long time. The secondary goal was to identify factors associated with predicting ICU mortality in individuals with long-term ICU LOS. Methods: Adult patients admitted to the medical ICU for a long time (≥75 days) were included in this retrospective secondary analysis study. Baseline demographic, clinical, and laboratory data were recorded upon inclusion in the study. Results: ICU mortality occurred in 78 (43.1%) patients, out of 188 participants. A greater portion of patients with sepsis at admission (62.7%) were observed in the death group (59.2% vs. 30.8%, P < 0.001), than the survivor group. Additionally, survived patients differed significantly in terms of age, family engagement, baseline cognitive impairment, activity, nurse anticipated turnover scale (ATS), duration of a mechanical ventilator (MV), and ICU LOS. The results of multivariate binary logistic regression showed that the older age and low family intervention can increase the risk of mortality in patients with sepsis at the time of admission, with a long ICU LOS. Conclusion: Our findings are crucially important to increase the awareness of the impact of sepsis, highlight the need for continued research into potential preventive and therapeutic interventions, and help guide resource allocation.

Ethical dilemmas may arise when medical management conflicts with a patient's values, culture, religion, or legal considerations. Many Muslims encounter ethical dilemmas as patients in perioperative and critical care settings. This article discusses the fundamentals of Islamic jurisprudence and how this may affect hospitalized patients in terms of cleanliness and prayer in the setting of stoma and urinary catheters, fasting, transfusion, transplants, xenografts and animal-based medications, do-not-resuscitate orders, and postmortem examinations. Provider familiarity with how such situations may affect Muslim patients is important to navigate potential conflict and to deliver competent care.

To determine the effect of aromatherapy with rose and lavender on the patient outcomes after open‐heart surgery (OHS). In the clinical trial, patients were randomized to four groups. One group received routine care, the placebo group received a cotton swab soaked in water and the other two groups received either a cotton swab containing three drops of rose or lavender essence (0.2 ml). A total of 160 patients were randomized into four groups. Intergroup anxiety was not significantly different; however, the reciprocal time‐group effect was significant among the four groups. The extubation time was significant among the four groups which related to rose essence group compared with the control group (p < .001) and placebo group (p = .029). The surgical site pain was significant in the rose essence and lavender groups compared to the control group. Aromatherapy can reduce extubation time, surgical site pain severity, and anxiety in patients undergoing OHS

The purpose of this study was to investigate the effect of psychological support provided by the patient's spouse as trained ICU doulas on mental disorders after 12 months of hospital discharge. This retrospective secondary analysis was conducted on married patients (patient- and patient's spouse as a unit) with no history of mental disorders. In this study, three groups of patients were compared with each other; ICU survivors with trained spouse as ICU-doulas (n = 359, 29%), ICU survivors without trained spouse (n = 461, 37.3%) and discharged patients from general wards without trained spouse (n = 416, 33.7%). In multivariate binary logistic regression, the odds ratio (OR) of mental disorders based on WHO-5 index (OR: 0.344, 95% CI: 0.265–0.446, P

Background: Due to the importance of amiodarone-induced hyperthyroidism in patients with heart failure, the purpose of the present systematic review and meta-analysis was to determine the prevalence of thyroid dysfunction (hypothyroidism and hyperthyroidism) in patients with heart disease who received amiodarone. Methods: Electronic databases including Scopus, PubMed, Web of science, and Science Direct were searched by two investigators. To assess the heterogeneity between the included studies, the chi-square χ2 test (α=0.05) and I2 index were used. Additionally, a random-effects model with 95% CI was used to estimate the pooled prevalence of thyroid dysfunction due to heterogeneity of the studies. To identify the cause of heterogeneity, a meta-regression analysis was employed. All analyses were performed using Stata ver13 (Stata Corporation, College Station, TX, USA). Results: The pooled prevalence of hypothyroidism was 23.43% (95% CI: 11.54-35.33) and hyperthyroidism was 11.61% (95% CI: 7.20-16.02). There was no significant association between the prevalence of hypothyroidism and the year of the study (P=0.152), sample size (P=0.805), and mean age of subjects in the sample groups (P=0.623). However, there was a significant association between the prevalence of hyperthyroidism and the year of the study (p=0.037), but no statistically significant association between either the prevalence of hyperthyroidism and sample size (P=0.425), or the prevalence of hyperthyroidism and the mean age of subjects in the sample groups (P=0.447). Conclusion: The prevalence of thyroid dysfunction in patients with cardiac arrhythmias receiving amiodarone was considerable. Extreme care should be exercised to improve monitoring of any thyroid abnormalities that may arise in patients receiving amiodarone.

Background: Many of the survivors of critical illnesses in the intensive care unit (ICU) suffer from physical disability for months after the treatment in the ICU. Identifying patients who are susceptible to disability is essential. The purpose of the study was to modify a model for early in-ICU prediction of the patient’s risk for physical disability two months after the treatment in the ICU. Methods: A prospective multicenter derivation–validation study was conducted from 1 July 2015, to 31 August 2016. We modified a model consisting of three risk factors in the derivation group and tested the modified model in the validation group. They were asked for their physical abilities before being admitted, two months after discharge from the ICU by a binary ADL staircases questionnaire. The univariate and multivariate logistic regression was used to modify physical disability components in the derivation data set. Receiver operating characteristic curves were used to determine the sensitivity and specificity of the threshold values in the validation group. Results: Five-hundred nineteen survivors were enrolled in the derivation group, and 271 in the validation. In multivariable analysis, the odds ratio (OR) of physical disability significantly increased with educational level ≤ elementary school (OR: 36.96, 95%CI: 18.14–75.29), inability to sit without support (OR: 15.16, 95%CI: 7.98–28.80), and having a fracture (OR: 12.74, 95%CI: 4.47–36.30). The multivariable validation model indicated that education level, inability to sit without support, and having a fracture simultaneously had sensitivity 71.3%, specificity 88.2%, LR+ 6.0, LR− 0.33, PPV 90.9, and NPV 64.9 to predict physical disability. Applying the coefficients derived from the multivariable logistic regression fitted on the derivation dataset in the validation dataset and computing diagnostic index sensitivity 100%, specificity 60.5%, LR+ 2.5, LR− 0.003, PPV 80.8, and NPV 100. The modified model had an excellent prediction ability for physical disability (AUC ± SE = 0.881 ± 0.016). Conclusions: Low education level, inability to sit without support, and having a fracture in a modified model were associated with the development of physical disability after discharge from ICU. Therefore, these clinical variables should be considered when organizing follow-up care for ICU survivors.

Curcumin, the active ingredient of the spice turmeric, has been shown to have anticancer activities in several preclinical and clinical studies. The prophylactic effect of curcumin against chemotherapy-induced damage and side effects was evaluated in a double-blind, placebo-controlled randomized trial. Eighty cancer patients on standard chemotherapy regimens were randomly assigned to receive curcumin as adjuvant therapy (500 mg per 12 hours) and matched control group to receive placebo for 9 weeks. Pre- and post-intervention, the changes in the health-related quality-of-Life (QoL) score (based on the University of Washington Quality-of-Life (UW-QoL) questionnaire, version 3), clinical symptoms, and hematological and biochemical parameters were assessed. Comparison between groups based on total QoL score showed that curcumin supplementation was not associated with improved QoL (P = 0.102). Hematological and biochemical analysis showed no statistical differences between the groups at the end of the trial (P 0.05). However, during the trial, significant differences were observed in hemoglobin (Hb), hematocrit (HCT), lactic acid dehydrogenase (LDH), serum glutamic-oxaloacetic transaminase (SGOT), and anaplastic lymphoma kinase (ALK) between the groups (P 0.05). Future studies in a larger homogenous population of cancer patients are required to confirm the adjuvant effect of curcumin on chemotherapy-induced QoL.

BackgroundTo develop ten new integrated weaning indices that can predict the weaning outcome better than the traditional indices.MethodsThis retrospective-prospective derivation-validation observational multicenter clinical trial (Clinical Trial.Gov, NCT 01779297), was conducted on 1,175 adult patients admitted at 9 academic affiliated intensive care units (ICUs; 4 surgical and 5 medical), from Jan 2013 to Dec 2018. All patients, intubated and mechanically ventilated for at least 24 h and ready for weaning were enrolled. The study had two phases: at first, the threshold values of each index that best discriminate between a successful and an unsuccessful weaning outcome was determined among 208 patients in the derivation group. In the second phase, the predictive performance of these values was prospectively tested in 967 patients in the validation group. In the prospective-validation set we used Bayes’ theorem to assess the probability of each test in predicting weaning.ResultsIn the prospective validation group, sensitivity, specificity, diagnostic accuracy, positive and negative predictive values, and finally area under the receiver operator characteristic curves and standard errors for each index (ten formulae) were calculated. Statistical values of ten formulae for aforesaid variables were higher than 87% (0.87–0.99).ConclusionThe new indices can be used for hospitalized patients in intensive care settings for accurate prediction of the weaning outcome.

The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918–0.987, P P P

Introduction Mental disorders are among the most prevalent health problems of the adult population in the world. This study aimed to identify the subgroups of staff based on mental disorders and assess the independent role of metabolic syndrome (MetS) on the membership of participants in each latent class. Methods This cross-sectional study was conducted among 694 staff of a military unit in Tehran in 2017. All staff of this military unit was invited to participate in this study. The collected data included demographic characteristics, anthropometric measures, blood pressure, biochemical parameters, and mental disorders. We performed latent class analysis using a procedure for latent class analysis (PROC LCA) in SAS to identify class membership of mental disorders using Symptom Checklist-90. Results Three latent classes were identified as healthy (92.7%), mild (4.9%), and severe (2.4%) mental disorders. Having higher age significantly decreased the odds of belonging to the mild class (adjusted OR (aOR = 0.21; 95% confidence interval (CI): 0.05–0.83) compared to the healthy class. Also, obesity decreased the odds of membership in mild class (aOR = 0.10, 95% CI: 0.01–0.92) compared to healthy class. On the other hand, being female increased the odds of being in severe class (aOR = 9.76; 95% CI: 1.35–70.65) class in comparison to healthy class. Conclusion This study revealed that 7.3% of staff fell under mild and severe classes. Considering educational workshops in the workplace about mental disorders could be effective in enhancing staff’s knowledge of these disorders. Also, treatment of comorbid mental disorders may help reduce their prevalence and comorbidity.

Background: COVID-19 is an infectious disease which caused a pandemic with many diseases and fatalities. This new variant of coronavirus called SARS-CoV-2 and is primarily characterized by respiratory symptoms. There are some data indicating that LDL-cholesterol (LDL-C) as well as HDL-cholesterol (HDL-C) levels are inversely correlated to disease severity and could act as a predictor for disease progression and unfavorable prognosis. However, the results of some other studies do not confirm this. This current study aimed to provide an answer to this question. ----- Methods: This prospective, single-center study analyzed 367 confirmed COVID-19 patients to find whether there are any differences in plasma lipoproteins between survivors and non-survivors patients or between the patients with a "duration of ≤10 days intensive unit care (ICU) stay" and patients with a "duration of >10 days ICU stay". ----- Results: No association between any lipid/lipoprotein parameter and the severity of COVID-19 could be found but survivors and non-survivors did differ concerning total cholesterol and LDL-C levels. ----- Conclusion: Multivariate cox regression analysis could not prove any association between lipids/lipoproteins and severe events in COVID-19 patients. Significantly less non-survivors with COVID-19 were taking atorvastatin than survivors which is consistent with the majority of previous findings.

Background Conflicting data suggest that statins could cause hepatitis in certain group of patients, while improving prognosis in patients affected by some chronic liver diseases. Therefore, we aimed to quantify the potential protective role of statins on some main liver-related health outcomes in clinical studies on patients affected by hepatitis. Methods We applied fixed-effects or random-effects meta-analyses with inverse variance weighting to calculate pooled estimates and confidence intervals (95% confidence intervals [CI]). We calculated the odds ratios (OR) and 95% CI for the targets of mortality and hepatocellular carcinoma, fibrosis, and cirrhosis. Results Nine studies (N: 195,602 patients) reported data on mortality of patients affected by chronic viral hepatitis, six studies (N: 72,960) reported data on the risk to develop hepatocellular carcinoma, two studies on fibrosis progression (N: 9678) and two studies (N: 85,205) on cirrhosis development. Statins reduce the risk to develop hepatocarcinoma (OR (95% CI) = 0.47 (0.28, 0.81), p=0.005) (Figure 1), liver fibrosis (OR (95% CI) = 0.55 (0.34, 0.87), p Conclusion Long-term treatment with statins seems to be safe in patients affected by hepatitis, while significantly improving their prognosis. Extensive education should be continued in order to avoid discontinuing statin therapy in patients with liver diseases. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases.Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16.Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P 0.001).FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.

The use of rehabilitation program for survivors of Acute Respiratory Distress Syndrome (ARDS) could be one of the important and fundamental steps to improve the pulmonary function and health related quality of life (HRQoL) of patients. This study was carried out to evaluate the effect of two rehabilitation techniques (Family-Based Empowerment Model (FECM)/Continuing Care Model (CCM), or both of them) on pulmonary function and HRQoL in ARDS survivor. From December 2009 to October 2014, ARDS survivors from mixed medical-surgical ICUs at four academic teaching hospitals in Tehran, Iran, randomly assigned to one of three intervention groups (A, B or C) or a control group (D). Pre- and post-interventions, pulmonary functions and HRQoL status of patients in all groups were collected 48 times through clinical measurements and various questionnaires during 5 years of follow-up. Significantly improvement was seen in the intervention groups compared to the control group, and the greatest benefit was observed in patients that received mixed of FCEM and CCM rehabilitation techniques. Co-administration of FCEM and CCM can improve pulmonary function as well as the life satisfaction of ARDS survivors. As a result, the execution of the empowerment model by nurses is recommended for ARDS survivors and the participation of their families at the same time. Trial registration: NCT02787720 (ClinicalTrial.gov, 01/06/2016).

This study assesses the impact of religiosity on delirium severity and patient outcomes among Shi’a Muslim intensive care unit (ICU) patients. We conducted a prospective observational cohort study in 21 ICUs from 6 Iranian academic medical centers. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM-ICU) tool. Eligible patients were intubated, receiving mechanical ventilation (MV) for ≥ 48 h. Illness severity was assessed using Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. A total of 4200 patients were enrolled. Patient religiosity was categorized as more (40.6%), moderate (42.3%), or less (17.1%) based on responses to patient and surrogate questionnaires. The findings suggest that lower pre-illness religiosity may be associated with greater delirium severity, MV duration, and ICU and hospital LOS. The lower mortality in the less religiosity group may be related in part to a greater proportion of female patients, but it remains unclear whether and to what extent greater religiosity impacted treatment decisions by patients and families. Further investigation is needed to validate and clarify the mechanism of the mortality findings.

Background: The rapid shallow breathing index (RSBI) is used clinically to help predict a patient’s likelihood of successful liberation from mechanical ventilation (MV). However, the traditional threshold (

Patients with rheumatoid arthritis (RA) are prone to depression due to several factors related to their RA, including chronic and persistent pain, functional disability, economic constraints, and the side effects of RA medication. Previous Iranian studies showed conflicting and inconclusive findings regarding the prevalence of depression among RA patients. Therefore, this systematic review and meta-analysis was conducted to estimate the true prevalence of depression in Iranian patients with RA. Search for eligible articles was performed using the keywords of depression, depressive disorder, dysthymic disorder, major depressive disorder, RA, and Iran, and their possible combinations in the following databases: Scientific Information Database, MagIran, Web of Science/ISI, PubMed, and Scopus. The search was restricted to articles published in Persian and English languages. The meta-analysis was performed using the random effects model, and the data were analyzed using the STATA software version 12. Overall, six articles were selected; the overall prevalence of depression among the Iranian patients with RA was 65.58% (95% CI: 56.53%-74.62%). There were no significant relationships between the prevalence of depression and articles' methodological quality and year of publication, participants' age, sample size, and duration of disease. More than half of RA patients suffer from depression. The overlap between the physical symptoms of RA and depression in this group of patients makes it difficult to correctly diagnose depression; therefore, initiative and efforts are required to improve the identification of early depression symptoms in RA patients in order to effectively manage their depression.

The emerging COVID-19 disease affects not only the physical health but also the emotional and psychological health of patients. This study aimed to explain the experiences of 22 recovered COVID-19 patients in Baqiyatallah hospital, Tehran, Iran. Data were collected through in-depth semi-structured interviews. All interviews were recorded and transcribed and then analyzed using the conventional content analysis method. This resulted in emergence of 3 themes "emotional-sensational paradox", "spiritual growth", and "experienced mental-psychological effects", with 11 main categories and 33 subcategories. The results of the study can be used to develop instructions and guidelines for the families of patients as well as healthcare teams to provide effective measures and interventions to minimize the suffering of patients and the damage to mental health.

Background and aims Non-contrast chest computed tomography (CT) scanning is one of the important tools for evaluating of lung lesions. The aim of this study was to use a deep learning approach for predicting the outcome of patients with COVID-19 into two groups of critical and non-critical according to their CT features. Methods This was carried out as a retrospective study from March to April 2020 in Baqiyatallah Hospital, Tehran, Iran. From total of 1078 patients with COVID-19 pneumonia who underwent chest CT, 169 were critical cases and 909 were non-critical. Deep learning neural networks were used to classify samples into critical or non-critical ones according to the chest CT results. Results The best accuracy of prediction was seen by the presence of diffuse opacities and lesion distribution (both=0.91, 95% CI: 0.83-0.99). The largest sensitivity was achieved using lesion distribution (0.74, 95% CI: 0.55-0.93), and the largest specificity was for presence of diffuse opacities (0.95, 95% CI: 0.9-1). The total model showed an accuracy of 0.89 (95% CI: 0.79-0.99), and the corresponding sensitivity and specificity were 0.71 (95% CI: 0.51-0.91) and 0.93 (95% CI: 0.87-0.96), respectively. Conclusions The results showed that CT scan can accurately classify and predict critical and non-critical COVID-19 cases.

The exaggerated host response to Sars-CoV-2 plays an important role in COVID-19 pathology but provides a therapeutic opportunity until definitive virus targeted therapies and vaccines become available. Given a central role of endothelial dysfunction and systemic inflammation, repurposing ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), statins, and aspirin has been of interest. In this retrospective, single-center study, we evaluated the primary outcomes of mortality and ICU admission in 587 hospitalized patients with documented COVID-19 with or without ACEIs, ARBs, statins, and aspirin. Atorvastatin was associated with reduced mortality, which persisted after adjusting for age, lockdown status, and other medications (OR: 0.18. 95% CI: 0.06-0.49, P = 0.001). ACEIs were also associated with reduced mortality in the crude model (OR: 0.20, CI: 0.06-0.66, P = 0.008), as ACEIs and ARBs were combined as a single group (OR: 0.35, CI: 0.16-0.75, P = 0.007), although ARBs alone did not reach statistical significance. There was no association between any medications and risk of ICU admission. Aspirin only achieved a significant association of reduced mortality in a subgroup of patients with diabetes in the crude model (OR: 0.17, CI: 0.04-0.80, P = 0.02). The reduced mortality observed with atorvastatin is consistent with other literature, and consideration should be given to atorvastatin as a COVID-19 treatment. While there was suggested benefit of ACEIs and ARBs in the present study, other studies are varied and further studies are warranted to recommend employing these medications as a treatment strategy. Nevertheless, this study combined with others continues to give credibility that ACEIs and ARBs are safe to continue in the setting of COVID-19.

Background. Colorectal cancer (CRC) and inflammatory bowel disease (IBD) are closely interrelated. However, the effect of having a family history of one disease on the risk of another remains undetermined. Aim. The purpose of this meta-analysis was to estimate the prevalence of a family history of CRC among patients with IBD, as well as the prevalence of a family history of IBD among patients with CRC. Methods. PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to identify studies reporting the prevalence of family history of IBD among patients with CRC, in addition to the prevalence of family history of CRC among IBD patients. Criteria for study inclusion consisted of the following: (1) studies that evaluated either IBD or CRC and dysplasia, (2) included all age groups, and (3) evaluated the family history effects for IBD or CRC. The total number of IBD patients and IBD patients with a family history of CRC and the total number of CRC patients and CRC patients with a family history of IBD were reviewed. The pooled prevalence of diseases was also estimated according to degree of relatives and geographical area. Random-effects models were used for estimating pooled prevalence. Results. A total of 27 studies were included with 26,576 IBD and 9,181 CRC or dysplasia patients. Eligible studies included 13 case-control, 10 cohort, and 4 cross-sectional types. The pooled prevalence of a family history of CRC among patients with IBD was 6% (95% CI: 4-9%). The pooled prevalence for first- and second-degree relatives (11%, 95% CI: 0-37%) was more than that for the other relative subgroups of relatedness degree. The prevalence in the American regions (8% (95% CI: 5-13%)) was higher than that in the others. The pooled prevalence for a family history of IBD among CRC or dysplasia patients was 11% (95% CI: 6-16%). The pooled prevalence for first-degree relatives (13% (95% CI: 3-28%) was higher than that for the other relative subgroups of relatedness degree; it was also greater in American countries (15%, 95% CI: 8-23%). Conclusion. This study emphasizes the relationship between a family history of IBD and CRC development. Additionally, there was notable prevalence for a family history of CRC among IBD patients. American countries and first-degree relatives were identified to have a higher prevalence for both disease processes.

Background: Males are more likely to die from COVID-19 than females. In addition, the mortality rate among positive and suspected COVID-19 patients were reported in many literatures. The aim of this study is to evaluate the sex differential effect in the COVID-19 mortality by different age groups and polymerase chain reaction (PCR) test results. Methods: in a multicenter cross-sectional study from 55 hospitals in Tehran, Iran, patients were categorized as the positive, negative and suspected cases. Age group, sex and hospital wards were also assessed in analysis. Results: A total of 25481 cases (14791 males) were included in the study with the mortality rate of 12.0%. The mortality rate in positive, negative and suspected cases were 20.55%, 9.97% and 7.31%, respectively. Although the mortality in negative test group was considerable, sex was not associated with the death rate in this group. Using Cox regression model, sex had a significant effect on the hazard of death due to COVID-19 in adults and senior patients having positive and suspected PCR test results. However, sex was not found as significant factor for mortality in patients with negative PCR test occurring to different age groups. Conclusion: Regardless of other risk factors, we found that sex differential effect in COVID-19 mortality varies significantly in different age groups; therefore, appropriate strategies should be designed to protect adult and senior men from this deadly infectious disease. Furthermore, owing to the considerable death rate of COVID-19 patients with negative test results, new policies should be launched increase the accuracy of diagnosis tests.

The article's abstract is not available.