Hospital Practices and Research

Abstract Background: The novel coronavirus has been found to have neurological manifestations, and cerebrospinal fluid (CSF) analysis could be helpful in the differential diagnosis of critically ill patients with neurological symptoms and act as a prognostic factor in these patients.
Objectives: In this study, we assessed the CSF of patients with COVID-19 who presented with encephalopathy to elucidate any common characteristics.
Methods: This cross-sectional study included 36 patients with positive COVID-19 PCR who presented with encephalopathy and were hospitalized. We evaluated RT-PCR, total cell counts, LDH, protein, and glucose levels of CSF samples. Clinical manifestations, neurological complaints, and outcomes (death or survival) were extracted from patients' files.
Results: A total of 36 patients underwent lumbar puncture and CSF analysis. RT-PCR for SARS-CoV-2 RNA was negative in all thirty-six cases. Fever was present in 29 (80.6%) patients, shortness of breath in 23 (63.9%), and cough in 14 (38.9%) as primary clinical manifestations. Seizures were reported in 12 (33.3%) patients as a neurological presentation. The mortality rate was 7 (19.4%) in our cases. Abnormalities in WBC count were found in 6 (16.6%) of CSF samples. The remaining patients had normal CSF results, indicating no specific pattern of CSF markers.
Conclusion: Our study did not reveal any usual patterns in CSF analysis. Moreover, we were unable to detect SARS-CoV-2 RNA in CSF samples definitively. These findings suggest that the indirect mechanisms of SARS-CoV-2 may play a significant role in the neurological manifestations associated with COVID-19.

Abstract This highlights the significance of parasitic infections as an important and overlooked aspect of infectious diseases amid the COVID-19 pandemic. Despite the focus on viral and bacterial infections, parasitic infections continue to pose a substantial public health challenge, especially in areas with restricted access to healthcare. The interaction between parasitic infections and COVID-19, including possible co-infections and their impact on disease severity, requires further investigation...

Abstract Background: The COVID-19 virus has created many problems for human beings in the real world, particularly in the health sector. One of the issues is in emergency hospitals, which are vital pillars of the healthcare system in every country. Providing timely treatment and access to healthcare facilities is a major problem in developing countries.
Objectives: The aim of the study was to simulate a hospital emergency department under COVID-19 conditions.
Methods: This study simulates the operations of an emergency department in a hospital under COVID-19 conditions as a case study in Iran. This study considers several assumptions about hospital facilities, including doctors, nurses, and patients. The patients are divided into two categories: some require immediate examination, while others wait in line for appropriate services.
Results: A flow diagram for the department is provided and converted into a model, which is implemented using GPSS software. The model is then run multiple times, and the outputs are collected. The outputs of the simulation and their statistical distributions are analyzed, and the performance of various statistical tests is examined. Finally, recommendations for improving the performance of the emergency system are presented.
Conclusion: The findings of this study can be used as the first step in preparing this tool. Accordingly, this study was conducted to identify existing and valid tools for measuring hospital readiness against the COVID-19 virus, translate those tools, and compare them.

Abstract Background: COVID-19 has altered and challenged healthcare and childbirth services provision. Midwives are among the first and most influential childbirth care providers during the COVID-19 pandemic. However, there is insufficient information about their experiences in delivering healthcare services, especially in Iran.
Objectives: This study aimed to explore midwives' challenges in providing prenatal care during the COVID-19 pandemic.
Methods: This qualitative study utilized conventional content analysis and was conducted from February 2021 to July 2021 in Shushtar, Iran. A total of 15 midwives were purposively selected with maximum diversity as participants. Data were collected through in-depth, semi-structured online interviews. MAXQDA (V10) software was used for data analysis.
Results: Data analysis resulted in 271 codes, 10 subcategories, and four main categories: "Care Environment", "Management of the Care Process", "Maternal Self-Care", and "Psychosocial Stress".
Conclusion: The findings of this qualitative study highlight the challenges midwives face in providing prenatal care, offering valuable insights for achieving quality care during crises. Focusing on these dimensions can help health policymakers design quality healthcare services during emergencies.

Abstract Background: Infection prevention, control, and health workers’ safety in the face of biological agents are among the vital issues in healthcare systems worldwide. Considering the high prevalence of COVID-19 infection and its high mortality rate, this epidemic can be tackled to some extent through infection control in the general population and promoting the safety of health centers.
Objectives: The aim of this study was to scrutinize the literature regarding measures adopted for infection control and safety of healthcare workers in health centers during the beginning of COVID-19.
Methods: A systematic review following the PRISMA guidelines was performed. Keywords related to the study namely, “prevention and control”, “safety”, “coronavirus”, “COVID-19”, and “health personnel” in PubMed, Web of Science, ScienceDirect, Scopus databases, and Google Scholar using AND/OR functions from February 2020 to July 2020 were searched. To select the documents, the titles of the retrieved studies were first evaluated for relevance; then, the abstracts and full texts of the papers with relevant titles were inspected.
Results: Out of 136 retrieved studies, 10 were relevant and their data were analyzed. Four articles highlighted the importance of prevention, three enunciated the importance of control, and three related to care providers’ safety. The results showed that the COVID-19 epidemic has affected the healthcare providers’ health; however, it is possible to prevent a catastrophe through strategic planning, prevention, and control measures.
Conclusion: Considering the importance of healthcare workers’ health, it is necessary to implement COVID-19 prevention and control management principles based on scientific evidence.

Abstract Background: The coronavirus Disease 2019 (COVID-19) pandemic emerged in December 2019, resulting in a high number of deaths worldwide. There is a need to investigate how this condition affected people with different diseases, particularly atopy.
Objectives: This study aimed to compare clinical symptoms, laboratory test results, radiological manifestations, and clinical outcomes between hospitalized COVID-19 patients with and without atopy.
Methods: This single-center cross-sectional study with matched controls was conducted on 106 (out of 334) COVID-19 patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, from March 24 to April 24, 2020. Among them, there were 40 and 66 cases with and without atopy, respectively. The non-atopic patients were also matched with the atopic patients in terms of age, gender, Body Mass Index (BMI), and the prevalence of comorbidities, particularly hypertension and diabetes. Patients' clinical characteristics, laboratory findings, and radiological features, recorded upon their admission, and the outcomes were then compared between both study groups.
Results: Compared with the non-atopic group, weakness, myalgia, and chills were more frequent in the patients affected with atopy (P <0.05), and neutrophil count, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), bilateral lung involvement, bilateral pneumonia, and Ground-Glass Opacity (GGO) were among the laboratory test results and radiological manifestations that were observed significantly less in atopic patients (P <0.05). No significant difference was further detected regarding the COVID-19 outcomes in both study groups (P >0.05).
Conclusion: This study showed that atopic conditions were capable of increasing the frequency of some COVID-19 clinical symptoms and reducing the severity of COVID-19 with regard to laboratory findings and radiological features on admission. In addition, atopy was not correlated with COVID-19 outcomes in atopic patients.

Abstract Background: The outbreak of COVID-19 has put more pressure on the medical staff.
Objectives: The current study was performed to determine the role of emotional exhaustion on self-compassion in nurses via the mediation of empathy during the outbreak of COVID-19.
Methods: The present study was a descriptive and analytical study conducted on 150 nurses working in Al-Zahra and Kashani hospitals in Isfahan, Iran in 2021. The data were collected by three standard questionnaires of Emotional exhaustion (Chen), Self-compassion (Neff), and Empathy (Davis) and were analyzed in SPSS version 24 and LISREL8 software.
Results: The results of the study revealed that the three variables of self-compassion, empathy and emotional exhaustion are not significantly different according to the demographic characteristics of nurses (P>0.05). There was a direct and significant relationship between empathy and emotional exhaustion (P<0.05). Ultimately, the proposed model has a good fit and in the direct and indirect relationships of the model, the role of empathy as a mediator between emotional exhaustion and self-compassion is confirmed.
Conclusion: In line with the obtained results, it is suggested that considering the spread of a deadly infectious disease, appropriate educational measures and strategies should be implemented to promote or boost the spirit of empathy among health sector employees, especially nurses.

Abstract Background: During disasters, hospitals play a key role in providing quality and appropriate medical services to increase resilience.
Objectives: This study was carried out with the aim of determining the response rate of the emergency department of Shiraz University of Medical Sciences hospitals to the Corona pandemic in 2021.
Methods: This cross-sectional descriptive research was conducted in educational-therapeutic hospitals of Shiraz University of Medical Sciences. For this purpose, 230 senior and middle managers, emergency department nurses and emergency medicine specialists participated in this study. Hospitals were placed in two categories: special centers for COVID-19 (3 hospitals) and other educational and medical centers (general and specialized centers) (8 hospitals). The information was collected by the hospital readiness assessment checklist (2020) for the management of infectious disease epidemic crisis based on the guidelines of the World Health Organization for the response of hospitals to the COVID-19. After collecting the data, it was entered into SPSS 22 and analyzed.
Results: Findings of this study showed that the readiness of hospitals is at a good level (87%). The studied hospitals performed very well in items of support and management of financial resources, communication management, human resources management, diagnosis and management of patients, but in item of rapid identification and control and prevention of infection, they performed very poorly. The centers of COVID-19 scored higher than other educational-treatment centers, continuation of services and increased capacity, rapid identification, diagnosis, prevention and control of infection, which was statistically significant (p <0.05).
Conclusion: Rapid identification of patients seems to be an important challenge in Shiraz University of Medical Sciences. The allocation of special hospitals for the care of COVID-19 patients is also effective in preparing them for the pandemic.

Abstract Background: Outbreak detection algorithms could play a key role in public health surveillance.
Objectives: This study aimed to compare the performance of three algorithms (EWMA, Cumulative Sum (CUSUM), and Poisson Regression) using the reported COVID-19 data for outbreak detection.
Methods: Three outbreak detection algorithms were applied to the data of COVID-19 daily new cases in Iran between 19/02/2020 and 20/06/2022, and 344 simulated outbreak days were injected into the data sequences. The Area Under the Receiver Operating Characteristics (ROC) Curve (AUC) and its 95% confidence intervals (95% CI) were also computed.
Results: EWMA9 had the lowest AUC (51%). Among the different algorithms, EWMA9 with λ = 0.9 and CUSUM 1 had the highest sensitivity with 100 and 87% (95% CI: 84%-91%), respectively.
Conclusion: According to the results, CUSUM, EWMA, and poison regression showed appropriate performance in detecting the COVID-19 outbreaks. These algorithms can be extremely helpful for health practitioners and policymakers in the detection of infectious disease outbreaks.

Abstract Background: Pandemics such as COVID-19 create heightened fear and anxiety, causing deterioration in the behaviours, social and psychological well-being of people. It can be thought that the anxiety levels of healthcare workers will increase more because they have a higher risk of contamination, work under COVID-19 isolation-measures and heavy workload.
Objectives: The aim of this study is to determine the COVID-19-related anxiety levels of individuals, the ways of coping with, the demographic factors affecting anxiety, and whether the anxiety level of healthcare workers is different from others.
Methods: This study was carried out with data obtained from 1017 participants via google forms between May-July 2020. In the collection of data, the 12-item COVID-19-related anxiety scale, which was developed by researcher and analysed for validity and reliability; 13 items for ways of coping; some demographic questions were used. The COVID-19-related anxiety scale consisted of three dimensions: “cognitive”, “physiological and emotional”, “behavioural”, which explained 71% of the variance. The Cronbach alpha of scale was 0.85.
Results: The COVID-19-related anxiety levels of participants were slightly above the moderate level (2.83±0.72). The anxiety levels of healthcare workers were not different from others. There was a difference in anxiety levels according to demographic characteristics of participants, such as age, gender, living in Turkey or abroad, working status/type, and smoking addiction. Cognitive coping, social support, distraction, relaxation techniques were identified as ways of coping with anxiety.
Conclusion: COVID-19 pandemic created anxiety in people. More studies need to understand the long-term effects of the pandemic.

Abstract The African continent is a known malaria-endemic region. Amid the COVID-19 pandemic, COVID-19/malaria co-infection is of critical importance in Africa due to the similarities in the manifestation of their symptoms. To avert compromising the health status of individuals on the African continent during the COVID-19 pandemic, this commentary sought to examine the link between COVID-19 and malaria, outlining strategies for improving the diagnosis and prevention of COVID-19 and malaria in Africa. A scale-up of malaria-focused care should be considered to ensure adequate reporting of COVID-19 cases in Africa. Likewise, individuals who present for malarial testing should be linked to COVID-19 testing and treatment care in Africa. Also, surveillance activities should be scaled up to ensure accurate COVID-19 case reporting and improved case notification. Regular refresher trainings should be organized for healthcare workers to promote healthcare service delivery.

Abstract Introduction: The main symptoms of new coronavirus in patients are fever or chills, tiredness, and dry cough. In this case, we reported a woman who got involved in COVID-19 pneumonia with gastrointestinal instead of lower respiratory symptoms.
Case Presentation: A 67 years old woman was referred to an outpatient clinic in Tehran with fever, chills, sneezing, tiredness, severe nausea, anorexia, and diarrhea. She did not have a cough, dyspnea, or chest pain and her lung sound was normal. According to the blood O2 saturation decreasing, C-reactive protein increasing, and the lung imaging findings, she was admitted with COVID-19 pneumonia diagnosis in the infectious care department of a hospital. The 2019-nCoV real-time polymerase chain reaction (PCR) intranasal assay was negative. She was treated with intranasal oxygen therapy, anti-inflammatory drugs, and prednisone. After one week she was discharged in generally good condition and quarantined for two weeks later. After 25 days the COVID-19 IgM and IgG antibodies were in positive ranges.
Conclusion: Severe fatigue, mainly in elders caused the inability to cough, and light inspiration force especially in the lower lung lobes could explain the normal lung sounds in the physical examination. Also, we hypothesized that reverse circulation of the virus may occur from the gastro intestine to the respiratory system. The gut-lung microbial imbalance may affect the severity in patients with extrapulmonary symptoms, especially in old ages. Furthermore, damage to the vagus nerve along the path in the proximity to lungs infected with COVID-19 can cause nausea without gastrointestinal involvement.

Abstract Background: The world is still witnessing a largely ongoing spread of coronavirus disease 2019 (COVID-19); therefore, the scientific findings in this area need to be shared promptly.
Objectives: This study aimed to assess the usefulness of Atorvastatin treatment in reducing COVID-19 mortality in patients with or without diabetes mellitus (DM) and to correlate them with C-reactive protein (CRP) levels.
Methods: This study consecutively enrolled patients with pneumonia symptoms, positive lung CT scan, and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on reverse transcription-polymerase chain reaction (RT-PCR). The outcome was defined as intensive care unit (ICU) admission and death. Clinical data and history of atorvastatin administration were evaluated. CRP levels were measured at baseline and repeated after one week in all patients.
Results: A total of 200 patients were included. Their mean age was 60.5 (SD = 16.5) years, 113 (56.5%) patients were male, 47 (23.5%) with pre-existing diabetes, and 64 (32%) patients were taking atorvastatin routinely. 68 (34%) required ICU admission of all the studied patients. No gender differences were found in ICU admission and death. The baseline CRP was not significantly different, but the secondary CRP was significantly different between DM and non-DM groups. Secondary CRP also showed a significant reduction in patients receiving atorvastatin (P = 0.017). The mortality was the same in atorvastatin or non-atorvastatin groups (P = 0.715).
Conclusion: It seems that taking statin has only some beneficial effects on improving CRP levels in patients with COVID-19. To achieve a reliable result, clinical trials are recommended.

Abstract Introduction: During the current worldwide pandemic of coronavirus disease 2019 (CPVID-19), this disease was first identified in Iran at the end of February. This study was conducted to examine patients with severe COVID-19 disease, who were treated with three medications, namely ReciGen, methylprednisolone, and Sovodak.
Case Presentation: We identified 10 patients (3 males and 7 females) with the mean (± SD) age of 55.70 ± 21.48 years, who were admitted to the only referral hospital in Rafsanjan County (Iran) from March to July 2020 with confirmed infections with severe COVID-19. They were treated with the combination therapy of subcutaneous ReciGen interferon every other day, methylprednisolone at a dose of 250 mg every 6 hours for 5 days, and one tablet of Sovodak daily.
Conclusion: In the series of cases investigated in this study, the general conditions of all patients improved in terms of their clinical parameters after receiving the combination therapy, and all patients were discharged with a blood oxygen level of ≥ 93% and in good general conditions.

Abstract Background: The health of healthcare workers (HCWs) is an indicator of the quality of health service provision during the COVID-19 pandemic.
Objectives: This study aimed to describe the symptomatology and positivity of COVID-19 infection and the type of COVID-19 care received among HCWs in a North-Central State in Nigeria.
Methods: This was a retrospective review of HCWs tested for COVID-19 as retrieved from the Surveillance Outbreak Response Management System between April 2020 and March 2021 in Kwara State, Nigeria.
Results: Among the 1453 HCWs, 831 (57.2%) were above 35 years and, 874 (60.2%) were females. Among the 259 HCWs who tested positive for COVID-19, 122 (23.8%) lived in urban areas (χ2 = 13.94, P ≤ 0.001). Also, 83 (30.7%) of symptomatic persons tested positive for COVID-19 (χ 2 = 37.766, P ≤ 0.001). Overall, 33 (12.7%) of the 259 positive HCWs received hospital-based COVID-19 care, and 33 (16.1%) who had less than 2 symptoms received hospital-based COVID-19 care (χ2 = 9.962, P = 0.002). HCWs who had cough had three times odds of testing positive for COVID-19 (OR = 3.299, 95% CI = 1.571–6.927, P = 0.002). Also, HCWs who manifested loss of taste had three times odds of testing positive for COVID-19 (OR = 3.392, 95% CI = 1.010–11.393, P = 0.048).
Conclusion: COVID-19 testing should be encouraged among HCWs, especially those with cough symptoms and loss of taste.

Abstract Background: Supportive respiratory care and airway management are very important in treating COVID-19 patients with respiratory failure. There are two techniques for supporting patients with respiratory failure.
Objectives: The current study aims to evaluate the efficacy and quality of patient care with early tracheostomy in intensive care unit (ICU) and compare mortality, hospital stay, and outcome between intubation and early tracheostomy.
Methods: This study is conducted on total patients with confirmed COVID-19 in the ICU centers of a tertiary hospital. At the beginning of the study, all patients were intubated and connected to a mechanical ventilator. Within three days, the intensivists randomly performed bedside percutaneous dilational tracheostomy (PDT) for half of the patients. Early tracheostomy was defined as conducting tracheostomy within three days from intubation.
Results: The total number of 36 patients was included in the study and categorized into two groups, including 18 patients in the early tracheostomy and 18 in orotracheal intubation. Half of the patients (50%) in the tracheostomy group were recovered from COVID-19 respiratory failure and discharged from ICU and hospital. All patients in the intubation group were expired. The length of staying alive in ICU in patients with an early tracheostomy was 26.47 ± 3.79 compared with 7.58 ± 2.36 days in intubated patients.
Conclusion: The early tracheostomy compared with orotracheal intubation in respiratory failure patients with COVID-19 can significantly decrease mortality. However, airway management with an early tracheostomy increases the hospitalization stay and can increase recovery. So, conducting the early tracheostomy is recommended in this study.

Abstract Background: Among suggested medications for the treatment of COVID-19, chloroquine derivates and angiotensin-converting–enzyme inhibitors (ACEIs)/angiotensin II type 1 receptor blockers (ARBs) are the two medications with conflicting effects on the development of the disease.
Objectives: The present study aimed to evaluate COVID-19 in patients with rheumatic diseases receiving chloroquine derivate.
Methods: Every patient with proven rheumatologic diseases registered in two referral centers in Tehran and Alborz, Iran was enrolled in the present descriptive cross-sectional study between May and June 2020. At first, the symptoms of COVID-19 were assessed, and if a case had suspicious symptoms, reverse transcription-polymerase chain reaction (RT-PCR) COVID-19 tests were done. Demographic and clinical data are documented for every patient. Then, the patients were grouped once according to their COVID-19 infection status and another time according to their hydroxychloroquine use.
Results: 1159 patients enrolled in the study with a mean age of 49.39 years. Frequency of hypertension was 22.17 %, diabetics (9.49%) and 20 (1.7%) patients were positive for COVID-19 testing. The most common symptoms of the COVID-19 positive cases were cough (5.2%) and fever (4%). There was no significant difference in receiving ACEIs/ARBs or other medications between COVID-19 positive or negative patients. Among the patients receiving hydroxychloroquine, 15 patients (1.7%) had proved COVID-19 versus 5 patients (1.7%) who were not receiving these medications (P>0.999).
Conclusion: The present study demonstrated that receiving ARBs or ACEIs was not different among patients with or without COVID-19. Moreover, receiving chloroquine derivate was not related to the development of COVID-19 in patients with rheumatologic disorders.

Abstract Background: Coronavirus disease 2019 (COVID-19) pandemic has been associated with various risks, including the exposure of infectious agents.
Objectives: The study aims at describing the incidence of blood and body fluid (BBF) exposure in a COVID-19 facility so as viral transmission potential through blood.
Methods: A descriptive study of BBF exposure notified was carried out in a community hospital in Qatar.
Results: In 2020, 29 needlesticks injuries were reported, which is a significant increase compared to the year 2019 (6 incidents) and 2018 (5 incidents). No evidence of SARS-CoV-2 transmission was shown concerning the injury using symptoms monitoring and lab test.
Conclusion: The increased risk of BBF exposure during the pandemic provides insight into the need to review the prevention practices of occupational exposure during pandemics. Additional studies are required to define the risk of COVID-19 related to occupational exposure to BBF.

Abstract Background: Coronavirus disease 2019 (COVID-19) has become a global challenge to the health care system. A novel agent to combat this deadly virus is still a matter of research. Herbal molecules have served humanity since the beginning.
Objectives: This narrative review aims to study the antiviral properties of medicinal plants, which are already effectively used in the past against various viruses. It derives the importance of exploration of such phytochemicals, which can be complementarily used to treat COVID-19.
Methods: Studies related to traditional medicine and treatment for viruses were retrieved from databases including PubMed, Google scholar until December 2020 using the keywords SARS-CoV-2, COVID-19, Immunological, Phyto-chemicals, Traditional Medicine. The resulting publications were analyzed to develop a narrative review on the traditional Indian phytochemicals that have been shown to effectively treat various viral infections and potentially treat or prevent COVID-19.
Results: Many of the researches are showing that Indian herbal compounds have a significant potential against viral diseases. Plants like Azadirachta indica, Withania somnifera, Tinospora cordifolia, Ocimum basilicum, and many more have been shown tremendous antiviral, anti-inflammatory, and immune-modulatory activities.
Conclusion: Phytochemicals obtained from the herbs can be helpful in the treatment and prevention of SARS-CoV-2via various modes such as inhibition of attachment, penetration, uncoating, replication, assembly, and release of respiratory viruses. Further analysis of the potential phytochemicals in treating SARS-CoV-2 in clinical trials is warranted.

Abstract Background: In December 2019, in Wuhan, China; a new coronavirus emerged that had not been previously identified in humans. Hence is crucial to characterize the infection risk among infected health care workers (HCWs), being responsible for secondary transmission to patients, and others.
Objectives: The current study aimed to assess the disease burden among the front-line warriors and efficiently planned the preventive and management strategies for such infections.
Methods: HCWs with clinical suspicion of COVID-19 infection, who reported to Fever Clinic for possible diagnosis by Truenat testing, were enrolled through a self-reporting Risk Assessment form. An oropharyngeal swab was subjected to Truenat testing based on the principle of Real time reverse transcription polymerase chain reaction (RT-PCR).
Results: Doctors comprised 60% of our HCWs. Eighty-three percent of the HCWs under study reported either the presence of BCG scar or gave a history of BCG immunization at birth. The maximum number of HCWs (29.16%) took Hydroxychloroquine prophylaxis for four weeks. Seventy-four percent of the HCWs affirmed the use of personal protective equipment (PPE) at the time of exposure. The most common mode of infection reported was the exposure to COVID-19 patients. Fever was the most common reported symptom. Truenat was positive in 9 of 100 HCWs who were tested, giving an infection rate of 9%.
Conclusion: The study provides insights into the burden of COVID-19 infection among HCWs, and guides us to evaluate and plan our preventive measures and management strategies for such infections.

Abstract Background: Medical equipment plays an important role in community health in critical situations such as the COVID-19 pandemic.
Objectives: This study was conducted to determine and identify the factors affecting the management of medical equipment in crisis situations.
Methods: The present study was conducted as a mixed qualitative and quantitative study in 2020. In the qualitative section using the targeted sampling method, ten medical equipment management experts and in the quantitative section using available sampling method, 200 managers and experts active in this field from hospitals and related companies were selected for this study. The qualitative part was conducted in two stages of reviewing texts and interviewing experts and in the quantitative part we evaluated the validity of the structure and the reliability of the questionnaire.
Results: The validity of the structure was assessed using heuristic factor analysis. KMO index was 0.971 and Bartlett test was significant (P < 0.05). All six approved components in the content validity section, based on the mathematical model, explain and determine more than 77% of the variance related to the purpose of the study which is the management of medical equipment in COVID-19 pandemic situations.
Conclusion: The results showed that the instructions, management, information technology, equipment, manpower, and physical space components had the highest and lowest priority in the management of medical equipment in critical situations, respectively. In this regard, appropriate instructions should be provided first and localized protocols should be communicated from the same source at the same time.

Abstract Background: Pneumomediastinum and pneumothorax are usually rare conditions after pneumonia. This study examines the progress of pneumonia of the coronavirus disease 2019 (COVID-19) to spontaneous pneumothorax and pneumomediastinum in a patient.
Case Presentation: The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back, and chest pain. The patient used to smoke but now he quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and a ground glass view was also seen in the lungs. In the patient’s tests, RT-PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed and it was positive. Treatment was initiated and because of the progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily; and cavitary changes, air-fluid appearance, and destructive changes of lungs were reported. After eight days, the patient’s cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax, and pneumomediastinum, thus a chest tube was inserted and oxygen therapy was begun on the patient with 3-6 L/min. After 5 days in CT, the patient was relieved of pneumothorax and pneumomediastinum and after a week, the chest tube came out.
Conclusion: Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastinum, and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastinum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.

Abstract The coronavirus SARS-CoV-2 disease (COVID-19) is the most current life-threating disease that affect health and economic sectors in the world. This pandemic raises weighty and urgent ethical issues that affected patients, health care provider and health care systems. Based on medical ethics textbooks, there are four fundamental ethical principles: The principle of respect for autonomy, the principle of beneficence, the principle of non-maleficence, and the principle of justice. Medical ethics scientists have well explained these principles before with full accuracy and detail. In this review article, we discussed the ethical issues raised during the COVID-19 pandemic. Health inequity and inequality, health care rationing/triage, contact tracing technologies and data privacy, movement restriction and exit strategies, and finally COVID-19 research ethics especially clinical trials and vaccine studies could cause ethical problems during Covid-19 pandemic. In this review article, we discuss about these issues and provide some ethical solutions to these issues

Abstract

Abstract Background: Nowadays, one of the most important social troubles is the sleep disorder that more than 40% of some population faced. Biofeedback (BFB) as a complementary method could reduce many of its effects.
Objectives: This study aims to show the effects of BFB on the promotion of sleep quality and control sleep disorder impacts.
Methods: An interventional study was conducted on 48 volunteer patients with sleep disorders. Twelve patients were included in each of four groups consisting of control. Pittsburgh Sleep Quality Index (PSQI) was used as a standard tool for sleep quality measurement in both groups. Abdominal breathing via chest breathing was trained as a BFB training exercise for patients. Heart rate variability (HRV) was measured before and after BFB training. Data were checked for outliers and normal distribution. SPSS version 22 and a diagram prepared by sigma plot version 14 did data analysis.
Results: The finding showed the promotion of sleep quality by pulse regulated abdominal breathing (PRAB) by a significant difference before and after BFB for four weeks.
Conclusion: Based on the finding of this study, polyvagal BFB training was utilized as a complementary method for HRV thus not only can it treat the patients with a sleep disorder but also promote sleep quality of the normal persons. Hence, the PRAB can be used for the patients with chief complain of sleep disorder.