Background: COVID-19 has become a pandemic since December 2019, causing millions of deaths worldwide. It has a wide spectrum of severity, ranging from mild infection to severe illness requiring mechanical ventilation. In the middle of a pandemic, when medical resources (including mechanical ventilators) are scarce, there should be a scoring system to provide the clinicians with the information needed for clinical decision-making and resource allocation. Objectives: This study aimed to develop a scoring system based on the data obtained on admission, to predict the need for mechanical ventilation in COVID-19 patients. Methods: This study included COVID-19 patients admitted to Sina Hospital, Tehran University of Medical Sciences from February 20 to May 29, 2020. Patients' data on admission were retrospectively recruited from Sina Hospital COVID-19 Registry (SHCo-19R). Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed to identify the predictive factors for mechanical ventilation. Results: A total of 681 patients were included in the study; 74 patients (10.9%) needed mechanical ventilation during hospitalization, while 607 (89.1%) did not. Multivariate logistic analysis revealed that age (OR,1.049; 95% CI:1.008-1.09), history of diabetes mellitus (OR,3.216; 95% CI:1.134-9.120), respiratory rate (OR,1.051; 95% CI:1.005-1.100), oxygen saturation (OR,0.928; 95% CI:0.872-0.989), CRP (OR,1.013; 95% CI:1.001-1.024) and bicarbonate level (OR,0.886; 95% CI:0.790-0.995) were risk factors for mechanical ventilation during hospitalization. Conclusions: A risk score has been developed based on the available data within the first hours of hospital admission to predict the need for mechanical ventilation. This risk score should be further validated to determine its applicability in other populations.

Background and AimsAdherence to the Mediterranean diet (MD) has been associated with a decreased risk of developing a variety of chronic diseases that are comorbidities in COVID-19 patients. However, its association to the severity and symptoms of COVID-19 are still unknown. This study aimed to examine the association between adherence to the MD pattern and COVID-19 severity and symptoms in Iranian hospitalized patients.MethodsIn this cross-sectional study, 250 COVID-19 patients aged 18 to 65 were examined. We employed a food frequency questionnaire (FFQ) to obtain data on dietary intake of participants in the year prior to their COVID-19 diagnosis. COVID-19 severity was determined using the National Institutes of Health's Coronavirus Disease 2019 report. Additionally, symptoms associated with COVID-19, inflammatory markers, and other variables were evaluated. The scoring method proposed by Trichopoulou et al. was used to assess adherence to the MD.ResultsThe participants' mean age was 44.1 ± 12.1 years, and 46% of them had severe COVID-19. Patients who adhered more closely to the MD had lower serum C-reactive protein levels (7.80 vs. 37.36 mg/l) and erythrocyte sedimentation rate (14.08 vs. 42.65 mm/h). Those with the highest MD score were 77% less likely to have severe COVID-19 after controlling for confounding variables. The MD score was also found to be inversely associated with COVID-19 symptoms, including dyspnea, cough, fever, chills, weakness, myalgia, nausea and vomiting, and sore throat.ConclusionHigher adherence to the MD was associated with a decreased likelihood of COVID-19 severity and symptoms, as well as a shorter duration of hospitalization and convalescence, and inflammatory biomarkers.

Background and aimsFruits and vegetables are rich in fiber and a good source of anti-inflammatory and immune-boosting vitamins, minerals, and antioxidants. We investigated the association between fruits, vegetables, and fiber intake and severity of COVID-19 and related symptoms in hospitalized patients.MethodsA total of 250 COVID-19 hospitalized patients aged 18 to 65 years were recruited for this cross-sectional study in Kashan, Iran, between June and September of 2021. Dietary intakes were assessed using an online validated 168-item food frequency questionnaire (FFQ). COVID-19 severity and symptoms were evaluated using the National Institutes of Health (NIH) COVID-19 Treatment Guidelines. Moreover, we examined COVID-19 symptoms, inflammatory biomarkers, and additional factors.ResultsThe mean age of participants was 44.2 ± 12.1 years, and 46% had severe COVID-19. Patients with higher consumption of fruits (OR: 0.28; 95% CI: 0.14-0.58, P-trend <0.001), vegetables (OR: 0.33; 95% CI: 0.16-0.69, P-trend <0.001), and dietary fiber (OR: 0.25; 95% CI: 0.12-0.53, P-trend <0.001) had lower odds of having severe COVID-19. In addition, they had shorter hospitalization and convalescence periods, lower serum C-reactive protein (CRP), and a reduced risk of developing COVID-19 symptoms such as sore throat, nausea and vomiting, dyspnea, myalgia, cough, weakness, fever, and chills.ConclusionHigher consumption of fruits, vegetables, and fiber was inversely linked with COVID-19 severity, clinical symptoms, hospitalization and convalescence duration, and CRP concentrations. The results should be interpreted with caution in light of the limitations, and prospective cohort studies are required to further evaluate these findings.

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Background Academic burnout has adverse effects on residents' professional behavior as well as personal aspects of their lives and can ultimately affect their performance in the workplace. This study aimed to determine the prevalence of burnout among surgical residents in Imam Khomeini hospital and the relationship between factors such as sex, marital status, living place, specialized field, and anxiety with burnout. Methods We conducted a cross‐sectional study in 2021. A validated version of the Maslach burnout inventory for students (MBI‐SS), the Beck Anxiety Inventory, and a questionnaire on contributing factors were used. Statistical analysis for the prevalence of burnout and comparison between scores of groups were performed. Results Of 130 surgical residents who answered the survey, 26% met the criteria for burnout. There was a significantly higher prevalence of burnout among PGY1 residents. Of these residents, 85.4% and 62.3% had high scores on emotional exhaustion and cynicism, respectively. We observed an association between different surgical disciplines and anxiety with burnout. Conclusions The prevalence of burnout among surgical residents was notable and higher than expected. There was a reliable association between anxiety and burnout. A longitudinal study on a group of students with a consideration of associated factors is suggested.

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Purpose. The COVID-19 pandemic has overwhelmed many healthcare systems. Seasonality is a feature of several infectious diseases. Studies regarding the association of seasonal variations and COVID-19 have shown controversial results. Therefore, we aimed to compare COVID-19 characteristics and survival outcomes between the fourth and fifth waves in Iran, which corresponded to spring and summer, respectively. Methods. This is a retrospective study on the fourth and fifth COVID-19 waves in Iran. One hundred patients from the fourth and 90 patients from the fifth wave were included. Data from the baseline and demographic characteristics, clinical, radiological, and laboratory findings, and hospital outcomes were compared between the fourth and fifth COVID-19 waves in hospitalized patients in Imam Khomeini Hospital Complex, Tehran, Iran. Results. The fifth wave patients were more likely to present with gastrointestinal symptoms than the patients from the fourth wave. Moreover, patients in the fifth wave had lower arterial oxygen saturation on admission (88% vs. 90%; P = 0.026 ), lower levels of WBCs (neutrophils and lymphocytes) (6300.00 vs. 8000.00; P = 0.004 ), and higher percentages of pulmonary involvement in the chest CT scans (50% vs. 40%; P < 0.001 ). Furthermore, these patients had longer hospital stays than their fourth-wave counterparts (7.00 vs. 5.00; P < 0.001 ). Conclusions. Our study indicated that patients in the summer COVID-19 wave were more likely to present with gastrointestinal symptoms. They also experienced a more severe disease in terms of peripheral capillary oxygen saturation, percentages of pulmonary involvement in CT scans, and length of hospital stay.