Background: This critical appraisal aims to clarify which systematic reviews on COVID-19 treatment are based on high-value evidence. Hereby, the most profitable medicines can be suggested. Methods:The mesh terms of "COVID-19 drug treatment" (Supplementary Concept)and "COVID-19 drug treatment" were sequentially utilized as search strategies in Medline and Science direct on October 18, 2020. Searches were confined to systematic reviews/meta-analyses. The Cochrane database was searched on November 1, 2020 with "COVID." With adding up four articles from other resources, 84 systematic reviews were considered for initial screening. Finally, 22 articles fulfilled the criteria and were assessed using PRISMA guidelines.Results: Increasing number of clinical trials from the onset of the COVID-19 pandemic has revealed that hydroxychloroquine and chloroquine are not only profitable but also deleterious. Lopinavir/ritonavir failed to maintain their initial efficacy in improving clinical symptoms and mortality rate. Steroids and tocilizumab were suggested in patients with intensely severe symptoms. Steroids reduced mechanical ventilation and death in severely ill patients. Plasma or immunoglobulins effects are absolutely controversial. Favorable impressions of remdesivir have been relied on for the early onset of this drug. Hypotension and abnormal liver function tests were realized as its side effects. Favipiravir has resulted in a higher viral clearance than remdesivir. However, this claim needs to be proved with subsequent clinical trials.Conclusions: Currently, remdesivir and favipiravir are advantageous drugs that should be administered in the early phases. Their side effects are not well known and need to be found in the following research projects. Steroids and tocilizumab have been considered beneficial in the cytokine storm phase.

Some previous studies suggested that the plasma exchange (PE) and hemoperfusion (HP) played a cardinal role in the treatment of severe coronavirus disease 2019 (COVID‐19) cases by diminishing the cytokine storm. This study aimed to assess the effects of PE and HP on cytokine storms in patients with severe COVID‐19 through a systematic scoping review. Four Electronic databases (Medline [accessed from PubMed], Scopus, Science Direct, and Cochrane library) were searched systematically on February 2, 2021, using MESH terms and related keywords in the English language. Considering the titles and abstracts, unrelated studies were excluded. The full texts of the remained studies were evaluated by authors, independently. Then, their findings were assessed and reported. A total of 755 articles were obtained within the first step of searching, and 518 remained after removing the duplications. Through the title and abstract screening, 438 were removed. Of the rest, 59 papers were excluded. Finally, after reading the full text of the remained articles, 21 were included in data extraction. Most of the previously reported evidence were case reports and case series. Findings were summarized in two categories. The first category encompassed nine studies regarding HP and continuous renal replacement therapy, and the second category included twelve studies about PE. The results revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID‐19 patients. Highlights Some studies showed that plasma exchange (PE) and hemoperfusion (HP) played an important role in the treatment of patients with severe COVID‐19 disease. The results of this systematic scoping review revealed that HP and PE within the cytokine storm phase would be beneficial with a high probability in the treatment of severely ill COVID‐19 patients.

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Objectives To explore the causes of medical errors (ME) and under-reporting amongst pediatric nurses at an Iranian teaching hospital. Design A qualitative study, based on individual, in-depth, semi-structured interviews and content analysis approach. Settings The study was conducted at the Pediatric Department of the largest tertiary general and teaching hospital in Shiraz, southern Iran. Participants The study population was all pediatrics nurses who work at Pediatric Department and they had been trained on ME, as well as methods to report them through the hospital’s ME reporting system. Purposive sampling was used by selecting key informants until data saturation was achieved and no more new information was obtained. Finally, 18 pediatric nurses were interviewed. Main outcome measure(s) Pediatrics nurses’ views on the causes of ME and under-reporting. Results We found five main factors causing ME and under-reporting: personal factors, workplace factors, managerial factors, work culture and error reporting system. These factors were further classified into proximal and distal factors. Proximal factors had direct relationship with ME and distal factors were contextual factors. Conclusion Causes of ME and under-reporting amongst pediatric nurses are complex and intertwined. Both proximal and distal factors need to be simultaneously addressed using context-specific approaches. Further research on other groups of healthcare workers and using a quantitative approach will be beneficial to elucidate the most appropriate interventions.

Background: Following an earthquake with a magnitude of 7.3 on the Richter scale took place in the west of Iran, on November 12th, 2017, numerous state and community response teams were dispatched for a variety of purposes. Objectives: This study aimed to describe the experiences of the medical team dispatched from Shiraz University of Medical Sciences (SUMS) in an emergency field hospital in the city of Sarpol-e-Zahab following the Kermanshah earthquake. Methods: In this cross-sectional study, the data collected by SUMS’s team were used. In this regard, the condition of the only local hospital in Sarpol-e-Zahab after the earthquake, the actions taken by SUMS’s team, the existing problems, as well as characteristics of the visited patients, were described. Finally, the satisfaction of the medical staff at the hospital under the study with the performance of the SUMS’s team was analyzed. Results: Following the earthquake, the only hospital in Sarpol-e-Zahab became semi-open. An emergency field hospital was partially established in the hospital’s parking lot. The SUMS’s team changed the arrangement of the field hospital, and during eight days, visited more than 9,000 patients. The most frequent chief complaints of patients were signs of the flu and respiratory infections, various types of trauma, and gastrointestinal problems. Conclusions: Our results indicated that the data were not adequate to cover all the aspects involved. This shows the necessity of developing a registry system for better management of healthcare at times of the crisis.

Background Narrowing a large set of features to a smaller one can improve our understanding of the main risk factors for in-hospital mortality in patients with COVID-19. This study aimed to derive a parsimonious model for predicting overall survival (OS) among re-infected COVID-19 patients using machine-learning algorithms. Methods The retrospective data of 283 re-infected COVID-19 patients admitted to twenty-six medical centers (affiliated with Shiraz University of Medical Sciences) from 10 June to 26 December 2020 were reviewed and analyzed. An elastic-net regularized Cox proportional hazards (PH) regression and model approximation via backward elimination were utilized to optimize a predictive model of time to in-hospital death. The model was further reduced to its core features to maximize simplicity and generalizability. Results The empirical in-hospital mortality rate among the re-infected COVID-19 patients was 9.5%. In addition, the mortality rate among the intubated patients was 83.5%. Using the Kaplan-Meier approach, the OS (95% CI) rates for days 7, 14, and 21 were 87.5% (81.6-91.6%), 78.3% (65.0-87.0%), and 52.2% (20.3-76.7%), respectively. The elastic-net Cox PH regression retained 8 out of 35 candidate features of death. Transfer by Emergency Medical Services (EMS) (HR=3.90, 95% CI: 1.63-9.48), SpO2≤85% (HR=8.10, 95% CI: 2.97-22.00), increased serum creatinine (HR=1.85, 95% CI: 1.48-2.30), and increased white blood cells (WBC) count (HR=1.10, 95% CI: 1.03-1.15) were associated with higher in-hospital mortality rates in the re-infected COVID-19 patients. Conclusion The results of the machine-learning analysis demonstrated that transfer by EMS, profound hypoxemia (SpO2≤85%), increased serum creatinine (more than 1.6 mg/dL), and increased WBC count (more than 8.5 (×109 cells/L)) reduced the OS of the re-infected COVID-19 patients. We recommend that future machine-learning studies should further investigate these relationships and the associated factors in these patients for a better prediction of OS.

Introduction: One of the largest religious gatherings in the world is the Arbaeen pilgrimage, which takes place on the 40th day after the anniversary of the martyrdom of Imam Hussein, the third Shiite Imam. This study was aimed to investigate how to set up the Sahib-al-Zaman treatment camp on the Arbaeen walking route in 2019 and the patients referring to it. Methods: This retrospective cross-sectional study was conducted on all patients referring to the Sahib-al-Zaman camp of Shiraz University of Medical Sciences, Shiraz, Iran in the Arbaeen Walking plan in 2019. In this study, how to set up camp was described. Patients’ data and drugs used by the medical team were collected, and then were analyzed. Results: Totally, 3477 patients were enrolled. The mean±SD of patients’ age was 33.77±16.19 (ranging from 1 to 96) years, and 2,183 patients (62.78%) were male. Most patients were Iranian (84.5%) and then Iraqi (13.66%), and only 1.84% were from other nationalities. Upper respiratory tract infection (60.2%), low back pain and muscle cramps (17.6%), and blister and need for dressing (12.3%) were the most common chief complaints in the patients. Adult cold pills, acetaminophen (325 mg), and cetirizine (10 mg) were the most commonly prescribed drugs for the patients. Conclusion: Although the data used in this study are not sufficient due to the lack of a pre-created data recording system, the results of this study showed that in addition to the importance and necessity of holding such ceremonies, health issues and facilities should also be considered.