Publications by authors named "Hossein Khalili"

195 Publications

Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial.

Pharmacol Rep 2021 Nov 27. Epub 2021 Nov 27.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Background And Objectives: Corticosteroids are commonly used in the treatment of hospitalized patients with COVID-19. The goals of the present study were to compare the efficacy and safety of different doses of dexamethasone in the treatment of patients with a diagnosis of moderate to severe COVID-19.

Methods: Hospitalized patients with a diagnosis of moderate to severe COVID-19 were assigned to intravenous low-dose (8 mg once daily), intermediate-dose (8 mg twice daily) or high-dose (8 mg thrice daily) dexamethasone for up to 10 days or until hospital discharge. Clinical response, 60-day survival and adverse effects were the main outcomes of the study.

Results: In the competing risk survival analysis, patients in the low-dose group had a higher clinical response than the high-dose group when considering death as a competing risk (HR = 2.03, 95% CI: 1.23-3.33, p = 0.03). Also, the survival was significantly longer in the low-dose group than the high-dose group (HR = 0.36, 95% CI = 0.15-0.83, p = 0.02). Leukocytosis and hyperglycemia were the most common side effects of dexamethasone. Although the incidence was not significantly different between the groups, some adverse effects were numerically higher in the intermediate-dose and high-dose groups than in the low-dose group.

Conclusions: Higher doses of dexamethasone not only failed to improve efficacy but also resulted in an increase in the number of adverse events and worsen survival in hospitalized patients with moderate to severe COVID-19 compared to the low-dose dexamethasone. (IRCT20100228003449N31).
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http://dx.doi.org/10.1007/s43440-021-00341-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627167PMC
November 2021

Predictors of the chest CT score in COVID-19 patients: a cross-sectional study.

Virol J 2021 11 18;18(1):225. Epub 2021 Nov 18.

Department of Infectious Diseases, Imam Khomeini Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, Iran.

Background: Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient's signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings.

Methods: All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0-25).

Results: Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period.

Conclusions: Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.
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http://dx.doi.org/10.1186/s12985-021-01699-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600490PMC
November 2021

Do interferons play a role in COVID-19?

Int J Clin Pract 2021 Nov;75(11):e14721

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.1111/ijcp.14721DOI Listing
November 2021

Famotidine Possible Cutaneous Rash in Covid-19 Patients: An Adverse Effect Case Series.

Curr Drug Saf 2021 Oct 4. Epub 2021 Oct 4.

Department of Infectious Diseases, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran. Iran.

Background: Various cutaneous manifestations have been observed in patients with COVID-19 infection. However, the skin side effects of the medications used for COVID-19, such as famotidine, have not been studied.

Objective: This case series aim to present our challenge to define cutaneous manifestations between famotidine and COVID-19.

Methods: We identified patients from Imam Khomeini hospital complex who were admitted to the ward with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) taking famotidine and having cutaneous rash. Clinical data were obtained through observation and intervention.

Results: We found 4 SARS-COV-2 patients with cutaneous manifestations. The mean (±SD) age of the patients was 57±2 years, 3 patients were men, and COVID-19 symptoms began 10±3 days before admission. The most common symptoms were cough and shortness of breath. All the patients were admitted for hypoxemic respiratory failure. Patients received famotidine for gastrointestinal prophylaxis, and all 4 patients developed Acral macular mountainous skin lesion in the upper and lower extremities, then we discontinued famotidine and lesions were recovered completely in all patients.

Conclusion: These cases prompted us to inform clinicians about cutaneous complications of famotidine in COVID-19 patients.

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http://dx.doi.org/10.2174/1574886316666211005102711DOI Listing
October 2021

Intravenous magnesium sulfate for prevention of vancomycin plus piperacillin-tazobactam induced acute kidney injury in critically ill patients: An open-label, placebo-controlled, randomized clinical trial.

Daru 2021 Dec 31;29(2):341-351. Epub 2021 Aug 31.

General Intensive Care Unit, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Recent studies have shown an increased risk of acute kidney injury (AKI) induced by vancomycin + piperacillin-tazobactam (VPT) combination. In this study, the efficacy of intravenous magnesium sulfate in prevention of VPT induced AKI in critically ill patients admitted to the ICU has been evaluated.

Methods: In an open-label, placebo-controlled, randomized clinical trial, 72 adults (≥ 18 years old) who had indications to receive VPT as empiric therapy were assigned to the magnesium or control group in 1:1 ratio. Concomitant with VPT, intravenous infusion of magnesium sulfate was started for patients in the magnesium group. The target serum level of magnesium was defined 3 mg/dl. Patients in the control group received normal saline as placebo. The target serum level of magnesium was defined 1.9 mg/dl in this group. The study's primary outcome was incidence of AKI during and up to 48 h after the treatment course. Escalation and de-escalation of VPT regimen, duration of hospitalization, length of ICU stay and 28-day mortality were secondary outcomes.

Results: Thirty patients in each group completed the examination. Five patients in the magnesium group and 11 patients in the control group experienced AKI (p = 0.072). De-escalation of VPT regimen was done approximately in 60% of patients. Duration of hospitalization and length of ICU stay were not statistically different between the groups. Finally, 28-day mortality was 23.33% in each group. Although the incidence of AKI was not statistically different between the groups in unadjusted logistic regression model, it became significant after adjusting for confounding factors [unadjusted model (OR = 0.34; 95% CI: 0.10-1.16, p = 0.084), adjusted model: (OR = 0.26; 95% CI: 0.07-0.96, p = 0.04)].

Conclusions: Administration of magnesium sulfate with the target serum levels around 3 mg/dL reduced the incidence of AKI in critically ill patients who were receiving VPT as empric therapy.
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http://dx.doi.org/10.1007/s40199-021-00411-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8602584PMC
December 2021

From uniprofessionality to interprofessionality: dual vs dueling identities in healthcare.

J Interprof Care 2021 Jun 18:1-6. Epub 2021 Jun 18.

Associate Professor, Dalhousie University; Affiliate Scientist, IWK Health Centre, Canada.

Healthcare systems are at times still viewed as siloed performances of single professions, wherein some groups hold hierarchical positions based on their expertise and prestige, rather than a collective functioning of interprofessional teams. Current policies, procedures, and regulations in healthcare education and practice seem to contribute to this context in which the various health and social care professions are set in opposition to one another. The historical, and still prominent, uniprofessional education and socialization practices position health and social care professions to view each as rivals and threats toward achieving their profession/al advancement and growth. The transformation from uniprofessionality to interprofessionality in healthcare requires the application of interprofessional socialization not just at the individual level, but also at the professional and system levels. In this process of interprofessional socialization, we need to embrace the uniqueness of each profession while cultivating an interprofessional collaboration culture in the system (dual identity). In so doing, we can facilitate a shifting mind-set, culture, operations, and policies in healthcare to recognize and foster the contribution and accountability of each profession toward achieving the quadruple aim of better care, better health, better value, and better work experience.
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http://dx.doi.org/10.1080/13561820.2021.1928029DOI Listing
June 2021

Treatment of toxoplasmic encephalitis with the combination of clindamycin plus azithromycin in an HIV-infected patient: A case report.

Clin Case Rep 2021 May 24;9(5):e04045. Epub 2021 Mar 24.

Faculty of Pharmacy Tehran University of Medical Sciences Tehran Iran.

The existence of alternative oral therapies could help clinicians to treat toxoplasmic encephalitis (TE) in the HIV patients. The combination of azithromycin and clindamycin may serve as an effective treatment for TE in HIV-infected patients.
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http://dx.doi.org/10.1002/ccr3.4045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142398PMC
May 2021

Clinical outcomes of patients with mild COVID-19 following treatment with hydroxychloroquine in an outpatient setting.

Int Immunopharmacol 2021 Jul 6;96:107636. Epub 2021 Apr 6.

Department of Pharmacotherapy, Tehran University of Medical Sciences, Postal Code: 1417614411, P.O. Box: 14155/6451, Tehran, Iran. Electronic address:

The role of hydroxychloroquine (HCQ) in early outpatient management of mild coronavirus disease 2019 (COVID-19) needs further investigation. This study was a multicenter, population-based national retrospective-cohort investigation of 28,759 adults with mild COVID-19 seen at the network of Comprehensive Healthcare Centers (CHC) between March and September 2020 throughout Iran. The baseline characteristics and outcome variables were extracted from the national integrated health system database. A total of 7295 (25.37%) patients who presented with mild COVID-19 within 3-7 days of symptoms onset received HCQ (400 mg twice daily on day 1 followed by 200 mg twice daily for the next four days and were then followed for 14 days). The main outcome measures were hospitalization or death for six months follow-up. COVID-19-related hospitalizations or deaths occurred in 523 (7.17%) and 27 (0.37%) respectively, in HCQ recipients and 2382 (11.10%) and 287 (1.34%) respectively, in non-recipients. The odds of hospitalization or death was reduced by 38% (odds ratio [OR] = 0.62; 95% confidence interval [CI]: 0.56-0.68, p = < 0.001) and 73% (OR = 0.27; 95% CI: 0.18-0.41, p = < 0.001) in HCQ recipients and non-recipients. These effects were maintained after adjusting for age, comorbidities, and diagnostic modality. No serious HCQ-related adverse drug reactions were reported. In our large outpatient national cohort of adults with mild COVID-19 disease who were given HCQ early in the course of the disease, the odds of hospitalization or death was reduced significantly regardless of age or comorbidities.
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http://dx.doi.org/10.1016/j.intimp.2021.107636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023208PMC
July 2021

Direct oral anticoagulant safety during breastfeeding: a narrative review.

Eur J Clin Pharmacol 2021 Oct 8;77(10):1465-1471. Epub 2021 May 8.

Department of Clinical Pharmacy, Faculty of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.

Purpose: There are limited data regarding the safety of direct oral anticoagulants (DOACs) during breastfeeding. The aim of the present study is to investigate the extent of excretion of DOACs into human milk according to the available clinical and experimental studies.

Methods: On 16th January 2021, we systematically searched PubMed, Scopus, Embase, and Web of Science for all studies which investigated DOACs in breastfeeding without any time frame and language limitation. Search keywords were [breastfeeding, breast feeding, breastfed, lactation, milk secretion OR milk] AND [apixaban OR Eliquist OR rivaroxaban OR Xarelto OR edoxaban OR Savaysa OR dabigatran OR Pradaxa OR dabigatran etexilate OR dabigatran etexilate mesylate OR direct oral anticoagulant OR DOAC OR new oral anticoagulant OR NOAC]. Finally, we identified six articles which reported DOAC use during breastfeeding or lactation.

Results And Conclusion: According to the available limited data, dabigatran has the least excretion in human breast milk. Rivaroxaban and dabigatran both have acceptable milk excretion cutoffs, whereas apixaban milk excretion is greater than the maximum allowed range. Further well-designed studies with larger sample sizes are required to generate consistent comparable data and clarify benefits and risks of each DOAC during breastfeeding.
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http://dx.doi.org/10.1007/s00228-021-03154-5DOI Listing
October 2021

Predictors of the prolonged recovery period in COVID-19 patients: a cross-sectional study.

Eur J Med Res 2021 May 6;26(1):41. Epub 2021 May 6.

Department of Infectious Disease, Imam Khomeini Hospital, Tehran University of Medical Sciences, Blv. Keshavarz, Tehran, 1419733141, Iran.

Background: The clinical course of COVID-19 may vary significantly. The presence of comorbidities prolongs the recovery time. The recovery in patients with mild-to-moderate symptoms might take 10 days, while in those with a critical illness or immunocompromised status could take 15 days. Considering the lack of data about predictors that could affect the recovery time, we conducted this study to identify them.

Methods: This cross-sectional study was implemented in the COVID-19 clinic of a teaching and referral university hospital in Tehran. Patients with the highly suggestive symptoms who had computed tomography (CT) imaging results with typical findings of COVID-19 or positive results of reverse transcriptase-polymerase chain reaction (RT-PCR) were enrolled in the study. Inpatient and outpatient COVID-19 participants were followed up by regular visits or phone calls, and the recovery period was recorded.

Results: A total of 478 patients were enrolled. The mean age of patients was 54.11 ± 5.65 years, and 44.2% were female. The median time to recovery was 13.5 days (IQR: 9). Although in the bivariate analysis, multiple factors, including hypertension, fever, diabetes mellitus, gender, and admission location, significantly contributed to prolonging the recovery period, in multivariate analysis, only dyspnea had a significant association with this variable (p = 0.02, the adjusted OR of 2.05; 95% CI 1.12-3.75).

Conclusion: This study supports that dyspnea is a predictor of recovery time. It seems like optimal management of the comorbidities plays the most crucial role in recovery from COVID-19.
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http://dx.doi.org/10.1186/s40001-021-00513-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100933PMC
May 2021

Intermediate-Dose versus Standard-Dose Prophylactic Anticoagulation in Patients with COVID-19 Admitted to the Intensive Care Unit: 90-Day Results from the INSPIRATION Randomized Trial.

Thromb Haemost 2021 Apr 17. Epub 2021 Apr 17.

Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background:  Thrombotic complications are considered among the main extrapulmonary manifestations of coronavirus disease 2019 (COVID-19). The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown.

Methods:  This article reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding.

Results:  Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]: 62 [50, 71] years; 237 [42.2%] women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55,  = 0.11). Findings were similar for other efficacy outcomes, and in the landmark analysis from days 31 to 90 (HR: 1.59, 95% CI: 0.45-5.06). There were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24).

Conclusion:  Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up.
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http://dx.doi.org/10.1055/a-1485-2372DOI Listing
April 2021

The effect of midodrine on lactate clearance in patients with septic shock: a pilot study.

J Comp Eff Res 2021 06 16;10(8):673-683. Epub 2021 Apr 16.

Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

The effect of midodrine on lactate clearance has not been assessed in critically ill patients yet. The goal of this study was to assess the effect of adjunctive midodrine therapy on lactate clearance in patients with septic shock. Patients with septic shock were assigned to receive either adjunctive midodrine 10 mg three-times a day for 5 days (midodrine group = 15 patients) or not (control group = 13 patients). The lactate clearance was significantly faster in the midodrine group than the control group (p = 0.049) with a large effect size ( = 0.141). When midodrine was added to intravenous vasopressors, it significantly accelerated lactate clearance in patients with septic shock. Trial registration number: IRCT20100228003449N25 (Clinicaltrials.gov).
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http://dx.doi.org/10.2217/cer-2020-0238DOI Listing
June 2021

Prevention of vancomycin-induced nephrotoxicity; an update review of clinical and preclinical studies.

Infect Disord Drug Targets 2021 Mar 31. Epub 2021 Mar 31.

Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran. Iran.

Purpose: Clinical and preclinical evidences regarding new strategies for prevention of vancomycin-induced nephrotoxicity are reviewed.

Methods: Evidence from 2014 to end of 2019 was included. Finally, twelve animal studies and one clinical trial were evaluated.

Results: Although incidence of vancomycin-induced nephrotoxicity was not reduced significantly in the clinical trial, antioxidants reduced incidence of vancomycin-induced nephrotoxicity in preclinical studies.

Conclusions: Antioxidants including vitamin C, vitamin E, cilastatin, melatonin, zingerone, rutin, naringenin, saffron, silymarin and dexmedetomidine were nephroprotective against vancomycin-induced nephrotoxicity in preclinical studies. The nephroprotective effects of these antioxidants must be confirmed before routine use in the clinical practice.
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http://dx.doi.org/10.2174/1871526521666210331164552DOI Listing
March 2021

Effect of Intermediate-Dose vs Standard-Dose Prophylactic Anticoagulation on Thrombotic Events, Extracorporeal Membrane Oxygenation Treatment, or Mortality Among Patients With COVID-19 Admitted to the Intensive Care Unit: The INSPIRATION Randomized Clinical Trial.

JAMA 2021 04;325(16):1620-1630

Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran.

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis.

Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU).

Design, Setting, And Participants: Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020.

Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up.

Main Outcomes And Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated.

Results: Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01).

Conclusions And Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19.

Trial Registration: ClinicalTrials.gov Identifier: NCT04486508.
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http://dx.doi.org/10.1001/jama.2021.4152DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7974835PMC
April 2021

Assessment of the Interprofessional Team Collaboration Scale for Students-AITCS-II (Student): Development and Testing.

J Allied Health 2021 ;50(1):e1-e7

Arthur Labatt Family School of Nursing, FNB Room 3351, Western University, London, ON N6A 5B9, Canada. Tel 519-661 2111 x 81010.

The challenge of measuring collaborative teamwork among interprofessional students has been reported in the literature. Emphasis in evaluating teamwork has been on socialization and attitudes towards wanting to work with others and not on other aspects of teamwork such as collaboration in teamwork. To date, while the Assessment of the Interprofessional Team Collaboration Scale (AITCS) has been used generically to measure collaboration in both practitioner and student 'teams,' it has been suggested that there may be a need for a student-specific version of this measure. The purpose of this paper is to report on the psychometric properties of the AITCS-II for students. Data sets from 316 student respondents completing pretest assessments of team collaboration were used for a descriptive analysis of the ATICS. Both exploratory (EFA) and confirmatory factor analyses (CFA) were carried out. Factors from the EFA were then used in the CFA to obtain a good model fit. The result was a 16-item AITCS-II for students that demonstrated a reasonable model fit related to four latent variables: partnership (3 items), cooperation (6 items), team working (4 items) and coordination (3 items). In conclusion, the student version of the AITCS-II provides some evidence for its validity and reliability that can be used to assess collaboration in interprofessional student groups.
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November 2021

The need for an integrated pharmacological response to the treatment of HIV/AIDS and depression.

Expert Opin Pharmacother 2021 Jun 13;22(9):1179-1192. Epub 2021 Feb 13.

Professor of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.

The coexistence of depression and HIV infection affects more than 9 million people worldwide. A literature review revealed a large gap regarding the pharmacotherapy of depression among patients dually diagnosed with HIV and depression.In this review, the authors covered the various dimensions of deploying integrated pharmacological treatment of HIV/AIDS and depression. This topic was addressed in two ways; first, the direct results of integrated pharmacotherapy in syndemic patients; second, the indirect effects of the integrated model on other outcomes of HIV care.: An integrated pharmacological response to the treatment of HIV and depression can bring substantial benefits to HIV outcomes and reduce the burden of both diseases. The direct advantages regarding pharmacological response to the treatment of depression along with HIV care are improving adherence to antiretroviral therapy, optimizing pharmacotherapy, minimizing drug interaction, and prevention of additive adverse drug reactions. Furthermore, in some cases, medication can target both depression and other neuropsychiatric or somatic comorbidities among people living with HIV/AIDS. The integrated pharmacotherapy also has some potential indirect advantages on HIV care outcomes like minimizing loss of care, reducing ongoing HIV transmission, and improving the outcomes of both diseases.
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http://dx.doi.org/10.1080/14656566.2021.1882419DOI Listing
June 2021

Reply to Dorgham et al., "Considering Personalized Interferon Beta Therapy for COVID-19".

Antimicrob Agents Chemother 2021 03 18;65(4). Epub 2021 Mar 18.

Department of Pharmacotherapy, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

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http://dx.doi.org/10.1128/AAC.00083-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8097451PMC
March 2021

Efficacy and safety of sofosbuvir/ ledipasvir in treatment of patients with COVID-19; A randomized clinical trial.

Acta Biomed 2020 11 10;91(4):e2020102. Epub 2020 Nov 10.

Tehran University of Medical Sciences, Tehran, Iran..

Background: There is no study regarding the use of SOF/LDP in treatment of COVID-19.  Objectives: In this study, the efficacy and safety of SOF/LDP were assessed in treatment of patients with mild to moderate COVID-19.

Methods: Among an open-label randomized clinical trial, 82 patients with mild to moderated COVID-19 were assigned to receive either SOF/LDP 400/100 mg daily plus the standard of care (SOF/LDP group, n=42) or the standard of care alone (control group, n=40) for 10 days. Time to clinical response, rate of clinical response, duration of hospital and ICU stay and 14-day mortality were assessed.

Results: Clinical response occurred in 91.46% of patients. Although rates of clinical response were comparable between the groups but it occurred faster in the SOF/LDP group than the control group (2 vs. 4 days respectively, P= 0.02). Supportive cares were provided in the medical wards for most patients but 17.07% of patients were transferred to ICU during the hospitalization course. However, durations of hospital and ICU stay were comparable between the groups.  14--day mortality rate was 7.14% and 7.5% in the SOF/ LDP and control groups respectively. No adverse effects leading to drug discontinuation occurred. Gastrointestinal events (nausea, vomiting and diarrhea) were the most common side effects (15.85%).

Conclusion: Added to the standard of care, SOF/LDP accelerated time to the clinical response. However, rate of clinical response, duration of hospital and ICU stay and 14-day mortality were not different. No significant adverse event was detected.  More randomized clinical trials with larger sample sizes are needed to confirm the efficacy and safety of SOF/LDP in the treatment of COVID-19.
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http://dx.doi.org/10.23750/abm.v91i4.10877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927527PMC
November 2020

A longitudinal, narrative study of professional socialisation among health students.

Med Educ 2021 04 7;55(4):478-485. Epub 2021 Jan 7.

School of Nursing, Dalhousie University, Halifax, NS, Canada.

Purpose: Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students.

Method: A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis.

Results: Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity.

Conclusions: Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.
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http://dx.doi.org/10.1111/medu.14437DOI Listing
April 2021

Intermediate versus standard-dose prophylactic anticoagulation and statin therapy versus placebo in critically-ill patients with COVID-19: Rationale and design of the INSPIRATION/INSPIRATION-S studies.

Thromb Res 2020 12 24;196:382-394. Epub 2020 Sep 24.

Rajaie Cardiovascular Medical and Research Center, Iran university of Medical sciences, Tehran, Iran.

Background: Microvascular and macrovascular thrombotic events are among the hallmarks of coronavirus disease 2019 (COVID-19). Furthermore, the exuberant immune response is considered an important driver of pulmonary and extrapulmonary manifestations of COVID-19. The optimal management strategy to prevent thrombosis in critically-ill patients with COVID-19 remains unknown.

Methods: The Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) and INSPIRATION-statin (INSPIRATION-S) studies test two independent hypotheses within a randomized controlled trial with 2 × 2 factorial design. Hospitalized critically-ill patients with reverse transcription polymerase chain reaction confirmed COVID-19 will be randomized to intermediate-dose versus standard dose prophylactic anticoagulation. The 600 patients undergoing this randomization will be screened and if meeting the eligibility criteria, will undergo an additional double-blind stratified randomization to atorvastatin 20 mg daily versus matching placebo. The primary endpoint, for both hypotheses will be tested for superiority and includes a composite of adjudicated acute arterial thrombosis, venous thromboembolism (VTE), use of extracorporeal membrane oxygenation, or all-cause death within 30 days from enrollment. Key secondary endpoints include all-cause mortality, adjudicated VTE, and ventilator-free days. Key safety endpoints include major bleeding according to the Bleeding Academic Research Consortium definition and severe thrombocytopenia (platelet count <20,000/fL) for the anticoagulation hypothesis. In a prespecified secondary analysis for non-inferiority, the study will test for the non-inferiority of intermediate intensity versus standard dose anticoagulation for major bleeding, considering a non-inferiority margin of 1.8 based on odds ratio. Key safety endpoints for the statin hypothesis include rise in liver enzymes >3 times upper normal limit and clinically-diagnosed myopathy. The primary analyses will be performed in the modified intention-to-treat population. Results will be tested in exploratory analyses across key subgroups and in the intention-to-treat and per-protocol cohorts.

Conclusions: INSPIRATION and INSPIRATON-S studies will help address clinically-relevant questions for antithrombotic therapy and thromboinflammatory therapy in critically-ill patients with COVID-19.
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http://dx.doi.org/10.1016/j.thromres.2020.09.027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513771PMC
December 2020

Interferon β-1b in treatment of severe COVID-19: A randomized clinical trial.

Int Immunopharmacol 2020 Nov 24;88:106903. Epub 2020 Aug 24.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

In this study, efficacy and safety of interferon (IFN) β-1b in the treatment of patients with severe COVID-19 were evaluated. Among an open-label, randomized clinical trial, adult patients (≥18 years old) with severe COVID-19 were randomly assigned (1:1) to the IFN group or the control group. Patients in the IFN group received IFN β-1b (250 mcg subcutaneously every other day for two consecutive weeks) along with the national protocol medications while in the control group, patients received only the national protocol medications (lopinavir/ritonavir or atazanavir/ritonavir plus hydroxychloroquine for 7-10 days). The primary outcome of the study was time to clinical improvement. Secondary outcomes were in-hospital complications and 28-daymortality. Between April 20 and May 20, 2020, 80 patients were enrolled and finally 33 patients in each group completed the study. Time to clinical improvment in the IFN group was significantly shorter than the control group ([9(6-10) vs. 11(9-15) days respectively, p = 0.002, HR = 2.30; 95% CI: 1.33-3.39]). At day 14, the percentage of discharged patients was 78.79% and 54.55% in the IFN and control groups respectively (OR = 3.09; 95% CI: 1.05-9.11, p = 0.03). ICU admission rate in the control group was significantly higher than the IFN group (66.66% vs. 42.42%, p = 0.04). The duration of hospitalization and ICU stay were not significantly different between the groups All-cause 28-day mortality was 6.06% and 18.18% in the IFN and control groups respectively (p = 0.12). IFN β-1b was effective in shortening the time to clinical improvement without serious adverse events in patients with severe COVID-19. Furthermore, admission in ICU and need for invasive mechanical ventilation decreased following administration of IFN β-1b. Although 28-day mortality was lower in the IFN group, further randomized clinical trials with large sample size are needed for exact estimation of survival benefit of IFN β-1b.
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http://dx.doi.org/10.1016/j.intimp.2020.106903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445008PMC
November 2020

Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir.

Daru 2020 Dec 28;28(2):625-634. Epub 2020 Aug 28.

Department of Epidemiology and Biostatistics, School of Public health, Tehran University of Medical Sciences, Tehran, Iran.

Background: The role of the antiviral therapy in treatment of COVID-19 is still a matter to be investigated. Also efficacy and safety of antiviral regimens were not compared according severity of the disease. In this study the efficacy and safety of hydroxychloroquine plus atazanavir/ritonavir was compared in patients with moderate and severe COVID-19.

Methods: We prospectively evaluated the clinical outcomes of 213 patients with COVID-19 during the hospitalization course and up to 56 days after the hospital discharge. The disease was categorized to moderate and severe based on the severity of pneumonia and peripheral oxygen saturation (SpO2). The patients received the national treatment protocol containing hydroxychloroquine (400 mg BD in first day and then 200 mg BD) plus atazanavir/ritonavir (300/100 mg daily) for 7 days. Main outcomes included discharge rates at day 7, 14 and 28, 28-day mortality, rate of intensive care unit (ICU) admission and intubation, length of hospital and ICU stay and incidence of adverse events.

Results: The mean (SD) age of patients was 60(14) years and 53% were male. According to WHO definition, 51.64% and 48.36% of the patients had moderate (SpO2 ≥ 90%) and severe disease (SpO2 < 90%) at baseline, respectively. The discharge rate of the moderate group was significantly higher than the severe group at day 7, 14 and 28 (HR = 0.49; 95% CI: 0.35-0.69, p = < 0.001 at day 7, HR = 0.48; 95% CI: 0.35-0.66, p = < 0.001 at day 14 and HR = 0.49; 95% CI: 0.36-0.67, p = < 0.001at day 28). The 28-day mortality of the severe group was six times higher than the moderate group (HR = 6.00; 95% CI: 2.50-14.44), p = < 0.001). The need of admission in ICU for the severe group and the moderate group was 37.86% and 18.18% of the patients. Length of hospital stay was significantly shorter in the moderate group in comparison with the severe group (5 ± 4 vs. 8 ± 6 days, p < 0.001). Patients in the moderate group experienced the serious adverse events and complications less than the severe group. The discharged patients were followed up to 56 days after discharge. Some of the patients complained of symptoms such as exertional dyspnea, weakness and new-onset hair loss.

Conclusion: Our study did not support the use of hydroxychloroquine plus atazanavir/ritonavir in patients who had SpO < 90% at the time of hospital admission. SpO2 was the only predictor of clinical outcomes (duration of hospital stay, discharge from the hospital and mortality) in patients treated with hydroxychloroquine plus atazanavir/ritonavir.
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http://dx.doi.org/10.1007/s40199-020-00369-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453126PMC
December 2020

Pathogenesis, clinical manifestations and complications of coronavirus disease 2019 (COVID-19).

Future Microbiol 2020 09 27;15:1287-1305. Epub 2020 Aug 27.

Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, 7146864685, Iran.

Despite the similarities in the pathogenesis of the beta coronaviruses, the precise infective mechanisms of SARS-CoV-2 remain unclear. In this review, we aim to focus on the proposed theories behind the pathogenesis of SARS-CoV-2 and highlight the clinical complications related to COVID-19. We conducted a literature search in Pubmed, Scopus and Google Scholar for the relevant articles regarding clinical complications and pathogenesis of COVID-19. Related articles were included and discussed. Respiratory system and the lungs are the most commonly involved sites of COVID-19 infection. Cardiovascular, liver, kidneys, gastrointestinal and central nervous systems are involved with different frequencies and degrees of severity.
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http://dx.doi.org/10.2217/fmb-2020-0110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493723PMC
September 2020

Interprofessional education and collaborative practice research during the COVID-19 pandemic: Considerations to advance the field.

J Interprof Care 2020 Sep-Oct;34(5):583-586. Epub 2020 Aug 24.

UW Center for Interprofessional Practice and Education (UW CIPE), University of Wisconsin-Madison, Co-Founding Lead, InterprofessionalResearch.Global (Ipr.global), Interprofessional.Global Leadership Team Member, Board Member of the Canadian Interprofessional Health Collaborative, Adjunct Research Professor, Western University , Canada.

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http://dx.doi.org/10.1080/13561820.2020.1807481DOI Listing
November 2020

A longitudinal survey on the impact of the COVID-19 pandemic on interprofessional education and collaborative practice: a study protocol.

J Interprof Care 2020 Sep-Oct;34(5):691-693. Epub 2020 Aug 22.

King's College London , London, UK.

Since the World Health Organisation declaration of COVID-19 as a global pandemic in early March 2020, the virus has been linked with serious illness, death, and social disruption around the world. The scope of the outbreak is rapidly evolving and ever changing. Many countries, cities and towns declared major closures and issued shelter-in-place orders. While phased re-opening is now occuring in many countries, the impact of the pandemic has been unprecedented. It is widely accepted that healthcare education and practice, including interprofessional education and collaborative practice, has been and will continue to be affected in profound ways. However, the severity and extent of the impact is yet to be determined and is likely to vary internationally. The study protocol reported here is a first attempt to systematically capture observations, experiences, and reflections globally with a view to identifying priorities for interprofessional education and collaborative practice research and development in the years to come, as well as inform future pandemic preparedness.
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http://dx.doi.org/10.1080/13561820.2020.1798901DOI Listing
November 2020

The COVID-19 crisis silver lining: interprofessional education to guide future innovation.

J Interprof Care 2020 Sep-Oct;34(5):587-592. Epub 2020 Aug 18.

UW Center for Interprofessional Practice and Education (UW CIPE), University of Wisconsin-Madison , Madison, United States.

Globally, the advent and rapid spread of the COVID-19 virus has created significant disruption to health professions education and practice, and consequently interprofessional education, leading to a model of learning and practicing where much is unknown. Key questions for this ongoing evolution emerge for the global context leading to reflections on future directions for the interprofessional education field and its role in shaping future practice models. Health professions programs around the world have made a dramatic shift to virtual learning platforms in response to closures of academic institutions and restrictions imposed on learners accessing practice settings. Telemedicine, slow to become established in many countries to date, has also revolutionized practice in the current environment. Within the state of disruption and rapid change is the awareness of a silver lining that provides an opportunity for future growth. Key topics explored in this commentary include reflection on the application of existing competency frameworks, consideration of typology of team structures, reconsideration of theoretical underpinnings, revisiting of core dimensions of education, adaptation of interprofessional education activities, and the role in the future pandemic planning. As an international community of educators and researchers, the authors consider current observations relevant to interprofessional education and practice contexts and suggest a response from scholarship voices across the globe. The current pandemic offers a unique opportunity for educators, practitioners, and researchers to retain what has served interprofessional education and practice well in the past, break from what has not worked as well, and begin to imagine the new.
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http://dx.doi.org/10.1080/13561820.2020.1800606DOI Listing
November 2020

CT-scan findings of COVID-19 pneumonia based on the time elapsed from the beginning of symptoms to the CT imaging evaluation: a descriptive study in Iran.

Rom J Intern Med 2020 Dec 17;58(4):242-250. Epub 2020 Dec 17.

Department of Infectious Diseases, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Coronavirus disease 2019 (COVID-19) was initially detected in Wuhan city, China. Chest CT features of COVID-19 pneumonia have been investigated mostly in China, and there is very little information available on the radiological findings occurring in other populations. In this study, we aimed to describe the characteristics of chest CT findings in confirmed cases of COVID-19 pneumonia in an Iranian population, based on a time classification. Eighty-nine patients with COVID-19 pneumonia, confirmed by a real-time RT-PCR test, who were admitted to non-ICU wards and underwent a chest CT scan were retrospectively enrolled. Descriptive evaluation of radiologic findings was performed using a classification based on the time interval between the initiation of the symptoms and chest CT-scan. The median age of patients was 58.0 years, and the median time interval from the onset of symptoms to CT scan evaluation was 7 days. Most patients had bilateral (94.4%) and multifocal (91.0%) lung involvement with peripheral distribution (60.7%). Also, most patients showed involvement of all five lobes (77.5%). Ground-glass opacities (GGO) (84.3%) and mixed GGO with consolidation (80.9%) were the most common identified patterns. We also found that as the time interval between symptoms and CT scan evaluation increased, the predominant pattern changed from GGO to mixed pattern and then to elongated-containing and band-like-opacities-containing pattern; on the other hand, the percentage of lung involvement increased. Bilateral multifocal GGO, and mixed GGO with consolidation were the most common patterns of COVID-19 pneumonia in our study. However, these patterns might change according to the time interval from symptoms.
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http://dx.doi.org/10.2478/rjim-2020-0019DOI Listing
December 2020

Online interprofessional education during and post the COVID-19 pandemic: a commentary.

Authors:
Hossein Khalili

J Interprof Care 2020 Sep-Oct;34(5):687-690. Epub 2020 Jul 16.

UW Center for Interprofessional Practice and Education (UW CIPE), University of Wisconsin-Madison , USA.

The full impact of the COVID-19 pandemic on higher education and interprofessional education programs in particular is yet to be determined, however, it is clear that this pandemic is changing the way we live, learn, and work. Online education is becoming the new normal in academia, but it is a development that may be posing a conundrum to some. Teachers of interprofessional education are expected to employ online education, but some may lack the knowledge and expertise to create and facilitate an engaging, positive, and supportive online environment for their students. This report discusses the application of Meaningful Discourse and the Community of Inquiry principles on developing online learning communities in interprofessional education.
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http://dx.doi.org/10.1080/13561820.2020.1792424DOI Listing
November 2020

A Randomized Clinical Trial of the Efficacy and Safety of Interferon β-1a in Treatment of Severe COVID-19.

Antimicrob Agents Chemother 2020 08 20;64(9). Epub 2020 Aug 20.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

To the best of our knowledge, there is no published study on the use of interferon β-1a (IFN β-1a) in the treatment of severe COVID-19. In this randomized clinical trial, the efficacy and safety of IFN β-1a were evaluated in patients with severe COVID-19. Forty-two patients in the interferon group received IFN β-1a in addition to the national protocol medications (hydroxychloroquine plus lopinavir-ritonavir or atazanavir-ritonavir). Each 44-μg/ml (12 million IU/ml) dose of interferon β-1a was subcutaneously injected three times weekly for two consecutive weeks. The control group consisted of 39 patients who received only the national protocol medications. The primary outcome of the study was time to reach clinical response. Secondary outcomes were duration of hospital stay, length of intensive care unit stay, 28-day mortality, effect of early or late administration of IFN on mortality, adverse effects, and complications during the hospitalization. Between 29 February and 3 April 2020, 92 patients were recruited, and a total of 42 patients in the IFN group and 39 patients in the control group completed the study. As the primary outcome, time to the clinical response was not significantly different between the IFN and the control groups (9.7 ± 5.8 versus 8.3 ± 4.9 days, respectively,  = 0.95). On day 14, 66.7% versus 43.6% of patients in the IFN group and the control group, respectively, were discharged (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.05 to 6.37). The 28-day overall mortality was significantly lower in the IFN than the control group (19% versus 43.6%, respectively, = 0.015). Early administration significantly reduced mortality (OR, 13.5; 95% CI, 1.5 to 118). Although IFN did not change the time to reach the clinical response, adding it to the national protocol significantly increased discharge rate on day 14 and decreased 28-day mortality. (This study is in the Iranian Registry of Clinical Trials under identifier IRCT20100228003449N28.).
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http://dx.doi.org/10.1128/AAC.01061-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449227PMC
August 2020
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