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Background: During the COVID-19 pandemic, disease coding significantly influenced national and international strategies for prevention, treatment, and control. This study aimed to assess the factors influencing COVID-19 records' coding errors in teaching hospitals in South Khorasan province.

Materials and methods: In 2022, researchers conducted a cross-sectional study in South Khorasan Province, Iran. Data was gathered using a self-developed questionnaire distributed among medical coders in all hospitals. Descriptive statistics were employed in the data analysis using SPSS version 19.

Results: The study's results showed that non-observance of diagnostic principles by physicians (66 out of 92), a lack of specialized medical coding specialists (52 out of 92), and the use of ambiguous and non-standard abbreviations (51 out of 92) were the most significant factors affecting COVID-19 coding errors. Among the three main factors affecting COVID-19 records' coding errors, factors related to the medical coder (47.66 out of 92), factors related to healthcare providers (29.8 out of 92), and organizational and environmental factors (21.4 out of 92) were the most significant.

Conclusion: This study revealed that multiple factors contribute to coding errors in COVID-19 records, with the most critical being physicians' non-adherence to diagnostic principles, the shortage of medical coding specialists, the use of unclear and non-standard abbreviations, and the absence of COVID-19 coding continuing education. Therefore, we recommend conducting workshops on diagnosis and coding for medical coders, particularly emphasizing the precise coding of COVID-19 records.

Background: Medication errors can lead to damage to patients with various disabilities or death. This study aims to identify factors affecting the incidence of medication error and its association with patient safety culture from the nurse's perspective during the COVID-19 pandemic.

Materials and methods: This cross-sectional study was conducted among 340 employed in the hospitals affiliated with Shiraz University of Medical Sciences in 2021. Data were collected by applying a questionnaire for medication error and the standard questionnaire of the Hospital Survey on Patient Safety Culture. Descriptive statistics, the independent t-test, ANOVA, and Pearson correlation were applied using SPSS software version 23.

Results: The main reasons for medication errors were fatigue due to the workload (3.13±1.16 out of 5), method of supervision in the hospital units (3.06±0.98 out of 5), and massive pile-up of duties (3.00±1.19 out of 5). Other results indicated a significant negative association between factors affecting medication error and patient safety culture (r=-0.574, p=0.002). A significant correlation was observed among factors affecting medication error and patient safety culture with demographic determinants of age and years of working experience (p<0.05). Significant differences were also observed among the two main studied variables, the number of monthly work shifts, and the number of patients (p<0.05).

Conclusion: Applying strategies for the reduction of physical fatigue and mental exhaustion along with balancing work shifts and managing the accumulative duties and massive tasks can help decrease the rates of medication errors.

Background: During the last decade, more attention was paid to the tumor cell microenvironment, especially to tumor stroma-infiltrating lymphocytes (TILs). This study aimed to assess the prognostic impact of different TILs subpopulations and PD-L1 positive tumor cells in localized lung adenocarcinomas.

Materials and methods: We conducted a retrospective descriptive study, which included localized adenocarcinomas diagnosed in the department of pathology and resected in the Thoracic Surgery Department of the same hospital between 2015 and 2020. TILs were analyzed using the immunohistochemical method for Fox-P3, CD4, CD8, CD20, and CD3. Besides, the PD-L1 antibody was used to assess tumor cell expression. Intra-tumoral and stromal labeled lymphocytes were quantified by manual counting at high magnification (X400). Fox-P3+/CD8+, Fox-P3+/CD4+, FoxP3+/PD-L1+, and CD8+/CD4+ ratios were subsequently calculated. The prognostic value of TILs was assessed with respect to overall survival (OS) and recurrence free survival (ReFS).

Results: A total of 44 localized adenocarcinomas were included. In the univariate analysis, the prognostic factors influencing OS included gender, adenocarcinoma subtype, Tumor-Infiltrating Lymphocyte (TIL) score, TIL grade, PD-L1 expression, PD-L1 grade, tumor immunity in the microenvironment, and the expressions of various immune markers: CD3, CD4, CD8, CD20, and FoxP3. The analysis also considered the FoxP3 ratio, FIL score, and different ratios involving immune markers, such as CD8/CD4 ratio, FoxP3/CD8 ratio, FoxP3/CD4 ratio, and FoxP3/PD-L1 ratio. The prognostic factors influencing the ReFS consisted of gender, the adenocarcinoma subtype, TIL score, TIL grade, PD-L1, PD-L1 grade, TIM, CD8 expression, CD20 expression, FIL score, Fox-P3/CD8 ratio, Fox-P3/CD4 ratio, and Fox-P3/PD-L1 ratio. Multivariate analysis revealed no independent predictive factors of OS or ReFS.

Conclusion: Despite the limitations of this study, the results highlighted that TILs may not represent an independent prognostic factor in localized adenocarcinomas and don't play a major role in comparison to the tumor stage.

Background: To compare the efficacy of a high-flow nasal cannula (HFNC) versus conventional oxygen therapy (COT) in the treatment of patients admitted to the emergency department (ED) for acute respiratory failure (ARF).

Materials and methods: In this prospective randomized clinical trial, 66 patients aged 18 years or older who presented with ARF to the ED were enrolled and assigned into two equal groups to receive either COT or HFNC for 60 minutes. The primary outcome was the intubation rates. The secondary outcomes were the effect of intervention on oxygenation, ICU admission rate, and effect on physiologic variables.

Results: 33 patients were treated in each group. The main causes of ARF were chronic obstructive pulmonary disease (COPD), pneumonia, and asthma. The need for intubation was higher in COT than in HFNC (42.5% vs 12.1%, P = 0.004). Patients with HFNC had a higher dyspnea improvement than those treated with COT (93.9% vs 63.7%, P = 0.002). They also showed greater improvement in oxygen saturation (increase in SpO₂ was 8.3% vs. -0.5, difference 8.8% (6.8 to 10.9)), and in respiratory rate (decrease 3.0 beats/min vs 0.2 beats/min, differences 2.8(0.8 to 4.6)). The ICU admission was higher in the COT group (51.5 vs 15.2, P=0.002).

Conclusion: HFNC reduced the need for intubation and ICU admission in the patients presenting to the ED with ARF compared with COT. In addition, HFNC was associated with a greater reduction in RR and improvement in SpO₂ compared with COT.

Background: Forecasting the longevity of patients' immune stability could be the most effective approach to preventing illnesses. This study investigates immunoglobulin M (IgM) serum longevity, immunoglobulin G (IgG), and corresponding risk factors in the first phase seropositive patients in Mazandaran, Iran.

Materials and methods: This descriptive cross-sectional study aimed to assess IgM and IgG serum levels in a cohort of 184 seropositive patients during six months. The data analysis involved various statistical methods including descriptive statistics, the chi-square test, independent and paired t-tests, and single and multivariate logistic regression.

Results: A total of 103 (56%) patients lacked the necessary antibodies, whereas 81 (44%) remained seropositive. According to the results of multivariable logistic regression, patients with a travel history, hospital admissions, and end-stage renal disease (ESRD) had 3.24 (P=0.04), 12.63 (P=0.018), and 9.79 (P=0.001) times higher chances of stable seropositivity, respectively. The average IgG and IgM serum levels fell by 4.5 and 3 units, respectively (P<0.001). In addition, serum levels of IgM and IgG increased by 12% and 12.5%, respectively, and dropped by 75.5% in both serums. There was no increase in either serum level for any of the patients.

Conclusion: The duration of immune serum stability in patients can significantly reduce disease mortality. The concurrent detection of IgM and IgG antibodies also assists in identifying the infectious stage.

Background: The recent outbreak of Coronavirus 2019 (COVID-19) is a respiratory disorder caused by the Acute Respiratory Syndrome Coronavirus 2. At the start of the epidemic, early intubation was the optimal strategy for managing ARDS caused by COVID-19. Several non-invasive methods for respiratory support in patients with moderate to severe COVID-19 may reduce intubation, disease severity, ventilator use, and hospitalization in the intensive care unit (ICU). In this study, the characteristics of COVID-19 patients who failed NIV therapy were compared with those who had successful NIV.

Materials and methods: The present descriptive-analytical study was conducted at the COVID-19 center of KHORSHID University Hospital. Patients were aged > 18 years with confirmed COVID-19 and hospitalized in the ICU from the beginning of January to the end of March 2021. They had an oxygen level of < 88% despite receiving 15 L of oxygen with reserve masks and were undergoing non-invasive ventilation (NIV) treatment. Data collection included patients' demographic information, vital signs, and test results upon hospital admission, and assessed disease severity using APACHE, SAPS, and SOFA scores. Patients were categorized into responders (R) and non-responders (NR) to determine predictors of non-invasive ventilation (NIV) success, with follow-up based on device tolerance and changes in vital signs.

Results: 71 Individuals were candidates for NIV. Twenty patients were excluded from the study, and 51 patients were included in the study. Of these, 35 patients underwent NIV treatment failure (NR). On the other hand, 16 (31.4%) patients completely recovered after receiving NIV (R) and they were discharged from the ICU.

Conclusion: Serum Albumin and BMI levels of COVID-19 patients undergoing NIV therapy seem to affect their responses to treatment. Hence, it is recommended to evaluate the nutritional status of patients before the start of NIV .

Background: Asthma is one of the most common respiratory diseases. Hyssopus officinalis L. is a medicinal herb that has shown anti-asthmatic effects and has also been recommended in Persian Medicine literature for its treatment. In this study, the efficacy of hyssop in mild to moderate asthma was investigated considering the patients' phenotype (having productive/non-productive cough).

Materials and methods: In a randomized triple-blind placebo-controlled trial, 60 mild-to-moderate asthmatic patients were randomized to receive either hyssop syrup (5 ml twice daily containing 6g Hyssopus officinalis L. extract) or plain sugar syrup (5 ml twice daily) for 4 weeks as an adjuvant to routine treatment. Outcome measures were the Asthma Control Test (ACT), pulmonary function tests, Expert Panel Report 3 (EPR3), and wheezing severity.

Results: The patients with productive cough in the hyssop group showed significant improvement in forced expiratory volume in 1 second (FEV1), ACT (at the 4th week), peak expiratory flow (PEF), maximal expiratory flow rate 25-75 (MEF25-75%), and wheezing severity. However, those with dry cough got worse regarding these indices.

Conclusion: Hyssop syrup is effective for asthmatic patients with productive cough and a higher BMI, but it is not suitable for those experiencing a dry cough. It highlights the importance of syndrome differentiation in asthmatic patients and a posteriori subgrouping in data analysis. This approach enhances treatment accuracy and response rates while reducing adverse effects. Future trials are guaranteed to approve this categorization in asthma treatment.

Background: Due to the rapid launch and development of vaccines (the most ideal protocol for countering COVID-19), monitoring of post-vaccination side effects is essential. This study aimed to assess symptoms and side effects of three types of COVID-19 vaccines (Sputnik, AstraZeneca, and Sinopharm) and the details of their relationship with demographic characteristics in Iran.

Materials and methods: A cross-sectional and telephonic interview-based study was conducted from May 12 to July 11, 2021, among 420 university staff who received both doses of the COVID-19 vaccine. The association of vaccination behavior-related symptoms after the first and second doses with age, gender, vaccine type, blood type, underlying medical situation, and past infection and reinfection with SARS-CoV-2 was analyzed.

Results: The majority of participants were men (58.7%), the median age was 41.30+11.208 years, and 18.6% were vaccinated with the Sputnik vaccine, 75.1% with Sinopharm, and 6.3% with AstraZeneca. In addition, 47.3% and 41.8% were symptomatic after first and second dose vaccination, respectively. The frequency of symptoms was higher in younger individuals, women, and AstraZeneca recipients (p = 0.001). The most frequently reported symptoms were fever, weakness, and muscular and injection site pain. These symptoms were more reported after the first dose than the second one. There was no significant connection between blood types, underlying medical situations, past infection and reinfection with SARS-CoV-2, and the prevalence of symptoms.

Conclusion: AstraZeneca, Sputnik, and Sinopharm COVID-19 vaccines were found to be safe and the lowest incidence of symptoms was seen in Sinopharm recipients.