Background: Levamisole has shown clinical benefits in the management of COVID-19 via its immunomodulatory effect. However, the exact role of Levamisole effect in clinical status of COVID-19 patients is unknown. We aimed to evaluate the efficacy of Levamisole on clinical status of patients with COVID-19 during their course of the disease. Methods: This prospective, double-blind, randomized controlled clinical trial was performed in adult patients with mild to moderate COVID-19 (room-air oxygen saturation > 94%) from late April 2020 to mid-August 2020. Patients were randomly assigned to receive a 3-day course of Levamisole or placebo in combination with routine standard of care. Results: With 25 patients in each arm, 50 patients with COVID-19 were enrolled in the study. Most of the study participants were men (60%). On days 3 and 14, patients in Levamisole group had significantly better cough status distribution when compared to the placebo group (P-value = 0.034 and 0.005, respectively). Moreover, there was significant differences between the two groups in dyspnea at follow-up intervals of 7 (P-value = 0.015) and 14 (P-value = 0.010) days after receiving the interventions. However, no significant difference in fever status was observed on days 1, 3, 7, and 14 in both groups (P-value > 0.05). Conclusion: The results of the current study suggest that Levamisole may improve most of clinical status of patients with COVID-19. The patients receiving Levamisole had significantly better chance of clinical status including cough and dyspnea on day 14 when compared to the placebo. However, the effect-size of this finding has uncertain clinical importance. Trial registration: The trial was registered as IRCT20190810044500N7 (19/09/2020).

Colchicine has shown clinical benefits in the management of COVID‐19 via its anti‐inflammatory effect. However, the exact role of colchicine in COVID‐19 patients is unknown. The current clinical trial was performed on 202 patients with moderate to severe COVID‐19. Patients were randomly assigned in a 1:1 ratio to receive up to a 3‐day course of 0.5 mg colchicine followed by a 12‐day course of 1 mg colchicine in combination with standard care or a 15‐day course of standard care. Among 202 randomized patients, 153 completed the study and received colchicine/standard care or continued standard care (M age, 54.72 [SD, 15.03] years; 93 [63.1%] men). On day 14, patients in the colchicine/standard care group had significantly higher odds of a better clinical status distribution on chest CT evaluation (p = .048). Based on NYHA classification, the percentage change of dyspnea on day 14 between groups was statistically significant (p = .026), indicating a mean of 31.94% change in the intervention group when compared with 19.95% in the control group. According to this study, colchicine can improve clinical outcomes and reduce pulmonary infiltration in COVID‐19 patients if contraindications and precautions are considered and it is prescribed at the right time and in appropriate cases.

Background. COVID‐19 has led to significant hospitalization and intensive care unit admission rates. The demographic parameters of COVID‐19 patients, such as age, underlying illnesses, and clinical symptoms, substantially influence the incidence and mortality of these individuals. The current study examined the clinical and demographic characteristics of COVID‐19 intensive care unit (ICU) patients in Yazd, Iran. Methods. The descriptive‐analytical cross‐sectional study was conducted on ICU patients with a positive RT‐PCR test for coronavirus, admitted to the ICU in Yazd province, Iran, over 18 months. To this end, demographic, clinical, laboratory, and imaging data were collected. Moreover, patients were divided into good and worse clinical outcome groups based on their clinical outcomes. Subsequently, data analysis was performed at a 95% confidence interval (CI) using SPSS 26 software. Results. 391 patients with positive PCR were analyzed. The average age of the patients in the study was 63.59 ± 17.76, where 57.3% were male. On the high‐resolution computed tomography (HRCT) scan, the mean lung involvement score was 14.03 ± 6.04, where alveolar consolidation (34%) and ground‐glass opacity (25.6%) were the most prevalent type of lung involvement. The most common underlying illnesses in the study participants were hypertension (HTN) (41.4%), diabetes mellitus (DM) (39.9%), ischemic heart disease (IHD) (21%), and chronic kidney disease (CKD) (20.7%). In hospitalized patients, the rates of endotracheal intubation and mortality were 38.9% and 38.1%, respectively. Age, DM, HTN, dyslipidemia, CKD, cerebral vascular accident (CVA), cerebral hemorrhage, and cancer were reported to be significantly different between these two groups of patients, indicating an increase in the rate of intubation and mortality among these patients. Furthermore, the multivariate logistic regression analysis revealed that DM, HTN, CKD, CVA, neutrophil‐to‐lymphocyte ratio (NLR), the percentage of lung involvement, and initial O₂ saturation significantly increase the mortality of ICU patients. Conclusion. Several features of COVID‐19 patients influence the mortality in these individuals. According to the findings, early detection of this disease in people at high risk of death can prevent its progression and lower mortality rates.

Introduction. Proper oxygen therapy is crucial in hospitals, particularly intensive care units, to ensure safety and accuracy. The role of nurses during oxygen therapy is vital, as their knowledge and correct performance significantly impact patients’ clinical conditions. A study was carried out to examine the knowledge and performance of nurses regarding safe oxygen therapy. The study aimed to identify the obstacles hindering safe oxygen therapy and assess the impact of training on the knowledge and performance of intensive care nurses. Methods. This study was conducted among the ICU nurses at Shahid Rahnemoun Teaching Hospital in Yazd, Iran. The study method is a sequential combination of descriptive, qualitative, and educational phases. The first stage involved examining the knowledge and performance of 80 ICU nurses in oxygen therapy. The study employed content analysis to elaborate on participants’ perspectives on safe oxygen therapy challenges and potential solutions. The third phase involved a two‐group study with pre‐ and post‐tests to examine the effect of training on ICU nurses’ knowledge and performance in oxygen therapy. Results. The study found that intervention and control groups had low average scores in knowledge, performance, and total score of oxygen therapy before the study, with no significant difference. There was a significant difference between intervention and control groups one and three months after the intervention in the areas of knowledge (after‐1 month 24.41 vs. 20.29, 95% CI [3.144–5.098], after‐3 month 22.13 vs. 20.24, 95% CI [0.729–3.053]), performance (after‐1 month 21.54 vs. 18.05, 95% CI [2.898–4.073], after‐3 month 19.74 vs. 18.63, 95% CI [0.400–1.824]), and total score of oxygen therapy (after‐1 month 45.95 vs. 38.34, 95% CI [6.288–8.925], after‐3 month 41.87 vs. 38.87, 95% CI [1.394–4.613]). Conclusion. The study’s findings revealed that nurses in ICUs lack the appropriate knowledge and performance in oxygen therapy. A lack of knowledge and correct practice, insufficient monitoring of oxygen therapy, and defects in hospital equipment are contributing factors. The training was found to improve the knowledge and performance of nurses significantly. Consistent training at shorter intervals is suggested for nurses to keep their knowledge current.

Patient safety is vital to health care delivery and service quality. Therefore, it should be a priority in every healthcare system worldwide. As the importance of patient safety is increasingly recognized, the emphasis on training and its impact on safety competencies and quality of care has also grown. Innovation in education is essential to keep pace with the growing need to enhance patient safety through an effective education program. Therefore, this study was conducted to compare the effectiveness of the patient safety education program in Case-based Learning (CBL), lectures, and reflection on the knowledge, attitude, and performance of patient safety in the nurses of the Intensive care unit (ICU) and emergency department of Shahid Rahnemoon Hospital, Yazd. The quasi-experimental study was conducted by the nurses of the intensive care unit and emergency departments of Shahid Rahnamoon Teaching Hospital, Yazd, Iran, from November 2023 to the end of April 2024, using a three-group quasi-experimental intervention design with a pre and post-test. Nurses were randomly divided into three teaching groups: lecture, case-based learning, and reflection. The knowledge, attitude, and patient safety performance questionnaires were used before and three months after the intervention. In this study, 113 nurses were analyzed across three groups: Case-Based Learning (CBL) with 38 participants, reflection with 38 participants, and lecture with 37 participants. The mean scores for knowledge pre- and post-study in the three groups were as follows: CBL (4.81 ± 1.24 vs. 8.07 ± 1.36), reflection (4.94 ± 1.39 vs. 8.18 ± 1.44), and lecture (5.16 ± 1.42 vs. 7.75 ± 1.40). Similarly, the average scores for attitude pre- and post-study were recorded as: CBL (41.50 ± 4.89 vs. 54.68 ± 4.64), reflection (41.23 ± 6.22 vs. 49.94 ± 6.42), and lecture (41.37 ± 6.75 vs. 48.62 ± 5.64). For practice, the average scores pre- and post-study were CBL (3.44 ± 1.05 vs. 6.26 ± 1.22), reflection (3.55 ± 1.08 vs. 5.76 ± 1.58), and lecture (3.59 ± 1.06 vs. 5.13 ± 1.53). These results indicate overall knowledge, attitude, and practice improvement across all groups following the study. Before the study, there were no significant differences in knowledge (F = 0.621, p = 0.539), attitude (F = 0.018, p = 0.982), and practice (F = 0.19, p = 0.828) among the three groups. After the study, no significant difference was found in knowledge (F = 0.938, p = 0.394); however, a significant difference was observed in attitude (F = 12.13, p < 0.0001) and practice (F = 506, p = 0.005). According to the study's findings, all three groups of nurses demonstrated significantly higher scores in knowledge, attitudes, and performance after the intervention compared to before. However, no significant difference was observed among the three groups in the area of knowledge. Nonetheless, case-based learning significantly improved the average scores for attitudes and performance. These results indicate that patient safety training programs effectively enhance nurses' knowledge.

Key Clinical Message: Atrial myxoma is a rare disease but has a broad clinical presentation and complication that involves several systems‐ heart, lungs, brain, and systemic. An interdisciplinary approach is very important to optimize the outcome in patients with atrial myxomas. A thorough examination by primary care providers is crucial. Then radiologists or cardiologists can help with imaging modalities that can help diagnose and characterize the tumor. Prior to surgical resection by cardiothoracic surgeons, patients need to be evaluated by pulmonologists, cardiologists, and anesthesiologists for preoperative risk stratifications. In patients with neurological complications, pulmonary complications, or infectious endocarditis, input from neurologists, hematologists, infectious disease specialists is essential for patient care. In case antiplatelet/anticoagulation therapy or antibiotic treatment is warranted, pharmacists can provide valuable recommendations. Myxoma is the most common benign cardiac primary tumor, occurring in the right atrium in only 15%–20% of cases. This disease is asymptomatic initially depending upon size of the tumor, and symptoms develop as the tumor spreads. Atrial myxomas are associated with a triad of complications, including obstruction, emboli, and constitutional symptoms (such as fever and weight loss). This regard, embolization of the pulmonary circulation system is a complication of right myxoma. The patient was a 40‐year‐old male who presented to the emergency department complaining of fever and confusion. He had been previously hospitalized due to COVID‐19 and treated with Remdesivir and plasmapheresis. He had tachycardia, tachypnea, thrombocytopenia, and increased liver enzymes. Chest imaging showed nodular lesions with necrotic areas and cavitary lesions in both lungs and the right atrium infected clot was seen in echocardiography. He was treated with intravenous antibiotics and finally underwent heart surgery due to the diagnosis of pulmonary septic embolism. The patient was finally diagnosed with right atrial myxoma according to heart mass histopathology. It is worth noting that the patient's thrombosis had already developed on the right atrial myxoma, which delayed the diagnosis in this patient. This thrombus formation was due to the hypercoagulability state of COVID‐19 and following the insertion of a central venous catheter to perform plasmapheresis as a complication of treatment. Special attention should be paid to thromboprophylaxis and the early diagnosis of intravascular and intracardiac thrombosis in COVID‐19 patients. Furthermore, the use of imaging modalities is recommended to differentiate thrombus from myxoma.