1 2008-6164 Babol University of Medical Sciences 2287 pharmacology A brief review of the latest pharmacological treatments of COVID-19 Eftekhar Seyed Parsa b Kazemi Sohrab c Moghadamnia Ali Akbar d b Student research committee, Health Research Center, Babol University of Medical Sciences, Babol, Iran c Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran d Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 1 11 2020 11 Covid 19 Supplement 1 460 465 15 04 2020 20 06 2020 New Coronavirus which is called 2019-nCoV (2019-Novel-Coronavirus) or SARS-Cov-2 (Severe Acute respiratory Syndrome-Coronavirus 2) causes deadly pneumonia that first appeared in December 2019 in Wuhan city in China. This virus spreads all over the world quickly and made several problems for the community and healthcare system. Several drugs have been tried to manage COVID-19; however, our knowledge of this virus is not complete. At any rate, effective treatment or vaccine for this disease has not been discovered yet. Furthermore, to achieve this goal, more studies are needed on the structure of the virus and its pathogenesis mechanism. In this article, we summarized several articles suggesting treatments of COVID-19.
2528 Traditional Medicine Hospital diet for COVID-19, an acute respiratory infectious disease: An evidence-based Protocol of a Clinical Trial Moslemi Fard Masoud e Goeji Narjess f Ghadimi Reza g Kamalinejad Mohammad h Shirafkan Hoda i Mozaffarpur Seyyed Ali j e Department of Persian Medicine, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran f Department of History of Medical Sciences, School of Persian Medicine, Babol University of Medical Sciences, Babol, Iran g Social Determinants of Health Research Center, Research Health Institute, Babol University of Medical Sciences, , Babol, Iran h School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran i Social Determinants of Health Research Center, Research Health Institute, Babol University of Medical Sciences, , Babol, Iran j Traditional Medicine and History of Medical Sciences, Research Health Institute, Babol University of Medical Sciences, , Babol, Iran 1 11 2020 11 Covid 19 Supplement 1 466 478 27 09 2020 28 10 2020 Background: COVID-19 caused a global pandemic problem. No confident management is introduced for it yet. This study aimed to propose a dietary protocol for hospitalized patients with the diagnosis of acute respiratory infectious disease caused by COVID-19 based on Persian Medicine. Methods: This study was conducted in three phases. In the first phase, any diseases that could be matched with the clinical features of infection with COVID-19 were searched in selected PM references. In the second phase, medicinal herbs and foods that were available and could be used in the hospital diet were extracted and summarized. In the third phase, the new documentation of these pharmaceutical and food items was conducted. Results: The signs and symptoms of infectious respiratory disease caused by COVID-19 can be categorized in the field of Zato al-rieh that can mainly be matched with pneumonia. Based on the described criteria, some nutrients and medicinal materia medica have been introduced for acute respiratory infection including Cydonia oblonga, Honey, Citrus sinensis, Malus domestica, Citrus medica, Crocus sativus, Raisin, Rosa Damas Cena, D.Carota, Camellia Sinensis, Anethum graveolens dhi, Punica granatum, Petroselinum Crispum, Coriandrum sativum, Urtica dioica, Allium sativum, Sesamum indicum Conclusion: Most materia medica has documents in current articles including anti-cough suppressants, antiviral properties, anti-bacterial, anti-inflammatory, antioxidant, immunomodulatory etc. A protocol of hospital diet for patients with infectious respiratory syndrome caused by COVID-19 has been introduced in this manuscript. 2384 Health How to Exercise During Coronavirus Quarantine? Hoseini Rastegar k k Department of Exercise Physiology, Faculty of Sport Sciences, Razi University, Kermanshah, Iran 1 11 2020 11 Covid 19 Supplement 1 479 483 19 06 2020 30 09 2020 The COVID-19 pandemic caused stress and anxiety in many people that can be reduced by regular physical activity. Regular physical exercise is essential for health. In the absence of COVID-19 symptoms, no limitation in physical activity is recommended.  However, parameters such as frequency, intensity, type, and time need to be considered to prescribe the program and obtain the best results. Consequently, The level of physical activity that should be done during the outbreak has always been one of the most important and common questions. 2283 Health Factors associated with the psychological status during the Coronavirus pandemic, baseline data from an Iranian Province Ansari Ramandi Mohammad Mostafa l Yarmohammadi Hossein m Beikmohammadi Somayeh n Hosseiny Fahimi Behzad Hassan o Amirabadizadeh Alireza p l Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran m Student Research Committee, Shahed University, Tehran, Iran n Department of Cardiology, Universitätsmedizin Schleswig-Holstein, Lubeck, Germany o Department of Cardiology, Universitätsmedizin Schleswig-Holstein, Lubeck, Germany p Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran 1 11 2020 11 Covid 19 Supplement 1 484 494 15 04 2020 11 05 2020 Background: The 2019 coronavirus disease (COVID-19) is threatening public health in many ways. The psychological situation of individuals is important and limited data is available from Iran. In this study, we aimed to illustrate the psychological distress of the general population and evaluate factors affecting it.  Methods: An online cross-sectional survey was done from 29th to 31st March 2020 in South Khorasan province, affected later than other parts of the country. We included sociodemographic questions, Hospital Anxiety, and Depression Scale (HADS) questionnaire and questions addressing various symptoms and diseases. Most questions had multiple choices to be chosen from and some were open questions. Univariate and multivariate analysis in SPSS software were used to find significant relationships. Results: A total of 844 responses were collected, from which 788 records were included in the analysis. The mean age of responders was 36.61 ± 10.97 (age range: 18-88) and 484 (61.4%) of them were female. The mean scores in the anxiety and depression subscale of the HADS questionnaire were 7.01±3.68 and 6.72±3.71 respectively. Experiencing cardiovascular and COVID-19 related symptoms was significantly associated with a higher number of individuals having abnormal anxiety and depression results (p value<0.001). Widowed individuals, females and those experiencing above-stated symptoms showed a significant association with increased anxiety and depression in multivariate analysis. Conclusions: Although many existing elements influence the psychological well-being of society during a pandemic, experiencing symptoms related to other diseases or having multiple chronic diseases may cause an extra burden on the psychological state of the society. 2332 Health Predisposing risk factors for COVID-19 infection: A case-control study Shahbazi Fatemeh Solgi Manoochehr Khazaei Salman Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran 1 11 2020 11 Covid 19 Supplement 1 495 500 21 05 2020 11 08 2020 Background: The ongoing epidemics of coronavirus disease 2019 (COVID-19) have caused serious concerns in terms of public health. Literature that focuses on the risk factors of this issue is limited especially in developing countries. This study aimed to determine the predictors of COVID-19 infection in the west region of Iran. Methods: This case-control study was conducted from February to April 2020 in Nahavand county, western Iran. Cases were all patients were positive for coronavirus and, the controls included people who had clinical signs consistent with COVID-19, but their test results were negative. Two controls were selected for every case. Multivariate logistic regression was used to estimate the effects of epidemiological characteristics on the incidence of COVID-19. Results: Significant risk factors for COVID-19 infection based on the multivariable logistic regression model were male gender (OR = 1.82, p = 0.0.15), age group over 60 years (OR = 2.04, p = 0.017), living in urban areas (OR = 1.79, p = 0 .018), being married (OR = 2.08, p = 0.022), having history of contact with the corona patients (OR = 5.61, p = 0.009), and comorbidities (OR = 1.78, p = 0.031). Conclusions: This study highlighted factors associated with the occurrence of COVID-19 infection. These findings may help to guide recommendations for the protection of high-risk groups. 2386 Health Preventing the frequency of infectious diseases in vulnerable groups - by anticipating the role of actors in implementing the decision-making model in conditions of uncertainty pandemic experience Covid-19 Hashemi Amree Mitra Enayati Taraneh Salehi Mohammad Department of Educational Management, Sari Branch, Islamic Azad University, Sari, Iran Department of Educational Management, Sari Branch, Islamic Azad University, Sari, Iran Department of Educational Management, Sari Branch, Islamic Azad University, Sari, Iran 1 11 2020 11 Covid 19 Supplement 1 501 511 20 06 2020 02 08 2020 Background: The purpose of this study is to prevent the prevalence of infectious diseases in vulnerable groups by anticipating the role of actors in implementing decision-making models in conditions of uncertainty in medical universities. Methods: This research is an applied research by combining qualitative and quantitative methods based on the foundation data theory (Grand Theory). To determine the dimensions of the model, the statistical population included crisis management managers and faculty members of Mazandaran University of Medical Sciences. The data collection has been done through targeted sampling and interviews, semi-structured interviews, analysis method,  and coding method. The statistical population to present the model include senior and middle managers of Mazandaran University of Medical Sciences. The simple random sampling method based on the sample size was determined by Cochran's method, and the collected date from the researcher's questionnaire was analyzed through nonparametric statistical experiments, Kolmogorov test Smirnov, SPSS SMARTPLS, Excel and the method of modeling structural equations with the least squares approach has been partial. Results: The path coefficient of each dimension in explaining the decision model in uncertainty conditions based on T statistic and p value and SRMR value was 0.137, which was a good value and the main actors in implementing the model were policymakers, managers and staff. Conclusion: The implementation of this model will lead to a change in the decisions made by health system authorities in conditions of uncertainty, and will increase the ability of managers of medical universities and the resilience of the health system. 2347 Internal COVID-19 and ICU admission associated predictive factors in Iranian patients Sadeghi Amir Eslami Pegah Dooghaie moghadam Arash Pirsalehi Ali Shojaee Sajad Vahidi Mohammad Soheili Amirali Ghanimat Faezeh Keshmiri Yasaman Abdi Saeed Zali Mohammad Reza Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 1 11 2020 11 Covid 19 Supplement 1 512 519 30 05 2020 15 08 2020 Background: The pandemic situation created an overwhelmed needs for ICU facilities, according to this problem, the need of accurate the management of facilities represents bold. In this study, prognostic risk factors for ICU admission among COVID-19 hospitalized patients were evaluated. Methods: From 22 February to April 20, 2020. Totally,214 COVID-19 patients participated in this study. The included patients were between 18- 80 years old, and the patients who previously admitted for COVID-19 were excluded. The comorbid medical conditions, admission laboratory, demographic data, and first manifestations were analyzed between two groups, including ICU and non-ICU admitted patients. The statistical analysis, univariate and multivariate analysis were afforded. The value of the predictors in risk assessment of ICU admission were estimated. Results: 55 patients (25.7%)  were admitted in ICU. The ICU admitted patient’s mortality rate was about 68%. The age was significantly higher among ICU admission group (P=0.03). Admission O2 saturation was significantly lower among ICU admitted patients (P=0.00). The kidney disease and malignancy history were more frequent in ICU-admitted patients (P=0.04, P=0.00). Myalgia was the clinical manifestation that significantly presented more frequent in ICU-admitted patients. INR, CRP, ESR, HB, and Lymphocyte were significantly different between two groups. After multivariable analysis, admission O2 saturation, hematocrit, CRP and myalgia could significantly predict the risk of ICU admission. Furthermore, the value of predictors was estimated in our study. Conclusion: Based on our results, the admission O2 saturation, HCT, CRP levels at first admission and myalgia presentation could be considered as the valuable predictors of ICU admission. 2329 Gastroentrology Risk factors related to liver injury in non-Intensive Care Unit admitted patients infected with COVID-19: A retrospective study of 102 patients Sadeghi Amir Eslami Pegah Dooghaie Moghadam Arash Pirsalehi Ali Shojaei Sajad Jalilian Khave Laya Sanadgol Ghazal Hasanzade Taha Shirini Dorsa Asadzadeh Aghdaei Hamid Abdi Saeed Zali Mohammad Reza Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 1 11 2020 11 Covid 19 Supplement 1 520 526 19 05 2020 26 08 2020 Background: Liver is one of the target organs for COVID-19 infection. The liver damage in critically ill patients was investigated in previous studies, but there is no available data about liver injury in mild to moderate form of infection with COVID019. In this study, we estimated the prognostic factors related to liver injury in NON-ICU admitted patients infected with COVID-19. Methods: in this retrospective study, 102 eligible adult participants admitted in the ward were included. Demographic characteristics, admission duration, underlying disease, manifestations of infection, and laboratory data were analyzed. Then, with statistical, univariate, and multivariate analysis, the associated and independent factors were estimated. Results: the mean age of the study population was 55.13± 17.02 years old. The most common symptom was fever (45.8%). The most frequent co-morbidity was hypertension (25%). 65 patients had liver injury (63.72%). According to statistical analysis CRP were significantly higher in liver injury group (P=0.01, respectively). Univariate analysis reported ALKP, and CRP associated significantly with liver injury (P=0.04, OR= 1.003, Cl 95%= 1.000-1.007; P=0.03, OR= 1.009, Cl 95%= 1.000- 1.017, respectively). No independent factor was detected in multivariate analysis. Based on Spearman’s rank correlation coefficients CRP and lymphocyte correlated significantly with AST (r=0.22, P=0.00; r=-0.13, P=0.09, respectively). Moreover, neutrophil, CRP, and lymphocyte correlated with ALT (r=0.27, P=0.01; r=0.23, P=0.02; r= -0.19, P=0.05, respectively). Conclusion: Although in the current study, no independent factor was detected, CRP had a significant association with liver injury. It appears the role of inflammatory pathways in the severity of this infection. 2351 Infectious Diseases Diagnostic value of chest CT in Iranian patients with suspected COVID-19 Salehi-Pourmehr Hanieh Pourfathi Hojjat Tarzamni Mohammad Kazem Ghojazadeh Morteza Naghili Behrooz Zarrintan Armin Mehdipour Reza Hajebrahimi Sakineh Research center for Evidence-Based- Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran. Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Radiology Department, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Research center for Evidence-Based- Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran. Research Center for Infectious and Tropical Disease, Tabriz University of Medical Sciences, Tabriz, Iran Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran Research center for Evidence based- medicine, Tabriz University of Medical Sciences, 5166614756, Tabriz, Iran. Research center for Evidence-Based- Medicine, Iranian EBM Center: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical Sciences, Tabriz, Iran. 1 11 2020 11 Covid 19 Supplement 1 527 530 31 05 2020 28 09 2020 Background: In the current COVID-19 pandemic, there is a rising need for a rapid and reliable diagnostic tool. We hypothesized that chest computed tomography (CT) can be a potential alternative for reverse transcription-polymerase chain reaction (RT-PCR). The aim of this study was to compare the diagnostic value of chest CT and RT-PCR in Iranian patients with suspected COVID-19. Methods: In a retrospective, single-center case series, 568 consecutive hospitalized or outpatient patients with suspected COVID-19 underwent chest CT and/or RT-PCR testing at Imam Reza Hospital, the tertiary teaching hospital of Tabriz University of Medical Sciences in Iran, from February 21 and March 28, 2020. Results: The sensitivity of chest CT for signifying COVID-19 was 64% (95% CI: 56%–71%) on the basis of positive RT-PCR results as a standard method. CT imaging also had a specificity of 77% (95% CI: 73%–81%), positive predictive value of 35% (95% CI: 0.31–0.39), negative predictive value of 66% (95% CI: 0.61–0.69), positive likelihood ratio of 2.79 (95% CI: 2.26–3.46), and negative likelihood ratio of 0.47 (95% CI: 0.38–0.57). Conclusion: Chest CT had higher specificity than RT-PCR in the diagnosis of COVID-19, . Therefore, it can play a crucial role in the early diagnosis. Similar to the previous studies, the typical CT features were patchy ground-glass opacities as well as peripheral aspects of the lungs consolidations. 2414 Infectious Diseases Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19 Patients and Control Group and Relationship with Disease Prognosis Eslamijouybari Mohammad Heydari Keyvan Maleki  Iradj Moosazadeh Mahmood Hedayatizadeh-Omran Akbar Vahedi Lale Ghasemian Roya Sharifpour Ali Alizadeh-Navaei Reza Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran 1 11 2020 11 Covid 19 Supplement 1 531 535 09 07 2020 07 09 2020 Background: The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis given the role of complete blood counts in the COVID-19 prognosis. Methods: COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population who were matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study. Results: The number of participants in the case and control groups was 527. Of these, 464 (44%) were females. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (p = 0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P = 0.000). NLR had a significant relationship with severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P = 0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06) respectively. Conclusion: NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those died and recovered from COVID-19. 2438 Infectious Diseases Accuracy of the pre-hospital triage tools (qSOFA, NEWS, and PRESEP) in predicting probable COVID-19 patients’ outcomes transferred by Emergency Medical Services Saberian Peyman Tavakoli Nader Hasani-Sharamin Parisa Modabber Maryam Jamshididana Mahnaz Baratloo Alireza Anesthesiology Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, Iran Tehran Emergency Medical Service Center, Tehran, Iran Tehran Emergency Medical Service Center, Tehran, Iran Tehran Emergency Medical Service Center, Tehran, Iran Department of Emergency Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 1 11 2020 11 Covid 19 Supplement 1 536 543 29 07 2020 28 10 2020 Background: This study aimed to evaluate the efficiency of pre-hospital triage tools including the qSOFA, NEWS, and PRESEP in determining the prognosis of probable COVID-19 patients. Methods: In this diagnostic accuracy study, all probable COVID-19 patients older than 16-year-old who were transferred to the hospital by the Tehran Emergency Medical Services (EMS) during the first month of the pandemic, entered to the study. The scores of qSOFA, NEWS, and PRESEP were calculated using data gathered while providing pre-hospital care. The primary outcome was death; and the secondary outcomes were ICU admission, length of stay in the ICU, and length of hospital stay. Results: The data of 557 individuals with the mean age of 56.93±18.31 were analyzed of whom 67.5% were males. The area under the ROC curve (AUC) of qSOFA, NEWS, and PRESEP for ICU admission was 0.553, 0.557, and 0.551, respectively. The AUC of qSOFA, NEWS, and PRESEP for death was 0.596, 0.566, and 0.604, respectively. The best obtained cut-off point for qSOFA was a score >0 (the sensitivity and specificity were 25.0 and 85.68%, respectively), for NEWS was a score >2 (the sensitivity and specificity were 83.61 and 32.67%, respectively), and for PRESEP was a score >1 (the sensitivity and specificity were 54.10 and 55.56%, respectively). Conclusion: Based on the findings of the current study, it is likely that the available pre-hospital triage tools (qSOFA, NEWS, and PRESEP) do not have proper efficacy to predict death, ICU admission, and disease severity of COVID-19 patients. 2596 Infectious Diseases Epidemiologic comparison of the first and second waves of coronavirus disease epidemics in Babol, North of Iran Jalali Seyed Farzad Ghassemzadeh Mostafa Mouodi Simin Javanian Mostafa Akbari Kani Mehdi Ghadimi Reza Bijani Ali Department of Cardiology, Babol University of Medical Sciences, Babol, Iran Department of Dermatology, Babol University of Medical Sciences, Babol, Iran Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Babol University of Medical Sciences, Babol, Iran Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 1 11 2020 11 Covid 19 Supplement 1 544 550 11 11 2020 19 10 2020 Background: A few studies compared the epidemiologic features of the first and second waves of coronavirus disease 2019 (COVID-19) outbreak. This research was carried out to compare the 1st and the 2nd waves of the epidemics in the northern Iran. Methods: In this observational research, demographic, clinical and laboratory characteristics of the patients with COVID-19, admitted to four government hospitals affiliated to Babol University of Medical Sciences during the 1st and the 2nd waves of COVID-19 epidemics have been compared. The period from May 21, 2020 to September 21, 2020 was considered as the second wave of the epidemics while from February 19, 2020 to May 20, 2020, as the first wave of the outbreak in this region. Results: Out of 6691 total hospitalized cases, 4374 (65.37%), including 1532 (49.6%) people in the first wave and 2842 (78.9%) in the second wave had RT-PCR test for disease confirmation. Among those who were examined with RT-PCR test, 2322 patients (53.1%) including 728 (31.4%) persons in the first wave and 1594 (68.6%) in the second wave were positive for SARS-CoV-2 RNA. 414 (56.9%) of the confirmed cases in the first wave and 767 (48.1%) in the second wave were males (p<0.001). Gastrointestinal symptoms were more incidental in the second wave of the disease. However, severe respiratory conditions were more common during the first wave (p<0.001). Crude mortality rate was lower in the second wave of the outbreak (p<0.001). Conclusion: Different epidemiologic characteristics were found in the second wave of COVID-19 outbreak in comparison with the first wave of the epidemics in northerrn Iran. 2350 Infectious Diseases Thrombotic events in COVID-19 patients: a case series and literature review Javidarabshahi Zahra Khatami Shohre Rezazade Roxana Saeedian Neda Mozdourian Mahnaz Lung Diseases Research Center, Mashhad University of Medical Science, Mashhad, Iran Department of Internal Medicine, Mashhad University of Medical Science, Mashhad, Iran Department of Internal Medicine, Mashhad University of Medical Science, Mashhad, Iran Department of Internal Medicine, Mashhad University of Medical Science, Mashhad, Iran Lung Diseases Research Center, Mashhad University of Medical Science, Mashhad, Iran 1 11 2020 11 Covid 19 Supplement 1 551 556 31 05 2020 19 09 2020 Background: Coronavirus disease 2019 (COVID-19) has rapidly emerged as a threatening pandemic. Clinical features of this pandemic involve a wide range of manifestations and are not completely known. Here, we present six cases of thrombotic events in patients with COVID-19. Case presentation: In this case series, we present six patients with confirmed COVID-19, according to real-time polymerase chain reaction, who were referred to our emergency department and were found to have thrombotic events. Pulmonary thromboembolism was diagnosed in three patients by computed tomography (CT) angiography. One patient was found to have deep vein thrombosis in Doppler ultrasonography. Another patient who presented with loss of consciousness, was finally diagnosed with cerebrovascular accident using brain CT. One of the patients had developed a myocardial infarction that was evident in the electrocardiography. Conclusion: It is ostensible that COVID-19 puts the patients at an increased risk for developing thrombotic conditions, possibly through formation of hyper-inflammatory and hyper-coagulative states. However, further prospective studies are recommended to confirm these findings. 2295 Infectious Diseases Neurologic manifestations in patients with COVID-19: A case report Ebrahimpour Soheil Mohseni Afshar Zeinab Mohseni Sima Masrour-roudsari Jila Oladzade Sahar Bayani Masomeh Babazadeh Arefeh Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Department of Radiology, Al Jalil Hospital-Aghala , Golestan University Of Medical Sciences, Gorgan, Iran Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. 1 11 2020 11 Covid 19 Supplement 1 557 560 27 04 2020 11 08 2020 Background: There are very few reports about the neurological complications of COVID-19.We describe two COVID-19 patients with neurologic presentations. Case Presentation: Herein we present neurological manifestations in 2 hospitalized patients with COVID-19. The patients showed most common symptoms of COVID-19 along with common conflicts in CT scans of lung such as ground-glass opacities (GGOs). First case revealed two episodes of generalized tonic–clonic seizures; brain CT scan in second patients revealed an extensive hypodense lesion in the left cerebellar hemisphere. All cases received supportive care, antibiotics, and antiviral medications. All cases were discharged with a good general condition. Conclusion: The current case series report the association between neurological involvements and COVID-19. Clinicians should be aware of neurologic symptoms in the setting of COVID-19, which might even be the first presentations of this infection. 2375 Cardiology Chest pain and high troponin level without significant respiratory symptoms in young patients with COVID-19 Hedayat Behnam hosseini kaveh Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran 1 11 2020 11 Covid 19 Supplement 1 561 565 13 06 2020 09 09 2020 Background: Of all patients infected with COVID-19, 95% have mild symptoms, but 5% may experience severe illness. There are reports of myocardial injury associated with the COVID19 infection in middle aged and old people with baseline cardiac conditions. Acute myocardial injury has been suggested as a marker for disease severity. Sometimes it is hard to differentiate between acute coronary syndrome and acute myocarditis; hence detailed history taking, lab tests and imaging will be necessary. Case Presentation: Herein, we described two young patients presenting with chest pain and no significant respiratory symptoms, one without cardiovascular risk factors and another one with diabetes mellitus and cigarette smoking. COVID-19 was documented with real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR). Conclusion: Early Chest CT scan besides coronary CT angiogram (if available) in suspicious cases can help physician to make fast decisions. These two cases both had complication-free hospital stay. Despite markedly high on-admission troponin levels, which is known as a marker of poor prognosis they discharged in good condition. One month follow-up was also uneventful. 2496 Infectious Diseases SARS-CoV-2 infection: its psychiatric manifestations Lorenzo-Villalba Noel Jannot Xavier Syrovatkova Anezka Michel Vincent Andres Emmanuel Hôpitaux Universitaire de Strasbourg Hôpitaux Universitaire de Strasbourg Hôpitaux Universitaire de Strasbourg Hôpitaux Universitaire de Strasbourg Hôpitaux Universitaire de Strasbourg 1 11 2020 11 Covid 19 Supplement 1 566 568 11 09 2020 19 10 2020 Background:  The clinical presentation of SARS-CoV-2 infection was initially dominated by respiratory symptoms. However the clinical spectrum is wide and neuropsychiatric syndromes are also a source of medical concern. Our aims are to present an atypical clinical presentation of SARS-CoV-2 infection characterized by auditory hallucinations and unusual behavior and to emphasize the diversity of clinical manifestations of SARS-CoV-2 infection. Case Presentation:  A 33-year-old woman was admitted to the emergency department (ED) with a one-day history of auditory hallucinations, unusual behavior, changes in her sleeping habits and incoherent speech. No other symptoms were reported. Blood examinations confirmed high elevated white cell count and C-reactive protein. The head CT scan was normal but the chest scan showed right ground-glass opacities in the lower zones. The oropharyngeal swab was positive for SARS-CoV-2.  Based on these results, the diagnosis of SARS-CoV-2 infection was retained. The patient received no specific treatment for SARS-CoV-2 infection and only needed oxygen therapy support for 7 days. Additional dose of Olanzapine 10 mg daily was initially prescribed but the patient was back to her usual self on day 14 of hospital admission leading to its discontinuation. This clinical course was consistent with a first episode of psychosis triggered by SARS-CoV-2 infection. Conclusions: Neuroinflammation owing to SARS-CoV-2 infection could be responsible for a wide and unknown spectrum of neuropsychiatric manifestations. During this pandemic, special attention should be given to patients with no previous history of psychiatric disorders presenting to ED with neuropsychiatric syndromes of unknown etiology. 2358 Cardiology Complete heart block and itchy rash in a patient with COVID-19 Dehghani Firouzabadi Mohammad Goudarzi Sogand Dehghani Firouzabadi Fatemeh Moosaie Fatemeh ENT and Head & Neck Research Center and Department, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 1 11 2020 11 Covid 19 Supplement 1 569 571 04 06 2020 15 08 2020 Background: The outbreak of coronavirus disease 2019 (COVID-19) has become a global crisis, as the World Health Organization (WHO) declared COVID-19 as a global pandemic. Complete heart block, resulting from an abnormal heart rhythm, is a rare presentation of this infection, which can be life-threatening due to possible progression into ventricular tachycardia. Case Presentation: We report a critical case of COVID-19 in a young woman without any medical history. She was admitted to the hospital with a rare, but serious presentation of temporary complete heart block with a skin rash after three weeks of treatment with an antiviral agent and hydroxychloroquine. The result of cardiac monitoring, using a Holter monitor, was normal, and her sinus rhythm returned to normal without any interventions. Conclusion: This case emphasized the importance of regular follow-ups for patients with COVID-19 and highlighted the need for attention to unusual presentations, such as brief episodes of unconsciousness and chest pain.    2357 Internal Plasmapheresis with corticosteroids and antiviral: a life-saving treatment for severe cases of Covid 19 (A case report) Bagherzadeh Mohammad Parham Mahmoud Zohali Somayeh Molaii Sedighe Vafaeimanesh Jamshid Department of Internal Medicine, School of Medicine, Qom University of Medical sciences Department of Internal Medicine, School of Medicine, Qom University of Medical sciences Student research committee, Qom University of Medical Sciences, Qom, Iran, Student research committee, Qom University of Medical Sciences, Qom, Iran, Gastroenterology and Hepatology Disease Research Center, Qom University of Medical sciences 1 11 2020 11 Covid 19 Supplement 1 572 576 04 06 2020 22 08 2020 Background: COVID-19 pandemic is a global concern. In this study we suggest using a novel three-dimensional treatment mainly based upon immune system modulation to revolve the virus chaos, regarding to the cytokine storm introduced as the main character of COVID-19 infection scenario. Case Presentation: A young man infected by 2019-nCoVwho suffered from respiratory arrest and loss of consciousness(On March 27,2020), undergoes cardiopulmonary resuscitation and then Endotracheal  intubation and upon ICU administration and confirmed diagnosis of COVID-19, Considering critical condition of the young patient, plasmapheresis was performed once on a daily basis, three doses of interferonbeta(IFN-β-1b) was injected subcutaneously every other day and dexamethasone was given at a dose of 4 mg every 8 hours (TID).After 2 days, the patient was extubated and transferred from the ICU to the ward (March 31,2020) where plasmapheresis was performed 4 times daily for 4 days.Finally ,after 7 days of hospitalization, the patient was discharged with a good general condition. Conclusion: we modulated immune system through plasmapheresis to sweep out the released cytokines and corticosteroid along with interferon andcommon antiviral treatments. Our data suggest this combined method to be effective for critically ill COVID-19 patients. 2302 Surgery Surgery priority at the time of COVID-19 pandemic, a conceptual frame work recommendation Akbari Atieh Mehrvar Narjes Akbari Mohammad Esmaeil 1 11 2020 11 Covid 19 Supplement 1 577 579 02 05 2020 19 10 2020 Background: The current pandemic disease, COVID-19, is making fear and affecting the quality of life in 2020. The mentioned disease can spread human to human, especially by asymptomatic carriers. Healthcare providers and surgeons are at the risk of conferring with COVID-19. Surgical history in pandemic situations is rare. Case Presentation: In this regard, the present study designed for suggesting practical and fundamental issues around the efficacy of surgery at the time of COVID-19 pandemic. Conclusion: This information and recommendations could be as a valuable source for surgeons in low and middle-income countries. 2343 Pulmonology Prone Position Effects in the Treatment of Covid-19 Patients Rahmani Farzad Salmasi Shiva Rezaeifar Parisa Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IR Iran Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IR Iran Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, IR Iran 1 11 2020 11 Covid 19 Supplement 1 580 582 27 05 2020 12 08 2020 Prone positioning is a conventional method to enhance oxygenation in Acute Respiratory Distress Syndrome (ARDS) patients who need mechanical ventilator . It is proven that oxygenation is significantly more beneficial in prone position compared to the supine position. Furthermore, numerous evidences have confirmed that prone positioning could prevent lung injuries caused by ventilators 2251 psychiatry Insomnia drug therapy in COVID-19 patients; a Letter to Editor Rismanbaf Ali Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran 1 11 2020 11 Covid 19 Supplement 1 583 584 21 03 2020 19 10 2020 Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the newly emerging SARS-CoV-2 virus that was first reported in December 2019 and was announced as a pandemic disease on March 11th, according to a World Health Organization (WHO) warning (1). SARS-CoV-2 is mainly transmitted through respiratory droplets and close contact, accordingly, requires treatment in isolation. It has been reported that many patients developed sleep disturbances due to isolation treatment or medication use, which can lead to pathological events and impaired immunity, and need to prescribe hypnotic medications (2). Also, some patients may have taken hypnotic medications before developing COVID-19 and may be dependent on these medications, and now, with the onset of COVID-19 and the addition of new drugs for its treatment, they need to change their hypnotic medications.