Medical Journal of The Islamic Republic of Iran (MJIRI)

---

The study of toxicities which are caused by free radical inducing chemicals (e.g., carbon tetrachloride), helps to determine the mode of action of those important drugs which act by inhibiting free radicals. Evaluation of toxicities induced by carbon tetrachloride and phenobarbitone administration was carried out in seventy healthy male rabbits. Each animal received CCI4 0.25-0.5 mL/kg body weight, intraperitoneally, twice weekly for eleven doses. During this period, the only water which was provided for drinking to these animals contained 0.25 g/L pentobarbitone. Examination of these animals revealed that carbon tetrachloride produced severe liver and kidney injuries which could be assessed by physical parameters, liver and kidney function tests, and microscopic .examinations of the vital organs of these aninlals.

---

The selected parts of four medicinal plants, Achillea millefolium, Hibiscus rosasinensis, Linum usitatissimum and Pluchea lanceolata were extracted in absolute methanol to determine their analgesic activity. Analgesic activity was assessed on intact mice by tail flick latency via the tail immersion method. The analgesic activities of these plant extracts were compared with acetylsalicylic acid (300 mg/kg) which was used as the standard drug. Extracts were given orally in doses of 300,500 and 1000 mg/kg. 0.9% saline was administered to the control group of animals. Results showed that Linum usitatissimum and Pluchea lanceolata possessed highly significant analgesic activity, while Achillea millefolium and Hibiscus rosasinensis did not show any significant effects.

---

 Backgrounds: Thyroid hormones play an important physiological role in human metabolism. Erythrocyte abnormalities are frequently associated with thyroid disorder. However, they are rarely investigated and related to the subclinical and primary hypothyroidism in Kashmiri Patients. In this study an attempt was made to study hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients.

 

Methods: This retrospective study included 600 subjects, among which were untreated subclinical hypothyroid (n=110), treated subclinical hypothyroid (n=110), untreated primary hypothyroid (n=100), treated primary hypothyroid (n=100) and euthyroid (n=180). This study was carried out at Department of Biochemistry, Government Medical College Srinagar. The hematological parameters and thyroid profile of the subjects were assessed by the Sysmex (Italy) and ECLIA (Germany) 2010 automatic analyzer. Mean, standard deviation (SD), analysis of variance (Two-way ANOVA), and multiple comparisons were used to report our results, with p<0.05 or p<0.01 considered as statistically significant.

 Results: In this study group we compared the hematological parameters in these groups, untreated subclinical hypothyroid, treated subclinical hypothyroid, untreated primary hypothyroid, treated primary hypothyroid and euthyroid. We found that hematological parameters like Hb, RBC, MCV, HCT, RDW,RBC% were significantly increased in untreated subclinical hypothyroidism and untreated primary hypothyroidsm, with the p value being less than 0.05 whereas, in treated SCH & Pr. Hypothyroid, results were insignificant. The results reported in these groups as mean±SD, were statistically tested by ANOVA and multiple comparison tests. In untreated subclinical hypothyroid the values were: Hb (10.83±1.33 g/dl ), RBC (4.21±0.66 106/μl), MCV (84.56±6.84 fL), HCT (38.5±2.2 %), RDW (17.91±2.37 fL), RBC% (84.36±13.2 %) and in untreated primary hypothyroid, Hb (10.73±0.86 g/dl), RBC (4.63±0.51 106/μl), MCV (83.34±6.92 fL), HCT (38.6±2.6%), RDW (14.93±5.47 fL), RBC% (92.63±10.30%) suggesting that these patients were at risk of anemia and other erythrocyte abnormalities. MCV is an inexpensive approach to study the types of anemia and explore related information like production, destruction, loss and morphological changes of RBC'S.

 

Conclusion: The thyroid dysfunction is frequently associated with anemia in subclinical hypothyroidism and primary hypothyroidism. Subclinical hypothyroidism (SCH) is associated with serious complications. Substantial numbers of patients with the risk of SCH could be getting converted into primary hypothyroidism. Such conditions should be identified and corrected. On the other hand, their presence could move to a thyroid dysfunction, allowing its early management.

 

---

 Background: The aim of this study was to investigate the psychometric properties of Social Capital Questionnaire (SCQ) developed by Onyx and Bullen (2000) among a sample of medical science students in Tehran University of Medical Sciences, Iran and to compare the factor analysis with findings from two previous studies in Australia and the United States.

 Methods: Multistage cluster sampling was employed to recruit 293 medical science students (Male: 95/Female: 198) from 7 faculties in Tehran University of Medical Sciences. After translating SCQ into Persian applying back-translation technique and three-stage consensus panel, the questionnaires administered to the respondents and they were asked to complete them. Statistical Analysis was performed using SPSS version 16.0 for Windows.

 Results: Exploratory Factor Analysis (EFA) was conducted to evaluate factor structure of the Persian SCQ (PSCQ), which showed a moderate replicability, validity, and reliability (Cronbach alpha= .79) to those found in previous studies. Twelve factors extracted with eight values greater than 1 which altogether accounted for 76.23% of the total variance. Applying Cattell's scree test, it was indicated that between seven and eight factors extracted. The correlations between factors were detected in the low (at the lowest 0.002) to modest (at the highest 0.614) range.

 Conclusion: The differences found in the factor analysis between the studies may be ascribed to the various types of populations studied. Despite the difference in populations studied, our findings support the meaningfulness of P-SCQ as an instrument that is worthy of further attention for use in social health researches, although more studies are recommended to help researchers in comparing its variety in dimensions of different communities.

---

Background: The National Health Accounts keep track of all healthcare related activities from the beginning (i.e. resource provision), to the end (i.e. service provision). This study was conducted to address following questions: How is the Iranian health system funded? Who distribute the funds? For what services are the funds spent on?, What service providers receive the funds? Methods: The required study data were collected through a number of methods. The family health expenditure data was obtained through a cross sectional multistage (seasonal) survey while library and field study was used to collect the registered data. The collected data fell into the following three categories: the household health expenditure (the sample size: 10200 urban households and 6800 rural households-four rounds of questioning), financial agents data, the medical universities financial performance data. Results: The total health expenditure of the Iranian households was 201,496,172 million Rials in 2008, which showed a 34.4% increase when compared to 2007. The share of the total health expenditure was 6.2% of the GDP. The share of the public sector showed a decreasing trend between 2003-2008 while the share of the private sector, of which 95.77% was paid by households, had an increasing trend within the same period. The percent of out of pocket expenditure was 53.79% of the total health expenditure. The total health expenditure per capita was US$ 284.00 based on the official US$ exchange rate and US$ 683.1 based on the international US$ exchange rate.( exchange rate: 1$=9988 Rial). Conclusion: The share of the public and private sectors in financing the health system was imbalanced and did not meet the international standards. The public share of the total health expenditures has increased in the recent years despite the 4th and 5th Development Plans. The inclusion of household health insurance fees and other service related expenses increases the public contribution to 73% of the total.

---

  Background: The incidence of ulcerative colitis (UC) is rising in populations with western-style diet, rich in fat and protein, and low in fruits and vegetables. In the present study, we aimed to evaluate the association between dietary protein intakes and the risk of developing incident UC.

  Methods : Sixty two cases of UC and 124 controls were studied using country-specific food frequency questionnaire (FFQ). Group comparisons by each factor were done using χ2 test, and significance level was set at α= 0.05. Logistic regression adjusted for potential confounding variables was carried out.

  Results : Univariate analysis suggested positive associations between processed meat, red meat and organ meat with risk of ulcerative colitis. Comparing highest versus lowest categories of consumption, multivariate conditional logistic regression analysis accounting for potential confounding variables indicated that patients who consumed a higher amount of processed meat were at a higher risk for developing UC (P value for trend= 0.02). Similarly, patients who consumed higher amounts of red meat were at a higher risk for UC (P value for trend= 0.01). The highest tertile of intake of organ meat was associated with an increased risk of ulcerative colitis with a statistically significant trend across tertiles (P value for trend= 0.01) when adjusted.

  Conclusion : In this case-control study we observed that higher consumptions of processed meat, red meat and organ meat were associated with increased risk for UC.

---

Background: Gender inequality harms the health of millions of women and girls in all over the world. This study aimed to identify the state of gender equity in the health sector of the Islamic Republic of Iran.

  Methods: This study was based on the secondary analysis of the available data in four provinces. The research team held three sessions to select the appropriate indicators for measuring gender equity in Iran. Moreover, using the data of different sources, the indexes were evaluated by applying the brain storming method.

 To demonstrate the difference between females and males, the ratio of females to males was measured in each indicator. The confidence intervals were used to show significant differences in the gap between men and women. Educational indicators were analyzed using the appraisal framework of UNESCO and International Institute for Education Planning. 

  Results: Findings revealed gender equality in the indicators of education and under–five underweight in all the provinces. However, the indicator of information on the mild psychological diseases showed inequality in favor of males. Infants’ mortality, under-five mortality, crude death, drug abuse and smoking showed inequality in favor of females in all the four provinces. The incidence of tuberculosis, severe psychological diseases, and basic and supplementary insurance coverage was equal in all provinces except Tehran.

  Conclusion: This study revealed gender inequality in many indicators among the provinces. Therefore, improving this condition requires policymaking, planning, and conducting appropriate strategies with proper gender approaches.

---

Background: Breastfeeding has been recognized to have a great deal of benefits for both the mothers and infants. Moreover, the importance of exclusive breastfeeding in the first six months of life has been greatly acknowledged. Therefore, this study aimed to determine the prevalence of starting breastfeeding in the first hour after delivery and the exclusive breast milk feeding as well as the age at which complimentary foods are provided to the child and duration of breastfeeding in Iran.

  Methods: This nationwide cross-sectional study was conducted in the frame of a national survey, Iran Multiple Indicator Demographic and Health Survey (IrMIDHS), in 31 provinces of Iran. Participants were selected by multistage cluster sampling. The target sample was 3,096 clusters consisting of 2,187 urban and 909 rural families. Data were collected using a questionnaire through face-to-face interviews.

  Results: The rate of exclusive breastfeeding was 53.13% with higher prevalence in rural (67.76%) than in urban areas (47.79%) (P = 0.04), and among girls (56.35%) compared to boys (50.60%). The prevalence of breastfeeding as the main diet of Iranian infants under six months old was 70.72% and the prevalence of initiation of breastfeeding (up to the first hour after delivery) was 68.70%.  The probability of breastfeeding continuance among twelve to fifteen months children was 84.22%; the corresponding figure was 51% among twenty to twenty three months old babies (p=0.03).

  Conclusion: Exclusive breastfeeding should be encouraged; and strategies that are more effective should be designed to protect, train and support young mothers to breastfeed their infants. The importance of early beginning of breastfeeding and its continuation should be underscored.

---

Background: Threatened preterm labor (TPL) is the leading cause of hospitalization during pregnancy. Tocolytic agents are the
primary therapeutic options for TPL. The aim of this study is to compare intramuscular progesterone with oral nifedipine as a tocolytic
agent.
Methods: This randomized controlled trial was carried out in a teaching hospital (Shahid Akbarabadi) in Tehran, Iran, from December
2011 to November 2012. Three hundred and fifteen singleton pregnant women aged >18 yrs at 26-34 weeks’ gestation with the diagnosis
of threatened preterm labor (TPL) were randomly received either intramuscular progesterone or oral nifedipine for tocolysis. Maternal
and neonatal outcomes were then compared between the two interventions. P value less than 0.05 was considered statistically significant.
IRCT registration number of this study is IRCT201112198469N1
Results: The success rate of progesterone and nifedipine in treating TPL were 83% and 82.7%, respectively. There was no significant
difference between the two interventions with regard to gestational age at delivery, type of delivery, the time interval until the delivery,
birth weight, NICU admission rate and hospital stays. Progesterone administration was associated with lower duration of NICU stay as
compared with nifedipine (0.33±0.77 days vs.1.5±3.2 days, p<0.05). None of the two drugs caused any major side effects.
Conclusion: Single dose intramuscular progesterone is as effective as oral nifedipine in treating TPL. It also significantly reduces the
NICU stay.

---

Background: Based on the target income hypothesis, the economic behavior of physicians is mainly affected by their target income. This study aimed at designing an instrument to explain how general practitioners (GPs) set their desired income.
   Methods: A self-administered questionnaire of affecting factors on GPs' target income was extracted from literature reviews and a small qualitative study. Respondents were 666 GPs who completed the questionnaire (response rate= 52%) during 2 seasonal congresses of Iranian GPs. The principal component analysis (PCA) with varimax rotation was used to classify the variables and data reduction. Sample adequacy test, sphericity test, eigenvalues of components, and scree plot were evaluated for PCA. Cronbach's alpha was also checked to assess the internal consistency of the principal components.
   Results: The results of the KMO measure of sampling adequacy (0.657) and Bartlett’s test of sphericity (809.05, p<0.001) revealed that the collected data were suitable for PCA.
Based on the scree plot pattern and eigenvalues greater than 1, 6 components including perceived comparative income, importance of responsiveness to patients, perceived socioeconomic status, economic expectations, socioeconomic status of paternal family, and provision of luxury services were selected, which explained 65.19% of the total variance. Finally, only those with a Cronbach's alpha value higher than 0.6 were considered reliable (the first 4 components). 
   Conclusion: Based on the target income hypothesis, a physician’s desired level of income affects their behavior. Our developed instrument and its mentioned components can be used in future studies related to GPs' behavior, especially those studies related to the economic aspects of GPs’ behavior. It also helps formulate a better payment mechanism for primary care providers. 
 

---

Background: Fetal male gender may affect the progression of labor and could be a risk factor for labor arrest. This study was conducted to evaluate the effect of fetus gender on labor curve.
   Methods: In this cohort study, 1550 singleton term pregnant women in labor phase (either spontaneous or by induction) were enrolled. Results of regular cervical examination, dilation, length of labor stages, mode of delivery, and sex of the fetus, and birth weight were recorded for all participants. Labor progression curve was compared between two sex groups with independent t test and chi2 test.
   Results: Finally, 1527 women completed the study (47.8% female and 52.1% male). Mean duration from beginning of the active phase up to full dilatation, from 4 to 6 cm, 6 to 8 cm, and 8 to 10 cm dilatations, were significantly longer in the male sex group compared to the female (p˂0.05). All durations were also significantly different when parity was considered (p˂0.05). We could not show fetal sex as an independent risk factor for active phase arrest (OR Adjusted: 1.18, CI 95% 1.01:1.42).
   Conclusion: Active phase stage was slower and longer in women who carried male fetuses compared to those carrying female fetuses; however, fetal sex did not increase the risk of active phase arrest.
 
 

---

Background: Nonmarket stated preferences valuation, especially discrete choice experiments (DCEs), is one of the commonly used techniques in the health sector. The primary purpose of this approach is to help select attributes and attributes-levels that are able to properly describe health care products or services. This study aimed at developing attributes and attributes-levels for basic health insurance system in Iran.
   Methods: This study was conducted in 3 phases. First, narrative review was performed to identify related attributes. Also, 9 experts were interviewed to identify relevant attributes of health insurance in context. Other 36 experts rated the attributes and levels. Then, the research team decided on the inclusion of attributes and levels in the final design. The design was constructed using generic and D-efficient method with SAS 9.1. The design was divided into 3 blocks, each having 8 choice sets. Finally, the choice set was piloted with 45 participants.
   Results: Public hospitals, and private hospitals benefits, dental insurance coverage, inpatient benefits, rehabilitation therapy, and paraclinical benefits, long-term care,  medical devices benefits (Ortez, Protez, etc.), and monthly premium were identified and included in the final attribute design (D-efficiency = 98.16). The pilot study revealed that participants could easily understand and answer all the choice sets.
   Conclusion: The results of our study indicated that health insurance service benefit packages and premium were among the most important attributes that need to be included in the final attribute design for Iranians. The policymakers and health insurance organizations should emphasize these attributes in the benefit packages to make improvements. The emphasis on these attributes can help elicit people’s preferences and willingness to pay for attributes.
 

---

Background: The health insurance and family physician reform in Iran were implemented in 2005. This study was conducted to assess the effect of these reforms on avoidable hospitalizations among the rural population of Eslam-shahr County, Iran.
   Methods: We conducted a before-after study in Eslam-shahr County’s single existing hospital. This county is a part of the Tehran Province of Iran. The demographic characteristics and diagnostic codes of the rural population that were hospitalized during the 2 years leading to, and after the reforms were extracted from the hospital’s electronic information system. A list of 61 three-character and 131 four-character AHs codes were developed based on the literature review. We estimated a logistic regression model which included gender and age as independent variables to assess changes in the probability of avoidable hospitalizations following reform implementation. Analyses were carried out using STATA version 13.
   Results: We recorded 817 rural hospitalizations before and 967 hospitalizations after reform implementation, suggesting that hospitalization growth after the reforms was almost 18.4%. The logistic regression results show that the probability of avoidable hospitalizations after the interventions had decreased compared to before the interventions were put into place (OR: 0.46; 95% CI: 0.24-0.88). Also, the probability of AHs among the 60< year-old age group was considerably higher compared to other age groups. No statistical relationship was found between avoidable hospitalizations and gender. 
   Conclusion: The reforms may have had a mixed effect on hospitalization. They may result in increased hospitalizations due to responding to the unmet needs of the population, and simultaneously they may lead to a decrease in avoidable hospitalizations and eliminate the costs imposed by them upon the health system. 
 

---

   Background: Mutations in embB gene have been reported in ethambutol (EMB) resistance Mycobacterium tuberculosis (M. tuberculosis) isolates. The aim of this study was survey on embB 306 and 406 EMB resistant M. tuberculosis isolated from patients in West of Iran (2014-2015).
   Methods: Fifty strains of M. tuberculosis from patients with pulmonary tuberculosis (TB) were considered. Drug susceptibility using proportional method was performed. Polymerase chain reaction (PCR) -DNA sequencing was applied for mutation in embB 306 and 406 codon detection. Data were analyzed in SPSS 16 software using descriptive statistics and Fisher's exact test (p<0.05).
   Results: In this study 7 (14%) M. tuberculosis isolates were resistant to EMB. 6 (85.71%) and 1 (14.28%) resistant isolates had embB 306 and 304 codon mutations, respectively. Between embB306 mutations and resistance to EMB and MDR isolates had a significant relationship (p<0.001).
   Conclusion: The data indicated that embB 306 mutations have effect on EMB resistant. Detection of EMB resistant and these mutations prominent for antibiotic prescription.
 

---

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking.
   Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model.  Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described.
   Results: The followings were done to accomplish the goals of each step: collecting experts’ viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation).
   Conclusion:  In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran’s health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.
 
 

---

Background: According to the Global tuberculosis (TB) Report 2014, released by World Health Organization (WHO), difference between estimated number of TB patients and the number of patients who are registered by the National Tuberculosis Programs (NTBP) is about 3 million annually in the world. In the current study, we investigated the level of under-reporting of TB cases between labs with poor collaboration background with NTBP in Tehran.
   Methods: In the context of TB, this is an inventory study that evaluating the level of under-reporting of TB cases. To do inventory study, first, after selecting laboratories based on poor collaboration background with NTBP and developing patient’s list we matched the patient’s list with the MoHME’s database then, patients that were not recorded in NTBP’s list were identified, and those with available telephone numbers were called.
    Results: Out of 23 selected labs, 10 (5 private, 5 public (other than PHC)) had individuals with positive results. 71.6% of all samples are tested in public labs. Out of 23633 performed tests, 1396 individuals were positive. The under-reporting was, 62.5% and 39% in public and private laboratories, respectively.
   Conclusion: Public and private sector laboratories will be able to significantly reduce their failure to report if they comply with the recommended requirements and standards of the NTBP in their Processes and software for registering patient information.
 

---

Background: The world’s population is growing older. Inappropriate and irrational use of drugs in the elderly is a considerable health concern due to consequences such as increased morbidity and adverse drug events. This study aimed to evaluate the rationality of prescribing and determining the extent of inappropriate prescribing in a sample of geriatric patients in Tehran.
   Methods: This cross sectional study was performed on 1512 prescriptions of patients aged ≥ 65 years from 5 pharmacies affiliated to Tehran University of Medical Sciences in 2014. Prescription of potentially inappropriate medications (PIMs) was investigated using the Beers Criteria along with WHO prescribing indices. Date were analyzed using SPSS software, and significance level was set at less than 0.05.
   Results: Mean (SD) age of patients was 73.9(6.7) years. A total of 472 (31.2%) patients received at least 1 PIM. Benzodiazepines were the most frequent drug class and general practitioners (GPs) were the most frequent prescriber of PIMs. The highest and the lowest percentage of prescriptions containing brand-names were prescribed by subspecialists (62.5%) and GPs (42.2%), respectively. Antibiotics and injectable medications were prescribed for 26.8% and 28.5% of patients by GPs. Mean (SD) number of drugs per prescription was 3.57 (1.92). Prescriptions containing systemic antibiotics and PIMs had significantly higher mean number of drugs compared to those without these items (both P < 0.001).  
   Conclusion: There is a need for interventions to improve the quality of prescribing for elderly patients, especially by GPs. Also, there are still some problems in rational use of drugs based on prescribing indices, especially, prescribing brand-names and injectable medications.
 

---

Background: Promoting ethics is one of the goals of education, but the free flow of communication and divulging unethical behaviors in e-learning make the urgent need to clarify ethical values. Therefore, the aim of this study was to prepare ethical codes to develop and deliver e-contents.
   Methods: A draft of e-content ethical codes was prepared based on the literature review. Then, it was further revised by e-learning, medical education, ethics, and e-content experts. Finally, the draft was finalized through a 2-round Delphi process among related experts all over the country.
   Results: The final document of e-content ethical codes, including introduction, definitions, and 7 ethical code statements, was devised.
   Conclusion: Considering the difference between e-content and other kinds of publications, this set of ethical codes can be used straightforwardly to assess ethical aspects of e-contents.

---

Background: There are relatively scant data to determine whether hospital visitors could serve as a proper source of controls in case-control studies of illicit drug use. The aim of this study was to evaluate using neighborhood versus hospital visitor controls in reporting opium use.
   Methods: We used data from 2 independent case-control studies of cancer in Iran. In the first study, controls were selected from neighborhoods of the patients. For the second one, controls were selected from among hospital visitors. In the latter study, hospital visitors were companions of the patients or others visiting the hospital for reasons other than disease treatment. We used stata (version 12; Stata Corp( for all analyses and with a significance level of 0.05.
   Results: Data from 616 of neighborhood controls and 414 of hospital visitor controls were analyzed. Opium point prevalence among men was significantly higher in hospital visitors than neighborhood controls (43.3% vs 32.2%; P = 0.047), while the prevalence of cigarette smoking was very similar in both control groups (46.3% vs 47.2%; P = .847). Using a logistic regression analysis, in an unadjusted analysis, neighborhood controls were less likely to report opium use in both genders, with (unadjusted OR = 0.77; 95% CI: 0.59,1). After adjusting for potential confounders, the differences of opium use between the 2 control groups became more pronounced (Adjusted OR = 0.26; 95% CI: 0.10, 0.69).
   Conclusion: Because of the similarity of reporting cigarette smoking among neighborhood controls but substantially lower reporting of opium use among them, we concluded that neighborhood controls underreport opium use—a sensitive question— and that using neighborhood control biases the findings in case-control studies. Hospital visitor controls may be more appropriate than neighborhood controls for case-control studies of illicit drugs.
 

---

Background: Coronavirus disease 2019 (COVID-19) is a contagious disease caused by a newly identified coronavirus. Our knowledge about the survival rate and prognostic factors of the disease is not established well. The purpose of this study was to evaluate the predictors of COVID-19 mortality in Hamadan province in western Iran.
   Methods: In this study, we included all laboratory-confirmed COVID-19 cases with known treatment outcomes in Hamadan province, Iran, between 20, 2020, to May 10, 2020. Demographic, clinical, laboratory data, and treatment outcomes were obtained from computerized medical records and compared between survived cases and patients with death outcomes. Univariable and multivariable logistic regression models were used to determine the predictors of death.
   Results: From 749 investigated patients, 77 patients (10.28%) died during the treatment. The Mean age of patients was 53.97±19.04 years. Multivariable logistic regression showed that males had 2.07 (95% CI: 1.73, 2.54) fold higher odds of death. Those with 60 years old and more had 6.49 (95% CI: 4.53, 7.93) fold higher odds of death. Patients with an underlying disease had 7.14 (95% CI: 6.94, 7.38) fold higher odds of death, and patients who were hospitalized in the ICU ward had 2.24 (95% CI: 1.75, 2.90) times higher odds of COVID-19 related mortality.
   Conclusion: The potential predictors of death in COVID-19 cases, including the male gender, older age, and having an underlying disease could help physicians to identify patients with poor prognoses at an early stage and better management of them.