Conduction System Disease and Atrioventricular Block in Victims of COVID-19 in Iran (preprint)

Background: More recently, a growing body of literature on COVID-19 has investigated the electrophysiological issues presetting as a disease manifestation of COVID-19 and highlight the spectrum of arrhythmias observed in patients with COVID-19 infection. This Study discuss the prevalence of arrhythmias and conduction system disease in patients with COVID-19. Method electrocardiographic data and comorbidity data of 432 expired COVID-19 patients admitted to Faghihi Hospital of Shiraz University of Medical Sciences from August 1st until December 1st were reviewed. Results AVB was found in 40(9.3%) patients. 28(6.5%) of the patients suffered from 1st degree AVB, and 12(2.8%) suffered from CHB. Changes in ST-T wave compatible with myocardial infarction or localized myocarditis appeared in 189(59.0%) patients. Findings compatible with myocardial injury such as fragmented QRS, and prolonged QTc were assessed with prevalence of 21.1% (91 patients), 6.5% (28 patients). In victims of COVID-19, conduction disease was not related to any underlying medical condition. Fragmented QRS, axis deviation, presence of S1Q3T3 and poor R wave progression were significantly related to conduction system disease in victims of COVID-19 (P value > 0.05, Table 3) Conclusion Our findings can serve in future studies that aim to develop a risk stratification method for susceptible COVID-19 patients. Myocardial injury appears to role significantly in COVID-19 morbidity and mortality. Consequently, we recommend health policymakers to consider separate catheterization laboratories that provide service only to COVID-19 patients.

Burnout Among Physicians and Medical Interns: Comparing Time-periods of Coronavirus Disease Outbreak in Shiraz (preprint)

Background: Physician burnout is a serious issue associated with physician attrition, mental and physical problems, and medical errors. This study aimed to investigate prevalence of overall burnout among Interns-Residents and general physician (GPs)-Specialist during the COVID-19 pandemic in Iran.Methods: This cross-sectional study was conducted among 220 Interns-Residents and 212 GPs-Specialists in university affiliated hospitals and clinics in Shiraz, Iran. A random sampling method used to recruit the samples and the data gathered using a valid questionnaire. We used covariance analysis and multiple logistic regression to analyze the data.Results: Multiple logistic regression for GPs-Specialists showed that working in COVID-19 wards during June-July (OR = 13.93) was associated with increasing odds of overall burnout. However, older age was associated with decrease odds overall burnout (OR = 0.94). Multiple logistic regression for Interns-Residents revealed that age (OR = 1.24) and being single (OR = 1.66) were positively associated with overall burnout.Conclusions: The present finding could remind policy makers the importance of burnout issue among physicians during the pandemics and could persuade them for taking appropriate action in order to prevent this phenomenon. It is suggested that focusing on strategies such as improving organizational resilience, improvement of healthcare working environment, and development of coping skills among physicians could be helpful in this regard.

The COVID-19 Pandemic, Socioeconomic Effects, and Intimate Partner Violence Against Women: A Population-Based Cohort Study in Iran (preprint)

Background: Intimate partner violence (IPV) is a significant public health challenge. IPV hotlines in high-income settings have reported rising numbers of calls in the COVID-19 pandemic era. However, no systematic studies to examine prevalence and risk factors of IPV have transpired. We investigated the prevalence, pattern, and socioeconomic risk factors of IPV pre- and six months after the onset of pandemic (hereafter post-pandemic) among a cohort of Iranian women.Methods: Our population-based IPV survey was conducted before the onset of the COVID-19 epidemic in Iran, when we interviewed 2502 partnered Iranian women aged 18-60 years. We conducted a follow-up measurement six months later (n=2116). Prevalence and first-time incidence (FTI) of psychological, physical, and sexual IPV and their 95% confidence interval (CI) were estimated. Adjusted Odds Ratio (OR) and their 95% CI were estimated.Results: The post-pandemic prevalence of IPV (65∙4%; CI: 63∙4%- 67∙4%) was higher than pre-pandemic prevalence (54∙2%; CI: 52∙2%- 56∙3%). At follow up, FTI of IPV was 25∙5% (CI: 22∙9%- 28∙4%). The highest increase of FTI was observed in cases of physical and sexual IPV. Being employed was correlated with IPV (OR: 0∙42; CI: 0∙25- 0∙68). Having the highest socioeconomic status (OR: 0∙04; CI: 0∙01- 0∙17) and a full-time employed partner (OR: 0∙02; CI: 0∙01- 0∙03) were correlated with physical IPV.Interpretation: The prevalence and severity of IPV have increased following the onset of the COVID-19 pandemic. Unemployment of women or their partners and pre-pandemic lower socioeconomic status are risk factors of IPV against women without previous experience of IPV. Monitoring programs should target these populations to prevent IPV. Guidelines for addressing IPV in the context of the COVID-19 pandemic need to be adapted for low- and middle-income countries.Funding: Vice-Chancellor for Research, Shiraz University of Medical SciencesDeclaration of Interests: The authors declare that there is no conflict of interests.Ethics Approval Statement: The study protocol was approved by the Institutional Review Board (IRB) of Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1399.301).

Temperament and character of patients with alcohol toxicity during COVID -19 pandemic (preprint)

Background: Corona virus epidemic may be acts as a stressor or trauma that affects both physical health and mental health. People exhibited various reactive behaviors to confront with this stressful situation. In Iran, one of the common motives for alcohol consumption is to scape problems and cope with stresses. It has been shown that personality factors influence alcohol consumption, since they are associated with drinking motives. The main purpose of this study was to investigate the correlation between temperament and character and alcohol abuse. Methods: : This cross-section study was conducted on 135 alcohol intoxicated patients admitted to emergency room in March 2020 and 255 participants who were randomly selected from public in Shiraz. A questionnaire consisted of TCI (Temperament and character inventory) and several questions about COVID-19 pandemic. It was completed by a trained interviewer using the matched answer technique. Demographic factors were self-reported. Results: : Among the alcohol intoxicated group, 117 (86.7%) were males and 18(13.3%) were females. The mean age of the participants was 32.43±10.81 years. Among control group, 99 (38.8%) were males and 156 (61.2%) were females. The mean age of control group was 33.12±14.77 years. Alcohol toxicity was mostly observed among the young males (male/female ratio was 6.45). According to temperament and character index, mean scores of novelty seeking, harm avoidant, and self-transcendence were higher in the alcohol toxicity group than normal population (P<0.01). Mean scores of reward dependent, cooperativeness, and self-directedness were higher in normal population than the alcohol toxicity group (P<0.001). The mean score of persistence was not significantly different between methanol intoxicated and normal population groups (P=0.718). Conclusion: Alcohol intoxicated patients had higher scores of novelty-seeking and self-transcendence and lower scores of reward-dependency scores, cooperativeness and self-directedness. These scores are associated with higher likelihood of personality disorders.

The Association between Poor Glycemic Control in Diabetes Mellitus and Progression of COVID-19 (preprint)

Background: Coronavirus disease 2019 (COVID-19) is a newly recognized disease whose rapid spread has resulted in a global pandemic. In this resepct, there are several comorbidities presumed to be associated with presentation of complications in COVID-19 such as diabetes mellitus (DM), hypertension (HTN), and cardiovascular diseases (CVDs). Therefore, this study aimed to explore whether DM was a risk factor influencing presentation, progression, and prognosis of COVID-19 or not.Methods: A total number of 447 patients with confirmed COVID-19 were selected from two centers for COVID-19 in the city of Shiraz, south-central Iran, from February 20 to April 29, 2020. Then, demographic data, medical history, signs and symptoms, laboratory test results, as well as chest computed tomography (CT) scan reports were collected and analyzed.Results: This study revealed that older age, HTN, and CVDs could be mostly seen in diabetic patients with COVID-19. In addition, such patients had prolonged hospital stay, lower oxygen (O2) saturation, and abnormal laboratory test results such as higher white blood cell (WBC) count, lower lymphocyte count, elevated serum tumor markers such as aspartate aminotransferase (AST), and abnormal kidney function.Conclusion: DM is an important risk factor for adverse endpoints in patients with COVID-19. In diabetic patients, proper consideration of clinical characteristics is thus of utmost importance. In addition, special clinical insight for disease prevention, good glycemic control during hospitalization, and efforts to develop a vaccine can help improve disease outcomes in this population.

Public sphere attitudes toward rumor sources on COVID-19 epidemics: Evidence from community perceptions in Iran (preprint)

Background Advancements in technology had raised a variety of information circulation methods. In the case of the COVID-19 outbreak, misinformation seems to travel far faster than the outbreak itself. Misleading rumors are double-edged swords arousing fear and panic on the one side and a reduction in commitment to sanitary measures and induction of wrongdoing on the other side, leading to the disruption of the mitigation measures to tackle with the pandemic. This study aimed to evaluate the factors affecting individuals’ attitudes toward rumor-producing media in Iran.Methods An online survey was conducted in Iran in March 2020 on the source of trusted information and misinformation along with individuals’ perception of the cause of misinformation propagation during the COVID-19 pandemic.Results The results showed that social media were considered as the primary rumor source from the perspective of a majority of the participants (59.3%). Lack of a reliable and formal news source was also introduced as the most common cause of a rumor formation by the participants (63.6%). To identify which media is the main source of rumors, the male participants who had high levels of education and were employed by the government proposed foreign media (P < 0.01); however, the male participants aged 30–50 years with middle income level believed that social media (P < 0.01) were producing rumors. In this regard, the high educated participants (P < 0.001), government employees, and middle-income individuals (P < 0.008) believed that national media produced rumors. In addition, the high-educated individuals (P = 0.002) and government employees (P = 0.009) mentioned that national media produced rumors.Conclusion Although these findings were obtained during the first encounter with the Corona epidemic, the authorities immediately introduced the national media as a source of reliable news, which allowed the media and its journalists to reduce the gap between themselves and public sphere. It is suggested that social networks and foreign media be more accountable in epidemics.

Laboratory features in severe vs. non-severe COVID-19 patients, a systematic review and meta-analysis (preprint)

OBJECTIVE: Understanding the common laboratory features of COVID-19 in severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. MATERIALS AND METHODS: Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of ‎Science, and Google Scholar from inception to 3rd of March 2020. Heterogeneity across included ‎studies was determined using Cochrane’s Q test and the I2 statistic. We used the fixed or random-effect models to pool ‎the weighted mean differences (WMDs) or standardized mean differences and 95% confidence ‎intervals (CIs).‎RESULTS:‎ Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapour) with 3396 ranging from 12-1099 patients, ‎were included. Our meta-analyses showed a significant decrease in ‎lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the ‎neutrophil, alanine ‎aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose ‎level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. However, no significant changes were observed in white blood cells (WBC), ‎ creatine kinase (CK), troponin I, myoglobin, interleukin-6 (IL-6), and potassium (K) between the two groups.‎CONCLUSIONS: This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of hospital admission. Future well-methodologically designed studies from other populations are strongly recommended.

Citizens’ Expectations from Government in Response to COVID-19 Pandemic: A Qualitative Study in Iran (preprint)

Background: The government is the main body in charge of controlling epidemics; hence, expectations from government’s intention and capacity would affect citizens’ behavior and flexibility. Given the severity of COVID-19 pandemic and an urgent need for people's cooperation in the prevention and combat processes, understanding the public perspectives would be crucial and instructive. This study aimed to explore such perspectives towards the current pandemic among the Iranian. Indeed, we sought to provide a favorable platform for effective policies in the face of the COVID-19 pandemic by recognizing public expectations.Methods: This cross sectional study used an open-ended online questionnaire to investigate the common perspectives of the Iranian towards government’s response to COVID-19 pandemic. The participants were selected using snowball and convenient sampling techniques across the country. The collected data were analyzed and described using thematic content analysis. Results: In general, 2547 participants agreed to participate in this study and completed the online questionnaire. According to the findings, the Iranian exhibited several expectations regarding the government's response to COVID-19 pandemic, based on which three main themes were extracted: (1) health-related expectations, (2) policy-related expectations, and (3) mass media-related expectations. In this study, a majority of the participants highlighted the need to consider and follow-up the patients and their families, provide financial and hygiene support during the pandemic, apply strict restrictions, and have close monitoring and controlling procedures. Furthermore, they mentioned that authorities and news agencies should observe honesty and transparency principals. Conclusions: Our findings revealed that people expect the government and other responsible institutions to minimize the burden of this pandemic on them through adopting effective policies. The study findings could help policy-makers become aware of people's expectations and develop better strategies.

The role of comorbidities and clinical predictors of severe disease in COVID-19: a systematic review and meta-analysis (preprint)

Background COVID_19 is unpredictable due to non-specific symptoms and clinical course diversity in different individuals. We analyzed studies regarding the factors associated with severe status of the disease to identify unique findings in severely affected patients. Methods We systematically searched the electronic databases, including PubMed, Scopus, EMBASE, Web of Science, and Google Scholar from inception to 12th of March 2020. Cochranes Q and I-square statistics were used to assess the existence of heterogeneity between the included studies. We used the random-effects model to pool the odds ratios (ORs) at 95% confidence intervals (CIs). Results Seventeen articles out of 3009 citations were included. These contained 3189 patients, of whom 732 were severely affected (severe group) and 3189 were in non-severe group. Using the random-effects model, our meta-analyses showed that the odds of comorbidities, including COPD, DM, HTN, CVD, CKD, and symptoms, including dyspnea, dizziness, anorexia, and cough, were significantly higher among the severe group compared with the non-severe group. There were no significant changes in odds of CVA, liver disease, immunodeficiency/immunosuppression, fever, fatigue, myalgia, headache, diarrhea, sore throat, nasal congestion, sputum, nausea, vomiting, chest pain between the two groups. Conclusions Early recognition and intervention can be critical in management, and might stop progression to severe disease. Predictive symptoms and comorbidities can be used as a predictor in patients who are at risk of severe disease.